title: White matter hyperintensities and chronicity of depression.
abstract: 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.
authors.affiliation: Department of General Psychiatry, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. angela.heiden@akh-wien.ac.at
authors.forename: Angela
authors.initials: A
authors.lastname: Heiden
authors.forename: Joachim
authors.initials: J
authors.lastname: Kettenbach
authors.forename: Peter
authors.initials: P
authors.lastname: Fischer
authors.forename: Bettina
authors.initials: B
authors.lastname: Schein
authors.forename: Ahmed
authors.initials: A
authors.lastname: Ba-Ssalamah
authors.forename: Richard
authors.initials: R
authors.lastname: Frey
authors.forename: Mohammad Mehdi
authors.initials: MM
authors.lastname: Naderi
authors.forename: Talin
authors.initials: T
authors.lastname: Gulesserian
authors.forename: Daniela
authors.initials: D
authors.lastname: Schmid
authors.forename: Siegfried
authors.initials: S
authors.lastname: Trattnig
authors.forename: Herwig
authors.initials: H
authors.lastname: Imhof
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kasper
mesh_terms: 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