Am J Psychiatry 1991; 148:1336-1340
Copyright © 1991 by American Psychiatric Association
Cognitive outcome following tricyclic and electroconvulsive treatment of major depression in the elderly
A Stoudemire, CD Hill, R Morris, D Martino-Saltzman, H Markwalter and B Lewison
Medical-Psychiatric Unit, Emory University Hospital, Atlanta, GA.
OBJECTIVE: This study sought to ascertain the affective and cognitive
outcome after tricyclic and electroconvulsive treatment of elderly
medical-psychiatric patients meeting diagnostic criteria for major
depression, some of whom had normal cognitive functioning and some of whom
were cognitively impaired before treatment. METHOD: Patients who met
criteria for major depression on the basis of a structured diagnostic
interview and who scored 17 or more on the Hamilton Rating Scale for
Depression were evaluated with the Mattis Dementia Rating Scale. The
patients were then treated in a nonrandom manner with either tricyclic
antidepressants or ECT (followed by tricyclic maintenance therapy). The
majority of the patients treated with ECT had not responded previously to
tricyclics. Follow-up psychometric testing was repeated in 6 months.
RESULTS: Among the patients with normal pretreatment cognitive functioning,
cognition was generally stable. Among the patients with pretreatment
cognitive impairment, a substantial number--including those receiving
ECT--demonstrated improvement in cognition. While the majority of patients
improved with respect to both their affective and cognitive states, certain
treatment- refractory subgroups were nevertheless identified. CONCLUSIONS:
The data suggest that cognitive dysfunction associated with depression may
improve after treatment in a substantial number of elderly patients,
including those receiving ECT. Relapse rates, however, may be relatively
high, and residual symptoms may persist, which emphasizes the need for
optimal initial and long-term antidepressant strategies for this
population.
