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Deep white matter hyperintensities in patients with bipolar depression, unipolar depression and age-matched control
Trevor Silverstone1, Heather McPherson, Qunhuan Li
1Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Objective:
Hyperintensities in the white matter of the brain (DWH) and in the periventricular area (PVH) seen on magnetic resonance imaging (MRI) have been reported to be more frequent in patients with bipolar disorder (BP) than in normal subjects. To examine this further we compared MRI of patients with BP with age-matched patients with major depressive disorder (unipolar depression, UP) and healthy control subjects.
Methods:
T2 weighted axial and coronal brain MRI scans were obtained from 13 patients in the depressive phase of BP, 11 with current UP and 19 age-matched control subjects. The degree of DWH and PVH present in each scan was determined using a standardized scoring method.
Results:
The PVH ratings were similar in the three groups of subjects. However, proportionately more BP patients had higher DWH scores than either UP patients or controls. Although this difference did attain statistical significant, a main effect of age was noted. Further, subjects over the age of 50 were under-represented in the UP group.
Conclusions:
Notwithstanding the small total sample size and relative lack of older subjects in the UP group, the fact that almost twice as many BP patients showed more severe DWH suggests that patients with BP may be more vulnerable to develop these changes than UP patients and healthy controls.
Insights
Patients with bipolar disorder (BP) show more deep white matter hyperintensities (DWH) on MRI scans compared to those with unipolar depression (UP) or healthy controls. This suggests a potential vulnerability in BP patients to developing these brain changes.
Area of Science:
- Neuroimaging
- Psychiatry
- Neurology
Background:
- White matter hyperintensities (WMH), including deep white matter (DWH) and periventricular hyperintensities (PVH), are observed on MRI scans.
- Previous studies suggest WMH are more prevalent in bipolar disorder (BP) patients than in healthy individuals.
Purpose of the Study:
- To compare the prevalence and severity of DWH and PVH in patients with BP, patients with unipolar depression (UP), and healthy control subjects using MRI.
- To investigate potential differences in white matter changes between BP and UP.
Main Methods:
- Brain MRI scans (T2 weighted axial and coronal) were acquired from 13 BP patients (depressive phase), 11 UP patients, and 19 age-matched healthy controls.
- A standardized scoring method was used to quantify the degree of DWH and PVH in each subject's MRI scan.
Main Results:
- Periventricular hyperintensity (PVH) ratings were comparable across all three groups (BP, UP, controls).
- A higher proportion of BP patients exhibited elevated deep white matter hyperintensity (DWH) scores compared to UP patients and controls.
- While the difference in DWH was not statistically significant, age was identified as a significant factor, with fewer than 50-year-old subjects in the UP group.
Conclusions:
- Despite limitations including small sample size and underrepresentation of older subjects in the UP group, findings suggest BP patients may be more susceptible to developing DWH.
- The observed higher prevalence of DWH in BP patients warrants further investigation into the neurobiological underpinnings of these changes.