Correlation between plasma cortisol and white matter hyperintensity in middle-aged and elderly individuals with major depressive disorder: A cross-sectional study

To examine the relationship between plasma cortisol levels and the severity of white matter hyperintensities (WMH) in patients with major depressive disorder (MDD). This study included 240 patients with MDD who were hospitalized in the Department of Neuropsychology at Hebei General Hospital from January 1, 2023, to December 31, 2024. General data and plasma cortisol concentrations were obtained. Based on the total score of the Fazekas scale, patients were divided into 3 groups: no/mild group (Fazekas scale total score 0-2 points, 87 participants), moderate group (Fazekas scale total score 3-4 points, 85 participants), and severe group (Fazekas scale total score 5-6 points, 68 participants). The disparities in general and clinical data among various patient groups were compared, and the risk factors for WMH were investigated. Among 3 groups of patients, significant differences were in terms of age (58.23 ± 8.64 vs 63.59 ± 7.62 vs 67.51 ± 7.78), proportion of hypertension (37.90% vs 42.40% vs 67.60%), total cholesterol (4.85 ± 1.06 vs 4.95 ± 1.12 vs 4.53 ± 1.05), low-density lipoprotein (3.00 ± 0.70 vs 3.10 ± 0.81 vs 2.67 ± 0.79), and plasma cortisol level (13.25 ± 4.31 vs 14.36 ± 4.51 vs 15.86 ± 5.06). Age (odds ratio [OR] = 1.10, P = .00), hypertension (OR = 1.54, P = .03), and cortisol level (OR = 1.09, P = .00) were independent risk variables for the severity of WMH in individuals with MDD, while low-density lipoprotein (OR = 0.30, P = .04) was a protective factor for the severity of white matter hyperintensity in patients with depression. Plasma cortisol is proposed as an independent risk factor influencing the severity of white matter hyperintensity in individuals with MDD, and ameliorating elevated cortisol levels in these patients may enhance their prognosis.