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1.
Biol Psychiatry ; 61(8): 1007-10, 2007 Apr 15.
Article in English | MEDLINE | ID: mdl-17123478

ABSTRACT

BACKGROUND: This study tested the hypothesis that microstructural white matter abnormalities in frontostriatal-limbic tracts are associated with poor response inhibition on the Stroop task in depressed elders. METHOD: Fifty-one elders with major depression participated in a 12-week escitalopram trial. Diffusion tensor imaging was used to determine fractional anisotropy (FA) in white matter regions. Executive function (response inhibition) was assessed with the Stroop task. Voxelwise correlational analysis was used to examine the relationship between Stroop performance and fractional anisotropy. RESULTS: Significant associations between FA and Stroop color word interference were evident in multiple frontostriatal-limbic regions, including white matter lateral to the anterior and posterior cingulate cortex and white matter in prefrontal, insular, and parahippocampal regions. CONCLUSIONS: These findings suggest that microstructural white matter abnormalities of frontostriatal-limbic networks are associated with executive dysfunction of late-life depression. This observation provides the rationale for examination of specific frontostriatal-limbic pathways in the pathophysiology of geriatric depression.


Subject(s)
Depression/physiopathology , Geriatric Assessment , Neuropsychological Tests , Aged , Aged, 80 and over , Anisotropy , Antidepressive Agents, Second-Generation/therapeutic use , Brain Mapping , Citalopram/therapeutic use , Depression/drug therapy , Depression/pathology , Diffusion Magnetic Resonance Imaging/methods , Female , Humans , Inhibition, Psychological , Male , Middle Aged , Neural Pathways/drug effects , Neural Pathways/pathology , Predictive Value of Tests , Problem Solving/physiology
2.
Biol Psychiatry ; 58(3): 204-10, 2005 Aug 01.
Article in English | MEDLINE | ID: mdl-16018984

ABSTRACT

BACKGROUND: Executive dysfunction is common in geriatric depression and persists after improvement of depressive symptoms. This study examined the relationship of executive impairment to the course of depressive symptoms among elderly patients with major depression. METHODS: A total of 112 nondemented elderly patients with major depression participated in an 8-week citalopram trial at a target daily dose of 40 mg. Executive functions were assessed with the initiation/perseveration subscale of the Dementia Rating Scale and the Stroop Color-Word test. Medical burden was rated with the Cumulative Illness Rating Scale. RESULTS: Both abnormal initiation/perseveration and abnormal Stroop Color-Word scores were associated with an unfavorable response of geriatric depression to citalopram. In particular, initiation/perseveration scores below the median (< or =35) and Stroop scores at the lowest quartile (< or =22) predicted limited change in depressive symptoms. Impairment in other Dementia Rating Scale cognitive domains did not significantly influence the outcome of depression. CONCLUSIONS: Executive dysfunction increases the risk for poor response of geriatric depression to citalopram. Because executive functions require frontostriatal-limbic integrity, this observation provides the rationale for investigation of the role of specific frontostriatal-limbic pathways in perpetuating geriatric depression. Depressed elderly patients with executive dysfunction require vigilant clinical attention because they might be at risk to fail treatment with a selective serotonin reuptake inhibiting antidepressant.


Subject(s)
Depression/complications , Geriatric Assessment , Learning Disabilities/etiology , Problem Solving/physiology , Aged , Aged, 80 and over , Antidepressive Agents/therapeutic use , Citalopram/therapeutic use , Demography , Female , Humans , Learning Disabilities/drug therapy , Male , Multivariate Analysis , Neuropsychological Tests , Predictive Value of Tests , Problem Solving/drug effects , Psychiatric Status Rating Scales , Time Factors
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