1
|
Low A, Ng KP, Chander RJ, Wong B, Kandiah N. Association of Asymmetrical White Matter Hyperintensities and Apolipoprotein E4 on Cognitive Impairment. J Alzheimers Dis 2020; 70:953-964. [PMID: 31306121 DOI: 10.3233/jad-190159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Asymmetrical patterns of cerebral damage have been widely observed in a range of neurodegenerative diseases, including Alzheimer's disease (AD). OBJECTIVE To elucidate the clinical associations of asymmetrical white matter hyperintensities (WMH) in mild cognitive impairment (MCI) and AD. METHODS Regional WMH asymmetry of 340 participants (90 healthy controls, 132 MCI, 118 AD) was calculated as the difference in normalized hemispheric WMH volume (WMH/ICV) adjusted for structural brain asymmetry of respective lobar regions and total WMH. WMH asymmetry was analyzed in relation to disease classification, cognition, and APOE4 status using ANCOVA and multiple regression analysis, controlling for gender, age, ethnicity, and correcting for multiple comparisons using Bonferroni correction. Moderation analysis examined interaction effects of APOE4 on associations between cognition and WMH asymmetry. RESULTS Greater left-dominant occipital WMH asymmetry was observed in AD, compared to healthy controls and MCI, and was associated with poorer global cognition, memory, language, and executive functions among cognitively impaired participants (MCI and AD). Cognitively impaired APOE4 carriers displayed greater left-dominant WMH asymmetry in the whole brain and frontal lobe, compared to non-carriers. Importantly, effects were independent of structural brain asymmetry, global cerebral atrophy, and overall WMH burden. Moderation analysis demonstrated associations between left-dominant WMH asymmetry and cognition in cognitively impaired APOE4 non-carriers, but not APOE4 carriers. CONCLUSION Leftward asymmetry of WMH may be more pathological in nature, compared to symmetrical WMH. Furthermore, the detrimental effects of WMH asymmetry was more relevant in APOE4-negative cognitive impairment, compared to APOE4-positive which may be driven primarily by AD pathology.
Collapse
Affiliation(s)
- Audrey Low
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Russell Jude Chander
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Benjamin Wong
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | - Nagaendran Kandiah
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore.,Duke-NUS, Singapore, Singapore
| |
Collapse
|
2
|
Xie H, Zhang Q, Huo K, Liu R, Jian ZJ, Bian YT, Li GL, Zhu D, Zhang LH, Yang J, Luo GG. Association of white matter hyperintensities with migraine features and prognosis. BMC Neurol 2018; 18:93. [PMID: 29966519 PMCID: PMC6027560 DOI: 10.1186/s12883-018-1096-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 06/25/2018] [Indexed: 01/02/2023] Open
Abstract
Background White matter hyperintensities (WMHs) are frequently detected in migraine patients. However, their significance and correlation to migraine disease burden remain unclear. This study aims to examine the correlation of WMHs with migraine features and explore the relationship between WMHs and migraine prognosis. Methods A total of 69 migraineurs underwent MRI scans to evaluate WMHs. Migraine features were compared between patients with and without WMHs. After an average follow-up period of 3 years, these patients were divided into two groups, according to the reduction of headache frequency: improved and non-improved groups. The percentage and degree of WMHs were compared between these two groups. Results A total of 24 patients (34.8%) had WMHs. Patients with WMHs were significantly older (39.0 ± 7.9 vs. 30.6 ± 10.4 years, P < 0.001) and had a longer disease duration (median: 180.0 vs. 84.0 months, P = 0.013). Furthermore, 33 patients completed the follow up period (15 patients improved and 18 patients did not improve). Patients in the non-improved group had a higher frequency of WMHs (55.6% vs. 13.3%, P = 0.027) and median WMHs score (1.0 vs. 0.0, P = 0.030). Conclusions WMHs can predict unfavorable migraine prognosis. Furthermore, WMHs may have a closer association with age than migraine features.
Collapse
Affiliation(s)
- Hui Xie
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Qiang Zhang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi, China.,Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, 710068, China
| | - Kang Huo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Rui Liu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Zhi-Jie Jian
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Yi-Tong Bian
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Guo-Liang Li
- Arrhythmia Unit, Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Dan Zhu
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Li-Hui Zhang
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi, China
| | - Jian Yang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Guo-Gang Luo
- Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, Shaanxi, China.
| |
Collapse
|
3
|
Briggs R, Carey D, Kennelly SP, Kenny RA. Longitudinal Association Between Orthostatic Hypotension at 30 Seconds Post-Standing and Late-Life Depression. Hypertension 2018; 71:946-954. [DOI: 10.1161/hypertensionaha.117.10542] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 11/09/2017] [Accepted: 01/18/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Robert Briggs
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| | - Daniel Carey
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| | - Sean P. Kennelly
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| | - Rose Anne Kenny
- From the Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland (R.B., D.C., R.A.K.); Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland (R.B., R.A.K.); and Age-Related Health Care, Tallaght Hospital, Dublin, Ireland (R.B., S.P.K.)
| |
Collapse
|
4
|
Briggs R, Carey D, Kenny RA, Kennelly SP. What is the Longitudinal Relationship between Gait Abnormalities and Depression in a Cohort of Community-Dwelling Older People? Data From the Irish Longitudinal Study on Ageing (TILDA). Am J Geriatr Psychiatry 2018; 26:75-86. [PMID: 28967608 DOI: 10.1016/j.jagp.2017.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/11/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Does baseline gait disturbance predict incident depression in a cohort of community-dwelling older people? METHODS This is a longitudinal study, embedded within the Irish Longitudinal Study on Ageing (TILDA), examining the association between baseline depression and incident gait abnormalities, as well as between baseline gait abnormalities and incident depression at 2 year follow-up. Depression was defined as a score of ≥16 on the Centre for Epidemiological Studies Depression Scale (CES-D). Gait abnormality was defined as a Timed Up and Go Test (TUG) ≥12 seconds. Assessments were carried out at baseline and at 2 year follow-up. RESULTS 7% (179/2,638) had baseline depression and 11% (296/2,638) had a gait abnormality at baseline. The incidence of new-onset depression and gait abnormality at Wave 2 was 4% (95/2,364) and 13% (308/2,342) respectively. Logistic regression models demonstrated that baseline gait abnormality was a significant predictor of incident depression with an Incidence Rate Ratio (IRR) of 2.00 (95% CI: 1.18 - 3.40, p =0.010, t =2.57, df =625), which was not attenuated after controlling for covariates. Baseline depression was a predictor of incident gait abnormality at Wave 2 with an IRR of 1.68 (95% CI: 1.16 - 2.43, p =0.006, t =2.75, df =625) but this association was no longer statistically significant when analysis was adjusted for clinical variables. CONCLUSIONS This study demonstrates that baseline gait disturbance, measured by TUG, predicts incident depression, defined by CES-D, in a population-representative cohort of community-dwelling older people. Possible biological mechanisms for this relationship include white matter disease and executive dysfunction.
Collapse
Affiliation(s)
- Robert Briggs
- Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland; Age-related Health Care, Tallaght Hospital, Dublin, Ireland.
| | - Daniel Carey
- Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Rose Anne Kenny
- Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland; Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | | |
Collapse
|
5
|
Wu M, Aizenstein HJ. The Multi-Faceted Relationship between White Matter Lesions and Late-Life Depression. Am J Geriatr Psychiatry 2017; 25:1322-1325. [PMID: 29050911 PMCID: PMC10833147 DOI: 10.1016/j.jagp.2017.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Minjie Wu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA.
| |
Collapse
|
6
|
van Agtmaal MJM, Houben AJHM, Pouwer F, Stehouwer CDA, Schram MT. Association of Microvascular Dysfunction With Late-Life Depression: A Systematic Review and Meta-analysis. JAMA Psychiatry 2017; 74:729-739. [PMID: 28564681 PMCID: PMC5710252 DOI: 10.1001/jamapsychiatry.2017.0984] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/26/2017] [Indexed: 12/14/2022]
Abstract
Importance The etiologic factors of late-life depression are still poorly understood. Recent evidence suggests that microvascular dysfunction is associated with depression, which may have implications for prevention and treatment. However, this association has not been systematically reviewed. Objective To examine the associations of peripheral and cerebral microvascular dysfunction with late-life depression. Data Sources A systematic literature search was conducted in MEDLINE and EMBASE for and longitudinal studies published since inception to October 16, 2016, that assessed the associations between microvascular dysfunction and depression. Study Selection Three independent researchers performed the study selection based on consensus. Inclusion criteria were a study population 40 years of age or older, a validated method of detecting depression, and validated measures of microvascular function. Data Extraction and Synthesis This systematic review and meta-analysis has been registered at PROSPERO (CRD42016049158) and is reported in accordance with the PRISMA and MOOSE guidelines. Data extraction was performed by an independent researcher. Main Outcomes and Measures The following 5 estimates of microvascular dysfunction were considered in participants with or without depression: plasma markers of endothelial function, albuminuria, measurements of skin and muscle microcirculation, retinal arteriolar and venular diameter, and markers for cerebral small vessel disease. Data are reported as pooled odds ratios (ORs) by use of the generic inverse variance method with the use of random-effects models. Results A total of 712 studies were identified; 48 were included in the meta-analysis, of which 8 described longitudinal data. Data from 43 600 participants, 9203 individuals with depression, and 72 441 person-years (mean follow-up, 3.7 years) were available. Higher levels of plasma endothelial biomarkers (soluble intercellular adhesion molecule-1: OR, 1.58; 95% CI, 1.28-1.96), white matter hyperintensities (OR, 1.29; 95% CI, 1.19-1.39), cerebral microbleeds (OR, 1.18; 95% CI, 1.03-1.34), and cerebral (micro)infarctions (OR, 1.30; 95% CI, 1.21-1.39) were associated with depression. Among the studies available, no significant associations of albuminuria and retinal vessel diameters with depression were reported. Longitudinal data showed a significant association of white matter hyperintensities with incident depression (OR, 1.19; 95% CI, 1.09-1.30). Conclusions and Relevance This meta-analysis shows that both the peripheral and cerebral forms of microvascular dysfunction are associated with higher odds of (incident) late-life depression. This finding may have clinical implications because microvascular dysfunction might provide a potential target for the prevention and treatment of depression.
Collapse
Affiliation(s)
- Marnix J. M. van Agtmaal
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Alfons J. H. M. Houben
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Coen D. A. Stehouwer
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Miranda T. Schram
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Heart and Vascular Center, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
7
|
Briggs R, Kenny RA, Kennelly SP. Does baseline hypotension predict incident depression in a cohort of community-dwelling older people? Data from The Irish Longitudinal Study on Ageing (TILDA). Age Ageing 2017; 46:648-653. [PMID: 28338875 DOI: 10.1093/ageing/afx033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Indexed: 01/16/2023] Open
Abstract
Background hypotension is now recognised as a risk factor for syncope, cardiovascular events and mortality, but it may also represent a risk factor for late life depression (LLD). The aim of this study was to clarify the longitudinal relationship between hypotension and incident LLD. Methods this is a longitudinal study involving community-dwelling participants aged ≥50 years, using data from The Irish Longitudinal Study on Ageing. The Centre for Epidemiological Studies Depression Scale (CES-D) was administered at baseline and at follow-up 2 years later. Blood pressure (BP) was measured at baseline. Participants with a CES-D score ≥16 at baseline and those taking antidepressants were excluded and considered to have a current diagnosis of depression. A score of ≥16 at follow-up was used to define incident depression. Results about 4,525 participants were included and 200 participants had diagnosis of incident LLD. The incident depression group had lower systolic BP at baseline than the non-depressed group (132.8 ± 1.43 mm Hg vs. 136.0 ± 0.30 mm HG, P = 0.025). Logistic regression showed those with systolic BP <130 mm HG had an unadjusted odds ratio of 1.31 (1.01-1.68) for incident depression. This persisted after adjustment for confounding factors. Conclusion systolic BP <130 mm Hg increased the likelihood of incident depression in a cohort of community-dwelling older adults. These findings are important because systolic hypotension may represent a potentially modifiable risk factor for LLD. They are also relevant in the context of BP treatment targets for older people.
