Longitudinal Changes in White Matter Hypointensities in Recurrent Late-Life Depression

Area of Science:

• Neuroimaging
• Geriatric Psychiatry
• Vascular Neurology

Background:

• White matter hypointensities (WMhs) on T1 and white matter hyperintensities (WMH) on T2-FLAIR indicate vascular risk in late-life depression (LLD).
• Larger baseline WMH are linked to depression recurrence, but longitudinal WMH accumulation and relapse risk in older adults are understudied.

Purpose of the Study:

• To investigate the relationship between white matter hyperintensity (WMh) accumulation and late-life depression (LLD) recurrence over two years.
• To determine if baseline WMH load and accumulation rate predict relapse risk in remitted LLD patients.

Main Methods:

• A 2-year multi-site study involving 223 participants (157 remitted LLD, 66 controls) with T1 imaging every 8 months.
• Mixed-effects modeling analyzed WMh accumulation rates by relapse status; Cox models estimated relapse risk based on baseline WMh and accumulation rate (low/high, slow/rapid).

Main Results:

• Relapse groups showed greater baseline WMh than controls.
• WMh accumulation rates did not differ between non-depressed and remitted LLD participants.
• Individuals with high baseline WMh and rapid accumulation had a significantly higher risk of relapse (HR=2.92).

Conclusions:

• Greater baseline WMh is associated with LLD relapse, independent of accumulation rate.
• The rate of WMh progression was not a significant predictor of relapse in this cohort.
• Patients with high baseline WMh and rapid accumulation may require closer clinical monitoring for depression relapse.