Progression of cerebral white matter lesions is not associated with development of depressive symptoms in elderly subjects at risk of cardiovascular disease. The PROSPER Study

Versluis, Cisca; Mast, Roos C. van der; Buchem, Mark A. van; Bollen, Edward L.E.M.; Blauw, Gerard J.; Eekhof, Just; Wee, Nic J.A. van der; Craen, Anton J. M. de

doi:10.1002/gps.1477

Cited by 57 publications

(46 citation statements)

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“…Our finding that WMLs preceded major depression is in agreement with three previous longitudinal studies using MRI (Godin et al, 2008;Steffens et al, 2002;Teodorczuk et al, 2007). However, two longitudinal population-based studies did not support this association (Ikram et al, 2010;Versluis et al, 2006). WMLs most likely reflect ischemic demyelination (Pantoni and Garcia, 1997).…”

Section: Discussionsupporting

confidence: 90%

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Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

Olesen

Gustafson

Simoni

et al. 2010

Neuropsychopharmacol

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The influence of organic brain changes on the development of depression in the elderly is uncertain. Cross-sectional studies, most often from clinical samples, report associations with brain atrophy and cerebrovascular disease, while longitudinal population studies have given mixed results. Our aim was to investigate whether cortical atrophy and white matter lesions (WMLs) on computed tomography (CT) predict occurrence of depression in the elderly. This is a prospective population-based study with 5-year follow-up. The baseline sample included 525 elderly subjects, aged 70-86 years, without dementia or major depression, with a score on the Mini-Mental State Examination above 25, and without dementia at follow-up. Cortical atrophy and WMLs were evaluated at baseline using CT. The main outcome measure was development of major or minor depression at follow-up according to Diagnostic and Statistical Manual of Mental Disorders, fourth edition, as evaluated using neuropsychiatric examinations and hospital discharge registers. Logistic regression was used to estimate risk. Over the period of 5 years, 20 individuals developed major and 63 minor depression. Presence of temporal lobe atrophy (odds ratio (OR) ¼ 2.81, 95% confidence interval (CI) 1.04-7.62) and moderate-to-severe WMLs (OR ¼ 3.21, 95% CI 1.00-10.26) independently predicted major, but not minor, depression after controlling for various confounders. Other brain changes did not predict occurrence of depression. Our findings suggest that temporal lobe atrophy and WMLs represent relatively independent and complementary pathways to major depression in the elderly. This may have implications for prevention, as both neurodegeneration and cerebrovascular disease have been related to preventable factors.

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Section: Discussionsupporting

confidence: 90%

“…The results from longitudinal population-based studies are conflicting. Three studies using MRI reported that WMLs increased the risk of subsequent depression (Godin et al, 2008;Steffens et al, 2002;Teodorczuk et al, 2007) while two could not confirm these findings (Ikram et al, 2010;Versluis et al, 2006).…”

Section: Introductionmentioning

confidence: 97%

Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

Olesen

Gustafson

Simoni

et al. 2010

Neuropsychopharmacol

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“…In addition, more voluminous baseline white matter lesions were associated with an increased risk of developing depression during life in subjects who were free of depression. In contrast, in a 3-year longitudinal study, Versluis et al [90] did not find any relationship between WMHs and depressive symptoms in elderly subjects.…”

Section: White Matter Hyperintensities On Brain Mri: Not New But Stilmentioning

confidence: 87%

Review of Cerebral Microangiopathy and Alzheimer’s Disease: Relation between White Matter Hyperintensities and Microbleeds

Hommet

Mondon²,

Constans

et al. 2011

Dement Geriatr Cogn Disord

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Although Alzheimer’s disease (AD) is basically considered to be a neurodegenerative disorder, cerebrovascular disease is also involved. The role of vascular risk factors and vascular disease in the progression of AD remains incompletely understood. With the development of brain MRI, it is now possible to detect small-vessel disease, whose prevalence and severity increase with age. The first types of small-vessel disease to be described were white matter hyperintensities (WMHs). More recently, small areas of signal loss on T₂*-weighted images, also called microbleeds (MBs), have been reported. Cerebral MBs are focal deposits of hemosiderin that indicate prior microhemorrhages around small vessels, related to either ruptured atherosclerotic microvessels or amyloid angiopathy. Consequently, using brain MRI for the detection of microangiopathy may prove useful to improve our understanding of the impact of the vascular burden in AD pathology. The relationship between microangiopathy and the clinical course of AD or the conversion of mild cognitive impairment to AD remains questionable in terms of cognitive or affective symptoms, particularly if we consider MBs.

