Longitudinal increase in the volume of white matter hyperintensities in late-onset depression.
BACKGROUND
Cerebrovascular disease is thought to play a role in the pathogenesis of geriatric major depression. One finding supporting such a "vascular depression" is the increased neuropathology in the form of white matter hyperintensities (WMH) found in patients diagnosed with a late-onset depression. However, at present there is little evidence that a longitudinal increase in WMH burden within an individual is associated with the onset of a late-life depression.


METHODS
This study examined three-year longitudinal change in WMH volume and in cognition in: (a) an older man who developed his first episode of major depression during the study period, and (b) a comparison group of twelve older individuals who remained depression free. All subjects received at baseline and three years later a structural magnetic resonance imaging (MRI) using fast-FLAIR technology. The images were analyzed with semi-automated computerized software to obtain WMH volumes. Subjects also received at both time points the Mini Mental State Exam (MMSE) as well a series of cognitive tasks assessing executive abilities (verbal fluency, Trail Making Test and Stroop test) since executive dysfunction is thought to be characteristic of a vascular depression.


RESULTS
The individual who became depressed during the followup showed an increase in WMH volume that exceeded the 95% Confidence Intervals (CI) for change in the comparison group. This individual also showed a similar decline on the measures of executive function but not on the MMSE.


CONCLUSIONS
These results are consistent with cerebrovascular disease being a factor in the pathogenesis of late-onset depression (i.e. "vascular depression").
Nebes
Robert D
RD
Department of Psychiatry, WPIC, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA. nebesrd@msx.upmc.edu
Reynolds
Charles F
CF
Boada
Fernando
F
Meltzer
Carolyn C
CC
Fukui
Melanie B
MB
Saxton
Judith
J
Halligan
Edythe M
EM
DeKosky
Steven T
ST
D017668:Age of Onset; D000368:Aged; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000098:blood supply / Q000473:pathology*; D002561:Cerebrovascular Disorders / Q000150:complications*; D003072:Cognition Disorders / Q000503:physiopathology*; D003866:Depressive Disorder / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule