Objective: Depressed elderly patients and normal controls age 60 or older were compared to examine gender differences in medical comorbidity and structural brain changes on MRI.
Design: Cross-sectional MRI study of depressed patients and normal controls
Materials and Methods: Patients and controls were closely matched by age and education. They underwent a thorough neuropsychiatric, laboratory, and physical examination and the MRI scans. Measures of the total frontal lobe and the frontal gray and white matter volumes corrected by the intracranial volume were obtained using magnetic resonance imaging (MRI) together with clinical measures of overall medical (CIRS) and cerebrovascular burden (CVRF).
Results: The study samples were comprised of 22 patients with MDD (9 men, 13 women; mean age 71.4 + 8.1) and 15 controls (4 men and 11 women; mean age 72 + 6.1). In the univariate analysis, the depressed group had lower MMSE scores (p=0.02); greater severity of medical comorbidity (CIRS scores) (p=0.003) compared to the controls. The depressed group had lower total frontal (p<0.03), left (p<0.03) and right (p<0.05) frontal volumes than the controls (p<0.02). In the depressed group, men had smaller corrected frontal volumes (p<0.01), as well as frontal white matter volume (p<0.05) compared with women. In the logistic regression, frontal total volume and frontal white matter volumes predicted gender assignment after controlling for age (p<0.01) in the depressed group, but not in controls.
Conclusion: Geriatric depression is associated with greater severity of medical comorbidity and brain structural changes. However, gender differences in brain structural changes appear to play a role in geriatric depression, thereby indicating that gender differences in neuroanatomy may be important in the pathophysiology of geriatric depression.
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