title: Long-term prognosis of patients with major depression and silent cerebral infarction.
abstract: OBJECTIVE
  Many studies have examined the effects of cerebrovascular changes on treatment response in geriatric depression. However, few such studies have examined the relationship between cerebrovascular changes and long-term prognosis. We examined the effects of cerebrovascular changes on the course of geriatric depressive symptoms, dementia rates, and mortality over a follow-up period of approximately 10 years.
  
  
  METHODS
  Participants were 84 patients with major depression (age of onset over 50 years); patients suffering from strokes, neurological disorders, and other psychiatric disorders were excluded. Magnetic resonance imaging findings were used to classify all patients into silent cerebral infarction (SCI)-positive (n = 37) or SCI-negative groups (n = 47). Prognoses were ascertained using a review of clinical charts and mailed questionnaires.
  
  
  RESULTS
  Only 5% of patients with SCI were able to maintain remission whereas 36% of patients without SCI were able to do so. Total duration of depressive episodes was significantly longer in the SCI-positive group than in the SCI-negative group. SCI was also associated with a higher risk of dementia.
  
  
  CONCLUSIONS
  The results of this long-term follow-up study demonstrate that the presence of SCI is associated with a relatively poor prognosis in geriatric depression.
authors.affiliation: Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences Hiroshima University, Hiroshima, Japan. hidehisa @ hiroshima-u.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Yamashita
authors.forename: T
authors.initials: T
authors.lastname: Fujikawa
authors.forename: H
authors.initials: H
authors.lastname: Takami
authors.forename: I
authors.initials: I
authors.lastname: Yanai
authors.forename: Y
authors.initials: Y
authors.lastname: Okamoto
authors.forename: S
authors.initials: S
authors.lastname: Morinobu
authors.forename: S
authors.initials: S
authors.lastname: Yamawaki
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D003704:Dementia / Q000150:complications; D003865:Major Depressive Disorder / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors