Early- and Late-Onset Depression in Late Life: A Prospective Study on Clinical and Structural Brain Characteristics and Response to Electroconvulsive Therapy

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• 作者：Annemiek Dols ; M.D. ; Ph.D.^a ; ^b ; ^{a.dols@ggzingeest.nl} ; Filip Bouckaert ; M.D.^d ; ^e ; Pascal Sienaert ; M.D. ; Ph.D.^e ; Didi Rhebergen ; M.D. ; Ph.D.^a ; ^b ; Kristof Vansteelandt ; Ph.D.^f ; ^g ; Mara ten Kate ; M.D.^c ; Francois-Laurent de Winter ; M.D.^d ; Hannie C. Comijs ; Ph.D.^a ; ^b ; Louise Emsell ; Ph.D.^d ; ^h ; Mardien L. Oudega ; M.D.^a ; ^b ; Eric van Exel ; M.D. ; Ph.D.^a ; ^b ; Sigfried Schouws ; Ph.D.^a ; ^b ; Jasmien Obbels ; M.Sc.^e ; Mike Wattjes ; M.D. ; Ph.D.^c ; Frederik Barkhof ; M.D. ; Ph.D.^c ; Piet Eikelenboom ; M.D. ; Ph.D.^a ; Mathieu Vandenbulcke ; M.D. ; Ph.D.^d ; Max L. Stek ; M.D. ; Ph.D.^a ; ^b
• 关键词：Depression ; electroconvulsive therapy ; response ; late life ; early onset ; late onset ; structural brain
• 刊名：The American Journal of Geriatric Psychiatry
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：25
• 期：2
• 页码：178-189
• 全文大小：238 K
• 卷排序：25

文摘

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).MethodsBetween 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.ResultsResponse 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.ConclusionThe 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.