Impact of White Matter Lesions on Depression in the Patients with Alzheimer's Disease.
OBJECTIVE
Comorbid depression is common in patients with Alzheimer's disease (AD). An increase in white matter lesions (WMLs) has been associated with depression in both elderly individuals with normal cognition and patients with Alzheimer's disease. We investigated whether the severity and location of WMLs influence the association between WMLs and comorbid depression in AD.


METHODS
We enrolled 93 AD patients from Seoul National University Bundang Hospital. We administered both the Mini International Neuropsychiatric Inventory (MINI) and the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease Assessment Packet (CERAD-K) clinical and neuropsychological battery. Subjects also underwent brain magnetic resonance imaging (MRI). We diagnosed AD according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. We diagnosed depressive disorders according to the DSM-IV diagnostic criteria, and evaluated the severity of depressive symptoms using the Korean version of the Geriatric Depression Scale (GDS-K). We quantified the WML volumes from the brain MRI using a fully automated segmentation algorithm.


RESULTS
The log of the WML volume in the frontal lobe was significantly associated with depressive disorders (odds ratio=1.905, 95% CI=1.027-3.533, p=0.041), but not with the severity of depressive symptoms as measured by the GDS-K.


CONCLUSIONS
The WML volume in the frontal lobe conferred a risk of comorbid depressive disorders in AD, which implies that comorbid depression in AD may be attributed to vascular causes.
Department of Psychiatry, Dankook University College of Medicine, Cheonan, Republic of Korea.
Jung Jae
JJ
Lee
Department of Psychiatry, Dankook University College of Medicine, Cheonan, Republic of Korea.
Eun Young
EY
Lee
Department of Psychiatry, Dankook University College of Medicine, Cheonan, Republic of Korea.
Seok Bum
SB
Lee
Department of Psychiatry, Jeju National University School of Medicine, Jeju National University Hospital, Jeju, Republic of Korea.
Joon Hyuk
JH
Park
Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea.
Tae Hui
TH
Kim
Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Hyun-Ghang
HG
Jeong
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Jae Hyoung
JH
Kim
Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Ji Won
JW
Han
Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. ; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea. ; Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
Ki Woong
KW
Kim
Alzheimer's disease; Depression; White matter lesions