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“…Three prospective MRI studies [188][189][190] and 1 CT study 157 reported that WMLs increased the risk of subsequent depression, while 2 MRI studies could not confirm these findings. 158,191 Part of the relation between white matter changes and depression may be mediated by loss of functional ability. 192 WMLs in elderly depressed patients may influence outcome of depression, such as time to relapse 193 and response to antidepressant therapy.…”

Section: Cerebrovascular Diseasementioning

confidence: 99%

Psychiatric Disorders in the Elderly

Skoog

2011

Can J Psychiatry

107

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Recent research has shown that depression, anxiety disorders, and psychosis are more common than previously supposed in elderly populations without dementia. It is unclear whether the frequency of these disorders increases or decreases with age. Clinical expression of psychiatric disorders in old age may be different from that seen in younger age groups, with less and often milder symptoms. Concurrently, comorbidity between different psychiatric disorders is immense, as well as comorbidity with somatic disorders. Cognitive function is often decreased in people with depression, anxiety disorders, and psychosis, but whether these disorders are risk factors for dementia is unclear. Psychiatric disorders in the elderly are often related to cerebral neurodegeneration and cerebrovascular disease, although psychosocial risk factors are also important. Psychiatric disorders, common among the elderly, have consequences that include social deprivation, poor quality of life, cognitive decline, disability, increased risk for somatic disorders, suicide, and increased nonsuicidal mortality.Can J Psychiatry. 2011;56 (7):387-397. Key Words: depression, anxiety, psychosis, elderly, epidemiologic methods, prevalence, risk factors, comorbidityM ost research on mental disorders have been concerned with dementia and to some extent with depression. Other mental disorders, such as anxiety disorders and psychotic disorders, have received less attention. This review will discuss the frequency of mental disorders in the elderly, and its relation to age. Aspects of mental disorders in the elderly without dementia, such as clinical expression and comorbidity, cognitive function and dementia, cerebral neurodegeneration and cerebrovascular disease, and risk factors and consequences, will also be discussed. Frequency of Mental Disorders in the ElderlyThe prevalence of mental disorders is high among the elderly, 1-4 with a prevalence of almost 20% in people without dementia aged 65 years and older.2 While most people in epidemiologic studies are below age 90 years, it was recently reported that almost one-third of people without dementia aged 95 years fulfilled criteria for a psychiatric disorder: 17% had depression, 9% anxiety, and 7% a psychotic disorder. 5Most studies on the epidemiology of mental disorders in the elderly without dementia have been concerned with depression. Cross-sectional studies report prevalence figures of around 5% to 10% for depression, 3,[6][7][8][9][10][11][12] and 1% to 5% for major depression.2,3,13 These figures may be even higher in the developing world.14 This makes depression more common than dementia in people aged 65 years and older. The prevalence of depressive symptoms are even more common than the clinical diagnoses. Such subsyndromal forms of depression are nevertheless associated with adverse outcomes, such as stroke, disability, and mortality. 15-18Anxiety disorders include GAD, agoraphobia, panic anxiety disorder, OCD, social phobia, and specific phobias. Recent research suggests that anxiety disorder...

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Progression of cerebral white matter lesions is not associated with development of depressive symptoms in elderly subjects at risk of cardiovascular disease. The PROSPER Study

Abstract: This longitudinal study does not confirm the involvement of cerebrovascular disease expressed as MRI white matter hyperintensities in the development of depressive symptoms in elderly subjects.

Cited by 57 publications

References 40 publications

Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

Review of Cerebral Microangiopathy and Alzheimer’s Disease: Relation between White Matter Hyperintensities and Microbleeds

Psychiatric Disorders in the Elderly

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