Objective: a comprehensive literature review suggests that suicidal behaviour results from a complex interplay between stressful events and vulnerability factors including cognitive deficits. The aim of this systematic literature review was to identify the neurocognitive markers associated with suicide vulnerability in elderly people.
Method: a systematic English Medline literature search of cohort studies, case-control studies and cross-sectional studies published between January 1960 and December 2012 was performed, combining the MeSH terms "Suicide", "Neuropsychology", "Neuropsychological Tests", "Executive Function", "Magnetic Resonance Imaging", "Diffusion Magnetic Resonance Imaging", "Positron-Emission Tomography", "Prefrontal Cortex", "Tomography, Emission-Computed, Single-Photon", and "Diffusion Tensor Imaging". The abstract selection was based on the Strobe checklist for observational studies.
Results: of the 446 original articles, 10 neuropsychological and 4 brain imaging studies were selected. The number of suicidal subjects ranged from 10 to 29 (mean age=66.8 to 79.1 years old, 0-85% women). Executive functions, in particular decision-making and cognitive inhibition, were more impaired in the depressed elderly with a history of suicide attempts compared to those without such a history. fMRI data, which need to be confirmed in further details, showed abnormalities of fronto-limbic circuits which are involved in suicide vulnerability in the elderly independently of any associated psychopathological conditions including depression.
Conclusion: this literature review confirms the existence of neurocognitive markers of suicide vulnerability in elderly people. A neuropsychological assessment could thus help to identify the suicide vulnerability of a depressed elderly person, a first step for both pharmacological and psychotherapeutic cares.
Keywords: age; cognitive inhibition; decision making; neuropsychology; suicide.