title: Midlife psychological distress associated with late-life brain atrophy and white matter lesions: a 32-year population study of women.
abstract: OBJECTIVE
  Long-standing psychological distress increases the risk of dementia, especially Alzheimer's disease. The present study examines the relationship between midlife psychological distress and late-life brain atrophy and white matter lesions (WMLs), which are common findings on neuroimaging in elderly subjects.
  
  
  METHODS
  A population-based sample of 1462 women, aged 38 to 60 years, was examined in 1968, with subsequent examinations in 1974, 1980, 1992, and 2000. Computed tomography (CT) of the brain was done in 379 survivors in 2000, and of those, 344 had responded to a standardized question about psychological distress in 1968, 1974, and 1980. WMLs, cortical atrophy, and central atrophy (ventricular sizes) were measured at CT scans.
  
  
  RESULTS
  Compared with women reporting no distress, those reporting frequent or constant distress at one examination or more (in 1968, 1974, and 1980) more often had moderate-to-severe WMLs (multiadjusted odds ratio = 2.39, 95% confidence interval = 1.16-4.92) and moderate-to-severe temporal lobe atrophy (multiadjusted odds ratio = 2.51, 95% confidence interval = 1.04-6.05) on brain CT in 2000. Frequent/constant distress was also associated with central brain atrophy, that is, higher bicaudate ratio, higher cella media ratio, and larger third-ventricle width.
  
  
  CONCLUSIONS
  Long-standing psychological distress in midlife increases risks of cerebral atrophy and WMLs on CT in late life. More studies are needed to confirm these findings and to determine potential neurobiological mechanisms of these associations.
authors.affiliation: Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden. lena.johansson@neuro.gu.se
authors.forename: Lena
authors.initials: L
authors.lastname: Johansson
authors.forename: Ingmar
authors.initials: I
authors.lastname: Skoog
authors.forename: Deborah R
authors.initials: DR
authors.lastname: Gustafson
authors.forename: Pernille J
authors.initials: PJ
authors.lastname: Olesen
authors.forename: Margda
authors.initials: M
authors.lastname: Waern
authors.forename: Calle
authors.initials: C
authors.lastname: Bengtsson
authors.forename: Cecilia
authors.initials: C
authors.lastname: Björkelund
authors.forename: Leonardo
authors.initials: L
authors.lastname: Pantoni
authors.forename: Michela
authors.initials: M
authors.lastname: Simoni
authors.forename: Lauren
authors.initials: L
authors.lastname: Lissner
authors.forename: Xinxin
authors.initials: X
authors.lastname: Guo
mesh_terms: D000328:Adult; D000367:Age Factors; D001284:Atrophy / Q000000981:diagnostic imaging / Q000453:epidemiology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001927:Brain Diseases / Q000453:epidemiology* / Q000473:pathology; D002908:Chronic Disease; D015986:Confounding Factors, Epidemiologic; D003704:Dementia / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D006801:Humans; D016014:Linear Models; D008875:Middle Aged; D011159:Population Surveillance; D013315:Stress, Psychological / Q000453:epidemiology* / Q000473:pathology; D013548:Sweden / Q000453:epidemiology; D013702:Temporal Lobe / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016387:Women's Health