Cognition, white matter hyperintensities and suicide risk in late-life depression patients: an exploratory study

Suicide among older adults represents a major public health concern and is closely associated with late-life depression (LLD). White matter hyperintensities (WMHs), frequently observed in the aging population, have been linked to both LLD and cognitive impairment. However, the role of WMH burden and cognitive dysfunction in older adults with LLD who have recently attempted suicide remains unclear. This study aims to investigate differences in WMH burden and cognitive performance across three groups: LLD patients with a recent suicide attempt (recent suicide attempt group, RSA), non-suicidal LLD patients (non-suicidal group, NS), and healthy older adults (healthy comparison group, HC). We further examine whether the relationship between WMH load and cognitive function varies by suicide attempt status.

This cross-sectional study included 58 adults aged 65 years and older. Participants were categorized into three groups: RSA (n = 17), NS (n = 20), and HC (n = 21). All participants underwent brain MRI and completed multiple psychological evaluations and neurocognitive tests, including the Cognitive Abilities Screening Instrument. We compared the three groups with respect to cognitive function, WMHs, and the relationship between WMH load and cognitive performance.

LLD patients with a recent suicide attempt (RSA) had significantly poorer global cognitive function and greater periventricular WMH compared to non-suicidal LLD patients and healthy controls. Greater WMH was significantly associated with lower cognitive function only in the suicide-attempt group.

Worse global cognitive function and greater WMHs may collectively increase the risk of suicidal attempts in LLD patients.