Patient-reported cognitive dysfunction negatively impacts functioning in patients with major depressive disorder – preliminary findings from the perform study

Objectives: PERFORM (Prospective Epidemiological Research on Functioning Outcomes Related to Major depressive disorder) is a 2-year prospective observational cohort study conducted in Europe to describe the functioning of patients with major depressive disorder (MDD) and factors associated with functional impairment. Here we report the impact of patient-reported cognitive dysfunction (PRCD) on quality of life (QoL), work and overall functioning at baseline, on a preliminary 1000-patient dataset. Methods: Outpatients were recruited from primary or secondary care. Inclusion criteria were: DSM-IV-TR diagnosis of MDD, 18-65 years old, initiation or first switch to an antidepressant, in monotherapy. Functioning was assessed by the SDS (Sheehan Disability Scale), work productivity by the WPAI-SHP (Work Productivity and Activity Impairment Questionnaire) and QoL by the EQ-5D (EuroQol-5 Dimensions) and SF-12 (12-Item Short-Form Health Survey). PRCD was assessed by the Perceived Deficit Questionnaire 5-item (PDQ-5). Descriptive analyses stratified on PDQ-5 quartiles were complemented with ANCOVA adjusted for severity of depression. Results: At inclusion, over 947 analysable patients, mean PDQ-5 score (ranging from 0 to 20) was 11.5 (SD=4.4). PRCD was associated with impairment of overall functioning, QoL and productivity. SDS total scores were 14.4, 18.5, 20.2, and 23.6 (first to fourth PDQ-5 quartiles, respectively) (p<0.001). Similar patterns were observed for WPAI-SHP presenteeism scores (impairment while working: from 36.9% in first quartile to 64.4% in fourth quartile, p<0.001; overall work impairment: from 41.5% to 71.3%, p<0.001). These associations remained statistically significant after adjustment for baseline depression severity in multivariate analyses. A negative impact of PRCD was also observed on sick-leave length and on QoL. Conclusions: At inclusion, subjective cognitive dysfunction in depressed patients was associated with poorer functioning, work productivity and QoL. This is in addition to any negative impact of the severity of depression on these outcomes. These preliminary results need to be confirmed on the full dataset

Supplementary Material for: A Predictive Microsimulation Model to Estimate the Clinical Relevance of Reducing Alcohol Consumption in Alcohol Dependence

<p><b><i>Background:</i></b> Alcohol consumption is one of the most important factors for disease and disability in Europe. In clinical trials, nalmefene has resulted in a significant reduction in the number of heavy-drinking days (HDDs) per month and total alcohol consumption (TAC) among alcohol-dependent patients versus placebo. <b><i>Methods:</i></b> A microsimulation model was developed to estimate alcohol-attributable diseases and injuries in patients with alcohol dependence and to explore the clinical relevance of reducing alcohol consumption. <b><i>Results:</i></b> For all diseases and injuries considered, the number of events (inpatient episodes) increased with the number of HDDs and TAC per year. The model predicted that a reduction of 20 HDDs per year would result in 941 fewer alcohol-attributable events per 100,000 patients, while a reduction in intake of 3,000 g/year of pure alcohol (ethanol) would result in 1,325 fewer events per 100,000 patients. <b><i>Conclusion:</i></b> The potential gains of reducing consumption in alcohol-dependent patients were considerable.</p