The authors conducted a 6-year follow-up of 16 patients with late-life depr
ession to evaluate the relationships between clinical and neuroradiologic v
ariables and disease outcome. Patients had a comprehensive neuropsychiatric
evaluation and magnetic resonance imaging (MRI) at baseline and follow-up.
Eight of the IG developed a chronic course of unremitting major depression
sufficient to cause significant psychosocial impairment. Six patients with
a chronic course and four patients with a non-chronic course of depression
had white matter hyperintensities (WMH) on MRI at baseline. Four patients
whose WMH increased in size over time developed a chronic unremitting cours
e of depression. No patients with non-chronic depression had large areas of
WMH at baseline or exhibited increased WMH size over time. Chronic depress
ion was associated with severity of cerebrovascular risk factors, apathy, a
nd poor quality, of life. Treatment and prevention of cerebrovascular disea
se may improve the outcome of late-life depression.