The prognostic significance of abnormalities seen on magnetic resonance imaging in late life depression: clinical outcome, mortality and progression to dementia at three years.
OBJECTIVE
To study the course of depressive symptoms over 3 years, rate of dementia and mortality in relation to baseline neuroradiological abnormalities.


METHODS
Retrospective casenote analysis of 38 patients (of 44) who had a Magnetic Resonance Imaging (MRI) scan 3 years earlier. Twenty-two patients also received a detailed interview.


RESULTS
Overall outcome was good for around two-thirds of the sample. Poorer clinical course was associated with lesions in pons and more than five Virchow Robins spaces in the corona radiata. Pontine raphe lesions and confluent periventricular lesions were associated with later dementia and with reduced survival from cardiovascular death. Males had more recurrences and a reduced survival.


CONCLUSIONS
MRI lesions influence outcome, mortality and the onset of dementia. However, because they are quite common in elderly depressed patients they have limited utility on their own as predictors of outcome. The association of periventricular lesions with dementia is a new finding, and suggests that the site and type of lesions may be as important than the quality of them.
Baldwin
R C
RC
York House, Manchester Royal Infirmary, Oxford Road, Manchester M13 9 WL, UK. robert.baldwin@man.ac.uk
Walker
S
S
Simpson
S W
SW
Jackson
A
A
Burns
A
A
D000368:Aged; D001921:Brain / Q000473:pathology*; D002318:Cardiovascular Diseases / Q000401:mortality; D003704:Dementia / Q000209:etiology / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009026:Mortality; D010286:Paraventricular Hypothalamic Nucleus / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D016019:Survival Analysis