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Effect of white matter hyperintensity on depressive symptoms according to the presence of the Apolipoprotein E ε4 allele in the elderly

Chang, Ki Jung; Son, Sang Joon; Lee, Kang Soo; Roh, Hyung Woong; Kim, Dongsoo; Hong, Chang Hyung; Oh, Byoung Hoon
Department of Psychiatry & Behavioural Sciences, Ajou University School of Medicine
OBJECTIVE: We aimed to examine the effects of white matter hyperintensity (WMH) on changes in depressive symptoms over time according to the presence of APOE ε4 allele in the elderly.
METHODS: We obtained data from elderly Korean subjects (n = 707) aged 60 years or older at baseline from the Clinical Research Center for Dementia of South Korea (CREDOS) study from November 2005 to July 2014. A linear mixed model stratified according to APOE genotype was constructed using Geriatric Depression Scale (GDS) score as a primary outcome and degree of overall, deep and periventricular WMH evaluated by a visual rating scale as a risk factor of interest.
RESULTS: Among APOE ε4 carriers, a severe degree of overall and deep WMH, but not periventricular WMH, predicted aggravation of depressive symptoms over time (overall WMH: coefficient = 0.96, p = 0.010; deep WMH: 0.87, p = 0.016). These effects were independent of age, sex, educational level, medical comorbid conditions, activity of daily living and general cognitive function. Among the three subscales of the GDS, pessimism and motivation subscale scores except mood subscale were influenced by severe WMH in APOE ε4 carriers (pessimism subscale: 0.48, p = 0.010, motivation subscale: 0.24, p = 0.038).
CONCLUSIONS: Considering WMH and presence of the APOE ε4 allele may be clinically relevant to predicting aggravation of depressive symptoms in geriatric patients, especially presenting motivational problem or pessimism.
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