Depression was ruining the life of an elderly woman with dementia who was being treated at McLean’s Geriatric Psychiatry Unit—just as these illnesses bring misery to so many others. After standard treatments failed, a course of electroconvulsive therapy (ECT) finally brought relief. To the clinicians’ surprise, the ECT also reduced the agitated and aggressive behaviors that had made it very difficult for the woman’s family to care for her.
That unexpected response, it turned out, had been described in the psychiatric literature. McLean clinician-researchers wanted to understand whether this experience fit with these earlier observations, so they conducted a careful review of the effectiveness and safety of prior ECT use in patients with depression and dementia. The positive results of that study appeared in a journal earlier this year and were met with great interest by geriatric clinicians around the country (American Journal of Geriatric Psychiatry 2012 January; 20(1): 61-72).
That tight feedback loop between clinical care and research is one of the hallmarks of the hospital’s Geriatric Psychiatry Program, according to Medical/Clinical Director James Ellison, MD, MPH. “We want to learn from each patient how we can improve our services,” he said. “So, we are always looking for insights into patients’ responses to treatment that might suggest better approaches to care.”
A Gift Rooted in a Relationship
More and more, McLean’s Geriatric Psychiatry Program—comprising two inpatient units and three outpatient programs, including one exclusively for patients with memory impairment—is doing exactly that. Thanks to generous support from the Rogers Family Foundation, one of the clinical program’s research arms has developed a robust effort aimed at exploring intriguing and important questions, such as why do dementia and mood disorders often go hand-in-hand? Why do some psychotropic medications work differently in older patients? How does long-term mental illness affect the physiology of the brain? And what biological causes lead to Alzheimer’s disease?
Deborah Rogers Pratt, trustee of the Rogers Family Foundation, said her family feels strongly about the importance of research into the causes and treatment of dementia, and believes McLean is uniquely qualified to make the discoveries that will give hope to families like hers. Their support is also rooted in the relationship that her mother—Jacqueline Rogers, who struggled with dementia—developed with Brent P. Forester, MD, MSc, director of mood disorders research, Geriatric Psychiatry Program.
“He was so wonderful with her and she loved him,” said Pratt. “She would be having a terrible day, struggling with memory, then she would arrive at his office and be able to answer all his questions. She pulled herself together for him because she liked him so much.”
The Research Program
One strength of the Geriatric Psychiatry Program’s research is its interdisciplinary and collaborative nature, drawing from the realms of genetic testing, high-tech brain imaging, neurochemistry, and postmortem neuropathological analyses of brain tissue, to name a few.
The Rogers Family Foundation’s support has been critical to several initiatives, including funding a three-year longitudinal study of older patients with depression and bipolar disorder. These subjects are assessed quarterly on measures of mood, cognition, and daily functioning. A subset of this group has undergone magnetic resonance scanning of their brains, contributed blood samples for genetic analysis, and agreed to donate their brains to the McLean-based Harvard Brain Tissue Resource Center for future postmortem neuropathological analysis.
As a result, the program has amassed a rich trove of data that will be used as the basis for other studies looking at everything from how cognitive function changes over time in older adults with bipolar disorder and depression to the types of changes in brain structure that occur in older adults with bipolar disorder.
“These longitudinal studies in aging adults with depression and bipolar disorder will allow us to better understand the natural course of their illnesses while identifying predictors of cognitive decline and dementia,” said Forester. “They also help us identify the factors associated with improved functional activity and quality of life with age. The ultimate goal is to use the findings as a basis for further research into novel treatments with more specific mechanisms of action.”
A new infusion of funding from the Rogers Family Foundation in 2011 and 2012 is enabling Dr. Forester to follow these patients for two more years, add 30 more subjects to the group, increase the number of MRI scans of patients with depression or bipolar disorder, do more genetic testing, and reach out to more patients to be brain donors after death. McLean is also participating in a large longitudinal study—taking place at 21 clinical and academic centers of excellence across the country—to improve the understanding of depression and its treatment.
With its ambitious research agenda and comprehensive clinical services—fueled by philanthropy from the Rogers Family Foundation and other donors—McLean’s Geriatric Psychiatry Program is making a difference for countless people whose lives have been touched by dementia and depression in later life.