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Updated: Nov 8, 2025
Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
Published on: July 28, 2013
White Matter Abnormalities in Late Onset First Episode Mania: A Diffusion Tensor Imaging Study
Jesus Ramírez-Bermúdez1, Oscar Marrufo-Melendez2, Cecilia Berlanga-Flores1
1National Autonomous University of Mexico, School of Medicine; National Institute of Neurology and Neurosurgery, Neuropsychiatry.
Introduction:
A first manic episode after 50 years of age is uncommon. Late Onset Mania might be indicative of abnormalities in white matter, probably related to vascular, degenerative, or inflammatory processes.
Objective:
To determine if patients with late onset mania have reduced white matter integrity according to Magnetic Resonance Diffusion Tensor Imaging (DTI) and structural MRI.
Methods:
Twenty-two patients with late onset mania (>50 years old) and 22 age-paired healthy subjects were included in the study. Fractional anisotropy (FA) was used as a quantitative measure of white matter integrity. Fazekas scale was assessed also to measure white matter abnormalities in the FLAIR sequence. The Frontal Assessment Battery, COGNISTAT and Trail making test A and B were used as cognitive measurements.
Results:
According to DTI, commissural connections (left corpus callosum), and limbic connections (right and left uncinate fasciculus) were different between the patients and the comparison group. Fractional anisotropy values in the left corpus callosum showed significant correlations with neuropsychological measures, and with the Fazekas scale score. According to Fazekas scale, a pathological score in the FLAIR sequence was significantly more frequent in the patients as compared to the comparison group.
Conclusions:
Patients with first episode mania in late life have relevant white matter abnormalities not explained by age, affecting interhemispheric and fronto-limbic networks probably related to executive functioning and emotional processing, at the level of the corpus callosum and the uncinate fasciculus. The etiology of this white matter loss of integrity in patients with late-onset mania is yet to be explored.
Insights
Late onset mania in individuals over 50 is linked to white matter abnormalities in the corpus callosum and uncinate fasciculus. These findings suggest potential neurobiological underpinnings for late-life manic episodes.
Area of Science:
- Neuroscience
- Geriatrics
- Psychiatry
Background:
- Late onset mania (first episode after age 50) is uncommon and may signal underlying neurological issues.
- Potential causes include vascular, degenerative, or inflammatory processes affecting white matter integrity.
Purpose of the Study:
- To investigate white matter integrity in patients with late onset mania using Magnetic Resonance Diffusion Tensor Imaging (DTI) and structural MRI.
- To correlate white matter integrity with cognitive function and clinical presentation.
Main Methods:
- Compared 22 late onset mania patients (>50 years) with 22 age-matched healthy controls.
- Utilized Diffusion Tensor Imaging (DTI) to measure fractional anisotropy (FA) for white matter integrity.
- Assessed white matter abnormalities using the Fazekas scale and performed cognitive tests (FAB, COGNISTAT, Trail Making A & B).
Main Results:
- Patients showed reduced white matter integrity in the corpus callosum and uncinate fasciculus compared to controls.
- Lower FA in the corpus callosum correlated with poorer neuropsychological test performance and higher Fazekas scores.
- Pathological white matter changes (Fazekas scale) were more frequent in late onset mania patients.
Conclusions:
- Late onset mania is associated with significant white matter abnormalities affecting interhemispheric and fronto-limbic networks.
- These abnormalities may underlie executive functioning and emotional processing deficits in late-life mania.
- The precise etiology of white matter integrity loss in late onset mania requires further investigation.
