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The differentiation of depression from dementia by temporal lobe magnetic resonance imaging

Published online by Cambridge University Press:  09 July 2009

J. T. O'Brien ,
P. Desmond ,
D. Ames ,
I. Schweitzer ,
V. Tuckwell  and
B. Tress
J. T. O'Brien
Affiliation:
Departments of Psychiatry and Radiology, University of Melbourne, Victoria, Australia
P. Desmond
Affiliation:
Departments of Psychiatry and Radiology, University of Melbourne, Victoria, Australia
D. Ames*
Affiliation:
Departments of Psychiatry and Radiology, University of Melbourne, Victoria, Australia
I. Schweitzer
Affiliation:
Departments of Psychiatry and Radiology, University of Melbourne, Victoria, Australia
V. Tuckwell
Affiliation:
Departments of Psychiatry and Radiology, University of Melbourne, Victoria, Australia
B. Tress
Affiliation:
Departments of Psychiatry and Radiology, University of Melbourne, Victoria, Australia
*
1Address for correspondence: Dr David Ames, Department of Psychiatry, Royal Melbourne Hospital, c/o The Royal Melbourne Hospital Post Office, Melbourne, Victoria 3050, Australia
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Synopsis

Temporal lobe Magnetic Resonance Imaging (MRI) was performed in 43 patients with NINCDS/ADRDA Alzheimer's disease (AD) (33 probable, 7 possible, 3 definite) and 32 subjects with DSM-III-R Major Depression (DEP) matched for age, sex and level of education. Hippocampus (anterior and posterior, right and left), amygdala, entorhinal cortex, para-hippocampal gyrus and cerebral cortex were rated for atrophy on a 4-point scale. Good discrimination between groups could be achieved using a cut-off of 2 or more on anterior hippocampal atrophy rating (sensitivity 93%; specificity 84%; 89% cases correctly grouped overall). Even among a subgroup of 9 mild AD subjects and 10 cognitively impaired DEP subjects (matched on mini-mental state score), the same cut-off correctly grouped 84% (16/19) cases. Hippocampal atrophy increased with age in both AD and DEP subjects leading to a reduction in specificity (but not sensitivity) for those aged over 75. Within the AD group a significant correlation was observed between length of history and atrophy of the entorhinal cortex (r = 0·39, P = 0·009). We conclude that temporal lobe atrophy on MRI can provide good discrimination between AD and DEP subjects, including those DEP patients with cognitive impairment apparent on screening tests of cognitive function.

Type
Original Articles
Information
Psychological Medicine , Volume 24 , Issue 3 , August 1994 , pp. 633 - 640
Copyright
Copyright © Cambridge University Press 1994

