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A Diffusion Tensor Magnetic Resonance Imaging Study of Frontal Cortex Connections in Very-Late-Onset Schizophrenia-Like Psychosis

Received August 11, 2004; revised April 5, 2005; accepted April 12, 2005. From the Section on Tissue Biophysics and Biomimetics, LIMB, NICHHD, National Institutes of Health, Bethesda, MD (DKJ,CP), the Section on Old-Age Psychiatry, Institute of Psychiatry, London, UK (DKJ,MC,SJR,RJH), Maudsley Hospital, Camberwell, London, UK (MC), Section on Neuroimaging, Div. of Psychological Medicine, Institute of Psychiatry, London, UK (SSS,PM), Div. of Clinical Neuroscience, St. George’s Hospital Medical School, London, UK (MOS), (JDM), Div. of Medical Physics, Leicester Royal Infirmary, Leicester, UK (MAH), Neuroimaging Research, Dept. of Neurology, Institute of Psychiatry, London, UK (AS,SCRW). Send correspondence and reprint requests to Robert Howard, Section on Old-Age Psychiatry, Institute of Psychiatry, De Crespigny Park, London, SE5 8AF, UK. e-mail: r.howard{at}iop.kcl.ac.uk
© 2005 American Association for Geriatric Psychiatry

Objective: Onset of psychosis after the age of 60 may be associated with structural abnormalities within cerebral white matter. The authors looked within white-matter tracts, which mediate connectivity of the frontal lobes, in psychotic patients for evidence of loss of fiber integrity consistent with degenerative damage. Methods: Fourteen patients with very-late-onset schizophrenia-like psychosis and an age-matched control group underwent diffusion tensor magnetic resonance imaging. Tract maps were constructed for each subject from the imaging data, and measurements of fractional anisotropy and mean diffusivity were made within the uncinate, superior longitudinal, and inferior occipito-frontal fasciculi, and the cingulum. Results: There were no significant differences in fractional anisotropy, a measure of the ordering of axons within fiber tracts, nor in mean diffusivity, an orientationally-averaged measure of the bulk diffusivity within each voxel, between patients and control subjects. Conclusion: The lack of difference in fractional anisotropy and mean diffusivity measures between patients and controls argues against the presence of structural abnormalities within these tracts and the notion that a focal white-matter abnormality within the tracts investigated underpins the onset of psychosis.

Key Words: Excitotoxicity • Diffusion Tensor MRI • Schizophrenia • Frontal Cortex

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