Introduction

Geriatric psychiatrists vary in the extent to which they use neuroimaging in their day-to-day practice (Spear, 1993). This probably not only reflects the variable availability of scanning facilities, access to them and their cost but also varying attitudes concerning the usefulness of imaging. However, the increasing vogue for the adoption of care protocols should ensure more uniform practice in future. Weinberger (1984) recommended that CT be performed for first episodes of major depressive disorder in the elderly, yet in an audit of over 600 elderly patients referred to an old-age psychiatry service, no patient had a scan performed for this indication (Spear, 1993). This rather confirms the view that many old-age psychiatrists find routine imaging of little value in their day-to-day management of the affective disorders.

This chapter presents information from research studies in this area and considers their implications for patient management; it has been organized around a number of naive questions that might concern the clinician:

1. (1) Do the brain images of old people with an affective disorder differ from those without an affective disorder?

2. (2) Do elderly people who develop an affective disorder late in life differ from those who developed it earlier in life?

3. (3) any of the abnormalities seen on imaging related to any of the psychopathological features found in the patient?

4. (4) neuroimaging help to differentiate between an affective disorder and dementia?

5. any neuroimaging changes related to treatment response or prognosis?

6. […]