Evidence for and against the notion of a specific subtype of depressive illness in the elderly is reviewed. There is little to support a distinction based on clinical features, neurobiological markers, treatment response or prognosis, but subtle organic cerebral change may predispose to late-onset depression in a significant minority of cases.
Abas M.A., Sahakian B.J., Levy R. ( 1990) Neuropsychological deficits and CT scan changes in elderly depressives. Psychol Med20: 507-520
2.
Abrams R.C., Alexopoulos G.S., Young R.C., Shamoian C.A. (1987) Geriatric depression and DSM-IIIR personality disorder criteria. J Am Geriatr Soc35: 383-386
3.
Alexopoulos G.S. (1989) Late-life depression and neurological brain disease . Int J Geriatr Psychiatr4: 187-190
4.
Alexopoulos G.S., Lieberman K.W., Young R.C. (1984a) Platelet MAO activity and age at onset of depression in elderly depressed women. Am J Psychiatr141: 1276-1278
5.
Alexopoulos G.S., Young R.L., Kocsis J.H. (1984b) Dexamethasone suppression test in geriatric depression . Biol Psychiatr19: 1567-1571
6.
Alexopoulos G.S., Abrams R.C., Young R.C. (1987) Late-life depression and dementing disorders. Abstract. American College of Neuropsychopharmacology, Puerto Rico
7.
Alexopoulos G.S., Young R.C., Shindledecker R.D. (1992) Brain computed tomography findings in geriatric depression and primary degenerative dementia. Biol Psychiatr31: 591-599
8.
American Psychiatric Association (1987) Diagnostic and statistical manual, 3rd edn revised. APA, Washington , DC
9.
Austin M-P., Ross M., Murray C., O'Carroll R.E., Ebmeier K.P., Goodwin G.M. (1992) Cognitive function in major depression. J Affective Disord25: 21-30
10.
Avery D., Winokur G. (1976) Mortality in depressed patients treated with electroconvulsive therapy and antidepressants. Arch Gen Psychiatr33: 1029-1037
11.
Baldwin B. (1988) Late life depression—undertreated?Br Med J296: 519
12.
Baldwin R.C. (1991) Depressive illness. In Jacoby R, Oppenheimer K (eds), Psychiatry of later life. Oxford University Press, Oxford, pp. 676-719
13.
Baldwin R.C. (1992) The nature, frequency and relevance of depressive delusions. In Katona C, Levy R (eds), Delusions and hallucinations in old age. Gaskell, Royal College of Psychiatrists, London, pp. 97-114
14.
Baldwin R.C. (1993) Late life depression and structural brain changes: a review of recent magnetic resonance imaging research. Int J Geriatr Pyschiatr8: 115-123
15.
Baldwin R.C., Byrne E.J. (1989) Psychiatric aspects of Parkinson's disease. Br Med J299: 3-4
16.
Baldwin R.C., Jolley D.J. (1986) The prognosis of depression in old age. Br J Psychiatr149: 574-583
17.
Baldwin R.C., Benbow S.M., Marriott A., Tomenson B. (1993) Depression in old age: a reconsideration of cerebral disease in relation to outcome. Br J Psychiatr163: 82-90
18.
Benbow S.B. (1989) The role of electroconvulsive therapy in the treatment of depressive illness in old age. Br J Psychiatr155: 147-152
19.
Bench C.J., Friston K.J., Brown R.G., Scott L.C., Frackowiak R S J, Dolan R.J. (1992) The anatomy of depression—focal abnormalities of cerebral blood flow in major depression. Psychol Med22:607-615
20.
Blazer D., Williams C.D. (1980) Epidemiology of dysphoria and depression in an elderly sample. Am J Psychiatr137: 439-444
21.
Blazer D., George L., Landerman R. (1986) The phenomenology of late life depression. In Bebbington P E, Jacoby R (eds), Psychiatric disorders in the elderly. Mental Health Foundation, London, pp. 143-152
22.
Bowen D.M., Najlerahim A., Proctor A.W., Francis P.T., Murphy E. (1989) Circumscribed changes of the cerebral cortex in neuropsychiatric disorders of later life. Proc Natl Acad Sci USA86: 9504-9508
23.
