Follow-up study of depression in the elderly - Clinical and SPECT data

Background imaging studies in depression of the elderly are often small and highly selective. Aims To investigate a large group of elderly depressed patients in order to assess changes in clinical, imaging and neuropsychological variables at follow-up. Method Patients(n=175, age range 65-91 years) with clinical depression were identified from consecutive local referrals. Clinical interviews, neuropsychological tests and SPECT scans were carried out at referral and at two-year follow-up. Results Of 84 re-examined patients, 46.5% were well, 9.5% were ill. 33% partially recovered and 11% had developed dementia. Duration of illness before index assessment was the only factor to predict outcome. Thirty-nine patients could be scanned and followed up. There were no differences between patients with good or poor depressive outcome on SPECT. Ten clinically improved patients could be re-examined with SPECT. There were relative increases in right cingulate gyrus and right cerebellum at follow-up. Conclusions The patient group was comparable with other studies showing high levels of residual depressive symptoms. Activity changes in limbic cortex are implicated in depression of old age. Declaration of interest Funded by the Gordon Small and the Scottish Hospitals Endowment Research Trust and by the Medical Research Council.