title: FMRI activation during executive function predicts response to cognitive behavioral therapy in older, depressed adults.
abstract: OBJECTIVE
  To test our hypothesis that pre-treatment executive function and brain regional activation during executive function would discriminate between responders and non-responders to cognitive behavioral therapy (CBT) in elderly depressed outpatients.
  
  
  METHODS
  Clinical cohort study.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  Sixty outpatients (age 59 years and older) completed 12 weeks of CBT between July 2010 and December 2011. Forty-four completed fMRI procedures.
  
  
  METHODS
  The main outcome consisted of a conversion from a clinical diagnosis (Mini-International Neuropsychiatric Interview) of depression to no clinical diagnosis of depression or a significant improvement in diagnostic criteria. Brain activation measured by functional magnetic resonance imaging during the Wisconsin Card Sorting task (WCST) was the primary predictor variable.
  
  
  RESULTS
  67% of patients had a positive response to CBT. Decreased activation in the left inferior frontal triangle and right superior frontal gyrus as well as increased activity in the right middle frontal gyrus and left superior frontal gyrus predicted a positive response to CBT. Demographic and neurocognitive measures of WCST performance were not significant predictors of a positive CBT outcome, whereas the measure of WCST-induced activity in the prefrontal cortex was a significant predictor.
  
  
  CONCLUSIONS
  These data are among the first to suggest that measures of prefrontal brain activation during executive functioning predict response to CBT in older adults. Further exploration of the specific underlying processes that these prefrontal cortical regions are engaging that contributes to better CBT outcomes is warranted in larger, randomized studies.
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Dolores Gallagher
authors.initials: DG
authors.lastname: Thompson
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Shelli R
authors.initials: SR
authors.lastname: Kesler
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA; VA Palo Alto MIRECC (Mental Illness Research, Education and Clinical Center), Palo Alto, CA.
authors.forename: Keith
authors.initials: K
authors.lastname: Sudheimer
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Kala Mehendra
authors.initials: KM
authors.lastname: Mehta
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Thompson
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Renee M
authors.initials: RM
authors.lastname: Marquett
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Holland
authors.affiliation: Palo Alto University/Pacific Graduate School of Psychology, Palo Alto, CA.
authors.forename: Robert
authors.initials: R
authors.lastname: Reiser
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Natalie
authors.initials: N
authors.lastname: Rasgon
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA.
authors.forename: Alan
authors.initials: A
authors.lastname: Schatzberg
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, CA; VA Palo Alto MIRECC (Mental Illness Research, Education and Clinical Center), Palo Alto, CA. Electronic address: roh@stanford.edu.
authors.forename: Ruth M
authors.initials: RM
authors.lastname: O'Hara
mesh_terms: D000368:Aged; D001931:Brain Mapping / Q000379:methods*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000503:physiopathology* / Q000628:therapy; D056344:Executive Function / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000503:physiopathology*; D016896:Treatment Outcome
keywords: Depression; cognitive-behavioral therapy; elderly; fMRI