Copyright ©2014 Baishideng Publishing Group Inc.
World J Radiol. Jun 28, 2014; 6(6): 223-229
Published online Jun 28, 2014. doi: 10.4329/wjr.v6.i6.223
Table 1 Salient publications of our research group about white matter hyperintensities in affective disorders
Ref.Sample characteristicsStudy typeLocation of WMHsMain findingsLimitations of the studyConclusion
Serafini et al[5]148 patients (77 men, 71 women) with BD-I having a mean age of 47.9 yrResearch articleCentrum semiovale (24.4%) and corona radiata (20.2%) regions, cortical and subcortical deep frontal (17.6%), parietal (15.1%), and temporal (8.4%) areasA total of 73 subjects (49.3%) reported PWMHs and 59 (39.9%) had DWMHs. Overall, 41 (27.7%) subjects had both PWMHs and DWMHs. Patients with BD-I and lower insight for mania had significantly more PWMHs (54.6% vs 22.2%; P < 0.05), significantly higher scores on the HDRS17 (27.05 ± 6.54 vs 23.67 ± 8.64; t146 = -1.98; P < 0.05), and more frequent BHS score ≥ 9 (66.2% vs 38.9%; P < 0.05) when compared to those with higher insight for maniaAll participants were inpatients (a potential confounder). The present study did not include a formal measure of insight. The effects of psychoactive medications on insight ratings and image processing were not analyzedPatients with PWMHs were more likely to have impaired insight than those without. Different insight levels reflected different MRI findings
Serafini et al[19]85 adult outpatients (16 men and 69 women) with CH and having a mean age of 50.1Research articleNot specifiedAbove 40% of patients had PWMHs and almost 98% had DWMHs. Patients with PWMHs differed from those without periventricular lesions on depression severity (t 77.76 = 2.30; P < 0.05). Patients with PWMHs had lower CES-D scores (13.79 ± 7.51 vs 18.19 ± 9.68) than patients without PWMHs. Patients with more severe DWMHs were older (53.89 ± 13.26 vs 47.40 ± 11.91) and reported lower scores on the drive dimension (9.97 ± 2.86 vs 11.14 ± 2.52) than patients with mild lesions or without any deep lesionDifferent mechanisms may be considered in the emergence of WMHs and it is possible that WMHs may represent only the ‘tip of the iceberg’ in terms of structural white matter lesionsPatients with PWMHs were 1.06 times more likely to have lower CES-D scores (P < 0.05) than patients without PWMHs. Patients with more severe DWMHs were 1.04 times more likely to be older (P < 0.05) than patients with mild or without any DWMHs
Serafini et al[16]247 patients (118 men, 129 women) with major affective disorders, specifically 143 BD-I, 42 BD-II, and 62 with MDDResearch articleCentrum semiovale (24.4%) and corona radiata (20.2%) regions, cortical and subcortical deep frontal (17.6%), parietal (15.1%), and temporal (8.4%) areas48% of patients had PWMHs (more than 15% had PWMHs of 2 or higher on the Fazekas modified scale), and 39% had DWMHs (more than 7% had DWMHs of 2 or higher on the Fazekas modified scale). Patients in the high dysthymic, cyclothymic, irritability, and anxiety group were more likely to have higher BHS ≥ 9 = 77% vs 52%; P > 0.001), more DWMHs (46% vs 29%; χ2n =3 = 9.90; P < 0.05), higher MINI suicidal risk (54% vs 42%; P < 0.05), and more recent suicide attempts (24% vs 14%; P < 0.05), than patients in the hyperthymia groupThe small sample size did not allow to generalize findings. The association between the lethality or number of suicide attempts and the presence, severity, or number of hyperintensities was not assessed. The study lacks of accounting for the cognitive effects of medicationsDifferences among temperament groups as measured by the TEMPS-A are supported by differences at the MRI indicating that different temperament profiles are associated with differences in subcortical brain structures
Serafini et al[20]A 76-year-old woman with BD hospitalized for a mixed stateCase report with a 2-yr follow-upNot specifiedPatient had severe WMHs, she took lithium and haloperidol during the hospitalization. She was euthymic at discharge as well as after two-years of follow-up. Her nutrition had a high concentration of Vitamin-DA second MRI was not performedAlthough WM lesions were persistent, the patient improved in both mood and quality of life. Lithium and Vitamin-D may have exerted possible protective effects
Serafini et al[18]54 patients (30 men and 24 women) with LOBD (≥ 60 yr old) having a mean age of 68 yr. 76% had a diagnosis of BD-I, and 24% had a diagnosis of BD-IILetter to the Editor including research dataCentrum semiovale (22%), corona radiata (15%), paratrigonal regions (6%), cortical, subcortical deep frontal (46%), parietal (24%) areasConfluence of DWMH lesions were found in 17% of the patients (modified Fazekas scale ≥ 2) whereas in 28% PWMH confluent lesions (modified Fazekas scale ≥ 2) were reported. No significant association resulted between diagnosis and PWMHs or DWMHs. BD-II with DWMHs had a poorer quality of life than BD-I subjectsThe link between clinical features of bipolar disorders and deep brain lesions on MRI remains quite unknownMRI findings of DWMHs could be a useful biological predictor of severity in patients with BD-II
Pompili et al[17]47 LOBD patients (55.3% men and 44.7% women)Review article including research dataFrontal (26.1) and centrum semiovale areas (26.1%), corona radiata (17.4%), parietal (17.4%), and paratrigonal regions (8.7%)55.3% of these patients had periventricular WMHs, 46.4% had WMHs of mild severity, 50% WMHs of moderate severity, and only 3.6 WMHs of high severity. 34% of LOBD patients had both deep and periventricular WMHs. A significant relationship between older age with LOBD and WMHs was reportedVascular-related mechanisms cannot be the only factors implicated in the pathophysiology of the WMHs in LOBD subjects. The study did not assess how cerebro-vascular risk factors are related to the type /intensity of medications, and the progression of WMHsMRI findings of WMHs could be a useful biological predictor of severity in patients with LOBD
Pompili et al[15]99 patients having a mean age of 46.5 yr. 40.4% were diagnosed as BD-I, 21.2% as BD-II, and 38.4% as unipolar MDDResearch articleCorona radiate (n = 10), centrum semiovale (n = 6), and frontal subcortical white matter (n = 18)It has been suggested that 27.3% of patients showed evidence of PWMHs and 36.4% of DWMHs whereas 14.1% of patients had hyperintensities in both locations. The presence of PWMHs was the only variable significantly associated with attempted suicide even after controlling for age. Subjects with PWMHs were 8 times more likely to have attempted suicide than individuals without PWMHs [OR = 8.08 (95%CI: 2.67-24.51)]The small sample size may affect the generalization of results. PWMHs were able to explain only a small part of the variability of suicide attempt risk, indicating that one single variable is not sufficient to predict suicidalityPatients with affective disorders and PWMHs are more likely to have a history of suicide attempts even after controlling for potential confounding variables such as cardiovascular risk factors and age
Pompili et al[12]65 subjects, 29 (44.6%) with a history of at least one suicide attempt, and 36 (65.4%) without. Subjects had a mean age of 44.61 yrResearch articleNot specifiedAfter logistic regression analyses, the prevalence of WMHs was significantly higher in subjects with past suicide attempts (P = 0.01) and other clinical indicators of elevated suicide riskThe association between WMHs and suicidality holds true for both unipolar and bipolar depressed patientsWMHs in patients with major affective disorders might be useful biological markers of suicidality