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Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia (‘pseudodementia’)*

Published online by Cambridge University Press:  09 July 2009

Godfrey D. Pearlson ,
Peter V. Rabins ,
Won S. Kim ,
Lynn J. Speedie ,
Paul J. Moberg ,
Alistair Burns  and
Mary J. Bascom
Godfrey D. Pearlson
Affiliation:
Department of Psychiatry and Behavioral Sciences, Division of Neuroradiology, Division of Medical Psychology and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
Peter V. Rabins*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Division of Neuroradiology, Division of Medical Psychology and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
Won S. Kim
Affiliation:
Department of Psychiatry and Behavioral Sciences, Division of Neuroradiology, Division of Medical Psychology and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
Lynn J. Speedie
Affiliation:
Department of Psychiatry and Behavioral Sciences, Division of Neuroradiology, Division of Medical Psychology and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
Paul J. Moberg
Affiliation:
Department of Psychiatry and Behavioral Sciences, Division of Neuroradiology, Division of Medical Psychology and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
Alistair Burns
Affiliation:
Department of Psychiatry and Behavioral Sciences, Division of Neuroradiology, Division of Medical Psychology and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
Mary J. Bascom
Affiliation:
Department of Psychiatry and Behavioral Sciences, Division of Neuroradiology, Division of Medical Psychology and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
*
1Address for correspondence: Dr Peter V. Rabins, Meyer 279, Department of psychiatry, Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, Maryland 21205, USA
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Synopsis

Twenty-six elderly (> 60 yrs) patients with DSM-III major depression were compared to 13 patients with NINCDS/ADRDA probable Alzheimer's disease (AD), and to 31 screened normal controls. Subjects were matched on age and sex. Fifteen of the 26 depressed patients were cognitively impaired on the Mini-Mental State Examination (MMSE) upon admission, but after treatment returned to the normal range. These 15 patients were defined as having the dementia syndrome of depression (DOD). The remaining 11 depressed patients were termed depressed, cognitively normal (DCN). All subjects received standardized cranial CT scans for assessment of ventricular brain ratio (VBR) and CT attenuation numbers. Subjects also received neuropsychological evaluation.

CT values for the 26 depressed patients lay between those of AD patients and normal controls. CT values for the DOD subgroup clustered near those of AD patients. Patterns of cognitive deficits and correlations of CT attenuation values with cognitive measures were also similar in AD and DOD. Most patients were reassessed at a mean of two years after initial testing; of the 11 of the 15 DOD re-examined, only one had undergone cognitive decline. By contrast, all AD patients retested had declined significantly. Episodes of DOD and DCN tended to ‘breed true’. This study suggests that while patients with DOD may have underlying structural brain abnormalities, obvious short-term progression to AD does not commonly occur.

Type
Original Articles
Information
Psychological Medicine , Volume 19 , Issue 3 , August 1989 , pp. 573 - 584
Copyright
Copyright © Cambridge University Press 1989

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Footnotes

*

Previously presented at the American Psychiatric Association 139th Annual Meeting, Washington, DC, 16 May 1986.

References

Albert, M., Naeser, M. A., Levine, H. L. & Garvey, A. J. (1984). CT density numbers in patients with senile dementia of the Alzheimer type. Archives of Neurology 41, 1264–1269.CrossRefGoogle Scholar
American Psychiatric Association (1980). Diagnostic and Statistical Manual of Mental Disorders, Third Edition. APA: Washington, DC.Google Scholar
Berrios, G. (1985). Depressive pseudodementia or melancholic dementia: a 19th-century view. Journal of Neurology, Neurosurgery and Psychiatry 48, 393–400.CrossRefGoogle ScholarPubMed
Bird, J. M. (1982). Computerized tomography, atrophy and dementia: a review. Progress in Neurobiology 19, 91–115.Google Scholar
Bird, J. M., Levy, R. & Jacoby, R. J. (1986). Computed tomography in the elderly: changes over time in a normal population. British Journal of Psychiatry 148, 80–85.CrossRefGoogle Scholar
Bondareff, W., Baldy, R. & Levy, R. (1981). Quantitative computed tomography in senile dementia. Archives of General Psychiatry 38, 1365–1368.Google Scholar
Brinkman, S. D., Sarwar, H., Levin, H. S. & Morris, H. H. (1983). Quantitative indexes of computed tomography in dementia and normal aging. Neuroradiology 138, 89–92.Google Scholar
Brody, H. & Vijayashankar, N. (1977). Anatomical changes in the nervous system. In Handbook of the Biology of Aging (ed. Finch, C. E. and Hayflick, L.), pp. 241–261. Van Nostrand: New York.Google Scholar
Bulbena, A. & Berrios, G. E. (1986). Pseudodementia: facts and figures. British Journal of Psychiatry 140, 87–94.Google Scholar
Burton, R. (1983). The Anatomy of Melancholy, pp. 139–141. Reprinted Vintage Books, a division of Random House: New York.Google Scholar
Caine, E. D. (1981). Pseudodementia. Archives of General Psychiatry 38, 1359–1363.Google Scholar
Creasey, H. & Rapoport, S. I. (1985). The aging human brain. Annals of Neurology 17, 2–10.Google Scholar
Cronholm, B. C. & Ottosson, J. O. (1961). Memory function and endogenous depression before and after ECT. Archives of General Psychiatry 5, 193–199.CrossRefGoogle Scholar
Cutler, N. R., Duara, R., Creasey, H., Grady, C. L., Haxby, J. V., Schapiro, M. B. & Rapoport, S. I. (1984). Brain imaging: aging and dementia. Annals of Internal Medicine 101, 355–369.CrossRefGoogle ScholarPubMed
Damasio, H., Eslinger, P., Damasio, A. R., Rizzo, M. & Huang, H. K. (1983). Quantitative computed tomographic analysis in the diagnosis of dementia. Archives of Neurology 40, 715–719.CrossRefGoogle ScholarPubMed
deLeon, M. J. & George, A. E. (1983). Computed tomography in aging and senile dementia of the Alzheimer type. In The Dementias (ed. Mayeux, R. and Rosen, W. G.), pp. 103–122. Raven Press: New York.Google Scholar
deLeon, M. J., Ferris, S. H., Blau, I., George, A. E., Reisturg, B., Kricheff, I. & Gershon, S. (1979). Correlations between computerized tomographic changes and behavioral deficits in senile dementia. The Lancet ii, 859.CrossRefGoogle Scholar
DiChiro, G., Brooks, R. A., Dubai, L. & Chew, E. (1978). The apical artifact: elevated attenuation values toward the apex of the skull. Journal of Computer Assisted Tomography 2, 65–70.Google Scholar
Dolan, R. J., Calloway, S. P. & Mann, A. H. (1985). Cerebral ventricular size in depressed subjects. Psychological Medicine 15, 873–878.Google Scholar
Folstein, M. F. & McHugh, P. R. (1978). Dementia syndrome of depression. In Alzheimer's Disease: Senile Dementia and Related Disorders (ed. Katzman, R.Terry, R. D. and Bick, K. L.), pp. 87–96. Raven Press: New York.Google Scholar
Folstein, M. F., Folstein, S. E. & McHugh, P. R. (1975). Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198.CrossRefGoogle Scholar
Gado, M., Patel, J., Hughs, C. P., Danziger, W. & Berg, T. (1983). Brain atrophy in dementia judged by CT scan ranking. American Journal of Neuroradiology 4, 499–500.Google Scholar
Gaupp, R. (1905). Die Depresionszustaende des hoeherne Rebensalters. Muenchener Medizinische Wochenschrift 52, 1531.Google Scholar
George, A. E., deLeon, M. J., Rosenbloom, S., Ferris, S., Gentes, C., Emmerich, M. & Kricheff, I. (1981). Parenchymal CT correlates of senile dementia (Alzheimer disease): loss of gray-white matter discriminability. American Journal of Neuroradiology 2, 205–213.Google Scholar
