Prognostic value of frontal functional neuroimaging in late-onset severe major depression

Background: There is growing evidence of a relationship between frontal neuroimaging and neuropsychological abnormalities and the physiopathology and course of late-onset major depression. Aims: To assess acute antidepressant response in late-onset major depression in relation to baseline frontal perfusion ratios. Method: A 99mTc HMPAO single photon emission computed tomographic brain scan was performed in medication-free patients with late-onset major depression, who were then included in a 12-week antidepressant treatment regimen. Logistic regression was used to define a predictive model of non-remission. Results: A total of 47 patients completed the study, 34 of whom were classed as remitters and 13 as non-remitters. The variable left anterior fronto-cerebellar perfusion ratio had a global predictive power of 87%. Analysing this variable together with the baseline variables age of onset and duration of index episode, the predictive power of the model rose to 94%. Conclusions: Our study suggests that a specific frontal functioning could predict the acute antidepressant response in late-onset severe major depression.