White matter hyperintensities and chronicity of depression.
OBJECTIVE
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 predominantly 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.


METHODS
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.


RESULTS
(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.


CONCLUSIONS
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.
Heiden
Angela
A
Department of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. angela.heiden@akh-wien.ac.at
Kettenbach
Joachim
J
Fischer
Peter
P
Schein
Bettina
B
Ba-Ssalamah
Ahmed
A
Frey
Richard
R
Naderi
Mohammad Mehdi
MM
Gulesserian
Talin
T
Schmid
Daniela
D
Trattnig
Siegfried
S
Imhof
Herwig
H
Kasper
Siegfried
S
D000368:Aged; D001479:Basal Ganglia / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000473:pathology* / Q000503:physiopathology*; D002552:Cerebral Ventricles / Q000473:pathology / Q000503:physiopathology; D002908:Chronic Disease; D003342:Corpus Striatum / Q000473:pathology / Q000503:physiopathology; D003657:Decision Making; D003865:Major Depressive Disorder / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D005625:Frontal Lobe / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index