Hachinski, V. C., Lassen, N. A. & Marshall, J. (1974). Multi-infarct dementia. The Lancet i, 207.CrossRefGoogle Scholar
Hamilton, M. A. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.Google Scholar
Haxby, J. V., Duara, R., Grady, C. L., Cutler, N. R. & Rapoport, S. (1985). Relations between neuropsychological and cerebral metabolic asymmetries in early Alzheimer's disease. Journal of Cerebral Bloodflow and Metabolism 5, 193–200.Google Scholar
Jacoby, R. J. & Levy, R. (1980 a). CT scanning and the investigation of dementia: a review. Journal of the Royal Society of Medicine 73, 366–369.Google Scholar
Jacoby, R. J. & Levy, R. (1980 b). Computed tomography in the elderly. 2. Senile dementia: diagnosis and functional impairment. British Journal of Psychiatry 136, 256–269.Google Scholar
Jacoby, R. J. & Levy, R. (1980 c). Computed tomography in the elderly. 3. Affective disorder. British Journal of Psychiatry 136, 270–275.Google Scholar
Jacoby, R. J., Levy, R. & Bird, J. M. (1981). Computed tomography and the outcome of affective disorder: a follow-up study of elderly patients. British Journal of Psychiatry 139, 282–292.Google Scholar
Jacoby, R. J., Levy, R. & Dawson, J. M. (1980). Computed tomography in the elderly. 1. The normal population. British Journal of Psychiatry 136, 249–255.Google Scholar
Jacoby, R. J., Dolan, R. J., Levy, R. & Baldy, R. (1983). Quantitative computed tomography in elderly depressed patients. British Journal of Psychiatry 143, 124–127.CrossRefGoogle ScholarPubMed
Janowsky, D. S. (1982). Pseudodementia in the elderly: differential diagnosis and treatment. Journal of Clinical Psychiatry 49, 19–25.Google Scholar
Kaplan, E. F., Goodglass, H. & Weintraub, S. (1978). The Boston Naming Test. E. Kaplan & H. Goodglass: Boston.Google Scholar
Kraepelin, E. (Reprinted 1976). Manic-Depressive Insanity and Paranoia, p. 375. Translated by Barclay, R. M.. E. & S. Livingston: Edinburgh, Arno Press: New York.Google Scholar
Kral, V. A. (1983). The relationship between senile dementia (Alzheimer Type) and depression. Canadian Journal of Psychiatry 28, 304–306.CrossRefGoogle ScholarPubMed
Laffey, P. A., Peyster, R. G., Nathan, R., Haskin, M. E. & McGinley, J. A. (1984). Computed tomography and aging: results in a normal elderly population. Neuroradiology 26, 273–278.Google Scholar
Lange, J. (1928). Die endogenen und reaktiven Gemuetserkrankungen. In Handbuch der Geisteskrankheiten, vol. 2 (ed. Bumke, O.), p. 4.Google Scholar
LeMay, M. (1983). Radiologic changes of the aging brain and skull. American Journal of Neuroradiology 5, 269–275.Google Scholar
McAllister, T. W. (1983). Overview: pseudodementia. American Journal of Psychiatry 140, 528–533.Google Scholar
Mahendra, B. (1985). Depression and dementia: the multi-faceted relationship. Psychological Medicine 15, 227–236.Google Scholar
Mathew, R. J., Meyer, J. S., Francis, D. J., Semchuk, K. M., Mortel, K. & Cleghorn, J. L. (1980). Cerebral bloodflow in depression. American Journal of Psychiatry 137, 1449–1450.Google Scholar
Naeser, M. A., Gebhardt, C. & Levin, H. L. (1980). Decreased computerized tomography numbers in patients with presenile dementia. Archives of Neurology 37, 401–409.Google Scholar
Naguib, M. & Levy, R. (1982 a). Prediction of outcome in senile dementia: a computed tomography study. British Journal of Psychiatry 140, 263–267.CrossRefGoogle ScholarPubMed
Naguib, M. & Levy, R. (1982 b). CT scanning in senile dementia: a follow-up of survivors. British Journal of Psychiatry 141, 618–620.Google Scholar
Nasrallah, H. A., McCalley Whitters, M. & Jacoby, C. G. (1982). Cerebral ventricular enlargement in young manic males. Journal of Affective Disorders 4, 15–19.Google Scholar
Nott, P. N. & Fleminger, J. J. (1975). Presenile dementia: the difficulties of early diagnosis. Acta Psychiatrica Scandinavica 51, 210–217.Google Scholar
Pearlson, G. D. & Veroff, A. E. (1980). Computerized tomographic scan changes in manic-depressive illness. The Lancet ii, 470.Google Scholar
Pearlson, G. D., Garbacz, D. J., Tompkins, R. H., Ahn, H. S., Gutterman, D. F. & DePaulo, J. R. (1984). Lateral ventricular enlargement in affective disorder: clinical correlates. American Journal of Psychiatry 141, 253–256.Google Scholar
