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Am J Psychiatry 1992; 149:620-625
Copyright © 1992 by American Psychiatric Association
White matter hyperintensity signals in psychiatric and nonpsychiatric subjects
FW Brown, RJ Lewine, PA Hudgins and SC Risch
Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30329.
OBJECTIVE: As part of an ongoing study investigating the relationship
between brain morphology/function and neuropsychological performance in
psychopathology, the authors conducted brain magnetic resonance imaging
(MRI) studies to investigate the prevalence and psychiatric significance of
white matter hyperintensity signals. METHOD: Brain MRI acquisition was done
with 0.5 and 1.5 Tesla Philips scanners. Psychiatric subjects (N = 229) and
normal volunteers (N = 154) were recruited by newspaper and local
advertising and by physician referral. DSM-III-R criteria were used. White
matter hyperintensity signals were rated on a 4-point scale of severity.
Prevalence rates and risk ratios were calculated. RESULTS: Prevalence rates
of hyperintensity signals in all psychiatric subjects (mean age = 34 years,
SD = 9) and normal volunteers (mean age = 34, SD = 10) were 6.6% and 9.1%,
respectively (a nonsignificant difference). When all psychiatric subjects,
subjects under age 45, and subjects age 45 and over in a diagnostic
category were considered, there were no statistically significant
differences between them and normal volunteers in the same age groups in
prevalence of schizophrenia, schizoaffective disorder, bipolar disorder,
major depression, and obsessive-compulsive disorder. A significant
difference existed between the severity of deep white matter hyperintensity
signals in subjects with major depression and normal volunteers. Older age
was correlated as a risk factor for white matter hyperintensity signals for
psychiatric subjects. CONCLUSIONS: These results do not support previous
findings of greater prevalence of hyperintensity signals in bipolar
disorder. Significantly higher prevalence rates of hyperintensity signals
were seen in subjects with major depression only when severity of the deep
white matter hyperintensity signals was considered. Older age is an
indirect risk factor for the presence of white matter hypertensity signals,
probably as a result of vascular changes associated with concurrent medical
illnesses.
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