Cognitive functions have a broad definition and are related to the processing of information by the brain. They include sensory processes as well as memory, concentration and thinking. Effective functioning in society requires efficient cognitive functions, which may be impaired for various reasons – due to psychiatric and neurological diseases, head injuries, cancer and exacerbations of chronic diseases. Impaired cognitive functions also form an important dimension of depression, a disease that is one of the leading causes of disability in the world. Weakened cognitive functions are burdensome for depressed patients and exclude them from normal life activities. Cognitive deficits in depression are reversible and can be rehabilitated.
Cognitive impairment in depression
Depression is not only a typical decline in well-being, but also a decline in the cognitive functioning of the patient. Dutch research results, published in the “Psychological Medicine” journal, indicate that cognitive impairment occurs in as many as 94% of depressed patients. These disorders can include deficits and distortions. Cognitive deficits include slower course of thinking, difficulty concentrating, impaired memory and a sense of intellectual disability, which patients can describe in detail. Cognitive dysfunctions in depression are noted not only subjectively but also observed by others. Employers see the employee’s occupational failure, and in the case of the elderly, disturbed cognitive processes are mistaken for an early symptom of dementia. Cognitive impairment, although objectively noticeable, is underrated as a symptom of depression and is not adequately treated. Long considered symptoms secondary to the main symptoms of depression, they gained the attention of researchers because it was noticed that cognitive impairment persists in some patients even after remission of other symptoms of depression. The resolution of cognitive dysfunctions does not necessarily follow the remission of typical symptoms of depression, and they may persist for longer period of time. This makes the diagnosis and rehabilitation of cognitive functions essential for the patients if they are to regain full life and social efficiency.
Attention and concentration
Patients with depression demonstrate reduced ability to focus and maintain attention responsible for selecting information. The attention of people with depression is focused on negative stimuli, patients with depression remember information of this nature more easily. There is a redirection of attention to everything negative inside and outside the body. Patients complain of problems with concentration, focusing attention on a conversation, reading a fragment of a book or watching a movie. These difficulties also arise when paying attention to several things at the same time. Problems with concentration may result in a lack of understanding of medical recommendations. Patient complaints should guide treatment of the handicapped area.
Weakened memory and thinking
The memory of a sick person operates incorrectly in the following modes: information recording, data storage and retrieval. Difficulties in maintaining attention make the absorption of incoming information largely reduced. Although the ability to learn is preserved in depression, it is worse than in healthy people. Memory determines orientation in space, which is why we notice worse spatial orientation of patients. Depressive patients demonstrate visual-spatial impairment. Weakened perception causes poor association of visual perceptions, which makes it difficult to orientate in the surrounding space. Depression and anxiety temporarily limit access to resources stored in memory. Lowering the thought drive, or mental slowness, is the characteristic image of a depressive condition. Patients suffering from depression may demonstrate impaired counting ability, difficulty remembering dates, names or shopping lists. The patients thoughts are available to the environment through their statements and behaviour. Although in depression there is no disturbance in the structure of the utterance or its sense, the patients’ environment should be sensitive towards statements that concern, e.g. poor mental condition. Thinking should lead to problem-solving, but depressed patients often feel “light-headed” and therefore cannot cope with the challenges of everyday life.
Poor decision making
Depressed patients are characterized by their impaired decision-making ability. This is because any tasks that require intellectual effort that do not proceed automatically are perceived as too difficult. Patients themselves see that they are unable to plan, or to solve problems. Difficulties arise in organizing the day or planning activities. Decisions are made slowly or not at all.
Patients with depression suffer from psychomotor slowing down, they also have problems with initiating spontaneous behaviour, which may result in loosening of relationships with their friends. Making choices is not facilitated by the loss of the patient’s self-confidence and loss of pleasure. Weakened executive functions mean that patients cannot cope with their household chores and professional duties. There is also the feeling of helplessness and hopelessness and anxiety about the risk of losing one’s job. Low self-esteem combined with a decrease in energy, loss of interests and negative thinking causes a person with depression to take up little activity in life and lose motivation. Lack of motivation is a particularly significant issue for the patients who, apart from depression, suffer from somatic diseases that require long-term rehabilitation. Negativism, lack of hope and motivation of the sick person can irritate others and weaken interpersonal relationships. The patients do not respond adequately to prompts, and the illness of one person may be associated with increasing suffering of the person trying to provide support.
Improve not only the mood
In treating depression, it is important not only to improve well-being, but also the quality of life by restoring the patient to active participation in the society. The mere resolution of depressive symptoms without improving cognitive functions will render it impossible to return to high-quality everyday life and take up life roles. Patients are aware of their deficits and the related life difficulties, which affects their withdrawal from social life and lowering of their well-being. Depression is a dangerous disease that puts life at stake, predisposing not only to suicide, but also to accidents and life-threatening somatic diseases. Fortunately, depression is treatable. It seems, however, that despite objective premises, cognitive deficits are not the target of therapeutic measures in the treatment of depression.
Treatment of depression
Even relatively mild and persistent depressions can interfere with the functioning and fulfillment of social roles. Patients’ conviction that all efforts are futile makes it difficult for them to initiate the treatment and comply with medical recommendations. Such an attitude of patients, coupled with the common stigma concerning mental illnesses, means that patients fail to seek the help of specialists. The consequences of depression can be very unfavourable, especially in people with accompanying somatic diseases. Depression observed after stroke and heart attack hinders the required rehabilitation. After a neurological or cardiac incident, a patient with depression may become unable to function independently in terms of physical and cognitive activity. Depression can be treated with the use of pharmacotherapy, which, however, can be easily discontinued by the patient. The use of psychotherapy can alleviate depression, but it can be difficult to get the patient to seek professional help. In turn, in hospital conditions, after severe diseases, such therapy may be necessary, but due to limitations it will not be available to those in need. Supporting a depressed patient using Virtual Reality is effective, and the relaxed formula encourages the use of this form of help. Therapeutic intervention using the innovative VR TierOne medical device allows you to eliminate the symptoms of depression, anxiety, stress and support cognitive functions at the same time.
Rehabilitation of cognitive functions
In the VR TierOne therapy the rehabilitation of cognitive functions, i.e. their improvement, takes place in an attractive virtual space that stimulates the senses. Changing the real environment and immersing yourself in the computer-generated environment forces you to focus your attention. Elimination of external distractors makes it easier to focus on the empowering therapeutic story prepared by the psychotherapist. The tasks awaiting the patient serve cognitive development, support memory, visual perception and eye-hand coordination. The soft music surrounding the patient, composed by a music therapist, further helps to maintain the state of conscious attention. The safe relaxing environment of the Virtual Garden reduces stress, which tends to impair the cognitive processes. Relaxation has a positive effect on memory and cognitive flexibility. VR TierOne therapy contains elements of training that improve cognitive processes, which is why it works well in the case of cognitive deficits in depression, after stroke and in COVID-19 convalescents, who struggle with cognitive impairment known as brain fog. The stimulating virtual environment supports the neuroplastic processes in the brain. During the therapy the patients carry out tasks, and they are rewarded for their completion. The patients gain self-confidence, experience their agency and regain motivation for further rehabilitation. In a state close to meditation, tensions and fears decrease, which has a positive effect on mental functions. After each therapy session, the patients’ understanding of their health condition grows and so does the willingness to continue treatment in the real world. Treatment of depression covering the entire spectrum of symptoms, along with the rehabilitation of cognitive functions, aims to achieve complete remission of the disease and prevent recurrence of depression in the future.