Pearlson, G. D., Kim, W. S., Kubos, K. L., Moberg, P. R., Jayaram, G., Goldfinger, A. D., Chase, G. A. & Tune, L. E. (1989). VBR, brain area and CT density in 50 schizophrenics. Archives of General Psychiatry 46, (in the press).Google Scholar
Phelps, M. E., Maziotta, J. C. & Gerner, R. (1983). Human cerebral glucose metabolism in affective disorders: drug-free states and pharmacologie effects. Journal of Cerebral Bloodflow and Metabolism 3, (Suppl), S7–S8.Google Scholar
Post, F. (1966). Somatic and psychic factors in the treatment of elderly psychiatric patients. Journal of Psychosomatic Research 10, 13–19.Google Scholar
Post, F. (1968). The factor of ageing in affective illness. In Recent Developments in Affective Disorders, (ed. Cooper, A. and Walk, A.), pp. 105–116. Headley Brothers: Ashford, Kent, British Journal of Psychiatry, Special Publication 2.Google Scholar
Post, F. (1972). The management and nature of depressive illnesses in late life: a follow-through study. British Journal of Psychiatry 121, 393–404.CrossRefGoogle ScholarPubMed
Post, F. (1975). Diagnosis of depression in geriatric patients. In Depression: Behavioral, Biochemical, Diagnostic and Treatment Concepts (ed. Gallant, D. M. and Simpson, G. M.), pp. 207–231. Spectrum: New York.Google Scholar
Rabins, P. V. (1981). The prevalence of reversible dementia in a psychiatric hospital. Hospital and Community Psychiatry 32, 490–492.Google ScholarPubMed
Rabins, P. V. (1983). Reversible dementia and the misdiagnosis of dementia: a review. Hospital and Community Psychiatry 34, 830–835.Google Scholar
Rabins, P. V., Merchant, A. & Nestadt, G. (1984). Criteria for diagnosing reversible dementia caused by depression: validation by 2-year follow-up. British Journal of Psychiatry 144, 488–492.Google Scholar
Reding, M., Haycox, J. & Blass, J. (1985). Depression in patients referred to a dementia clinic. A three-year prospective study. Archives of Neurology 42, 894–896.CrossRefGoogle Scholar
Reifler, B. V., Larson, E. & Handley, R. (1982). Coexistence of cognitive impairment and depression in geriatric outpatients. American Journal of Psychiatry 139, 623–626.Google ScholarPubMed
Rey, A. (1964). Lexamen Clinique en Psychologic Presses Universitaires de France: Paris.Google Scholar
Robinson, R. G., Kubos, K., Starr, L. B., Rao, K. & Price, T. B. (1984). Mood disorder in stroke patients. Brain 107, 81–93.Google Scholar
Ron, M. A., Toone, B. K., Garralda, M. E. & Lishman, W. A. (1979). Diagnostic accuracy in presenile dementia. British Journal of Psychiatry 134, 161–168.Google Scholar
Roth, M. (1955). The natural history of mental disorder in old age. Journal of Mental Science 101, 281–301.CrossRefGoogle ScholarPubMed
Schnitzlein, H. N. & Murtagh, F. R. (1985). Imaging Anatomy of the Head and Spine: A Photographic Color Atlas of MRI, CT Gross and Microscopic-Anatomy in Axial, Coronal and Saggital Planes. Urban & Schwarzenberg: Baltimore.Google Scholar
Sternberg, D. & Jarvik, M. E. (1976). Memory functions in depression. Archives of General Psychiatry 33, 219–224.Google Scholar
Synek, V. M. & Reuben, J. R. (1976). The ventricle-brain ratio using planimetric measurements of EMI scans. British Journal of Radiology 49, 223–233.CrossRefGoogle Scholar
Takeda, S. & Matsuzawa, T. (1985). Age-related changes in volumes of the ventricles, cisternae, and sulci: a quantitative study using computed tomography. Journal of the American Geriatric Society 33, 264–268.Google Scholar
Targum, S. D., Rosen, L. N., DeLisi, L. E., Weinberger, D. R. & Citrin, C. M. (1983). Cerebral ventricular size in major depressive disorder: association with delusional symptoms. Biological Psychiatry 118, 329–337.Google Scholar
Weingartner, H., Cohen, R. M., Murphy, D. L., Martello, J. & Gerdt, C. (1981). Cognitive processes in depression. Archives of General Psychiatry 38, 42–47.Google Scholar
Wells, C. E. (1979). Pseudodementia. American Journal of Psychiatry 136, 895–900.Google Scholar
Zatz, L. M., Jernigan, T. L. & Ahumada, A. J. (1982 a). Changes on cranial computed tomography with aging: intracranial fluid volume. American Journal of Neuroradiology 3, 1–11.Google ScholarPubMed
Zatz, L. M., Jernigan, T. L. & Ahumada, A. J. (1982 b). White matter changes in cerebral computed tomography related to aging. Journal of Computer Assisted Tomography 6, 19–23.CrossRefGoogle ScholarPubMed