Temporal relationships between depressive symptoms and white matter hyperintensities in older men and women

Abstract

Objective Associations between vascular disease and depression in late life, including increased white matter hyperintensities (WMHs), have been reported. Whether depression is an etiology or a consequence of vascular disease is still unknown. We investigated the temporal relationship between depressive symptoms and WMHs in older men and women. Methods We utilized data from 90 dementia-free older adults (39 women, 51 men), 57 years of age and older at baseline, from the neuroimaging substudy of the Baltimore Longitudinal Study of Aging. Participants were followed for up to 8 years. Ratings of white matter disease burden were available for the first, last, and at least one interim visit, and participants completed the Center for Epidemiologic Studies Depression Scale (CES-D) annually. Statistical models, performed separately in men and women, examined whether depressive symptoms predicted subsequent WMH ratings or WMHs predicted subsequent depressive symptoms. Results The total CES-D score was not associated with WMHs in men or women. In men, the CES-D depressed mood subscale predicted accelerating longitudinal increases in WMHs at older ages, but WMHs did not predict subsequent depressive symptoms. In women, there were no significant associations between the CES-D depressed mood subscale and WMHs. Conclusions White matter disease may be a consequence of depressed mood in men but not in women. Intervention strategies for depression may slow the progression of white matter disease in older men. These results add to previous findings documenting sex differences in the correlates of depressive disorders in late life.

White Matter Hyperintensity Accumulation During Treatment of Late-Life Depression

“…The relationship between WMHs and the vascular depression hypothesis is further strengthened by studies demonstrating that WMHs are associated with treatment outcomes (Aizenstein et al, 2011;Firbank et al, 2007;Heiden et al, 2005;Taylor et al, 2014). However, as several other studies have failed to find the association between WMHs and depression, the vascular depression hypothesis is not universally accepted (Aizenstein et al, 2011;Dotson et al, 2013). The failure to find robust cross-sectional associations between cerebrovascular disease and LLD does not prove that WMH changes do not promote depression, but may suggest that the association with depression is weak given the large variability of WMHs across elderly individuals.…”

Authors' reply

“…However, other recent studies have suggested that this sequence could be bidirectional. 2 As I argue elsewhere, 3 the relationship between physical disease and mood disorder in the elderly is likely to be aetiologically complex and characterised by reciprocity.…”

“…The recent paper by Gunnell et al 1 and the accompanying editorial by Pitman & Caine 2 clearly outline the practice and principles of a contemporary approach to suicide prevention in mental health settings. However, I do not think the policy initiative that every patient with a serious mental illness or a recent episode of self-harm should be followed up within a week of discharge is really a high-risk approach to suicide prevention.…”

“…2 Such groups are described in the 2012 suicide prevention strategy for England as those 'with particular vulnerabilities or problems with access to services' (p. 21). 3 The groups listed include children and young people; people with a history of childhood abuse; minority ethnic groups and asylum seekers; and people with untreated depression.…”

“…2 A universal intervention corresponds to the population approach, in that it is applied to a broad population irrespective of the risk of individual members, in order to change norms and values, to influence unidentified members of the population who may carry more risk and, ultimately, to shift the risk of the entire population. At the other end of the spectrum, an indicated intervention corresponds to a high-risk approach, in that it is applied to identified symptomatic individuals.…”