Long-term prognosis of patients with major depression and silent cerebral infarction.
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.
Yamashita
H
H
Department of Psychiatry and Neurosciences, Graduate School of Biomedical Sciences Hiroshima University, Hiroshima, Japan. hidehisa @ hiroshima-u.ac.jp
Fujikawa
T
T
Takami
H
H
Yanai
I
I
Okamoto
Y
Y
Morinobu
S
S
Yamawaki
S
S
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