The Multi-Faceted Relationship between White Matter Lesions and Late-Life Depression.
The Multi-Faceted Relationship between White Matter Lesions and Late-Life Depression.
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DOI：
10.1016/j.jagp.2017.09.017
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发表时间：
2017-12
期刊：
影响因子：
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通讯作者：
Minjie Wu;H. Aizenstein
中科院分区：
文献类型：
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作者：
Minjie Wu;H. Aizenstein
White matter lesions (WMLs), identified as hyperintensities (WMHs) on T2-weighted FLAIR MR brain images, are the most prominent MRI characteristic of vascular depression. The WMLs are thought to disrupt frontal-subcortical white matter tracts underlying emotion and cognition, and thus contribute to the development and course of late-life depression (LLD) 1–5. WMHs are more prevalent and extensive in LLD than in non-depressed older adults. 6–8 Among older adults with depression, greater WMHs are associated with greater depression severity, 9 lower executive function, 10 more persistent symptoms and poorer outcomes. 11–13 Further, longitudinal studies show that the progression of WMHs predicts a poor course of LLD. 14–16 However, it remains unclear how global and regional WMHs are related to the development and progression of specific depression symptoms. In this issue of American Journal of Geriatric Psychiatry, using a 10-year longitudinal follow-up design, Tully et al. report unique relationships between baseline regional WMHs and trajectories of discrete depression symptoms in incident depression and/or dementia. 17In the Tully et al. study, 1440 older adults were included from the Three-City Dijon cohort, who had no depression, dementia or stroke at baseline. The participants underwent MRI scans at baseline and were then followed for incident neurologic diseases and comorbidities up to five times over a 10-year period. Depression symptoms were assessed with the Center for Epidemiologic Studies Depression Scale (CES-D Scale) and its four subscales including somatic symptoms, depressed affect, low positive affect, and interpersonal problems. Tully et al. found unique relationships between WMH volumes (periventricular, deep, and total) and trajectories of discrete depression symptoms in incident depression and/or dementia. Specifically, periventricular WMH (PVWMH) volumes were associated with low positive affect among subjects who developed depression (N= 344), deep WMH (DWMH) volumes were associated with depressed affect in subjects who developed dementia (N= 49), and WMH volumes (periventricular, deep, and total) was associated with interpersonal problems in those with incident dementia and depression (N= 26). These findings shed insights on the mechanism of the vascular depression model. In particular, by showing that WMHs precede incident depression, they support a causal rather than just correlative relationship between cerebrovascular burden and depression in older adults. Further, these findings add to existing literature emphasizing the prognostic significance of lesion locations in the development of depressive symptoms in patients with incident depression or dementia.
