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Original Article |

Magnetic Resonance Imaging in Late-Life Depression:  Multimodal Examination of Network Disruption

Claire E. Sexton, DPhil; Charlotte L. Allan, MRCPsych; Marisa Le Masurier, DPhil, MRCPsych; Lisa M. McDermott, MSc; Ukwuori G. Kalu, MSc; Lucie L. Herrmann, MA (Hons), DClinPsy; Matthias Mäurer; Kevin M. Bradley, FRCR, FRCP; Clare E. Mackay, PhD; Klaus P. Ebmeier, MD
Arch Gen Psychiatry. 2012;69(7):680-689. doi:10.1001/archgenpsychiatry.2011.1862.
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Context  Disruption of frontal-subcortical and limbic networks is hypothesized to have a key role in late-life depression (LLD) and can be examined using magnetic resonance imaging (MRI) techniques. Gray matter can be examined using T1-weighted MRI, white matter using T2-weighted MRI and diffusion tensor imaging, and functional connectivity in resting-state networks using functional MRI. Although independent MRI studies have supported gray and white matter abnormalities in frontosubcortical and limbic networks and increased functional connectivity in the default-mode network in depression, no study has concurrently examined gray matter, white matter, and functional connectivity.

Objective  To examine whether results of different MRI techniques are complementary, multimodal MRI was used to compare gray matter, white matter, and resting-state networks between LLD and control groups.

Design  Cross-sectional, case-control, multimodal MRI analysis.

Setting  University research department.

Participants  Thirty-six recovered participants with LLD (mean age, 71.8 years) and 25 control participants (mean age, 71.8 years).

Main Outcome Measures  Gray matter was examined across the whole brain using voxel-based morphometry. Subcortical gray matter structures were also automatically segmented, and volumetric and shape analyses were performed. For white matter analysis, fractional anisotropy, axial diffusivity, and radial diffusivity values were examined using tract-based spatial statistics. For resting-state network analysis, correlation coefficients were compared using independent components analysis followed by dual regression.

Results  White matter integrity was widely reduced in LLD, without significant group differences in gray matter volumes or functional connectivity.

Conclusions  The present work strongly supports the hypothesis that white matter abnormalities in frontal-subcortical and limbic networks play a key role in LLD even in the absence of changes in resting functional connectivity and gray matter. Factors that could contribute to the lack of significant differences in gray matter and functional connectivity measures, including current symptom severity, medication status, and age of participants with LLD, are discussed.

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Figures

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Grahic Jump Location

Figure 1. Localization of group differences in fractional anisotropy (FA) and radial diffusivity (DR). A, Regions significantly reduced (P < .05) in FA in late-life depression are shown in red, overlaid on a green skeleton. B, Regions significantly increased (P < .05) in DR, in addition to being significantly reduced in FA, are shown in blue, again overlaid on a green skeleton. Significant regions are dilated for illustrative purposes.

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Grahic Jump Location

Figure 2. z Scores of fractional anisotropy (FA), radial diffusivity (DR), and axial diffusivity (DA) in voxels significantly reduced in FA in late-life depression (LLD). Data are given as mean z score ±2 SEs of the LLD group. Negative z scores represent reductions in FA and increases in DR and DA in LLD. By definition, z scores for the control group are zero. ATR indicates anterior thalamic radiation; CC, corpus callosum, CST, corticospinal tract; ILF, inferior longitudinal fasciculus; SLF, superior longitudinal fasciculus; and UF, uncinate fasciculus.

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Grahic Jump Location

Figure 3. Independent components analysis–defined networks: default-mode network (DMN) (A), anterior DMN (B), posterior DMN (C), executive control network (ECN) (D), and affective network (AN) (E).

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