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Lesion Explorer: A Video-guided, Standardized Protocol for Accurate and Reliable MRI-derived Volumetrics in Alzheimer's Disease and Normal Elderly
Published on: April 14, 2014
The association between white matter lesions on magnetic resonance imaging and noncognitive symptoms
1Institute for the Health of the Elderly, Newcastle General Hospital, Newcastle upon Tyne, UK. j.t.o'brien@ncl.ac.uk
Abstract:
A number of studies have suggested that cerebral changes, particularly deep white matter lesions (WML) visualized on magnetic resonance imaging (MRI), may be involved in the genesis of late life depression. This has been confirmed in a prospective study which also found a relationship between the presence of WML and poor 3-year outcome in elderly depressed subjects. Most studies find these lesions to predominate in frontal lobe and basal ganglia, supporting the hypothesis of "fronto-striatal" dysfunction in depression. To investigate whether WML are associated with mood disturbance in dementia, proton density and T2-weighted images were obtained in 80 subjects with dementia (dementia with Lewy bodies, n = 27; Alzheimer's disease, n = 28; vascular dementia, n = 25) and 26 age-matched normal controls. Periventricular lesions (PVL), white matter lesions (WML), and basal ganglia hyperintensities (BG) were visually rated blind to diagnosis using a semiquantitative scale. Frontal WML were associated with higher depression scores in patients with dementia, implying a common pathophysiology of depression irrespective of diagnosis. Further study of the neurobiological basis of WML is needed. This can best be achieved by serial clinical assessment combined with in vivo and in vitro MRI and neuropathological examination.
Insights
White matter lesions (WML) in the frontal lobe are linked to increased depression symptoms in dementia patients. This suggests a shared mechanism for depression across different neurological conditions.
Area of Science:
- Neuroscience
- Geriatrics
- Radiology
Background:
- Deep white matter lesions (WML) on MRI are implicated in late-life depression.
- WML are often found in the frontal lobe and basal ganglia, suggesting fronto-striatal dysfunction.
- Previous studies link WML to poorer outcomes in elderly depressed individuals.
Purpose of the Study:
- To investigate the association between WML and mood disturbances in various types of dementia.
- To explore if frontal WML correlate with depression severity in dementia patients.
Main Methods:
- Proton density and T2-weighted MRI scans were acquired from 80 dementia patients (DLB, AD, VaD) and 26 controls.
- Periventricular lesions (PVL), WML, and basal ganglia hyperintensities (BG) were rated using a semiquantitative scale.
- Assessments were conducted by raters blinded to the diagnosis.
Main Results:
- Frontal white matter lesions (WML) showed a significant association with higher depression scores in dementia patients.
- This finding implies a common pathophysiological basis for depression, regardless of the specific dementia diagnosis.
- The study included patients with dementia with Lewy bodies, Alzheimer's disease, and vascular dementia.
Conclusions:
- Frontal lobe white matter lesions are associated with depressive symptoms in dementia.
- This suggests a shared neurobiological pathway for depression in both late-life depression and dementia.
- Further research combining clinical assessment, in vivo/in vitro MRI, and neuropathology is recommended to understand WML's neurobiology.
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