Occult subcortical magnetic resonance findings in elderly depressives

Hyperintense signal areas (HSA) on T₂‐weighted brain magnetic resonance imaging (MRI) may reflect subtle cerebrovascular insufficiency and are common in elderly depressives. We hypothesized that these HSAs may indicate a vascular etiology for depression in late life, and that patients with late‐onset major depression (MDD) would therfore more often show HSAs than comparably aged recurrent depressives. We reviewed the brain MRI findings of a consecutive series of inpatients aged 50 or over who were treated for MDD during an 18‐month period. Patients with Parkinson's or other brain diseases predisposing to depression were not considered. Twenty‐seven (82%) of 33 patients with depression first apparent in late life and nine (64%) of 14 patients with earlier‐onset recurrent depression showed HSAs. This difference did not reach statistical significance. It was not attributable to the older mean age of the late‐onset group. These rates are in accord with an 86% rate reported in a series of patients referred for ECT (Coffey et al., 1988). They are much higher than the 20–30% figure for comparably aged normals (Bradley, 1984; Kirkpatrick and Hayman, 1987). HSAs were common in this series of elderly depressed inpatients, regardless of age of onset of illness.