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Am J Psychiatry 1996; 153:1280-1287
Copyright © 1996 by American Psychiatric Association
Cognition and white matter hyperintensities in older depressed patients
IM Lesser, KB Boone, CM Mehringer, MA Wohl, BL Miller and NG Berman
Department of Psychiatry, Harbor-UCLA Medical Center, Torrance 90509, USA.
OBJECTIVE: The authors compared amounts of white matter hyperintensity in
late- and early-onset depressed patients and never-depressed older
subjects, compared neuropsychological function in these groups, and
investigated the association between white matter hyperintensities and
cognitive function in depression. METHOD: Sixty currently depressed
patients whose first depression occurred after age 50 years, 35 depressed
patients over age 50 whose first depression occurred before age 35, and 165
nonpsychiatrically ill subjects over age 50 underwent magnetic resonance
imaging (MRI) and neuropsychological evaluation. Areas of white matter
hyperintensity were measured from MRI images. RESULTS: The late-onset
patients had more white matter hyperintensity than either of the other
groups. Compared to the nondepressed subjects, the patients had
significantly lower scores in the cognitive domains of nonverbal
intelligence, nonverbal memory, constructional ability, executive ability,
and information processing speed. The cognitive abnormalities were mostly
confined to the late-onset patients, and the presence of a large amount of
white matter hyperintensity was associated with significantly poorer
executive skills. However, most of the scores were not in the significantly
impaired range. CONCLUSIONS: Large amounts of white matter hyperintensity
are more frequent in patients with late-onsetdepression than in elderly
subjects with early- onset or no depression. Both late- and early-onset
elderly depressed patients show mild decrements in some "right hemisphere"
cognitive skills; the late-onset subjects also show deterioration in
information processing speed and executive functions. Patients with large
amounts of white matter hyperintensity have significantly poorer executive
function.
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