Collapse
Affiliation(s)
- Robert Briggs
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
- Department of Medical Gerontology, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
- Department of Age-Related Health Care, Tallaght Hospital, Dublin 24, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Dublin 2, Ireland
- Department of Medical Gerontology, Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin 8, Ireland
| | - Sean P Kennelly
- Department of Age-Related Health Care, Tallaght Hospital, Dublin 24, Ireland
| |
Collapse
|
8
|
Feng L, Jiang H, Li Y, Teng F, He Y. Effects of citicoline therapy on the network connectivity of the corpus callosum in patients with leukoaraiosis. Medicine (Baltimore) 2017; 96:e5931. [PMID: 28121935 PMCID: PMC5287959 DOI: 10.1097/md.0000000000005931] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aimed to investigate the effects of citicoline therapy on the network connectivity of the corpus callosum in patients with leukoaraiosis (LA) by diffusion tension imaging (DTI).A total of 30 LA patients with Fazekas score of 2 to 3 were voluntarily assigned into citicoline group (n = 14) and control group (n = 16). In citicoline group, citicoline was administered at 0.6 g/d for 1 year. In control group, central nervous system drugs should not be used, except for sleeping pills and antidepressants. Interventions for pre-existing diseases should be conducted in both groups. During the periods of citicoline therapy and post-treatment follow-up, cranial magnetic resonance imaging and DTI were routinely performed in these patients, and the genu, body, and splenium of corpus callosum were selected as the regions of interest (ROIs). The fractional anisotropy (FA) and mean diffusivity (MD) of each ROI were determined with PANDA software.On recruitment, there were no significant differences in the general characteristics, blood biochemical results, cognition function, and the FA and MD of the corpus callosum between 2 groups (P > 0.05). After 1-year treatment, the FA of the corpus callosum reduced gradually, but the MD of the corpus callosum tended to increased in both group, although significant differences were not observed. However, the reductions in FA of genu and splenium of corpus callosum in citicoline group were significantly lower than in control group (P < 0.05); the reductions in MD of genu, body, and splenium of corpus callosum in citicoline group were significantly lower than in control group (P < 0.05).In LA patients, the disruption of the network connectivity of the corpus callosum deteriorates over time. Citicoline treatment may delay the reduction in FA of corpus callosum, which might be beneficial for the improvement of network connectivity of the corpus callosum.
Collapse
Affiliation(s)
- Liang Feng
- Department of Neurology, Tongji Hospital, Tongji University
| | - Hong Jiang
- Department of Radiology, Tongji Hospital, Tongji University, Shanghai, China
| | - Yunxia Li
- Department of Neurology, Tongji Hospital, Tongji University
| | - Fei Teng
- Department of Neurology, Tongji Hospital, Tongji University
| | - Yusheng He
- Department of Neurology, Tongji Hospital, Tongji University
| |
Collapse
|
9
|
Obara T, Hasegawa H, Wachi Y, Tanaka M, Sato M, Kobayashi Y, Koshiba H, Nagai K, Yamada Y, Matsui T, Kozaki K. [The characteristics of a comprehensive geriatric assessment in patients with mild cognitive impairment with a cerebral white matter lesion]. Nihon Ronen Igakkai Zasshi 2016; 52:399-410. [PMID: 26700780 DOI: 10.3143/geriatrics.52.399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM Vascular dementia may be referred to as "treatable dementia" because its development and progress can be inhibited by intervention in the early stage. In particular, cerebral white matter lesions are readily encountered the clinical setting. In this study, we aimed to clarify the phenomenon and symptoms of patients with mild cognitive impairment (MCI) with cerebral white matter lesions prior to the onset of dementia. METHODS The subjects included 181 cases diagnosed with MCI among 643 consecutive new patients of the Center for Comprehensive Care on Memory Disorder at Kyorin University Hospital from January 1, 2013 to January 31, 2014. Patients with particular diseases were excluded. An interview, physical examination, comprehensive geriatric assessment, brain MRI and SPECT were performed for all subjects. The cerebral white matter lesions were evaluated using the modified Fazekas scale. We defined Grades 0 and 1 as the group without apparent cerebral white matter lesions and Grades 2 and 3 as the group with apparent cerebral white matter lesions. We compared the laboratory findings and outcomes of these two groups. RESULTS The age of the group with apparent cerebral white matter lesions was significantly higher than the group without apparent cerebral white matter lesions (P<0.05). No significant difference was observed regarding gender, MMSE, or "vegetable" term retrieval. A significant difference was observed in the total score and the subordinate component of the 21-item fall risk index and geriatric depression scale between the groups (P<0.05). Additionally, a significant difference was observed regarding the subordinate component of the instrumental ADL, the Dementia Behavior Disturbance Scale and the Zarit Care Burden Scale between the groups (P<0.05). CONCLUSIONS Our results suggest that the presence of white matter lesions at the stage of MCI has a significant relationship to care burden due to the deterioration of ADL, risk of falling, and the presence of depression and behavior disorders. We speculate that our results are useful for the explanation of the characteristics of MCI with white matter lesion to the patients and the care givers. Furthermore, these results may lead to improvements in the appropriate approach, intervention and appropriate nursing of such patients.
