Neuropathological evidence for ischemia in the white matter of the dorsolateral prefrontal cortex in late-life depression

Int J Geriatr Psychiatry. 2003 Jan;18(1):7-13. doi: 10.1002/gps.720.


Background: Signal hyperintensities on magnetic resonance imaging in late-life depression are associated with treatment resistance and poor outcome. These lesions are probably vascular in origin and proposed sites for vascular damage include the dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC).

Methods: We therefore examined white matter in these areas for microvascular disease and evidence of ischemia using intercellular adhesion molecule-1 (ICAM-1) and vascular adhesion molecule-1 (VCAM-1). We obtained postmortem tissue from elderly depressed (n = 20) and control (n = 20) subjects and blindly rated microvascular disease and ICAM-1 and VCAM-1 amount using quantitative image analysis in sections of the DLPFC, ACC and occipital cortex (OC; control area).

Results: We found a significant increase in ICAM-1 in the deep white matter of the DLPFC in the depressed group (p = 0.01) and a trend towards an increase for VCAM-1 (p = 0.10). In the gyral white matter there was a trend towards significance for both molecules (p = 0.07 and 0.10). No differences were found in the ACC or OC or for microvascular disease in any area.

Conclusions: These findings are consistent with white matter ischemia in the DLPFC and lend support to the 'vascular depression' hypothesis. They implicate the DLPFC as an important site in the pathogenesis of late-life depression and have major implications for the understanding and management of late-life depression and raise the possibility of novel treatments being introduced in the future.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Brain Ischemia / metabolism
  • Brain Ischemia / pathology*
  • Collagen / analysis
  • Depressive Disorder / etiology*
  • Depressive Disorder / metabolism
  • Depressive Disorder / pathology
  • Female
  • Gyrus Cinguli / chemistry
  • Gyrus Cinguli / pathology
  • Humans
  • Intercellular Adhesion Molecule-1 / analysis
  • Male
  • Occipital Lobe / blood supply
  • Occipital Lobe / chemistry
  • Occipital Lobe / pathology
  • Prefrontal Cortex / blood supply*
  • Prefrontal Cortex / chemistry
  • Prefrontal Cortex / pathology
  • Vascular Cell Adhesion Molecule-1 / analysis


  • Vascular Cell Adhesion Molecule-1
  • Intercellular Adhesion Molecule-1
  • Collagen