What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Depressive symptoms and history of depression (n=1077). Intervention: Severe subcortical white matter lesions vs. Mild or no white matter lesions. Primary outcome: Presence of depressive symptoms (OR 5.4, 95% CI 1.8-16.5).

November 1, 2000Archives of General Psychiatry434 citationsOpen Access

Cerebral White Matter Lesions and Depressive Symptoms in Elderly Adults

JGJan Cees de GrootCardiac Imaging FLFrank‐Erik de LeeuwRadboud University Nijmegen MOMatthijs OudkerkCardiac Imaging

Key Result

Elderly persons with severe subcortical white matter lesions were significantly more likely to have depressive symptoms compared to those with mild or no lesions (OR 5.4).

Study Design

Type

Cross-Sectional (n=1,077)

Multicenter

Yes

Structured PICO

Does the severity of cerebral white matter lesions increase the likelihood of depressive symptoms and history of depression in nondemented elderly adults?

Population

1,077 nondemented elderly adults aged 60 to 90 years from the Netherlands assessed for cerebral white matter lesions and depressive symptoms.

Exposure

Severe subcortical and periventricular white matter lesions (upper quintile) assessed via magnetic resonance imaging

Comparator

Mild or no white matter lesions (lowest quintile)

Outcome

Presence of depressive symptoms (defined as Center for Epidemiologic Studies Depression Scale [CES-D] score ≥16) and history of depressionpatient reported

Severe subcortical white matter lesions are strongly associated with the presence of depressive symptoms and a history of late-onset depression in elderly adults, supporting a vascular etiology for late-life depression.

Main Result

Odds Ratio: 5.4 (95% CI 1.8–16.5)

Limitations

Potential selection bias as participants were younger and more educated than nonparticipants.
Use of a retrospective questionnaire for history of depression may have introduced recall bias.
Findings in this elderly adult population cannot be extrapolated to younger age groups.

Abstract

BACKGROUND: There is evidence for a vascular cause of late-life depression. Cerebral white matter lesions are thought to represent vascular abnormalities. White matter lesions have been related to affective disorders and a history of late-onset depression in psychiatric patients. Their relation with mood disturbances in the general population is not known. We investigated the relation between white matter lesions and the presence of depressive symptoms or a history of depression in a population-based study. METHODS: In a sample of 1077 nondemented elderly adults, we assessed the presence and severity of subcortical and periventricular white matter lesions using magnetic resonance imaging, presence of depressive symptoms, and history of depression. Using multiple regression analysis, we examined the relation among white matter lesions, depressive symptoms, and history of depression. RESULTS: Most of the subjects had white matter lesions. Persons with severe white matter lesions (upper quintile) were 3 to 5 times more likely to have depressive symptoms as compared with persons with only mild or no white matter lesions (lowest quintile) (periventricular odds ratio OR = 3.3; 95% confidence interval CI, 1.2-9.5; subcortical OR = 5.4; 95% CI, 1.8-16.5). In addition, persons with severe subcortical but not periventricular white matter lesions were more likely to have had a history of depression with an onset after age 60 years (OR = 3.4; 95% CI, 1.1-10.7) compared with persons with only mild or no white matter lesions. CONCLUSION: The severity of subcortical white matter lesions is related to the presence of depressive symptoms and to a history of late-onset depression.

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