High WMH Volume and Depression Increase Risk of Functional Decline

Older adults with depression and a high volume of white matter hyperintensities (WMH) are at increased risk for functional decline, compared with older adults who have not been diagnosed with depression and older adults with low volumes of WMH, according to a study published in the January issue of American Journal of Geriatric Psychiatry.

In this investigation, 381 individuals age 60 or older responded to the Duke Depression Evaluation Schedule’s questions about their functional limitations. The study population, which comprised 244 patients with major depression and 137 individuals who had never had depression (ie, the controls), also underwent MRI to identify their total volume of WMH in the periventricular region and in deep white matter at baseline. The median length of follow-up for the study’s participants was five years, and some individuals were followed for as many as 16 years.

“We estimated linear mixed models to measure the associations between white matter lesion volume at baseline and change in functional status over time for each participant, controlling for age, sex, race, years of education, Mini-Mental State Examination score, and self-reported hypertension at the time of study enrollment,” said Celia F. Hybels, PhD, Associate Professor in Psychiatry and Behavioral Sciences at Duke University School of Medicine in Durham, North Carolina, and her colleagues.

Study participants with depression and a higher volume of WMH at baseline were at greatest risk for functional decline. Among participants who had never had depression, individuals with a higher WMH volume at the beginning of the study “had a more accelerated rate of functional decline,” compared with the other controls. In contrast to patients with depression and a higher volume of WMH at baseline, the patients with depression and a lower WMH volume at baseline had functional decline at a similar rate as controls with lower WMH volume.

The authors found that “depression is a modifier in the association between WMH and functional decline in older adults, which suggests one pathway by which older depressed adults develop disability. Those older adults with increased WMH volume who were also depressed had a sharper increase in the number of limitations over time, compared with older adults with a lower volume of WMH who were also depressed and with older adults without a history of depression. That depression is a moderator in the association between white matter pathology and functional decline suggests a unique contribution of depression.” They concluded by suggesting that follow-up studies use physical performance instead of self-report to measure individuals’ functional status.

—Katie Wagner Lennon

Older adults with depression and a high volume of white matter hyperintensities (WMH) are at increased risk for functional decline, compared with older adults who have not been diagnosed with depression and older adults with low volumes of WMH, according to a study published in the January issue of American Journal of Geriatric Psychiatry.

In this investigation, 381 individuals age 60 or older responded to the Duke Depression Evaluation Schedule’s questions about their functional limitations. The study population, which comprised 244 patients with major depression and 137 individuals who had never had depression (ie, the controls), also underwent MRI to identify their total volume of WMH in the periventricular region and in deep white matter at baseline. The median length of follow-up for the study’s participants was five years, and some individuals were followed for as many as 16 years.

“We estimated linear mixed models to measure the associations between white matter lesion volume at baseline and change in functional status over time for each participant, controlling for age, sex, race, years of education, Mini-Mental State Examination score, and self-reported hypertension at the time of study enrollment,” said Celia F. Hybels, PhD, Associate Professor in Psychiatry and Behavioral Sciences at Duke University School of Medicine in Durham, North Carolina, and her colleagues.

Study participants with depression and a higher volume of WMH at baseline were at greatest risk for functional decline. Among participants who had never had depression, individuals with a higher WMH volume at the beginning of the study “had a more accelerated rate of functional decline,” compared with the other controls. In contrast to patients with depression and a higher volume of WMH at baseline, the patients with depression and a lower WMH volume at baseline had functional decline at a similar rate as controls with lower WMH volume.

The authors found that “depression is a modifier in the association between WMH and functional decline in older adults, which suggests one pathway by which older depressed adults develop disability. Those older adults with increased WMH volume who were also depressed had a sharper increase in the number of limitations over time, compared with older adults with a lower volume of WMH who were also depressed and with older adults without a history of depression. That depression is a moderator in the association between white matter pathology and functional decline suggests a unique contribution of depression.” They concluded by suggesting that follow-up studies use physical performance instead of self-report to measure individuals’ functional status.

—Katie Wagner Lennon

Older adults with depression and a high volume of white matter hyperintensities (WMH) are at increased risk for functional decline, compared with older adults who have not been diagnosed with depression and older adults with low volumes of WMH, according to a study published in the January issue of American Journal of Geriatric Psychiatry.

In this investigation, 381 individuals age 60 or older responded to the Duke Depression Evaluation Schedule’s questions about their functional limitations. The study population, which comprised 244 patients with major depression and 137 individuals who had never had depression (ie, the controls), also underwent MRI to identify their total volume of WMH in the periventricular region and in deep white matter at baseline. The median length of follow-up for the study’s participants was five years, and some individuals were followed for as many as 16 years.

“We estimated linear mixed models to measure the associations between white matter lesion volume at baseline and change in functional status over time for each participant, controlling for age, sex, race, years of education, Mini-Mental State Examination score, and self-reported hypertension at the time of study enrollment,” said Celia F. Hybels, PhD, Associate Professor in Psychiatry and Behavioral Sciences at Duke University School of Medicine in Durham, North Carolina, and her colleagues.

Study participants with depression and a higher volume of WMH at baseline were at greatest risk for functional decline. Among participants who had never had depression, individuals with a higher WMH volume at the beginning of the study “had a more accelerated rate of functional decline,” compared with the other controls. In contrast to patients with depression and a higher volume of WMH at baseline, the patients with depression and a lower WMH volume at baseline had functional decline at a similar rate as controls with lower WMH volume.

The authors found that “depression is a modifier in the association between WMH and functional decline in older adults, which suggests one pathway by which older depressed adults develop disability. Those older adults with increased WMH volume who were also depressed had a sharper increase in the number of limitations over time, compared with older adults with a lower volume of WMH who were also depressed and with older adults without a history of depression. That depression is a moderator in the association between white matter pathology and functional decline suggests a unique contribution of depression.” They concluded by suggesting that follow-up studies use physical performance instead of self-report to measure individuals’ functional status.

—Katie Wagner Lennon