Neuropathological evidence for ischemia in the white matter of the dorsolateral prefrontal cortex in late-life depression

被引:81
作者
Thomas, AJ [1 ]
Perry, R
Kalaria, RN
Oakley, A
McMeekin, W
O'Brien, JT
机构
[1] Newcastle Gen Hosp, Wolfson Res Ctr, Inst Hlth Elderly, Dept Pathol, Newcastle Upon Tyne NE4 6BE, Tyne & Wear, England
[2] Newcastle Univ, Dept Psychiat, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England
[3] Newcastle Univ, Inst Ageing & Hlth, Newcastle Upon Tyne NE1 7RU, Tyne & Wear, England
关键词
depression; elderly; white matter; cell adhesion molecule; neuropathology;
D O I
10.1002/gps.720
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Background Signal hyperintensities on magnetic resonance imaging in late-life depression are associated with treatment resistance and poor outcome. These lesions are probably vascular in origin and proposed sites for vascular damage include the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC). Methods We therefore examined white matter in these areas for microvascular disease and evidence of ischemia using intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion molecule-1 (VCAM- 1). We obtained postmortem tissue from elderly depressed (n = 20) and control (n = 20) subjects and blindly rated microvascular disease and ICAM-1 and VCAM-1 amount using quantitative image analysis in sections of the DLPFC, ACC and occipital cortex (OC; control area). Results We found a significant increase in ICAM-1 in the deep white matter of the DLPFC in the depressed group (p = 0.01) and a trend towards an increase for VCAM-1 (p = 0.10). In the gyral white matter there was a trend towards significance for both molecules (p=0.07 and 0.10). No differences were found in the ACC or OC or for microvascular disease in any area. Conclusions These findings are consistent with white matter ischemia in the DLPFC and lend support to the 'vascular depression' hypothesis. They implicate the DLPFC as an important site in the pathogenesis of late-life depression and have major implications for the understanding and management of late-life depression and raise the possibility of novel treatments being introduced in the future. Copyright (C) 2002 John Wiley Sons, Ltd.
引用
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页码:7 / 13
页数:7
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