MRI-derived estimation of biological aging in patients with affective disorders in a 9-year follow-up - a prospective marker of future recurrence
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Background
We investigated associations of the brain age gap (BAG), the difference between actual and estimated age derived from MRI scans, with disease course over nine years in patients with affective disorders in a long-term prospective design.
Methods
At two time-points, we acquired T 1 -weighted MRI images (mean [SD] follow-up period 8.98 [2.20] years) of patients with Major Depressive Disorder (MDD; N=32) and Bipolar Disorder (BD; N=6) and healthy controls (HC; N = 37) at two sites (Dublin, Münster). Using a brain age prediction model trained on a sample of over 10,000 subjects of the German National Cohort (GNC), we estimated individual BAG at two time-points (baseline and follow-up) using gray matter segments derived from MRI images. Employing linear-mixed-effects models, we tested main effects of diagnosis and hospitalizations during follow-up on BAG at baseline and follow-up, as well as their interaction with time respectively. In an exploratory analysis, we tested if BAG at baseline was predictive of hospitalizations during the nine-year follow-up using logistic regression and 10-fold nested cross-validation.
Results
MDD patients showed a larger BAG compared to HC (MDD>HC: p=.039, MDD vs. BD: n.s.), while BD patients only showed a tendency for a larger BAG (p = .066). In the Münster subsample (N=52), patients with hospitalizations showed a higher BAG compared to patients without hospitalizations (p=.001). No significant group-by-time interaction could be detected. However, higher BAG at baseline was associated with the number of hospitalizations during follow-up (p=.018), however, the cross-validation of our prediction with an accuracy of 64.3 % was not significant (p=.071).
Discussion
Our results show that BAG did not change over time as a function of patients’ course of disease. The present study rather suggests that a higher estimation of biological aging (higher BAG) predicts future hospitalizations. Therefore, BAG may indicate a patient’s vulnerability to future recurrence.
