The prognostic significance of abnormalities seen on magnetic resonance imaging in late life depression: Clinical outcome, mortality and progression to dementia at three years

Objective. To study the course of depressive symptoms over 3 years, rate of dementia and mortality in relation to baseline neuroradiological abnormali ties. Design. Retrospective casenote analysis of 38 patients (of 44) who had a Ma gnetic Resonance Imaging (MRI) scan 3 years earlier. Twenty-two patients al so received a detailed interview. Results. Overall outcome was good for around two-thirds of the sample. Poor er clinical course was associated with lesions in pens and more than five V irchow Robins spaces in the corona radiata. Pontine raphe lesions and confl uent periventricular lesions were associated with later dementia and with r educed survival from cardiovascular death. Males had more recurrences and a reduced survival. Conclusions. MRI lesions influence outcome. mortality and the onset of deme ntia. However, because they are quite common in elderly depressed patients they have limited utility on their own as predictors of outcome. The associ ation of periventricular lesions with dementia is a new finding, and sugges ts that the site and type of lesions may be as important than the quality o f them. Copyright (C) 2000 John Wiley & Sons, Ltd.