title: Contribution of white matter hyperintensities, medial temporal lobe atrophy and cortical atrophy on outcome, seven to twelve years after ECT in severely depressed geriatric patients.
abstract: BACKGROUND
  Depression and cognitive decline are highly prevalent and often coexisting, however, the association between depression and dementia remains unclear. White matter hyperintensities (WMH), medial temporal lobe atrophy (MTA) and global cortical atrophy (GCA) are associated with depression, mild cognitive impairment and dementia; these structural abnormalities may therefore represent a common underlying mechanism of these diseases. We conducted a naturalistic prospective follow-up study in patients with severe geriatric depression who were formerly treated with ECT. The aim of the study was to investigate the effects of structural abnormalities in the brain on cognitive decline, dementia and survival.
  
  
  METHODS
  Survival data of 76 patients was obtained. 39 (51.3%) of them also participated in the follow-up study. Cognitive decline was identified 7-12 years after ECT (median 8.0), using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). A diagnosis of dementia was obtained from the family doctor of the patients.
  
  
  RESULTS
  Forty-two out of the 76 (55.3%) of the patients died during follow-up. Twenty-four out of the remained 39 (65.1%) patients who participated in the follow-up study reported cognitive decline and 7 among the 39 patients (17.9%) were diagnosed with dementia. Depression with psychotic symptoms was significantly associated with absence of cognitive decline at follow-up (p=0.007). WMH was significantly associated with mortality (plog rank=0.048). Finally, we observed a trend in significance between the association of GCA and cognitive decline at follow-up (p=0.078), CONCLUSIONS: Depression with psychotic symptoms is a depression subtype that might not be associated with cognitive decline at follow-up. Moderate or severe WMH before ECT in our cohort of depressed patients was associated with higher mortality and GCA was possibly associated with cognitive decline at follow-up.
authors.affiliation: GGZ inGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands; Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands; Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Mardien L
authors.initials: ML
authors.lastname: Oudega
authors.affiliation: GGZ inGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Dols
authors.affiliation: GGZ inGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Ilse
authors.initials: I
authors.lastname: Adelerhof
authors.affiliation: GGZ inGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Rozing
authors.affiliation: Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Mike P
authors.initials: MP
authors.lastname: Wattjes
authors.affiliation: GGZ inGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Hannie C
authors.initials: HC
authors.lastname: Comijs
authors.affiliation: Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, the Netherlands; Department of Radiology, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.affiliation: GGZ inGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Piet
authors.initials: P
authors.lastname: Eikelenboom
authors.affiliation: GGZ inGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Max L
authors.initials: ML
authors.lastname: Stek
authors.affiliation: GGZ inGeest/Department of Psychiatry, VU University Medical Center, Amsterdam, the Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: van Exel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000175:diagnosis; D002540:Cerebral Cortex / Q000473:pathology*; D060825:Cognitive Dysfunction / Q000209:etiology / Q000473:pathology; D003704:Dementia / Q000209:etiology / Q000473:pathology; D003863:Depression / Q000473:pathology; D003865:Major Depressive Disorder / Q000473:pathology*; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D013702:Temporal Lobe / Q000473:pathology*; D066127:White Matter / Q000473:pathology*
keywords: ECT; Geriatric depression; Global cortical atrophy; White matter hyperintensities