Late-life depression, heart failure and frontal white matter hyperintensity: a structural magnetic resonance imaging study

Abstract

The relevance of the relationship between cardiac disease and depressive symptoms is well established. White matter hyperintensity, a bright signal area in the brain on T2-weighted magnetic resonance imaging scans, has been separately associated with cardiovascular risk factors, cardiac disease and late-life depression. However, no study has directly investigated the association between heart failure, major depressive symptoms and the presence of hyperintensities. Using a visual assessment scale, we have investigated the frequency and severity of white matter hyperintensities identified by magnetic resonance imaging in eight patients with late-life depression and heart failure, ten patients with heart failure without depression, and fourteen healthy elderly volunteers. Since the frontal lobe has been the proposed site for the preferential location of white matter hyperintensities in patients with late-life depression, we focused our investigation specifically on this brain region. Although there were no significant group differences in white matter hyperintensities in the frontal region, a significant direct correlation emerged between the severity of frontal periventricular white matter hyperintensity and scores on the Hamilton scale for depression in the group with heart failure and depression (P = 0.016, controlled for the confounding influence of age). There were no significant findings in any other areas of the brain. This pattern of results adds support to a relationship between cardiovascular risk factors and depressive symptoms, and provides preliminary evidence that the presence of white matter hyperintensities specifically in frontal regions may contribute to the severity of depressive symptoms in cardiac disease. Correspondence

Vascular and cognitive functions associated with cardiovascular disease in the elderly

“…For the most part, the relationships with respect to the cognitive and MRI were theoretically consistent as one would expect attention, executive, and psychomotor function to be most affected in patients with greater WMH (Almeida et al, 2005;Bakker et al, 1999;Breteler et al, 1994;Chalela, Wolf, Maldjian, & Kasner, 2001;R. Cohen, 1993;R.…”

Cognitive performance in older adults with stable heart failure: Longitudinal evidence for stability and improvement

“…Indeed, this study found depression was associated with reduced baseline cognitive function in each domain, which is consistent with past cross-sectional studies examining this link in HF (Garcia et al, 2011; Pullicino et al, 2008). Depression in HF may represent a neuropsychiatric change secondary to underlying brain pathology, including white matter lesions of the frontal brain regions (Almeida et al, 2005) and such mechanisms are also thought to underlie cognitive impairment in HF (Hoth, 2010). Our findings showed that depression remained stable over time, which indeed may be attributed to minimal changes in neuropathology or disease severity.…”

The Effect of Subsyndromal Symptoms of Depression and White Matter Lesions on Disability for Individuals With Mild Cognitive Impairment

“…Therefore, we cannot exclude that this factor contributed to our failure to demonstrate the hypothesized association between SSD and WML. Lastly, we averaged WML volumes over the whole brain to evaluate the relationship of white matter abnormalities and SSD which might be a less specific measure than regional WMSH volumes given that previous studies have shown that frontal WML may have stronger associations with depressive symptoms than WMSH in other brain regions (41).…”