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Neurological findings in late-onset depressive disorder: comparison of individuals with and without depression

Department of Old Age Psychiatry, Manchester Mental Health & Social Care NHS Trust, Manchester Royal Infirmary, Manchester

SUZANNE JEFFRIES, MBChB

Meadowbrook Unit, Hope Hospital, Salford

ALAN JACKSON, MBChB, PhD

Department of Image Science & Biomedical Engineering, University of Manchester, Manchester

CAROLINE SUTCLIFFE, MSc, PSSRU

Faculty of Medicine, Dentistry and Nursing, University of Manchester, Manchester

NEIL THACKER, PhD and MARIETTA SCOTT, MSc

Department of Image Science & Biomedical Engineering, University of Manchester, Manchester

ALISTAIR BURNS, MD

School of Psychiatry & Behavioural Sciences, University of Manchester, Manchester, UK

Correspondence: Professor R.C. Baldwin, Department of Old Age Psychiatry, York House, Manchester Mental Health & Social Care NHS Trust, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9BX, UK. Tel: 0161 276 5317; Fax: 0161 276 5303; e-mail: robert.baldwin{at}man.ac.uk

Declaration of interest None. This research was supported by a grantto R.B. from Research into Ageing, England (grant 181).

Background Organic factors are thought to be important in late-life depressive disorder but there have been few studies specifically of neurological signs.

Aims To compare neurological signs in a group of patients with late-onset depression and in healthy controls.

Method Acase–control study comparing 50 patients with depression and 35 controls on three measures of central nervous system (CNS) signs: a structured CNS examination, the Neurological Evaluation Scale (NES) and the Webster rating scale for parkinsonism.

Results After adjusting for major depression at the time of evaluation and prescription of tranquillisers, ratings ontwo of the NES sub-scales (complex motor sequencing and‘other’signs) and on the Webster scale were significantly higher (more impaired) in patients compared with controls (P<0.05). With logistic regression, the NES was the main measure predictive of group outcome. There were no differences in scores of vascular risk or white matter but patients had patients had more atrophy.

Conclusions The findings add to the evidence that late-life depression is associated with organic brain dysfunction, perhaps mediated by neurodegeneration or subtle vascular impairment. The use of the NES in subjects with depression should be replicated.

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