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Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder
04:33

Association Between Sleep Quality and Cognitive Symptoms in Patients with Major Depressive Disorder

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Domain- and item-level symptom thresholds for severe cognitive impairment in major depressive disorder

Kuan-I Liu1, Wei-Chen Lin2, Ju-Wei Hsu3

  • 1Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.

Journal of Affective Disorders
|July 7, 2026
PubMed
Abstract

Insights

Depression severity, assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS) at the item level, can identify major depressive disorder (MDD) patients at risk for cognitive impairment. This symptom-level analysis complements overall scores for better risk assessment.

Area of Science:

  • Neuroscience
  • Psychiatry
  • Clinical Psychology

Background:

  • Cognitive impairment is a key feature of major depressive disorder (MDD), but its link to overall depression severity is inconsistent.
  • The Montgomery-Åsberg Depression Rating Scale (MADRS) total score may not fully capture individual symptom profiles, impacting cognitive risk assessment.
  • This study investigated whether MADRS subscale and item-level severity could provide additional information on cognitive impairment in MDD.

Purpose of the Study:

  • To determine if MADRS subscale and item-level severity predict severe cognitive impairment in patients with MDD.
  • To identify specific MADRS thresholds associated with severe cognitive impairment.
  • To explore domain-specific cognitive associations with MADRS symptom profiles.

Main Methods:

  • A cross-sectional analysis of 294 MDD patients from a longitudinal cohort in Taiwan.
  • MADRS total, subscale, and item-level scores were assessed against severe cognitive impairment (global cognitive composite z-score < -2 SD).
  • Regression models adjusted for age, sex, and education identified thresholds; exploratory analyses examined continuous cognitive domain z-scores.

Main Results:

  • MADRS total score was significantly associated with severe cognitive impairment.
  • All four MADRS subscales and 9 of 10 individual items were significant predictors.
  • Prevalence of severe cognitive impairment increased from 2-3% to 17-22% with higher MADRS subscale scores; thresholds often converged at score ≥ 3. Working memory, inhibition, and processing speed showed the clearest domain-specific associations.

Conclusions:

  • MADRS total, subscale, and item-level data can help identify MDD patients needing cognitive assessment.
  • Symptom-level thresholds offer complementary risk characterization beyond total scores.
  • Prospective validation of these symptom-level thresholds is required.
Keywords:
Cognitive impairmentMajor depressive disorderMontgomery–Åsberg Depression Rating ScaleSeverity thresholdSymptom dimensions

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