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Psychiatry Res. 2014 Apr 30;222(1-2):1-9. doi: 10.1016/j.pscychresns.2014.03.002. Epub 2014 Mar 14.

The structure of the geriatric depressed brain and response to electroconvulsive therapy.

Author information

1
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: M.Oudega@ggzingeest.nl.
2
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research and VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands.
3
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
4
Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
5
Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
6
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research and VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands.
7
Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, The Netherlands.
8
Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands.
9
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
10
Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands; Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam, The Netherlands.

Abstract

Electroconvulsive therapy (ECT) is the treatment of choice in severe geriatric depression. High remission rates may be influenced by specific brain morphology characteristic of geriatric depression. Our objective was to identify the relationship between brain structure, symptom profile, and ECT response. In a naturalistic cohort of 55 patients with a major depressive disorder, structural magnetic resonance imaging (MRI) was performed before ECT. Voxel-based morphometry was applied to determine regional differences in gray matter (GM) volume between patients and 23 matched healthy controls. Depressed patients with psychotic symptoms showed significantly higher remission rates and smaller regional GM volume of the left inferior frontal gyrus (IFG). Patients with late onset depression showed smaller regional GM volume of the bilateral lateral temporal cortex. Larger size of response in the whole patient group was related to smaller pretreatment regional GM volume of the right lateral temporal cortex, whereas faster speed of response was related to smaller pretreatment regional GM volume of the right IFG. ECT is most effective in depressed patients with psychotic symptoms. In this study the presence of psychotic symptoms was related to pretreatment smaller GM volume of the left IFG and bilateral temporal cortex. Smaller volume of the IFG pretreatment was related to faster treatment response, and smaller volume of the right lateral temporal cortex pretreatment was related to larger response to ECT. These results are possibly explained by the connectivity between these brain regions and an interconnected network that is particularly activated by the ECT-induced seizures.

KEYWORDS:

Depression with psychotic symptoms; Geriatric depression; Late onset depression; Magnetic resonance imaging (MRI); Voxel-based morphometry

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