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PAPERS: ROBERT BALDWIN, SUZANNE JEFFRIES, ALAN JACKSON, CAROLINE SUTCLIFFE, NEIL THACKER, MARIETTA SCOTT, and ALISTAIR BURNS Neurological findings in late-onset depressive disorder: comparison of individuals with and without depression The British Journal of Psychiatry 2005; 186: 308-313 [Abstract] [Full text] [PDF]

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Organic brain dysfunction in late-onset depression: A review of Medline abstracts

Arunraj Balakrishna Kaimal, MRCPsych, Uma .V. Nair, SHO in Psychiatry, Hergest Unit ,Bangor, LL57 2PW, Tel.01248384148, fax01248384888, mob 07812243439   (21 April 2005)

Organic brain dysfunction in late-onset depression: A review of Medline abstracts 21 April 2005
Arunraj Balakrishna Kaimal, MRCPsych, SHO in Psychiatry, Hergest Unit, Ysbyty Gwynedd, Bangor ,LL57 2PW. Tel. 01248384456. FAX.01248384888 , Uma .V. Nair, SHO in Psychiatry, Hergest Unit ,Bangor, LL57 2PW, Tel.01248384148, fax01248384888, mob 07812243439 Send letter to journal: Re: Organic brain dysfunction in late-onset depression: A review of Medline abstracts arunrajkaimal{at}hotmail.com Arunraj Balakrishna Kaimal, MRCPsych, et al.	Medical co-morbidity is common in late onset depression. Some studies suggest, presence of mild cognitive impairment up to 60%of patients with late onset depression and constitute a major diagnostic problem in geriatric psychiatry. As a response to the study of neurological findings in late onset depression by Baldwin et.al we performed an abstract review of Medline publications using the key word ‘late onset depression’ to identify the possible aetiological factors behind the increased occurrence of neurological signs in late onset depression. We identified 93 citations published between 1975 and 2005of which 75 titles were relevant to the topic. After reading all citations we found 63 abstracts discussing different aspects of late-onset depression, which we have included in the review. The main findings were outlined here briefly. Even though early onset and late onset depressions are similar phenotypically, there is an increased possibility of difference in aetiology. Vascular co-morbidities including an increased prevalence of hypertension is common in late-onset depression. There is much clinical and biologic overlap between late onset depression and dementia, sometimes the first being the prodrome of the later. There are at least a dozen studies showing some structural, functional and electrophysiological links between late onset depression and Alzheimer’s disease. There were observations that late onset depression is not a prodrome for a particular type of dementia, but the majority of patients who develop dementia will acquire Alzheimer’s disease or vascular dementia, as they are the most common causes of dementia. From several studies an association with genetic factors or Apolipoprotein E could not be established in the case of late onset depression. There are a number of structural or vascular factors identified mainly through imaging studies. Regionally specific decrease in grey matter [decreased volume of frontal and temporal lobes], ventricular enlargement, sulcal widening, and decreased volume of hippocampus and caudate nucleus were findings reported in more than one study. Deep white matter lesions and increased evidence of vascular events were also found in late onset depression. On functional imaging studies impairment of regional cerebral blood flow in left anterior temporal and left anterior frontal regions, was found to have an association with late onset depression. There is evidence of more frequent electro-encephalographic changes in late onset depression compared with early onset one. More over few studies examining psychological factors as aetiology concluded that there is a lesser association between life events and late onset depression, on comparison with early onset depression. All these findings increases the validity of the research question addressed by Baldwin et.al, which is stressing the importance of thorough physical examination in late onset depression. In the absence of clear guidelines for neuro-imaging in psychiatry, a detailed physical examination will be a good screening tool for the identification of the patient group, in which more expensive and invasive investigations are indicated.