Elsevier

Biological Psychiatry

Volume 63, Issue 7, 1 April 2008, Pages 663-669
Biological Psychiatry

Original Article
White Matter Lesions as a Predictor of Depression in the Elderly: The 3C-Dijon Study

https://doi.org/10.1016/j.biopsych.2007.09.006Get rights and content

Background

There is increasing evidence for a link between cerebrovascular disease and depression in the elderly but the mechanisms are still unknown. This study examines the longitudinal relationship between depression and white matter lesions (WML) in a sample of elderly aged 65 years and older.

Methods

Three City (3C)-Dijon is a 4-year follow-up population-based prospective study of 1658 subjects. At baseline, lifetime major depressive episode diagnosis was established using the Mini International Neuropsychiatric Interview. At each study wave, severity of depressive symptoms was assessed using Center for Epidemiological Studies-Depression (CES-D), and antidepressants intake was recorded. At baseline, lifetime major depression (LMD) was defined as lifetime major depressive episode or antidepressant medication intake. At follow-up, subjects were classified “incident depression” if scoring high at CES-D or antidepressant users. At baseline, cerebral magnetic resonance imaging (MRI) was performed to quantify WML volumes using an automated method of detection. At 4-year follow-up, 1214 subjects had a second MRI.

Results

Cross-sectional analysis showed a significantly higher WML volume in subjects with LMD compared with other subjects. Adjusted longitudinal analysis showed that increase in WML load was significantly higher in subjects with baseline LMD (2.1 cm3 vs. 1.5 cm3, p = .004). Among subjects free of depression up to baseline (n = 956), the higher the baseline WML volume, the higher the risk of developing depression during follow-up (odds ratio one quartile increase: 1.3; 95% confidence interval: = 1.1–1.7).

Conclusions

Our data show that depression and WML volumes are strongly related. These results are consistent with the hypothesis of a vascular depression in the elderly.

Section snippets

Sample

The Three City (3C) Study is a multicenter cohort study, conducted in three French cities (Bordeaux, Dijon, and Montpellier) and designed to estimate dementia risk attributable to vascular factors. A sample of noninstitutionalized subjects aged 65 years and older was randomly selected from the electoral rolls of each city. Between January 1999 and March 2001, 9294 subjects were enrolled (Bordeaux, n = 2104; Dijon, n = 4931; Montpellier, n = 2259). The detailed description of the study protocol

Results

The study sample at baseline is described in Table 1. Mean age of participants was 72.4 years (SD =4.1), and 60.6% of participants were women. Prevalence of LMD was 14.5%, and 13.1% of subjects had high depressive symptoms.

Factors associated with LMD are also shown in Table 1. LMD prevalence was higher in women. Mean age did not differ significantly between subjects with LMD (72.7 years; SD = 4.0) and subjects without (72.4 years; SD = 4.1), p = .20. Alcohol and tobacco consumptions were

Discussion

In this study of elderly subjects, WML severity was associated with lifetime major depression. Cross-sectional analyses showed that subjects with LMD had a mean volume of WML significantly higher than subjects without LMD. The plausibility of this association was strengthened by the longitudinal analyses, which showed that the progression of WML volume over 4-year follow-up was significantly higher in subjects with LMD at baseline.

Our cross-sectional findings are in line with most studies in

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