Grant: Fellowship Award - Aging

Depression is the most common treatable mental disorder in late life. When left untreated, late-life depression (LLD) amplifies disability, hastens functional and cognitive decline, increases hospitalizations and diminishes quality of life. Current treatments for LLD provide modest efficacy and it is estimated that up to 84% of individuals treated for LLD either do not respond to treatment or respond and then relapse. Several studies have demonstrated that repetitive transcranial magnetic stimulation (rTMS) is an efficacious treatment for treatment-resistant depression (TRD) in younger adults. This form of treatment involves a series of magnetic pulses directed to the brain at a frequency of 1-20 stimulations per second. There are very few studies that have evaluated rTMS in late-life. Moreover, these studies are limited by suboptimal stimulation parameters. Therefore, we propose to assess the efficacy of rTMS in TRLLD using optimized parameters. First, we will use bilateral rTMS, one of the most promising paradigms in rTMS treatment studies that has yet to be studied in an elderly population. Second, we will use stimulation intensities that account for age-related brain changes. Third, we will use MRI co-registration to more accurately target rTMS to the area of the brain involved in depression. Fourth, we will extend the treatment duration to up to 6 weeks. We also intend to assess the impairment in complex cognition associated with LLD. These impairments add to functional disability and predict treatment resistance. The neurobiological basis of these impairments are not fully understood. Using neurophysiological tests from our lab we will measure this cognitive domain and how it is effected by rTMS. Therefore, we hope to determine whether rTMS treatment can improve resistant depressive symptoms and gain a better understanding of the biological basis of complex cognitive impairments in LLD.