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OBJECTIVE: Many studies have examined the effects of cerebrovascular change on treatment response in geriatric depression. However, few such studies have examined the relationship between cerebrovascular changes and long term prognosis. We examined the effects of cerebrovascular change on the course of geriatric depressive symptoms, dementia rates, and mortality over a follow-up period of approximately 10 years.

METHOD: Participants were 84 patients with major depression (age of onset greater than 50 years old); patients suffering from strokes, neurological disorders, and other psychiatric disorders were excluded. MRI findings were used to classify all patients into silent cerebral infarction (SCI) positive (n = 37) or negative groups (n = 47). Patient prognoses were ascertained using a review of clinical charts and over the mail.

RESULTS: Only 5% of patients with SCI were able to maintain remission, whereas 36% of those patients without SCI were able to do so. Total duration of depressive episodes was significantly longer in the SCI positive group than in the SCI negative group. In addition, SCI was associated with a higher risk of the onset of dementia.

CONCLUSION: The results of this long-term follow-up study demonstrate that the presence of SCI is associated with a relatively poor prognosis for geriatric depression