Brodaty H., Peters K., Boyce P., Hickie I., Parker G., Mitchell P., Wilhelm K. (1991) Age and depression. J Affective Disord23: 137-149
24.
Caine E.D. (1981) Pseudodementia. Arch Gen Psychiatr38: 1359-1364
25.
Cawley R.H., Post F., Whitehead A. (1973) Barbiturate tolerance and psychosocial functioning in elderly depressed patients. Psychol Med8: 39-52
26.
Churchill C.M., Priolo C.V., Nemeroff C.B., Krishnan K R R, Breitner J C S (1991) Occult subcortical magnetic resonance findings in elderly depressives. Int J Geriatr Psychiatr6: 213-216
27.
Ciompi L. (1969) Follow-up studies on the evolution of former neurotic and depressive states in old age. J Geriatr Psychiatr3: 90-106
28.
Coffey C.E. (1987) Cerebral laterality and emotion: the neurology of depression. Comprehen Psychiatr28: 197-219
29.
Coffey C.E., Figiel G.S., Djang W.T., Weiner R.D. (1990) Subcortical hyperintensity on magnetic resonance imaging: a comparison of normal and depressed elderly subjects. Am J Psychiatr147: 187-189
30.
Coffey C.E., Weiner R.D., Djang W.T., Figiel G.S., Soady S A R, Patterson L.J., Holt P.D., Spritzer C.E., Wilkinson W.E. (1991) Brain anatomic effects of electroconvulsive therapy . Arch Gen Psychiatr48: 1013-1021
31.
Cole M., Hicking T. (1976) Frequency of minor organic signs in elderly depressives . Can Psychiatric Assoc J21: 7-12
32.
Conwell Y., Nelson J.C., Kim K.M., Mazure C.M. (1989) Depression in late life: age of onset as marker of subtype. J Affective Disord17: 189-195
33.
Copeland J R M, Dewey M.E., Wood N., Searle R., Davidson I.A., McWilliam C. (1987a) Range of mental illness among the elderly in the community: prevalence in Liverpool using the GMS-AGECAT package. Br J Psychiatr150: 815-823
34.
Copeland J R M, Gurland B.J., Dewey M.E., Davidson R.A., McWilliam C. (1987b) The distribution of dementia, depression and neurosis in elderly men and women in an urban community: assessed using the GMS-AGECAT package. Int J Geriatr Psychiatr2: 177-184
35.
Copeland J R M, Davidson I.A., Dewey M.E., Gilmore C., Larkin B.A., McWilliam C., Saunders P.A., Scott A., Sharma V., Sullivan C. (1992) Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence and three-year outcome in Liverpool . Br J Psychiatr161: 230-239
36.
David A., Blamire A., Breiter H. (1994) Functional magnetic resonance imaging. Br J Psychiatr164: 2-7
37.
Dolan R.J., Calloway S.P., Thacker P.F., Mann A.H. (1986) The cerebral cortical appearance in depressed subjects . Psychol Med16: 775-779
38.
Dolan R.J., Bench C.J., Brown R.G., Scott L.C., Friston K.J., Frackowiak R S J (1992) Regional cerebral blood flow abnormalities in depressed patients with cognitive impairment. J Neurol Neurosurg Psychiatr55: 768-773
Fleminger S. (1991) Depressive motor retardation. Int J Geriatr Psychiatr6: 459-468
42.
Forstl H., Burns A., Luthbert P., Cairns N., Lantos P., Levy R. ( 1992) Clinical and neuropathological correlates of depression in Alzheimer's disease. Psychol Med22: 877-884
43.
Gurland B.J. (1976) The comparative frequency of depression in various adult age groups. J Gerontol31: 283-292
44.
Heeren T.H., Van Hemert A.M., Lagaay A.M., Rooymans G.M. (1992) The general population prevalence of non-organic psychiatric disorders in subjects aged 85 years and over. Psychol Med22: 733-738
45.
Hendrickson E., Levy R., Post F. ( 1979) Averaged evoked responses in relation to cognitive and affective state of elderly psychiatric patients. Br J Psychiatr134: 494-501
46.