Collapse
Affiliation(s)
- Toshimasa Obara
- Department of Geriatric Medicine, Kyorin University School of Medicine
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Aizenstein HJ, Baskys A, Boldrini M, Butters MA, Diniz BS, Jaiswal MK, Jellinger KA, Kruglov LS, Meshandin IA, Mijajlovic MD, Niklewski G, Pospos S, Raju K, Richter K, Steffens DC, Taylor WD, Tene O. Vascular depression consensus report - a critical update. BMC Med 2016; 14:161. [PMID: 27806704 PMCID: PMC5093970 DOI: 10.1186/s12916-016-0720-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vascular depression is regarded as a subtype of late-life depression characterized by a distinct clinical presentation and an association with cerebrovascular damage. Although the term is commonly used in research settings, widely accepted diagnostic criteria are lacking and vascular depression is absent from formal psychiatric manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition - a fact that limits its use in clinical settings. Magnetic resonance imaging (MRI) techniques, showing a variety of cerebrovascular lesions, including extensive white matter hyperintensities, subcortical microvascular lesions, lacunes, and microinfarcts, in patients with late life depression, led to the introduction of the term "MRI-defined vascular depression". DISCUSSION This diagnosis, based on clinical and MRI findings, suggests that vascular lesions lead to depression by disruption of frontal-subcortical-limbic networks involved in mood regulation. However, despite multiple MRI approaches to shed light on the spatiotemporal structural changes associated with late life depression, the causal relationship between brain changes, related lesions, and late life depression remains controversial. While postmortem studies of elderly persons who died from suicide revealed lacunes, small vessel, and Alzheimer-related pathologies, recent autopsy data challenged the role of these lesions in the pathogenesis of vascular depression. Current data propose that the vascular depression connotation should be reserved for depressed older patients with vascular pathology and evident cerebral involvement. Based on current knowledge, the correlations between intra vitam neuroimaging findings and their postmortem validity as well as the role of peripheral markers of vascular disease in late life depression are discussed. CONCLUSION The multifold pathogenesis of vascular depression as a possible subtype of late life depression needs further elucidation. There is a need for correlative clinical, intra vitam structural and functional MRI as well as postmortem MRI and neuropathological studies in order to confirm the relationship between clinical symptomatology and changes in specific brain regions related to depression. To elucidate the causal relationship between regional vascular brain changes and vascular depression, animal models could be helpful. Current treatment options include a combination of vasoactive drugs and antidepressants, but the outcomes are still unsatisfying.
Collapse
Affiliation(s)
- Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrius Baskys
- Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA
| | - Maura Boldrini
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | - Breno S Diniz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Manoj Kumar Jaiswal
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
| | - Lev S Kruglov
- Department of Geriatric Psychiatry of the St. Petersburg Psychoneurological Research Institute named after V. M. Bekhterev, Medical Faculty of St. Petersburg University, St. Petersburg, Russia
| | - Ivan A Meshandin
- Clinical Department, Scientific and Practical Center of Psychoneurology named after V. M. Soloviev, St. Petersburg, Russia
| | - Milija D Mijajlovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Belgrade, Serbia
| | - Guenter Niklewski
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany
| | - Sarah Pospos
- Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA
| | - Keerthy Raju
- Consultant in Old Age Psychiatry, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Kneginja Richter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany.,Faculty for Social Sciences, Technical University of Nuremberg Georg Simon Ohm, Nuremberg, Germany
| | - David C Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Warren D Taylor
- Department of Psychiatry, The Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Veterans Affairs Medical Center, The Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Oren Tene
- Departments of Neurology and Psychiatry, Tel Aviv Medical Center, Tel Aviv, Israel.,Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| |
Collapse
|
11
|
Pantoni L, Fierini F, Poggesi A. Impact of cerebral white matter changes on functionality in older adults: An overview of the LADIS Study results and future directions. Geriatr Gerontol Int 2016; 15 Suppl 1:10-6. [PMID: 26671152 DOI: 10.1111/ggi.12665] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 11/30/2022]
Abstract
The evidence on the clinical significance of cerebral white matter changes (WMC) has mounted over the past few decades. WMC are recognized as one of the neuroimaging features of cerebral small vessel disease, and are associated with various disturbances and a poor prognosis. The Leukoaraiosis and Disability (LADIS) Study has contributed substantially to this body of knowledge. LADIS is a European multicenter collaboration aimed at assessing the role of WMC as an independent predictor of the transition to disability in initially non-disabled patients aged 65-84 years. Besides the demonstration that severe WMC cause a more than double risk of transition from an autonomous to a dependent status after 3 years of follow-up, the LADIS Study has also provided evidence on the role of WMC in relation to the decline of cognitive and motor performances, depressive symptoms associated with aging and cerebrovascular diseases, the presence of urinary disturbances, and various neurological abnormalities. The possible role of other lesions (lacunar infarcts, cerebral atrophy, corpus callosum morphology) and microstructural abnormalities (diffusion-weighted imaging changes in normal appearing brain tissue and in WMC) has also been investigated. In the present article, we review the main results of the LADIS Study and offer some considerations for future developments in the field, paying attention to the potential use of WMC progression as a surrogate marker in intervention trials in cerebral small vessel diseases. We also discuss some therapeutic perspectives regarding the beneficial impact of physical activity on the risk of vascular cognitive impairment in patients with WMC.
