SUBCORTICAL HYPERINTENSITIES ON MAGNETIC-RESONANCE-IMAGING IN PATIENTS WITH SEVERE DEPRESSION - A LONGITUDINAL EVALUATION

In a longitudinal evaluation of 37 patients with severe depression who had undergone brain magnetic resonance imaging (MRI) 6 months-2 years (mean 14.1 months) previously, the degree of residual dysfunction was predicted by the extent of subcortical white matter hyperintensities (WMHS, p <.01), longer time elapsed since the MRI scan (p < .05), olde r age (p < .05), and older age at onset of affective disorder (p < .05 ). Ten (27%) patients developed ''probable'' dementia syndromes of the vascular type, with such syndromes being predicted by WMHS (p <.01) a nd alder age of onset of affective disorder (p <.05). Institutionaliza tion of patients was predicted largely by the combination of chronic d epression, progressive cognitive decline, and advanced age. The study supports the notion that a subgroup of patients with late-onset depres sive disorders, without a family history of depression, and with risk factors to cerebrovascular disease, have extensive WMHS on MRI, and th at such structural brain changes predispose to chronic depression and progressive cognitive decline. (C) 1997 Society of Biological Psychiat ry.