It is unclear how best to address cognitive deficits in patients with late-life depression. Cognitive impairment is predictive of a poor response to antidepressants even with remission of depression, def icits may persist and signal a high risk of dementia. In a blinded, placebo-
controlled trial of donepezil as an adjunct to antidepressant therapy for the maintenance treat-ment of depression, the donepezil group had, at best, modest and transient improvement in cognitive measures over a 2-year period and a significantly higher risk of depression recurrence post hoc analyses suggested that these effects were limited to patients with concomitant mild cognitive impairment. Neither memantine, a drug approved for the treatment of Alzheimer’s disease, nor stimulants such as methylphenidate have been shown to have cognitive benefits in patients with late-life depression.