Long-term prognosis of geriatric major depression in relation to cognition and white matter integrity: follow up of two cases

Carlos Eduardo De Oliveira Alves,Eliasz Engelhardt,Jerson Laks,Gilberto Sousa Alves,Letice Ericeira-Valente,Denise Madeira Moreira,Maria Elisa Lanna,Felipe Kenji Sudo

doi:10.1590/s0047-20852012000200009

Carlos Eduardo De Oliveira Alves, Eliasz Engelhardt + Show 6 more

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https://doi.org/10.1590/s0047-20852012000200009

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Abstract

INTRODUCTION: The geriatric depression (GD) represents one of the most frequent psychiatric disorders in outpatient services specialized in old-age treatment. OBJECTIVE: The course of two illustrative cases of GD is discussed, highlighting its clinical picture after antidepressant treatment and underlining variables related to disease prognosis, treatment effectiveness and conversion to major cognitive disorders such as vascular dementia (VD). METHODS: The cognitive performance, depressive symptoms, autonomy and brain structural measurements as white matter hyperintensities (WMH) and hippocampal size, and microstructural integrity of WM with diffusion tensor imaging were followed during four years. RESULTS: Case 1, with a severe degree of WMH, was associated with worsening cognition and increasing functional disability. Case 2, with mild WMH, an improvement of cognitive functioning could be seen. CONCLUSIONS: The existence of different subtypes of GD, as presented in this report, points a pathophysiological heterogeneity of GD, and suggests a possible continuum vascular depression (VaDp) and vascular cognitive impairment (VCI).

Highlights

The geriatric depression (GD) represents one of the most frequent psychiatric disorders in outpatient services specialized in old-age treatment
The diffusion tensor imaging (DTI) data of both cases were submitted to post-processing to obtain DTI-FA values of the subcortical white matter, which were compared with a control sample of normal elderly individuals[22]
The present study shows evidence that a worsening of white matter hyperintensities (WMH) lesions is associated with a worse prognosis for GD and cognitive decline

Summary

Introduction

The geriatric depression (GD) represents one of the most frequent psychiatric disorders in outpatient services specialized in old-age treatment. The course of GD has shown to be rather heterogeneous[6], and it is assumed that the combination of white matter lesions and cognitive symptoms related to frontal lobe dysfunction might be associated to GD with specific features. This led to the concept of Vascular Depression (VaDp) hypothesis[7]. This condition proposed by Alexopoulos includes major depression occurring after 65 years of age, vascular risk factors and significant cerebrovascular disease, as main aspects, and cognitive impairment, represented by executive dysfunction, as a secondary aspect[7]. In some situa tions a spectrum of cognitive and behavioral impairment of vascular etiology, comprising vascular depression (VaDp), mild vascular cognitive impairment (VMCI), and vascular dementia (VaD) may be considered[8,9]

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