Henderson A.S., Jorm A.F., MacKinnon A., Christensen H., Scott L.R., Korten A.E., Doyle C. (1993) The prevalence of depressive disorders and the distribution of depressive symptoms in later-life: a survey using Draft ICD-10 and DSM-IIIR. Psychol Med23: 719-729
47.
Hopkinson G. (1964) A genetic study of affective illness in patients over 50. Br J Psychiatr110: 244-254
48.
Howard R.J., Beats B., Forstl H., Graves P., Bingham, J., Levy R. ( 1993) White matter changes in late onset depression: a magnetic resonance imaging study. Int J Geriatr Psychiatr8: 183-185
49.
Jacoby R.J., Levy R. ( 1980) Computed tomography in the elderly: affective disorder . Br J Psychiatr136: 270-275
50.
Jacoby R.J., Levy R., Bird J.M. (1981) Computed tomography and the outcome of affective disorder: a follow-up of elderly patients. Br J Psychiatr139: 288-292
51.
Junque C., Pujol J., Vendrell P., Bruna O., Jodar M., Ribas J.C., Vinas J., Capdevilla A., Marti-Vilalta J.L. (1990) Leuko-araiosis on magnetic resonance imaging and speed of mental processing. Arch Neurol47: 151-156
52.
Karlsson I. (1990) 5-HT reuptake inhibition in the elderly. In Yamashita I, Toru M, Coppen A J, (eds), Proceedings of the 17th CINP congress. Raven Press, New York, pp. 99-100
53.
Katona C. (1993) Optimising treatment for the elderly depressive: new antidepressants in the elderly. J Psychopharmacol7 (Suppl.): 131-134
54.
Kay D W K (1955) Outcome and cause of death in mental disorders of old age: a long-term follow-up of functional and organic psychoses. Acta Psychiatr Scand38: 249-275
55.
Kay D W K (1962) Outcome and causes of death in mental disorders of old age: a long-term follow-up of functional and organic psychoses. Acta Psychiatr Scand38: 249-276
56.
Kay D W K, Bergmann K. (1966) Physical disability and mental health in old age: a follow-up of a random sample of elderly people seen at home. J Psychiatr Res10: 3-12
57.
Kiloh L.G., Andrews G., Neilson M. (1988) The long-term outcome of depressive illness. Br J Psychiatr153: 752-757
58.
Kivela S-L., Pahkala K. (1989) Delusional depression in the elderly: a community study. Z Gerontol22: 236-241
59.
Kivela S-L.Pahkala K., Laippala P. (1988) Prevalence of depression in an elderly Finnish population. Acta Psychiatr Scand78: 401-413
60.
Kobari M., Meyer J.S., Ichijo M. (1990) Leukoaraiosis, cerebral atrophy and cerebral perfusion in normal aging. Arch Neurol47: 161-165
61.
Kral V.A., Emery O.B. (1989) Long-term follow-up of depressive pseudodementia of the aged. Can J Psychiatr34: 445-446
62.
Krishnan K R R, Doraiswamy P.M., Figiel G.S., Husain M.M., Shah S.A., Na C., Boyko O.B., McDonald W.M., Nemeroff C.B., Ellinwood E.H. (1992) Hippocampal abnormalities in depression. J Neuro-psychiatr Clin Neurosci3: 387-391
63.
Leake A., Ferrier I.C. (1993) Alterations in neuropeptides in aging and disease . Drugs Aging3: 408-427
64.
Lee A.S., Murray R.M. (1988) The long-term outcome of Maudsley depressives. Br J Psychiatr153: 741-751
65.
Lindesay J., Briggs K., Murphy E. (1989) The Guy's Age Concern survey of cognitive impairment, depression and anxiety in an urban elderly community. Br J Psychiatr155: 317-329
66.
Livingston G., Hawkins A., Graham N., Blizard B., Mann A. ( 1990) The Gospel Oak Study: prevalence rates of dementia, depression and activity limitation among elderly residents in inner London. Psychol Med20: 137-146
67.
