Cortical and Subcortical Abnormalities in Late-Onset Depression With History of Suicide Attempts Investigated With MRI and Voxel-Based Morphometry

Abstract

Late-onset major depression is thought to have a biological (vascular) basis, which could be a result of brain structure change. Vascular lesions can affect both the gray matter (GM) and white matter (WM), while most previous studies addressed WM abnormality. This study explored the disease- and symptom (history of suicide attempt) -related GM morphometry in elderly male patients with late-onset depression. A total of 70 patients with depression admitted to our geriatric psychiatric ward were investigated, and 26 age-matched males were recruited as controls. We used T1-weighted magnetic resonance imaging (MRI) to obtain cerebral structural information and adopted voxel-based morphometry (VBM) to investigate brain volume change related to disease (depression vs control) and symptom (depression with history of suicide attempt vs depression without history of suicide attempt). Late-onset depression was associated with smaller volumes in several regions of GM (insula and the posterior cingulate region) and WM (subcallosal cingulate cortex, floor of lateral ventricles, parahippocampal region, insula, and the cerebellum). Compared with nonsuicidal counterpart, suicidal depression was associated with decreased GM and WM volume in the frontal, parietal, and temporal regions, and the insula, lentiform nucleus, midbrain, and the cerebellum. Marked regional volume reduction was noticed at dorsal medial prefrontal cortex. Our results demonstrate that the development of suicidal behaviors in major depression is related to widespread but discrete volume reduction in several cortical and subcortical structures, fitting with the hypothesis that decreased cerebral volume in certain regions renders biological susceptibility to attempt suicide during depressive states.

Grey matter volume increase following electroconvulsive therapy in patients with late life depression: a longitudinal MRI study

“…27,29 Insular volume is decreased in elderly, hospitalized men with lateonset depression. 32 In pa tients with major depressive disorder (MDD) in general, the left dorsal anterior insular grey matter volume is decreased, 33 and illness duration is inversely correlated with grey matter density in the bilateral insula in remitted patients. 34 Grey matter volume reductions in the superior temporal area have been associated with illness duration and cumulative illness severity 35 as well as with enduring changes in patients with MDD even after recovery.…”

Brain grey matter volume alterations in late-life depression

“…The search strategy identified a total of 799 documents, and 11 VBM studies [10][11][12][13][14][15][16][27][28][29][30] met the inclusion criterion of comparing grey matter volume alterations between patients with LLD and healthy controls. No additional articles were found in the reference lists of the selected studies.…”

Prefrontal cortex, temporal cortex, and hippocampus volume are affected in suicidal psychiatric patients

“…Other studies suggest suicidality is attributable to a broader decrease in cerebral volume. Hwang and colleagues (Hwang et al, 2010) performed a study with geriatric depressed patients and found that suicidal patients with depression had decreased frontal, parietal and temporal lobe volumes as compared to non-suicidal patients with depression. Another study performed with schizophrenics supported the hypothesis that fronto-temporal regions are affected by suicidality; showing decreased cortical density in the left superior temporal lobe and left OFC in subjects who had attempted suicide compared to non-attempters (Aguilar et al, 2008).…”