Depression, cerebral atrophy, cognitive performance and incidence of dementia - Population study of 85-year-olds

Background Hospital-based studies suggest-that depression in old age relate s to organic brain changes. Aims To determine whether these findings are confirmed in a population-base d sample. Method A population sample of nondemented 85-year-olds (227 mentally health y and 62 with DSM-III-R depression were given a neuropsychiatric examinatio n and computerised tomographic scans of the brain, and followed for three y ears. Results On the Mini-Mental State Examination,those with a low educational l evel with major depression performed worse than the mentally healthy; this distinction was not evident among those who had received higher education. Measures of brain atrophy were similar in depressed and mentally healthy in dividuals. The three-year incidence of dementia was increased in those with early-onset major depression. Conclusions Higher education may protect against cognitive symptoms in depr essed individuals. The association between depression and cerebral atrophy in the elderly is not very strong. The higher incidence of dementia in thos e with early onset major depression may be due to a longer lifetime duratio n of depression, emphasising the importance of detecting and treating depre ssion in the community. Declaration of interest No commercial interest. Grants detailed in Acknowle dgements.