Comparison of White Matter Lesions on the Magnetic Resonance Imaging in Major Depression and Vascular Depression

Cheon, Jin Sook

Abstract

OBJECTIVES
The aims of this study were to identify the frequency and severity of white matter lesions on MRIs of late-life depression and deppression due to cerebrovascular diseases (vascular depression), to evaluate the relation with cerebrovascular risk factors, and finally to understand an important cause of late-life depression. DESIGN: The frequency and severity of the periventricular hyperintensity and the deep white matter hyperintensity were measured on the brain MRIs in the patients with major depression, vascular depression and neurotic controls over 50 yrs of age. The association of the white matter lesions with cerebrovascular risk factors were evaluated.
MATERIALS AND METHODS
The MRI films of 32 patients (15 males & 17 females) with major depression over 50 yrs of age, 25 patients (17 males & 8 females) with vascular depression, and 25 neurotic controls (6 males & 19 females) were analyzed for the white matter lesions according to the modified Fazekas criteria. The cerebrovascular risk factors including hypertension, arteriosclerosis, obesity, smoking, diabetes mellitus, thyroid function abnoramlities, EKG abnormality, stroke, etc were also assessed.
RESULTS
1) The frequency of periventricular lesions or deep white matter lesions were significantly higher in patients with vascular depression and major depression than in neurotic controls. 2) The intracerebral hyperintensities or classical infarctions were prevalent in frontal cortex (32.0%) and in basal ganglia (40.0%). 3) Among cerebrovascular risk factors, stroke (p<0.005), hypertension (p<0.025), EKG abnormality (p<0.005) and smoking (p<0.05) were significantly prevalent in the patients with vascular depression and major depression as compared with neurotic controls. 4) The severity of white matter lesions were significantly associated with the cerebrovascular risk factors (p<0.005) in patients with major depression over 50 yrs of age.
CONCLUSIONS
The white matter hyperintensities on brain MRIs of patients with major depression over 50 yrs of age were significantly associated with cerebrovascular risk factors, which suggested a vascular origin of pathogenesis of late-life depression.