Depressive symptoms, antidepressant use, and brain volumes on MRI in a population-based cohort of old persons without dementia

Abstract

We examined whether late-life depression, including depressive symptoms and antidepressant use, was associated with smaller total brain volume, smaller hippocampal volume, and larger white matter hyperintensity (WMH) volume in a large community-based cohort of old persons without dementia. Within the Washington/Hamilton Height-Inwood Columbia Aging Project (WHICAP), a community-based cohort study in northern Manhattan, 630 persons without dementia (mean age 80 years, SD = 5) had volumetric measures of the total brain, hippocampus, and WMH at 1.5 Tesla MRI and data on current depression, defined as a score of 4 or higher on the 10-item Center for Epidemiologic Studies-Depression (CES-D) scale, or use of antidepressants. Multiple linear regression analyses adjusted for age, gender, ethnicity, education, cardiovascular disease history, and MRI parameters showed that subjects with current depression had smaller relative total brain volume (B = -0.86%; 95% CI -1.68 to -0.05%; p < 0.05), smaller relative hippocampal volume (B = -0.07 ml; 95% CI -0.14 to 0.00 ml; p = 0.05), and larger relative WMH volume (natural logtransformed B = 0.19 ml; 95% CI 0.02 to 0.35 ml; p < 0.05). When examined separately, antidepressant use was significantly associated with smaller total brain, smaller hippocampal, and larger WMH volume, while high CES-D scores were not significantly associated with any of the brain measures, although the direction of association was similar as for antidepressant use. With the caveat that analyses were cross-sectional and we had no formal diagnosis of depression, our findings suggest that in this community-based sample of old persons without dementia, late-life depression is associated with more brain atrophy and more white matter lesions, which was mainly driven by antidepressant use.

Figure 1

Relative total brain volume according to presence of depression, as defined as a high CES-D score or antidepressant use, CES-D score only, and antidepressant use only. Mean volumes are adjusted for age, gender, ethnicity, years of education, sumscore of hypertension/diabetes/heart disease/stroke signs or symptoms, stroke on MRI, and white matter hyperintensity volume. Error bars represent standard errors. * indicates statistically significant difference (p<0.05).

Figure 2

Mean hippocampal volume (mean of left and right hippocampus) according to presence of depression, as defined as a high CES-D score or antidepressant use, CES-D score only, and antidepressant use only. Mean volumes are adjusted for age, gender, ethnicity, years of education, sumscore of hypertension/diabetes/heart disease/stroke signs or symptoms, stroke on MRI, and white matter hyperintensity volume. Error bars represent standard errors. * indicates statistically significant difference (p<0.05). # p=0.05

Figure 3

Mean relative white matter hyperintensity volume according to presence of depression, as defined as a high CES-D score or antidepressant use, CES-D score only, and antidepressant use only. Mean volumes are adjusted for age, gender, ethnicity, years of education, sumscore of hypertension/diabetes/heart disease/stroke signs or symptoms, stroke on MRI, and white matter hyperintensity volume. Error bars represent standard errors. * indicates statistically significant difference (p<0.05).