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References

Altshuler, L. L., Conrad, A., Hauser, P., Li, Z., Guze, B. H., Denikoff, K., Tourtellotte, W. & Post, R. (1991). Reduction of temporal lobe volume in bipolar disorder: a preliminary report of magnetic resonance imaging. Archives of General Psychiatry 48, 482–483.Google ScholarPubMed
American Psychiatric Association (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn (Revised) (DSM-III-R). APA: Washington, DC.Google Scholar
Ames, D., Dolan, R. & Mann, A. H. (1990). The distinction between depression and dementia in the very old. International Journal of Geriatric Psychiatry 5, 193–198.CrossRefGoogle Scholar
Braak, H. & Braak, E. (1991). Neuropathological stageing of Alzheimer-related changes. Acta Neuropathologica 82, 239–259.CrossRefGoogle ScholarPubMed
Burns, A., Jacoby, R. & Levy, R. (1990 a). Psychiatric phenemona in Alzheimer's disease. III. Disorders of mood. British Journal of Psychiatry 157, 81–86.CrossRefGoogle Scholar
Burns, A., Luthert, P., Levy, R., Jacoby, R. & Lantos, P. (1990 b). Accuracy of clinical diagnosis of Alzheimer's disease. British Medical Journal 301, 1026.Google Scholar
Chaves, M. L. F. & Izquierdo, I. (1992). Differential diagnosis between dementia and depression: a study of efficiency increment. Acta Neurologica Scandinavica 85, 378–382.Google Scholar
Cicchetti, D. V. (1976). Assessing inter-rater reliability for rating scales: resolving some basic issues. British Journal of Psychiatry 129, 452–456.CrossRefGoogle ScholarPubMed
Coffey, C. E., Wilkinson, W. E., Weiner, R. D., Parashos, I. A., Djang, W. T., Webb, M. C., Figiel, G. S. & Spritzer, C. E. (1993). Quantitative cerebral anatomy in depression. Controlled magnetic resonance study. Archives of General Psychiatry 50, 7–16.Google Scholar
Davis, P. C., Gray, L., Albert, M., Wilkinson, W., Hughes, J., Heyman, A., Gado, M., Kumar, A. J., Destian, S., Lee, C., Duvall, E., Kido, D., Nelson, M. J., Bellow, J., Weathers, S., Jolesz, F., Kikinis, R. & Brooks, M. (1992). The consortium to establish a registry for Alzheimer's disease (CERAD). Part III. Reliability of a standardized MRI examination of Alzheimer's disease. Neurology 42, 1676–1680.CrossRefGoogle Scholar
Desmond, P. M., Tress, B. M., Ames, D. J., Clement, J. G., Clement, P., Schweitzer, I. & Robinson, G. S. (1992). Volumetric and visual assessment of the mesial temporal structures in Alzheimer's disease.American Society of Neuroradiology Annual Meeting,St Louis USA, Abstract 102 (a), p. 68.Google Scholar
Desrosiers, G. (1992). Primary or depressive dementia: clinical features. International Journal of Geriatric Psychiatry 7, 629–638.Google Scholar
Emery, V. O. & Oxman, T. E. (1992). Update on the dementia spectrum of depression. American Journal of Psychiatry 149, 305–317.Google Scholar
Erkinjuntti, T., Lee, D. H., Gao, F., Steenhuis, R., Eliasziw, M., Fry, R., Merskey, H. & Hachinski, V. (1993). Temporal lobe atrophy on magnetic resonance imaging in the diagnosis of early Alzheimer's Disease. Archives of Neurology 50, 305–310.Google Scholar
Folstein, M., Folstein, S. & McHugh, P. (1975). ‘Mini-mental state’ a practical method for grading the cognitive state of patients for the clinician. Journal Psychiatric Research 12, 189–198.Google Scholar
Gustafson, L. (1987). Frontal lobe degeneration of non-Alzheimer type. II. Clinical picture and differential diagnosis. Archives of Gerontology and Geriatrics 6, 209–223.Google Scholar
Hall, J. N. (1974). Inter-rater reliability of ward rating scales. British Journal of Psychiatry 125, 248–255.Google Scholar
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278–296.CrossRefGoogle ScholarPubMed
Jack, C. R., Petersen, R. C., O'Brien, P. C. & Tangalos, E. G. (1992). MR-based hippocampal volumetry in the diagnosis of Alzheimer's disease. Neurology 42, 183–188.CrossRefGoogle ScholarPubMed
Jorm, A. F. (1986). Cognitive deficit in the depressed elderly: a review of some basic unresolved issues. Australian and New Zealand Journal of Psychiatry 20, 11–22.Google Scholar
Kesslak, J. P., Nalcioglu, O. & Cotman, C. W. (1991). Quantification of magnetic resonance scans for hippocampal and parahippocampal atrophy in Alzheimer's disease. Neurology 41, 51–54.CrossRefGoogle ScholarPubMed
Lishman, W. A. (1987). Organic Psychiatry, (ch. 10). Blackwell Scientific Publications: Oxford.Google Scholar
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. & Stadlan, E. (1984). Clinical diagnosis of Alzheimer's Disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health and Human Task Force in Alzheimer's Disease. Neurology 34, 939–944.CrossRefGoogle Scholar
Montgomery, S. A. & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.Google Scholar
Mulley, G. P. (1986). Differential diagnosis of dementia. British Medical Journal 292, 1416–1418.Google Scholar
Nieuwenhuys, R., Voogd, J. & van Huijzen, C. (1988). The Human Central Nervous System, 3rd edn. Springer Verlag: Berlin.Google Scholar
Pearlson, G. D., Rabins, P. V., Kim, W. S., Speedie, L. J., Moberg, P. J., Burns, A. & Bascom, M. J. (1989). Structural brain CT changes and cognitive deficits in elderly depressives with and without reversible dementia (‘pseudodementia’). Psychological Medicine 19, 573–584.CrossRefGoogle Scholar
Pearlson, G. D., Harris, G. J., Powers, R. E., Barta, P. E., Camargo, E. E., Chase, G. A., Noga, J. T. & Tune, L. E. (1992). Quantitative changes in medial temporal volume, regional cerebral blood flow, and cognitive in Alzheimer's disease. Archives of General Psychiatry 49, 402–408.Google Scholar
Rabins, P. V., Pearlson, G. D., Aylward, E., Kumar, A. J. & Dowell, K. (1991). Cortical magnetic resonance imaging changes in elderly inpatients with major depression. American Journal of Psychiatry 148, 617–620.Google Scholar
Reynolds, C. F., Kupfer, D. J., Houck, C. C., Stack, J. A., Berman, S. R. & Zimmer, B. (1988). Reliable discrimination of elderly depressed and demented patients by electroencephalographic sleep data. Archives of General Psychiatry 45, 258–264.Google Scholar
Roth, M., Tym, E., Mountjoy, C., Huppert, F., Hendrie, H., Verma, S. & Goddard, R. (1986). CAMDEX: a standardized instrument for the diagnosis of mental disorder in the elderly with special reference to the early detection of dementia. British Journal of Psychiatry 149, 698–709.Google Scholar
Scheltens, P. H., Leys, D., Barkhof, F., Huglo, D., Weinstein, H. C., Vermersch, P., Kuiper, M., Steinling, M., Ch Walters, E. & Valk, J. (1992). Atrophy of medial temporal lobes on MRI in ‘probable’ Alzheimer's disease and normal ageing: diagnostic value and neuropsychological correlates. Journal of Neurology, Neurosurgery and Psychiatry 55, 967–972.CrossRefGoogle ScholarPubMed
Seab, J. P., Jagust, W. J., Wong, S. T. S., Roos, M. S., Reed, B. R. & Budinger, T. F. (1988). Quantitative NMR measurements of hippocampal atrophy in Alzheimer's disease. Magnetic Resonance in Medicine 8, 200–208.Google Scholar
Squire, L. R. & Zola-Morgan, S. (1991). The medial temporal lobe memory system. Science 253, 1380–1386.Google Scholar
Swayze, V. W., Andreasen, N. C., Alliger, R. J., Yuh, W. T. C. & Ehrhardt, J. C. (1992). Subcortical and temporal structures in affective disorder and schizophrenia: a magnetic resonance imaging study. Biological Psychiatry 31, 221–240.Google Scholar
Wells, C. E. (1979). Pseudodementia. American Journal of Psychiatry 136, 895–900.Google Scholar