Hoarding Symptoms in Late Life Depression are Associated With Greater Executive Dysfunction and Disability and Poorer Response to Depression Treatment

•What is the primary question addressed by this study?What is the prevalence of hoarding disorder (HD) in Late life depression (LLD) and do hoarding symptoms in LLD contribute to greater executive dysfunction, disability, and poorer depression treatment response?•What is the main finding of this study?HD concurrence with LLD is common at 30.1%, which is higher than HD comorbidity with obsessive-compulsive disorder (≤18%) or HD prevalence in the general population of older adults (6%). Hoarding symptoms concurrent with LLD were associated with greater executive dysfunction, disability, and poorer response to depression treatment.•What is the meaning of the findings?Individuals with HD and LLD may be at greater risk for cognitive and functional decline, thus underscoring the need for increased screening of hoarding symptoms in LLD and tailored interventions for individuals with both conditions. Late life depression (LLD) and hoarding disorder (HD) are common in older adults and characterized by executive dysfunction and disability. We aimed to determine the frequency of co-occurring HD in LLD and examine hoarding severity as an additional contributor to executive dysfunction, disability, and response to psychotherapy for LLD. Cross-sectional. Outpatient psychiatry program. Eighty-three community-dwelling adults ages 65–90 with LLD. Problem-solving therapy. Measures of executive function, disability, depression, and hoarding severity were completed at post-treatment. Pearson's chi-squared tests evaluated group differences in rates of cognitive impairment, disability, and depression treatment response between participants with HD (LLD+HD) and LLD only. Separate linear regressions assessed associations between hoarding severity and executive function, disability, and psychotherapy response. Covariates included age, education, gender, and depression severity. Of 30.1% (25/83) LLD participants met HD criteria. Relative to LLD, LLD+HD participants demonstrated greater impairment rates on measures of executive function (letter-number-sequencing, X2(1)=4.0, p = 0.045; Stroop-interference, X2(1) = 4.8, p = 0.028). Greater hoarding severity was associated with poorer executive functioning performance (letter-number-sequencing (t[70] = −2.1,β = −0.05, p = 0.044), digit-span (t[71] = −2.4, β = −0.07, p = 0.019), letter-fluency (t[ 71] = −2.8, β = −0.24, p = 0.006)). Rates of disability were significantly higher for LLD+HD (88.0%) than LLD (62.3%), (X2[1] = 5.41, p = 0.0