CNSPulse
W23

EXAMINING THE IMPACT OF PATIENT-CENTERED APPROACHES ON THE ASSESSMENT AND MANAGEMENT OF COGNITIVE IMPAIRMENT IN MAJOR DEPRESSIVE DISORDER

Michael E. Thase — Rakesh Jain2, Jeff Carter3, Jacqueline Maytorena3, Laura Simone3, Larissa Jarzylo3 1Perelman School of Medicine, University of Pennsylvania, and Corporal Michael J. Crescenz VAMC, 2Texas Tech University School of Medicine, 3PRIME Education

2026 ASCP Annual Meeting

Introduction

Cognitive impairment affects nearly two-thirds of patients with major depressive disorder (MDD), may persist despite depressive episode remission, may worsen with repeated episodes of depression, and is associated with an increased risk of neurodegenerative disorders. Identifying and addressing cognitive impairment therefore should be a key goal of management to optimize long-term outcomes in MDD.

Methods

Between May 2024 and December 2025, clinicians and patients from five US-based psychiatry and behavioral health clinics participated in a quality improvement initiative. A steering committee comprised of patients and clinicians developed a point of care guide aimed at supporting conversations and shared decision-making around cognitive symptoms. Surveys were administered to patients with MDD (n=118) and their providers (n=74) before and after using the guide. Clinics participated in audit-feedback sessions to evaluate real-world data, identify gaps in evidence-based assessment and management, and develop action plans. Follow-up surveys of patients (n=96) and providers (n=48) were collected 3 months later to assess long-term impact.

Discussion

At baseline, 75% of patients had cognitive symptoms and more than half said that they had a high impact on their quality of life (QoL; Likert 4/5). Only 40% of patients were satisfied with their depression therapy (Likert 4/5) and 42% were not taking any therapy for depression. While 70% of clinicians assessed for cognitive impairment at most appointments, only 48% of patients said the same (Likert 4/5) and 25% of patients were never asked. Following guide integration, patients’ confidence in discussing cognitive symptoms increased from 56% to 75%, and 86% felt satisfied with the care decisions (both Likert 4/5). Clinicians set action plans aimed at increasing awareness of cognitive impairment with patients, engaging patients to take part in decision-making, and staying current on emerging evidence. The longitudinal survey revealed lasting changes in treatment for most patients; 44% of patients reported changes in MDD therapy and an additional 33% reported changes in management not related to therapy. Most patients reported improvements in cognitive health (70%) and increased confidence (74%) and involvement (81%) in decision-making. Most clinicians assessed cognitive impairment more frequently (70%) and invited patients to take part in care decisions (77%) as a result of the guide. These findings suggest that building frameworks to evaluate and manage cognitive impairment in MDD such as the collection of patient-reported outcomes and engagement in care planning through a point of care guide can help to uncover unmet needs in cognitive health and facilitate lasting improvements in care. This program was supported by an educational grant from Takeda Pharmaceuticals U.S.A., Inc.