Late-onset major depression is associated with age-related white matter lesions in the brainstem.
Age-related white matter lesions (ARWMLs) have been identified in various clinical conditions such as reduced gait speed, cognitive impairment, urogenital dysfunction, and mood disturbances. Previous studies indicated an association between ARWML and late-onset major depression. However, most of these focused on the extent of supratentorial ARWML and neglected presence and degree of infratentorial lesions.



In 45 patients (mean age 73.7 ± 6.3 years, 17 (37.8%) men, 28 (62.2%) women) with late-onset major depression, MRI findings (3.0-T MR system, Magnetom Trio, Siemens Medical Systems, Erlangen, Germany) were analyzed with emphasis on the extent of supratentorial and infratentorial, as well as brainstem ARWMLs, and compared with control subjects. ARWMLs were determined by semiquantitative rating scales (modified Fazekas rating scale, Scheltens' rating scale), as well as a semiautomatic volumetric assessment, using a specific software (MRIcron). Supratentorial and infratentorial, as well as brainstem ARWMLs, were assessed both on fluid attenuated inversion recovery and T2-weighted images.



Patients with late-onset major depression had significantly higher infratentorial ARWML rating scores (5 (5-7) vs 4.5 (3-6), p = 0.003) on T2-weighted images and volumes (1.58 ± 1.35 mL vs 1.05 ± 0.81 mL, p = 0.03) on T2-weighted images, as well as fluid attenuated inversion recovery images (2.07 ± 1.35 mL vs 1.52 ± 1.10 mL, p = 0.04), than normal controls. In more detail, in particular, the pontine ARWML rating subscore was significantly higher in patients with late-onset major depression (1 (1-2) vs 1 (1-1), p = 0.004).



The extent and localization of brainstem ARWML might be of importance for the pathophysiology of late-onset major depression. In particular, this may hold true for pontine ARWML. Copyright © 2016 John Wiley & Sons, Ltd.
Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Johannes
J
Schwichtenberg
Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Mansour
M
Al-Zghloul
Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Hans U
HU
Kerl
Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Holger
H
Wenz
Department of Geriatric Psychiatry, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Lucrezia
L
Hausner
Department of Geriatric Psychiatry, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Lutz
L
Frölich
Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Christoph
C
Groden
Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
Alex
A
Förster
D017668:Age of Onset; D000368:Aged; D000369:Aged, 80 and over; D001933:Brain Stem / Q000473:pathology*; D016022:Case-Control Studies; D003865:Major Depressive Disorder / Q000473:pathology*; D005260:Female; D005858:Germany; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D066127:White Matter / Q000473:pathology*
ARWML; brainstem; late-onset major depression; white matter lesions