title: Early- and Late-Onset Depression in Late Life: A Prospective Study on Clinical and Structural Brain Characteristics and Response to Electroconvulsive Therapy.
abstract: OBJECTIVE
  The clinical profile of late-life depression (LLD) is frequently associated with cognitive impairment, aging-related brain changes, and somatic comorbidity. This two-site naturalistic longitudinal study aimed to explore differences in clinical and brain characteristics and response to electroconvulsive therapy (ECT) in early- (EOD) versus late-onset (LOD) late-life depression (respectively onset <55 and ≥55 years).
  
  
  METHODS
  Between January 2011 and December 2013, 110 patients aged 55 years and older with ECT-treated unipolar depression were included in The Mood Disorders in Elderly treated with ECT study. Clinical profile and somatic health were assessed. Magnetic resonance imaging (MRI) scans were performed before the first ECT and visually rated.
  
  
  RESULTS
  Response rate was 78.2% and similar between the two sites but significantly higher in LOD compared with EOD (86.9 versus 67.3%). Clinical, somatic, and brain characteristics were not different between EOD and LOD. Response to ECT was associated with late age at onset and presence of psychotic symptoms and not with structural MRI characteristics. In EOD only, the odds for a higher response were associated with a shorter index episode.
  
  
  CONCLUSIONS
  The clinical profile, somatic comorbidities, and brain characteristics in LLD were similar in EOD and LOD. Nevertheless, patients with LOD showed a superior response to ECT compared with patients with EOD. Our results indicate that ECT is very effective in LLD, even in vascular burdened patients.
authors: Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: a.dols@ggzingeest.nl.
authors: Annemiek
authors: A
authors: Dols
authors: Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium; Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium.
authors: Filip
authors: F
authors: Bouckaert
authors: Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium.
authors: Pascal
authors: P
authors: Sienaert
authors: Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Didi
authors: D
authors: Rhebergen
authors: Department of Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium; Research Group of Quantitative Psychology and Individual Differences, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium.
authors: Kristof
authors: K
authors: Vansteelandt
authors: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Mara
authors: M
authors: Ten Kate
authors: Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium.
authors: Francois-Laurent
authors: FL
authors: de Winter
authors: Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Hannie C
authors: HC
authors: Comijs
authors: Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium; Translational MRI, Department of Imaging and Pathology, KU Leuven & Radiology, University Hospitals Leuven, Leuven, Belgium.
authors: Louise
authors: L
authors: Emsell
authors: Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Mardien L
authors: ML
authors: Oudega
authors: Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Eric
authors: E
authors: van Exel
authors: Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Sigfried
authors: S
authors: Schouws
authors: Academic Center for ECT and Neuromodulation, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium.
authors: Jasmien
authors: J
authors: Obbels
authors: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Mike
authors: M
authors: Wattjes
authors: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
authors: Frederik
authors: F
authors: Barkhof
authors: Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands.
authors: Piet
authors: P
authors: Eikelenboom
authors: Old-age Psychiatry, University Psychiatric Center KU Leuven, Leuven/Kortenberg, Belgium.
authors: Mathieu
authors: M
authors: Vandenbulcke
authors: Department of Old Age Psychiatry, GGZ inGeest, VU University Medical Center, Amsterdam, The Netherlands; EMGO+ Institute of Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors: Max L
authors: ML
authors: Stek
mesh_terms: D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D001921:Brain / Q000473:pathology*; D003866:Depressive Disorder / Q000000981:diagnostic imaging* / Q000628:therapy*; D004565:Electroconvulsive Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D011446:Prospective Studies
keywords: Depression; early onset; electroconvulsive therapy; late life; late onset; response; structural brain