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Depression in late life, cognitive decline and white matter pathology in two clinico-pathologically investigated cases

Lookup NU author(s): Dr Adrian Lloyd, Dr Janet Grace, Dr Evelyn Jaros, Emeritus Professor Robert Perry, Dr Andrew Fairbairn, Dr Alan Swann, Professor John O'Brien, Professor Ian McKeith

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Abstract

Case reports We report two cases of late life depression who became progressively more resistant to treatment, developed cognitive impairment, and began to exhibit neurological abnormalities and evidence of vascular disease. A discussion of the clinical features of the cases is accompanied by reports of neuropathology and neuroimaging findings. Extensive white matter lesions were present on computed tomography in both patients, and based ganglia infarcts were seen in one. Neuropathology revealed evidence of cerebral atrophy, demyelination and white matter lesions in addition to cerebrovascular and generalised vascular disease. Neither patient exhibited Alzheimer pathology outwith the norm for their age. We believe this to be the first report of neuropathological findings in depression with white matter changes. Literature review The pathological basis of white matter lesions and their relationship to depression, its age of onset and clinical features is addressed in relation to the cases described. Pathological investigation of white matter lesions has not previously been carried out in depression and hypotheses regarding their nature in this illness are based on extrapolation from research in a variety of other disorders. The association of depression with vascular risk factors is considered, as is the relationship between depression and cognitive deficits. There is a need for further investigation in this area. Copyright (C) 2001 John Wiley & Sons, Ltd.

Publication metadata

Author(s): Lloyd AJ, Grace JB, Jaros E, Perry RH, Fairbairn AF, Swann AG, O'Brien JT, McKeith IG

Publication type: Article

Publication status: Published

Journal: International Journal of Geriatric Psychiatry

Year: 2001

Volume: 16

Issue: 3

Pages: 281-287

ISSN (print): 0885-6230

ISSN (electronic): 1099-1166

Publisher: John Wiley & Sons

URL: http://dx.doi.org/10.1002/gps.328

DOI: 10.1002/gps.328

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