White matter hyperintensities and chronicity of depression

• Published in: Journal of psychiatric research Vol. 39; no. 3; pp. 285 - 293
• Main Authors: Heiden, Angela, Kettenbach, Joachim, Fischer, Peter, Schein, Bettina, Ba-Ssalamah, Ahmed, Frey, Richard, Naderi, Mohammad Mehdi, Gulesserian, Talin, Schmid, Daniela, Trattnig, Siegfried, Imhof, Herwig, Kasper, Siegfried
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01-05-2005; Elsevier
• Subjects: Aged; Basal Ganglia - pathology; Basal Ganglia - physiopathology; Biological and medical sciences; Brain - pathology; Brain - physiopathology; Cerebral Ventricles - pathology; Cerebral Ventricles - physiopathology; Chronic Disease; Chronicity; Corpus Striatum - pathology; Corpus Striatum - physiopathology; Decision Making; Deep white matter hyperintensities; Depression; Depressive Disorder, Major - pathology; Depressive Disorder, Major - physiopathology; Female; Frontal Lobe - pathology; Frontal Lobe - physiopathology; Geriatrics; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Periventricular hyperintensities; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Severity of Illness Index; White matter hyperintensities; Depression; White matter hyperintensities; Chronicity; Periventricular hyperintensities; Magnetic resonance imaging; Deep white matter hyperintensities; Human; Mood disorder; Volumetric analysis; Prevalence; Central nervous system; Nuclear magnetic resonance imaging; White matter; Encephalon; Symptomatology; Follow up study; Medical imagery; Evolution; Severity score; Predictive factor; Elderly; Comparative study; Hyperintensity
• ISSN: 0022-3956; 1879-1379
• DOI: 10.1016/j.jpsychires.2004.07.004

White matter hyperintensities (WMHs) on
T
2-weighted magnetic resonance imaging (MRI) of the brain are associated with advanced age and late-life depression. Most investigations predominately found these lesions in frontal lobe and basal ganglia supporting the hypothesis of a fronto-striatal dysfunction in depression. A prospective study was undertaken to investigate the association between extent of WMHs and clinical outcome in elderly depressed patients.
Thirty-one non-demented depressed subjects underwent a 1.5 T cranial MRI scan. The MRI scans were analysed in consensus by two experienced radiologists. Each MRI scan was assessed for presence and extent of WMHs, which are differentiated in periventricular hyperintensities (PVHs) and deep white matter hyperintensities (DWMHs). A total of 21 patients of the original cohort of 31 patients were re-assessed 5 years after baseline assessment. We ascertained the severity of depressive symptoms, the longitudinal course of depression, the cognitive decline and the global assessment of functioning at follow-up visit.
(1) Subjects with greater extent of WMHs had a significant higher Hamilton Depression Rating Scale (HAM-D) score, (2) had more severe longitudinal courses of depression (3) and had a lower Mini-Mental State Examination (MMSE) score.
WMHs on MRI are associated with poorer outcome in elderly depressed subjects. Further studies are needed to evaluate WHMs as prognostic factor for an appropriate treatment decision-making.