McAllister T.W. (1981) Cognitive functioning in the affective disorders . Comprehen Psychiatr22: 572-586
68.
Martin A.J., Friston K.J., Colebatch J.G., Frackowiak R S J (1991) Decreases in cerebral blood flow with normal aging . J Cerebral Blood Flow Metab11: 684-689
69.
Mayeux R., Stern G., Williams J B W, Cote L., Frantz A., Dyrenfurth I. (1986) Clinical and biochemical features of depression in Parkinson's disease. Am J Psychiatr143: 756-759
70.
Meats P., Timol M., Jolley D. (1991) Prognosis of depression in the elderly. Br J Psychiatr159: 659-663
71.
Mendelwicz J. (1976) The age factor in depressive illness: some genetic considerations. J Gerontol31: 300-303
72.
Meyers B.S., Greenberg R., Alexopoulos G. (1988) Age of onset and studies of late-life depression . Int J Geriatr Psychiatr3: 219-228
73.
Morris P., Rapoport S.I. (1990) Neuroimaging and affective disorder in late-life: a review. Can J Psychiatr35: 347-354
74.
Murphy E. (1982) Social origins of depression in old age. Br J Psychiatr141: 135-142
75.
Murphy E. (1983) The prognosis of depression in old age. Br J Psychiatr142: 111-119
76.
Murphy E., Brown G.W. (1980) Life events, psychiatric disturbance and physical illness. Br J Psychiatr136: 326-338
77.
Murphy E., Smith R., Lindesay J., Slattery J. (1988) Increased mortality rates in late-life depression . Br J Psychiatr152: 347-353
78.
Musetti L., Perugi G., Soriani A., Rossi V.M., Cassano G.B., Akiskal H.P. (1989) Depression before and after age 65: a re-examination . Br J Psychiatr155: 330-336
79.
Nelson J.C., Conwell Y., Kim K. ( 1989) Age at onset in late-life delusional depression. Am J Psychiatr146: 785-786
80.
Pearlson G.D., Rabins P.V., Kim W.S., Speedie L.J., Moberg P.L., Burns A., Bascom M.J. (1989) Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia ('pseudodementia') . Psychol Med19: 573-584
81.
Philpot M.P. (1986) Biological factors in depression in the elderly . In Murphy E (ed.), Affective disorders in the elderly. Churchill Livingstone, Edinburgh, pp. 53-77
82.
Philpot M.P., Banerjee S., Needham-Bennett H., Campos Costa D., Ell P.J. (1993) 99mTc-HMPAO single photon emission tomography in late life depression: a pilot study of regional cerebral blood flow at rest and during a verbal fluency task. J Affective Disord28: 233-240
83.
Pichot P., Pull C. ( 1981) Is there an involutional melancholia?Comprehen Psychiatr22: 2-10
84.
Post F. ( 1962) The significance of affective symptoms in old age. Maudsley Monographs 10, Oxford University Press, London
85.
Post F. ( 1968) The factor of ageing in affective disorder. In Coppen A, Walk A (eds), Recent developments in affective disorders. Royal Medico-Psychological Association Publication No. 2, Headley Bros, Kent, pp. 105-116
86.
Post F. ( 1972) The management and nature of depressive illnesses in late life: a follow-through study. Br J Psychiatr121: 393-404
87.
Rabins P.V., Harvis K., Koven S. (1985) High fatality rates of late-life depression associated with cardiovascular disease. J Affective Disord9: 165-167
88.
Reding M., Haycox J., Blass J. (1985) Depression in patients referred to a dementia clinic . Arch Neurol42: 894-896
89.
Reynolds C.F., Hoch C.C., Kupfer D.K., Buysse D.J., Houck P.R., Stack J.A., Campbell D.W. (1988a) Bedside differentiation of depressive pseudodementia from dementia. Am J Psychiatr145: 1099-1103
90.
Reynolds C.F., Kupfer D.J., Houck P.R., Hoch C.C., Stack J.A., Berman S.R., Zimmer B. (1988b) Reliable discrimination of elderly depressed and demented patients by electroencephalographic sleep data. Arch Gen Psychiatr45: 258-264
91.