Collapse
Affiliation(s)
- Leonardo Pantoni
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Fabio Fierini
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | | |
Collapse
|
12
|
Pasi M, Poggesi A, Salvadori E, Diciotti S, Ciolli L, Del Bene A, Marini S, Nannucci S, Pescini F, Valenti R, Ginestroni A, Toschi N, Mascalchi M, Inzitari D, Pantoni L. White matter microstructural damage and depressive symptoms in patients with mild cognitive impairment and cerebral small vessel disease: the VMCI-Tuscany Study. Int J Geriatr Psychiatry 2016; 31:611-8. [PMID: 26489377 DOI: 10.1002/gps.4368] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Disruption of cortical-subcortical circuits related to small vessel disease (SVD) may predispose to depression in the elderly. We aimed to determine the independent association between white matter (WM) microstructural damage, evaluated with diffusion tensor imaging (DTI), and depressive symptoms in a cohort of elderly subjects with mild cognitive impairment (MCI) and SVD. METHODS The vascular mild cognitive impairment (VMCI)-Tuscany Study is an observational multicentric longitudinal study that enrolled patients with MCI and moderate to severe degrees of WM hyperintensities on MRI. Lacunar infarcts, cortical atrophy, medial temporal lobe atrophy, microbleeds, and DTI-derived indices (mean diffusivity, MD and fractional anisotropy, FA) were evaluated on baseline MRI. Geriatric Depression Scale (GDS) (score 0-15) was used to assess depressive symptoms. An extensive neuropsychological battery, Instrumental Activities of Daily Living scale, and the Short Physical Performance Battery were used for cognitive, functional, and motor assessments, respectively. RESULTS Seventy-six patients (mean age: 75.1 ± 6.8 years) were included. Univariate analyses showed a significant association between GDS score and both DTI-derived indices (MD: r = 0.307, p = 0.007; FA: r = -0.245; p = 0.033). The association remained significant after adjustment for age, WM hyperintensities severity, global cognitive, functional and motor performances, and antidepressant therapy (MD: r = 0.361, p = 0.002; FA: r = -0.277; p = 0.021). CONCLUSIONS These results outline the presence of an association between WM microstructural damage and depressive symptoms in MCI patients with SVD. This relationship does not seem to be mediated by disability, cognitive, and motor impairment, thus supporting the vascular depression hypothesis.
Collapse
Affiliation(s)
- Marco Pasi
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Cesena, Italy
| | - Laura Ciolli
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Alessandra Del Bene
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Sandro Marini
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Serena Nannucci
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Francesca Pescini
- Stroke Unit and Neurology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Raffaella Valenti
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| | - Andrea Ginestroni
- "Mario Serio" Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Nicola Toschi
- Medical Physics Section, Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Mario Mascalchi
- "Mario Serio" Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy.,Institute of Neuroscience, Italian National Research Council, Florence, Italy
| | - Leonardo Pantoni
- NEUROFARBA Department, Neuroscience section, University of Florence, Florence, Italy
| |
Collapse
|
13
|
Inamura K, Shinagawa S, Nagata T, Tagai K, Nukariya K, Nakayama K. White matter hyperintensities are associated with the severity of late-life somatoform disorders and executive functions. Nord J Psychiatry 2015:1-8. [PMID: 26107407 DOI: 10.3109/08039488.2015.1053096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Medically unexplained symptoms are often seen in the elderly. Recently, correlations between medically unexplained symptoms and somatoform disorders (SDs) have been reported. The existence of many interactive psychiatric aetiologies is known among SDs. Late-life SDs might be influenced by some aetiological factors caused by ageing processes, such as structural changes in the brain and cognitive dysfunctions. AIMS Under such circumstances, we investigated the presence of subcortical white matter hyperintensities (WMHs), which increase with ageing, and hypothesized that subcortical WMHs are related to the disease severity of late-life SDs. Furthermore, we confirmed whether cognitive dysfunction influences this process. METHODS To evaluate these hypotheses, we examined patients with medically unexplained symptoms who met the criteria for undifferentiated somatoform disorder and divided the patients into three groups according to the degree of subcortical WMHs: grade 0, grade 1, and grade 2. The subcortical WMHs were rated using Fazekas grading. Differences in symptom severity and cognitive functions were compared among the three groups. RESULTS The grade 2 group had the severest symptoms. Furthermore, the grade 2 group had lower cognitive function scores than the other groups. CONCLUSIONS The present study showed that the presence of subcortical WMHs in patients with late-life SDs was a predictor of disease severity. Moreover, cognitive dysfunction appeared to play a role in the advancement of disease severity.
Collapse
Affiliation(s)
- Keisuke Inamura
- Keisuke Inamura, Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital , Chiba , Japan
| | | | | | | | | | | |
Collapse
|
14
|
Tanislav C, Kropp P, Grittner U, Holzhausen M, Fazekas F, Jungehülsing GJ, Tatlisumak T, von Sarnowski B, Putaala J, Huber R, Thijs V, Schmidt R, Kaps M, Enzinger C, Dichgans M, Norrving B, Rolfs A. Clinically relevant depressive symptoms in young stroke patients - results of the sifap1 study. Neuroepidemiology 2015; 44:30-8. [PMID: 25659436 DOI: 10.1159/000371389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 12/04/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Although post-stroke depression is widely recognized, less is known about depressive symptoms in the acute stage of stroke and especially in young stroke patients. We thus investigated depressive symptoms and their determinants in such a cohort. METHODS The Stroke in Young Fabry Patients study (sifap1) prospectively recruited a large multinational European cohort (n = 5,023) of patients with a cerebrovascular event aged 18-55. For assessing clinically relevant depressive symptoms (CRDS, defined by a BDI-score ≥18) the self-reporting Beck Depression Inventory (BDI) was obtained on inclusion in the study. Associations with baseline parameters, stroke severity (National Institutes of Health Stroke Scale, NIHSS), and brain MRI findings were analyzed. RESULTS From the 2007 patients with BDI documentation, 202 (10.1%) had CRDS. CRDS were observed more frequently in women (12.6 vs. 8.2% in men, p < 0.001). Patients with CRDS more often had arterial hypertension, diabetes mellitus, and hyperlipidemia than patients without CRDS (hypertension: 58.0 vs. 47.1%, p = 0.017; diabetes mellitus: 17.9 vs. 8.9%, p < 0.001; hyperlipidemia: 40.5 vs. 32.3%, p = 0.012). In the subgroup of patients with ischemic stroke or TIA (n = 1,832) no significant associations between CRDS and cerebral MRI findings such as the presence of acute infarcts (68.1 vs. 65.8%, p = 0.666), old infarctions (63.4 vs. 62.1%, p = 0.725) or white matter hyper-intensities (51.6 vs. 53.7%, p = 0.520) were found. CONCLUSION Depressive symptoms were present in 10.1% of young stroke patients in the acute phase, and were related to risk factors but not to imaging findings.
