White matter hyperintensities rather than lacunar infarcts are associated with depressive symptoms in older people: The LADIS study

Objective: Both white matter hyperintensities (WMH) and lacunar infarcts have been associated with the development of depression in older subjects, although the relative importance of the two and the influence of lesion location and concomitant vascular disease are unclear. This study investigates the relationship between location and burden of WMH and lacunes on depressive features in older people. Method: In a pan-European multicenter study of 626 older subjects, the authors examined the relationship between regional magnetic resonance imaging white matter hyperintensities, number of lacunar infarcts, depressive symptoms as assessed by the 15-item geriatric depression scale (GDS), cognitive status (Mini-Mental Status Examination), hypertension, and self-perceived health quality of life (QoL). Results: The authors found depressive symptoms to be correlated with WMH rating in the frontal (N = 626; Spearman's p = 0.161, p <0.001) and temporal (p = 0.14, p <0.001) but not occipitoparietal region (p = 0.07, p = 0.07). Basal ganglia lacunes were only weakly correlated with GDS (p = 0.09, p = 0.03), and lacunes in other regions showed no association. In a ordinal logistic regression model (controlling for QoL, Mini-Mental Status Examination, age, and with an interaction between WMH and hypertension), temporal WMH in the absence of hypertension independently predicted GDS, whereas neither history of stroke nor number of lacunar infarcts did. The authors compared left- versus right-sided WMH and found no effect of laterality on depressive symptoms. Conclusions: The results suggest that in this population of nondisabled older people, WMH have a greater influence on depressive symptoms than infarcts.