Clinical and cognitive outcome, course of late onset depression – A study from geriatric services of a tertiary care center in India

Abstract

Introduction Literature on outcome studies of late onset depression (LOD) is inconsistent and long-term follow-up over LOD is lacking from India. Aims and objective To study the course, outcome in LOD and to compare the cognitive performance between patients with LOD and healthy controls. Methodology Study design was a naturalistic follow-up study. Two hundred and ten case files of LOD between 2007 and 2012 were reviewed. Physical follow-up was done for fifty patients. Depression was assessed using GDS and MADRS, follow-up data using Longitudinal Interval Follow-up Evaluation (LIFE) and cognitive functions using HMSE, neuropsychological battery for Indian elderly, which was compared with matched healthy controls. Results Among 210 file reviews, 22.4% cases dropped out after initial visit. Among 79 cases, where follow-up information was available, 3 cases converted into BPAD, 1 had MCI and 1 of them was converted to dementia who was missing. Thirty-three were still symptomatic, 5 patients attained partial remission, 40 attained complete remission. Among 50 where in person evaluation was done, only 28% of patients had regular follow-up and 66% had attained remission from index episode out of which 54% had at least one relapse at follow-up. Subjects in LOD group had significantly inferior performance in Wordlist {IR ( P P P =0.013), IR ( P =0.040), DR ( P =0.014)}, DigitSpan {Forward ( P =0.014), Reverse ( P =0.012)}, CorsiSpan {Forward ( P =0.011), Reverse( P =0.039)}, Verbal fluency total ( P =0.010) and Total time for Tower of Hanoi ( P =0.009). However, remitted LOD patients performed better in executive functions and memory. Conclusion Patients with LOD appear to have poorer outcome with fewer remission rates, longer duration to achieve remission, high probability of relapse and poorer performance in cognitive functions.