Collapse
|
15
|
Hahn C, Lim HK, Won WY, Joo SH, Ahn KJ, Jung WS, Lee CU. Sub-regional volumes changes of the corpus callosum in the drug naive patients with late-onset depression. Prog Neuropsychopharmacol Biol Psychiatry 2015; 56:46-51. [PMID: 25134843 DOI: 10.1016/j.pnpbp.2014.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 07/21/2014] [Accepted: 07/23/2014] [Indexed: 12/20/2022]
Abstract
Although sub-regional analysis methods of the corpus callosum (CC) have been developed, there has been no in vivo magnetic resonance imaging (MRI) study on a sub-regional volume analysis of the CC of late-onset depression (LOD). The aim of this study was to investigate the CC volume differences between LOD subjects and healthy elderly controls using a sub-regional analysis technique. Forty subjects with LOD and thirty nine group-matched healthy control subjects underwent 3T MRI scanning, and sub-regional volumes of the CC were measured and compared between the groups. The volumes of total (F=5.8, p=0.001), the anterior (F=5.2, p=0.001) and the posterior CC (F=5.1, p=0.001) were significantly reduced in the LOD group as compared to the control group. We measured cognitive functions in several different domains (language functions, verbal learning, visuospatial functions, delayed recall, memory consolidation, recognition memory, and executive functions) through the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease. The anterior CC volume in the LOD group showed significant positive correlation with the Verbal Fluency scores. The posterior CC volume in the LOD group was positively correlated significantly with the Word List Memory, the Word List Recall and the Constructional Praxis scores. This study is the first to elaborate the sub-regional volume differences of the CC between controls and LOD patients. These structural changes in the CC might be at the core of the underlying neurobiological mechanisms in LOD.
Collapse
Affiliation(s)
- Changtae Hahn
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea; Catholic Argo-Medical Center, Seoul, Republic of Korea
| | - Hyun-Kook Lim
- Department of Psychiatry, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Wang Youn Won
- Department of Psychiatry, The Catholic University of Korea, Uijeongbu St. Mary's Hospital, Uijeongbu, Republic of Korea
| | - Soo-Hyun Joo
- Department of Psychiatry, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Kook Jin Ahn
- Department of Radiology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Won-Sang Jung
- Department of Radiology, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Chang Uk Lee
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea; Catholic Argo-Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
16
|
Wang L, Leonards CO, Sterzer P, Ebinger M. White matter lesions and depression: a systematic review and meta-analysis. J Psychiatr Res 2014; 56:56-64. [PMID: 24948437 DOI: 10.1016/j.jpsychires.2014.05.005] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 03/13/2014] [Accepted: 05/09/2014] [Indexed: 10/25/2022]
Abstract
We sought to determine if an association exists between overall, deep, and periventricular white matter hyperintensities and depression. We searched PubMed (Medline) and Scopus (Embase) from April-October 2012 using the MeSH terms: "White matter lesions" OR "white matter disease" OR "Cerebrovascular Disease" OR "Leukoencephalopathies" AND "Depressive Disorder" AND "magnetic resonance imaging," and "Depression" AND "leukoaraiosis." No language limits were implemented. Hand searching was performed of all included studies and relevant review articles. 913 PubMed and 188 Scopus citations were identified. Relevant, human, non-overlapping magnetic resonance imaging studies were eligible for inclusion if they reported generic data. We extracted the most adjusted odds ratios reported generated from comparing depression across severe (determined either volumetrically or visually) and mild/no white matter lesion groups. 19 reports were included. Cross-sectional subgroup analyses showed that deep white matter hyperintensities significantly associated with depression (N = 2261, odds ratio 1.02, 95% confidence interval 1.00-1.04, p = 0.02), whereas periventricular (N = 3813, odds ratio 1.08, 95% confidence interval 0.99-1.17, p = 0.07) and overall did not (N = 5876, odds ratio 1.12, 95% confidence interval 0.96-1.30, p = 0.14). Overall longitudinal analysis revealed a pooled odds ratio of 1.12 (N = 2015; 95% confidence interval 0.97-1.29; p = 0.13; Q = 7.19, p = 0.07; I2 = 58.3%). Longitudinal subgroup analyses revealed that overall white matter hyperintensities (N = 1882, odds ratio 1.22, 95% confidence interval, 1.06-1.4, p < 0.01) significantly associated with depression but deep did not (N = 660, odds ratio 2.02, 95% confidence interval, 0.56-7.22, p = 0.281). No significant heterogeneity was present in subgroup analyses. In conclusion, we found a significant, but weak association between white matter hyperintensities and depression.
Collapse
Affiliation(s)
- Li Wang
- International Graduate Program Medical Neurosciences, Charité - Universitätsmedizin, Berlin, Germany
| | - Christopher O Leonards
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany.
| | - Philipp Sterzer
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin, Berlin, Germany
| | - Martin Ebinger
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin, Berlin, Germany; Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin, Berlin, Germany
| |
Collapse
|
17
|
Alagiakrishnan K, Hsueh J, Zhang E, Khan K, Senthilselvan A. White matter disease severity of the brain and its association with geriatric syndromes. Postgrad Med 2014; 125:17-23. [PMID: 24200757 DOI: 10.3810/pgm.2013.11.2708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIM White matter disease (WMD) of the brain is considered to be secondary to small vessel ischemia and can be a single unifying risk factor for the development of geriatric syndromes. The aim of our study was to investigate the association of the global and regional severity of WMD in the brain with geriatric syndromes burden. METHODS In our retrospective study, consecutive outpatient charts from patients seen between January 2010 and June 2011 at University of Alberta Hospital Seniors Clinic were reviewed. Subjects with brain computed tomography (CT) scans were included in the study. Subjects with incomplete information or with diseases that confounded WMD assessment on CT were excluded. White matter disease was quantified on CT using Wahlund scoring. A multiple linear regression analysis was conducted to determine the association of WMD severity with geriatric syndromes burden after controlling for confounding vascular risk factors. RESULTS Of the 505 subjects, 326 (64.6%) were women. Mean age of the study patients was 79.8 years (SD ± 7.04), prevalence of WMD disease was 79.4%, and mean WMD score was 5.1 (SD ± 4.4). In subjects aged < and > 80 years, the mean number of geriatric syndromes was 2.83 (standard error of the mean [SE] 0.08) and 3.22 (SE 0.08), respectively. In the adjusted regression analysis, there was a significant association between WMD severity, globally (regression coefficient (β) = 0.457, SE 0.155; P = 0.003), as well as WMD in specific regions: frontal (P < 0.001), parieto-occipital (P = 0.004), and infratentorial regions (P = 0.04) with geriatric syndromes burden. The association remains even after correcting for age, sex, and all vascular risk factors. CONCLUSION In our study, there was a significant association between the severity of global and selected regional WMD of the brain with geriatric syndromes burden, thus raising the possibility of a shared biologic association through vascular pathology of the brain.
