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Longitudinal increase in the volume of white matter hyperintensities in late-onset depression
Robert D Nebes1, Charles F Reynolds, Fernando Boada
1Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. nebesrd@msx.upmc.edu
Insights
A longitudinal increase in white matter hyperintensities (WMH) was observed in an older man who developed late-onset depression. This finding supports the link between cerebrovascular disease and geriatric depression.
Area of Science:
- Neuroscience
- Geriatrics
- Psychiatry
Background:
- Cerebrovascular disease is implicated in geriatric major depression.
- White matter hyperintensities (WMH) are associated with late-onset depression.
- Longitudinal WMH increase evidence in late-life depression onset is limited.
Purpose of the Study:
- To investigate the longitudinal relationship between WMH volume changes and the onset of late-life depression.
- To examine cognitive changes associated with WMH progression in older adults.
Main Methods:
- Three-year longitudinal study of an older man with new-onset depression and a comparison group.
- Structural MRI (fast-FLAIR) used to quantify WMH volume.
- Cognitive assessments included Mini Mental State Exam (MMSE) and executive function tests.
Main Results:
- The depressed individual showed a significant increase in WMH volume exceeding the comparison group's 95% Confidence Intervals (CI).
- This individual experienced a decline in executive functions but not on the MMSE.
- Comparison group showed no significant WMH increase or cognitive decline.
Conclusions:
- Findings support cerebrovascular disease as a factor in late-onset depression (vascular depression).
- Longitudinal WMH increase may precede or coincide with the onset of geriatric depression.
Background:
Cerebrovascular disease is thought to play a role in the pathogenesis of geriatric major depression. One finding supporting such a "vascular depression" is the increased neuropathology in the form of white matter hyperintensities (WMH) found in patients diagnosed with a late-onset depression. However, at present there is little evidence that a longitudinal increase in WMH burden within an individual is associated with the onset of a late-life depression.
Methods:
This study examined three-year longitudinal change in WMH volume and in cognition in: (a) an older man who developed his first episode of major depression during the study period, and (b) a comparison group of twelve older individuals who remained depression free. All subjects received at baseline and three years later a structural magnetic resonance imaging (MRI) using fast-FLAIR technology. The images were analyzed with semi-automated computerized software to obtain WMH volumes. Subjects also received at both time points the Mini Mental State Exam (MMSE) as well a series of cognitive tasks assessing executive abilities (verbal fluency, Trail Making Test and Stroop test) since executive dysfunction is thought to be characteristic of a vascular depression.
Results:
The individual who became depressed during the followup showed an increase in WMH volume that exceeded the 95% Confidence Intervals (CI) for change in the comparison group. This individual also showed a similar decline on the measures of executive function but not on the MMSE.
Conclusions:
These results are consistent with cerebrovascular disease being a factor in the pathogenesis of late-onset depression (i.e. "vascular depression").