Anterior cingulate dysfunction in geriatric depression.
BACKGROUND
Although several brain abnormalities have been identified in geriatric depression, their relationship to the pathophysiological mechanisms leading to the development and perpetuation of this syndrome remain unclear.


METHODS
This paper reviews findings on the anterior cingulate cortex (ACC) function and on the relationship of ACC abnormalities to the clinical presentation and the course of geriatric depression in order to elucidate the pathophysiological role of ACC in this disorder.


RESULTS
The ACC is responsible for conflict detection and emotional evaluation of error and is connected to brain structures that regulate mood, emotional valence of thought and autonomic and visceral responses, which are functions disturbed in depression. Geriatric depression often is accompanied by abnormalities in some executive functions and has a clinical presentation consistent with ACC abnormalities. Indices of ACC dysfunction are associated with adverse outcomes of geriatric depression.


CONCLUSIONS
Converging findings suggest that at least some ACC functions are abnormal in depression and these abnormalities are pathophysiologically meaningful. Indices of ACC dysfunction may be used to identify subgroups of depressed elderly patients with distinct illness course and treatment needs and serve as the theoretical background for novel treatment development.
Alexopoulos
George S
GS
Weill Cornell Institute of Geriatric Psychiatry, Department Of Psychiatry, Weill Cornell Medical College, New York, USA. gsalexop@med.cornell.edu
Gunning-Dixon
Faith M
FM
Latoussakis
Vassilios
V
Kanellopoulos
Dora
D
Murphy
Christopher F
CF
D000368:Aged; D001931:Brain Mapping / Q000379:methods; D003866:Depressive Disorder / Q000503:physiopathology*; D005071:Evoked Potentials; D006179:Gyrus Cinguli / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D049268:Positron-Emission Tomography