Collapse
|
18
|
Huang CC, Liu ME, Chou KH, Yang AC, Hung CC, Hong CJ, Tsai SJ, Lin CP. Effect of BDNF Val66Met polymorphism on regional white matter hyperintensities and cognitive function in elderly males without dementia. Psychoneuroendocrinology 2014; 39:94-103. [PMID: 24275008 DOI: 10.1016/j.psyneuen.2013.09.027] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 09/30/2013] [Accepted: 09/30/2013] [Indexed: 12/26/2022]
Abstract
White matter lesions, also termed White Matter Hyperintensities (WMH), on T2-weighted MR images, are common in the elderly population. Of note, their presence is often accompanied with cognitive decline and the risk of dementia. Even though previous brain ischemia and WM lesion studies have been conducted and indicated that brain-derived neurotrophic factor (BDNF) might protect against neuronal cell death, the interaction between regional WMH volume and the BDNF Val66Met polymorphism on the cognitive performance of healthy elderly population remains unclear. To investigate the genetic effect of BDNF on cognitive function and regional WMH in the healthy elderly population, 90 elderly men, without dementia, with a mean age of 80.6 ± 5.6 y/o were recruited to undergo cognitive tests, structural magnetic resonance imaging (MRI) scans, and genotyping of BDNF alleles. Compared with Met homozygotes, Val homozygotes showed significantly inferior short-term memory (STM) performance (P = .001). A tendency toward dose-dependent effects of the Val allele on WMH volume was found, and Val homozygotes showed larger WMH volume in the temporal (P = .035), the occipital (P = .006), and the global WMH volume (P = .025) than others. Significant interaction effects of BDNF genotypes with temporal WMH volume on STM performance was observed (F1,89 = 4.306, P = .041). Val homozygotes presented steeper negative correlation compared to Met carriers. Mediation analysis also demonstrated that WMH in temporal, limbic, and subcortical regions might mediate the relationship between BDNF's genetic effect and STM performance. Our findings supported the hypothesis that the BDNF Val66Met polymorphism may affect susceptibility to regional WMH volume and such genotype-by-WMH interaction effect is correlated with cognitive decline in non-demented elderly males, in which the Met allele plays a protective role.
Collapse
Affiliation(s)
- Chu-Chung Huang
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Mu-En Liu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kun-Hsien Chou
- Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taiwan
| | - Albert C Yang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Center for Dynamical Biomarkers and Translational Medicine, National Central University, Chungli, Taiwan
| | - Chia-Chun Hung
- Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chen-Jee Hong
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Ching-Po Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan; Brain Connectivity Lab, Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Brain Research Center, National Yang-Ming University, Taiwan.
| |
Collapse
|
19
|
Tang WK, Chen Y, Liang H, Chu WCW, Mok VCT, Ungvari GS, Wong KS. Cerebral microbleeds as a predictor of 1-year outcome of poststroke depression. Stroke 2013; 45:77-81. [PMID: 24178917 DOI: 10.1161/strokeaha.113.002686] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral microbleeds (CMBs) are common in stroke survivors and community-dwelling elderly. The clinical significance of CMBs in the outcome of poststroke depression (PSD) is unknown. This study examined the association between the 1-year outcome of PSD and CMBs. METHODS The study population comprised 774 Chinese patients with acute ischemic stroke who were admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong. Three and 15 months after the onset of the index stroke, a research assistant administered the locally validated 15-item Geriatric Depression Scale. PSD was defined as a Geriatric Depression Scale score of ≥7. Of the 213 patients with PSD at the 3-month follow-up, 135 (63.4%) attended the 15-month follow-up, at which time 89 (65.9%) patients remained depressed (nonremitters), and 46 (34.1%) had recovered (remitters). The presence and location of CMBs were evaluated with magnetic resonance imaging. RESULTS In comparison with the remitters, nonremitters were more likely to have lobar CMBs (18.4% versus 4.3%; P=0.024). Lobar CMBs remained an independent predictor of PSD in the multivariate analysis, with an odds ratio of 4.96 (P=0.039). CONCLUSIONS The results suggest that lobar CMBs may influence the outcome of PSD. The importance of CMBs in the clinical course of depression in stroke survivors warrants further investigation.
