In contrast to the investigators’ expectations, primary care physicians are better at identifying depression in older patients who have cognitive impairment than they are at recognizing depression in those whose cognition is intact.

This is the first study to look at the role of cognitive status in the physician’s ability to recognize depression (J Gen Intern Med. 2006; 21: 1042-1044).

This study was prompted by the concern that time constraints in busy primary care practices would cause physicians to overlook depression in patients who were cognitively impaired—either because the mental status problems masked the mood disorder or the physician’s time was usurped by managing the cognitive dysfunction.

The investigators also speculated that even if depression was recognized, it would be less likely to be treated in a patient who was cognitively impaired.

The study population consisted of 330 adults aged ≥65 years (average age, 75.2 years; 75.5% women) from 13 Maryland primary care practices. Participants were evaluated using standard measures of psychological and cognitive status. Their physicians were asked to grade each patient’s level of cognition and depression on the 4-point Likert scale (ie, none, mild, moderate, severe) and to report any treatment for depression they offered during the 6 months of the study.

Results showed that physicians were 3.7 times more likely to recognize depression in patients who were cognitively impaired than in those who were cognitively intact. In addition, physicians were 2.6 times more likely to treat depression in patients with mental status problems than in the other patients. These numbers changed little after adjusting for age, gender, ethnicity, education, as well as functional, psychological, and cognitive status.

The investigators hypothesized that primary care physicians may be more alert to depression in cognitively impaired elderly, because they know that identifying and treating depression in such patients—either by prescribing antidepressant therapy or by nonpharmacologic interventions—can improve patient outcomes.

However, this hypothesis assumes that recognition depends on the results of therapy. Other explanations, such as physicians’ increased attentiveness to psychological issues in patients with impaired cognition, merit further investigation.