White Matter Hyperintensities and the Course of Depressive Symptoms in Elderly People with Mild Dementia

Abstract

Objectives: To explore the relationship between white matter hyperintensities (WMH) and the prevalence and course of depressive symptoms in mild Alzheimer’s disease (AD) and Lewy body dementia. Design: This is a prospective cohort study conducted in secondary care outpatient clinics in western Norway. Subjects: The study population consisted of 77 elderly people with mild dementia diagnosed according to standardised criteria. Methods: Structured clinical interviews and physical, neurological, psychiatric, and neuropsychological examinations were performed and routine blood tests were taken. Depression was assessed using the depression subitem of the Neuropsychiatric Inventory and the Montgomery-Åsberg Depression Rating Scale (MADRS). A standardised protocol for magnetic resonance imaging scan was used, and the volumes of WMH were quantified using an automated method, followed by manual editing. Results: The volumes of total and frontal deep WMH were significantly and positively correlated with baseline severity of depressive symptoms, and depressed patients had significantly higher volumes of total and frontal deep WMH than non-depressed patients. Higher volumes of WMH were also associated with having a high MADRS score and incident and persistent depression at follow-up. After adjustment for potential confounders, frontal deep WMH, in addition to prior depression and non-AD dementia, were still significantly associated with baseline depressive symptoms (p = 0.015, OR 3.703, 95% CI 1.294–10.593). Similar results emerged for total WMH. Conclusion: In elderly people with mild dementia, volumes of WMH, in particular frontal deep WMH, were positively correlated with baseline severity of depressive symptoms, and seemed to be associated with persistent and incident depression at follow-up. Further studies of the mechanisms that determine the course of depression in mild dementia are needed.

Neuropsychiatric Symptoms in Alzheimer Disease, Vascular Dementia, and Mixed Dementia

“…Apathy has been related to anterior cingulate atrophy [17,18]. Aside from atrophy, white matter hyperintensities (WMH) have been associated with NPS; periventricular WMH volumes have been related to hallucinations, depression and anxiety in patients with AD and VaD dementias [19], more so if in the frontal lobe [20,21]. In another study, changes in white matter, primarily in the frontal and parieto-occipital regions, were suggested to contribute to the development of delusional misidentification in patients with AD [22].…”

Relationship between Orthostatic Hypotension and White Matter Hyperintensity Load in Older Patients with Mild Dementia

“…They have been associated with depression [5] and dementia [6]. WMH predict functional decline in voiding, mobility and cognition, and depression [7]–[9].…”

Toward the development of a cost-effective e-depression detection system

“…The high performance of the combination of the largest Lya punov exponent and regularity dimension features suggests the computational usefulness of the application of chaos and nonlinear dynamical methods to the cost-effective analysis of the photoplethysmography for depression detection. There are evidences about the close relationships between depression and cardiovascular disease [12] and dementia [30], and the use magnetic resonance imaging for quantifying white matter hyperintensities of the brain has been studied to validate such hypotheses [29], [30]. Computational tools for effective analysis of photoplethysmographic waves would add another significant piece of information for these studies.…”