Increased White Matter Hyperintensity and Impact on Executive Function in Suicide Attempters with Late-Life Depression

2020 
Objective: Late-life depression (LLD) is associated with greater risk of suicide and white matter hyperintensity (WMH), which is also found in suicide attempter (SA) regardless of age. Greater periventricular WMH is related to worse cognitive function. We investigated the spatial distribution of WMH in suicide attempters with LLD and its association with cognitive function. Methods: We recruited 114 participants with LLD (34 with history of suicide attempt and 80 without) and 47 elderly controls (individuals without LLD or history of suicide attempt). Suicide attempters were also classified as early and late life SA (using 55 as median age). WMH was quantified by an automated segmentation algorithm and was classified into different regions including juxtaventricular, periventricular, deep, and juxtacortical WMH. We used analysis of covariance and generalized linear model to compare group differences in WMH (global and regional) and its association with neurocognitive function. Results: Suicide attempters with LLD had significantly higher global WMH (F3, 150 = 2.856, p = 0.039) and periventricular WMH (F3, 150 = 3.635, p=0.014) compared to other groups. This difference was primarily in early-life SAs compared to late-life. There was a significant interaction between global WMH and suicide attempt history on executive function, where SAs with high WMH had lower executive function. Conclusion: Individuals with LLD and a history of suicide attempt had greater WMH (primarily in periventricular WMH) compared to others without. WMH in SAs was associated with reduced executive function and may be an underlying mechanism for cognitive decline in older adults with suicidality. Funding Statement: This study was supported by funding from Supported by (1) medical research grants CMRPG3C0041/42 from Chang Gung Memorial Hospital and NRRPG2H0031 from Ministry of Science and Technology, Taiwan to Chemin Lin (2) NMRPG3G6031/32 and NMRPG3J0121 from Ministry of Science and Technology, Taiwan to Shwu-Hua, Lee (3) the KKHo International Charitable Foundation to Tatia Lee. Declaration of Interests: All authors declare that no support, financial or otherwise, has been received from any organization that may have an interest in the submitted work; and (ii) there are no other relationships or activities that could appear to have influenced the submitted work. Ethics Approval Statement: This project was approved by the ethics committee of the Chang Gung Memorial Hospital Institutional Review Board (IRB: 201601753B0C102).
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