title: Multimodal MRI markers support a model of small vessel ischemia for depressive symptoms in very old adults.
abstract: In older adults, depressive symptoms are associated with lower quality of life, high morbidity and mortality. This study aims to identify brain magnetic resonance imaging (MRI) features associated with late-life depressive symptoms in the population. Older community-dwelling adults (n=314) from the Health ABC study underwent brain MRI. Logistic regression was used to characterize the relationships between depressive symptoms (Center for Epidemiologic Studies of Depression scale, CES-D) and the following whole-brain variables: white matter hyperintensity (WMH) burden, fractional anisotropy (FA), and gray matter volume (GMV). Analyses examining possible regional differences between the CES-D groups controlled for Modified Mini-Mental State Examination score and diabetes status. The relative importance of localization of the markers was examined by comparing the distribution of significant peaks across the brain. Each whole-brain variable showed loss of integrity associated with high CES-D. For GMV, the odds ratio (OR)=0.84 (95% confidence interval (CI) 0.74, 0.96); for FA, OR=0.714 (95% CI 0.57, 0.88); for WMH, OR=1.89 (95%CI 1.33, 2.69). Voxel-wise analyses and patterns of peak significance showed non-specific patterns for white matter measures. Loss of GMV was most significant in the bilateral insula and anterior cingulate cortex. This study supports a cerebrovascular pattern for depressive symptoms in older adults. The localization of gray matter changes to the insula, a watershed area and a hub of affective circuits, suggests an etiological pathway from ischemia to increased depressive burden.
authors.affiliation: Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA; Geriatric Psychiatric Neuroimaging, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. Electronic address: tudorascudl@upmc.edu.
authors.forename: Dana L
authors.initials: DL
authors.lastname: Tudorascu
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Caterina
authors.initials: C
authors.lastname: Rosano
authors.affiliation: Department of Neurosciences, School of Medicine, University of California, San Diego, CA, USA.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Venkatraman
authors.affiliation: Geriatric Psychiatric Neuroimaging, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: MacCloud
authors.affiliation: Laboratory of Epidemiology, Demography, and Biometry, National Institute of Health, Bethesda, MD, USA.
authors.forename: Tamara
authors.initials: T
authors.lastname: Harris
authors.affiliation: Department of Psychiatry, Neurology and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
authors.affiliation: Geriatric Psychiatric Neuroimaging, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Aizenstein
mesh_terms: D000369:Aged, 80 and over; D001808:Blood Vessels / Q000473:pathology*; D001921:Brain / Q000473:pathology*; D002545:Brain Ischemia / Q000473:pathology*; D001931:Brain Mapping; D003866:Depressive Disorder / Q000473:pathology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation; D064847:Multimodal Imaging; D009413:Nerve Fibers, Myelinated; D011788:Quality of Life
keywords: Depression; Geriatric; MRI markers