Abstract
OBJECTIVES: As alcohol use is common among older depressives, we assessed structural brain changes over 2 years and examined their association with changes in alcohol consumption. DESIGN: Longitudinal cohort study. SETTING: Academic health center. PARTICIPANTS: Adults aged 60 and older who met DSM criteria for a major depressive episode. INTERVENTION: Participants were offered treatment with sertraline. MEASUREMENTS: Participants completed structured interviews for reported alcohol consumption, had a clinical interview with a study psychiatrist, completed a cognitive battery at baseline and every twelve months, and underwent a 3T structural MRI as baseline and at 2-year follow-up. Volumetric brain changes were calculated. RESULTS: Among 58 participants, 45 were classified as moderate drinkers (≤7 drinks/week) and 13 as risky drinkers (>7 drinks/week). Compared with moderate drinkers, risky drinkers at baseline had significantly thinner cortical thickness and smaller volume in several frontal cortical regions, posterior cingulate, postcentral cortices, right insula, right putamen, and right inferior parietal sulcus. Annualized change in cortical thickness and volume correlated negatively with changes in the average number of drinks per week. Decreased depression severity, increased cognitive function score, and decreased alcohol consumption over the 2-year follow-up were each associated with annualized volumetric changes in specific common regions. CONCLUSION: These MRI findings demonstrate the adverse impact of alcohol use in older adults on the fronto-striatal circuit. They highlight the need for careful screening and treatment referral for risky alcohol use among older adults with depression.