Reynolds C.F., Buysse D.J., Kupfer D.J., Hoch C.C., Houck P.R., Matzzie J., George C.J. (1990) Rapid eye movement sleep deprivation as a probe in elderly subjects. Arch Gen Psychiatr47: 1128-1136
92.
Robinson R.G., Kubos K.L., Starr L.B., Rao K., Price T.R. (1984) Mood disorders in stroke patients: importance of location of lesion. Brain107: 81-93
93.
Rogers D., Lees A.J., Smith E., Trimble M., Stern G.M. (1987) Bradyphrenia in Parkinson's disease and psychomotor retardation in depressive illness. Brain110: 761-776
94.
Roth M. ( 1955) The natural history of mental disorder in old age. J Ment Sci101: 281-301
95.
Sackheim H.A., Prohovnik I., Moeller J.R., Brown R.P., Apter S., Prudic J., Devanand D.P., Mukherjee S. (1990) Regional cerebral blood flow in mood disorders 1. Comparison of major depressives and normal controls at restArch Gen Psychiatr47: 60-70
96.
Sahakian B.J. (1991) Depressive pseudodementia in the elderly. Int J Geriatr Psychiatr6: 453-458
97.
Sapolsky R., Krey L., McEwen B. (1986) The neuroendocrinology of stress and aging: the glucocorticoid cascade hypothesis. Endocrine Rev7: 284-301
98.
Schmidt R., Fazekas F., Offenbacher H., Dusek T., Zach E., Reinhart B., Grieshofer P., Freidl W., Eber B., Schumacher M., Koch M., Lechner H. (1993) Neuropsychological correlates of MRI white matter hyperintensities: a study of 150 normal volunteers. Neurology43: 2490-2494
99.
Schneider L.S. (1992) Psychobiologic features of geriatric affective disorders. Clin Geriatr Med8: 253-265
100.
Snowdon J. (1990) The prevalence of depression in old age. Int J Geriatr Psychiatr5: 141-144
101.
Spar J.E., Gerner R. (1982) Does the dexamethasone suppression test distinguish dementia from depression?Am J Psychiatr139: 238-240
102.
Steingart A., Herrman N. (1991) Major depressive disorder in the elderly: the relationship between age of onset and cognitive impairment. Int J Geriatr Psychiatr6: 593-598
103.
Upadhyaya A.K., Abou-Saleh M.T., Wilson K., Grime S.J., Critchley M. (1990) A study of depression in old age using single photon emission tomographyBr J Psychiatr157 (Suppl. 9): 76-81
104.
Veith R.C., Raskind M.A. (1988) The neurobiology of aging: does it predispose to depression?Neurobiol Aging9: 101-117
105.
Weingartner H., Cohen R.M., Murphy D.L., Martello J., Gerdt C. (1981) Cognitive processes in depression. Arch Gen Psychiatr38: 42-47
106.
Weingartner H., Cohen R.M., Bunney W.E., Ebert M.H., Kaye W. ( 1982) Memory-learning impairments in progressive dementia and depression. Am J Psychiatr139: 135-136
107.
Weissman M.M., Leaf P.J., Tischler C.L., Blazer D.G., Karno M., Livingston Bruce M., Florio L.P. (1988) Affective disorders in five United State communities . Psychol Med18: 141-153
108.
Willmuth L.R. (1979) Medical views on depression in the elderly: historical notes. J Am Geriatr Soc27: 495-499
109.
World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines, WHO, Geneva
110.
Yesavage J.A., Brink T.L. (1983) Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res17: 37-49
111.
Young R.C., Nambudiri D., Alexopoulos G.S., Roe R. ( 1988) Ventricular-brain ratio and response to nortriptyline in geriatric depression (abstract). Annual Meeting, Society of Biological Psychiatry
112.
Zubenko G.S., Moossy J. (1988) Major depression in primary dementia: clinical and neuropathological correlates. Arch Neurol45: 1182-1186
113.
Zubenko G.S., Sullivan P., Nelson J.P., Belle S.H., Huff J., Wolf G.L. (1990) Brain imaging abnormalities in mental disorders of late life. Arch Neurol47: 1107-1111
