background In depressed elderly structural abnormalities in the brain, such as white matter hyperintensities (wmh), medial temporal lobe atrophy (mta) or global cortical atrophy, may influence therapeutic response and cognition during treatment.
aim To study neuroimaging factors and ect in depressed elderly.
method In a naturalistic clinical cohort of 81 elderly patients with unipolar depression, magnetic resonance images (mri) were rated before ect treatment. Severity of depressive symptoms was measured by using the Montgomery Åsberg Depression Rating Scale (madrs). Mini-Mental Scale Examinations (mmse) were weekly obtained between ect as measures of global cognition.
results Patients with mta had a lower mean percentage decrease in madrs scores after ect (37.9% in those with-, compared to 66.2% in those without, p = 0.008). Patients without mta had a three times greater chance to remit from their depression compared to patients with mta i.e. the hazard ratio for remission was 3.22 (95% ci 1.30 to 7.69, p = 0.01). In contrast, no differences in change in madrs scores were found for wmh or global cortical atrophy. Patients with wmh, but not mta, who were treated with bilateral ect, were more at risk to develop severe cognitive sideeffects during treatment.
conclusions mta – not wmh or global cortical atrophy – contributes to poor response to ect in severely depressed elderly. These findings suggest that assessment of mta may be useful in the prediction of ect response. Patients with wmh and their relatives can be informed that the chance to develop cognitive disturbance during ect is heightened, especially when treated bilaterally, but that the results, both in response and cognitive functioning, at the end of the ect course are equally well.