Collapse
Affiliation(s)
- Wai Kwong Tang
- From the Department of Psychiatry (W.K.T., H.L.), Department of Imaging and Interventional Radiology (W.C.W.C.), and Department of Medicine and Therapeutics (V.C.T.M., K.S.W.), Chinese University of Hong Kong, Hong Kong SAR, China; Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, P.R. China (Y.C.); The University of Notre Dame Australia/Marian Centre, Perth, Australia (G.S.U.); and School of Psychiatry and Clinical Neuroscience, University of Western Australia, Perth, Australia (G.S.U.)
| | | | | | | | | | | | | |
Collapse
|
20
|
Frontal lobe atrophy in depression after stroke. Stroke Res Treat 2013; 2013:424769. [PMID: 23533960 PMCID: PMC3596905 DOI: 10.1155/2013/424769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 01/21/2013] [Indexed: 11/26/2022] Open
Abstract
Background. Frontal lobe atrophy (FLA) is associated with late life depression. However, the role that FLA plays in the development of depression after stroke (DAS) remains unknown. This study thus examined the association between FLA and DAS. Methods. A convenience sample of 705 Chinese patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong participated in the study. A psychiatrist administered the Structural Clinical Interview for DSM-IV to all patients and made a diagnosis of DAS three months after the index stroke. Results. Eighty-five (12.1%) patients were diagnosed with DAS. In univariate analysis, the DAS patients were more likely to have severe FLA (14.1% versus 5.6%). Severe FLA remained an independent predictor of DAS in multivariate analysis, with an odds ratio of 2.6 (95% confidence intervals = 1.2–5.9). Conclusions. The results suggest that FLA may play a role in the pathogenesis of DAS, which supports the hypothesis that cumulative vascular burden may be important in predicting DAS. Further investigations are needed to clarify the impact of FLA on the clinical presentation, treatment response, and outcome of DAS in stroke survivors.
Collapse
|
21
|
Jellinger KA. Organic bases of late-life depression: a critical update. J Neural Transm (Vienna) 2013; 120:1109-25. [PMID: 23355089 DOI: 10.1007/s00702-012-0945-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/30/2012] [Indexed: 02/07/2023]
Abstract
Late-life depression (LLD) is frequently associated with cognitive impairment and increases the risk of subsequent dementia. Cerebrovascular disease, deep white matter lesions, Alzheimer disease (AD) and dementia with Lewy bodies (DLB) have all been hypothesized to contribute to this increased risk, and a host of studies have looked at the interplay between cerebrovascular disease and LLD. This has resulted in new concepts of LLD, such as "vascular depression", but despite multiple magnetic resonance imaging (MRI) studies in this field, the relationship between structural changes in human brain and LLD is still controversial. While pathological findings of suicide in some elderly persons revealed multiple lacunes, small vessel cerebrovascular disease, AD-related lesions or multiple neurodegenerative pathologies, recent autopsy data challenged the role of subcortical lacunes and white matter lesions as major morphological substrates of depressive symptoms as well as poorer executive function and memory. Several neuropathological studies, including a personal clinico-pathological study in a small cohort of elderly persons with LLD and age-matched controls confirmed that lacunes, periventricular and deep white matter demyelination as well as AD-related lesions are usually unrelated to the occurrence of LLD. In the same line, neuropathological data show that early-onset depression is not associated with an acceleration of age-related neurodegenerative changes. Very recent data on the critical role of glia-modulating neuronal dysfunction and degeneration in depression are discussed.
Collapse
Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, 1070 Vienna, Austria.
| |
Collapse
|
22
|
Grool AM, Gerritsen L, Zuithoff NPA, Mali WPTM, van der Graaf Y, Geerlings MI. Lacunar infarcts in deep white matter are associated with higher and more fluctuating depressive symptoms during three years follow-up. Biol Psychiatry 2013; 73:169-76. [PMID: 23079234 DOI: 10.1016/j.biopsych.2012.08.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 08/12/2012] [Accepted: 08/13/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Disruption of frontal-subcortical circuits by cerebral small-vessel disease is thought to predispose to depression characterized by motivational symptoms. We examined the influence of lacunar infarcts and white matter lesions (WML) on severity and course of depressive symptoms during 3 years follow-up. METHODS Within the SMART-Medea study, analyses were performed in 650 patients with symptomatic atherosclerotic disease (62±9 years). Volumetric WML measures (deep and periventricular) were obtained with 1.5T magnetic resonance imaging at baseline; infarcts were rated visually. Depressive symptoms were assessed with Patient Health Questionnaire-9 at baseline and during five follow-up times and categorized into motivational and mood scores. RESULTS Using generalized estimating equation models, a relation between lacunar infarcts in deep white matter and an increased severity (mean difference=1.47, 95% confidence interval .33-2.60) and more fluctuating course (p value interaction infarcts * time=.04) of depressive symptoms during follow-up was found, adjusted for age, sex, education, vascular risk, and cognition. This relation was primarily driven by motivational symptoms. Lacunar infarcts were not associated with severity or course of depressive symptoms. Deep WML were associated with a more fluctuating but not more severe course of depressive symptoms. Excluding patients with major depressive disorder did not change the results. CONCLUSIONS In patients with symptomatic atherosclerotic disease and relatively mild depressive symptoms, depressive symptoms, characteristic of motivational problems, remained higher during 3 years follow-up in patients with lacunar infarcts in deep white matter and that symptom severity fluctuated over time.
Collapse
Affiliation(s)
- Anne M Grool
- Julius Center for Health Sciences and Primary Care, Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | |
Collapse
|
23
|
White matter hyperintensities and quality of life in acute lacunar stroke. Neurol Sci 2012; 34:1347-53. [PMID: 23247600 DOI: 10.1007/s10072-012-1267-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
White matter hyperintensities (WMH) are common in stroke. The influence of WMH on health-related quality of life (HRQoL) following a lacunar stroke is unknown. This study evaluated the impact of WMH on HRQoL in acute lacunar stroke. A cohort of 160 patients with acute lacunar stroke admitted to the stroke unit of a university-affiliated regional hospital in Hong Kong was recruited. Three months after the index stroke, a research assistant administered the Short Form-36 (SF-36) to assess HRQoL. The severity of WMH was evaluated with magnetic resonance imaging (MRI). In univariate analysis, the severity of deep WMH (DWMH) negatively correlated with patients' vitality (VT; p < 0.05), social function (SF; p < 0.001), role-emotional (RE; p < 0.01), mental health (MH; p < 0.01), and mental component summary (MCS; p < 0.001) scores of HRQoL. DWMH was independently associated with all of the above five SF-36 scores (p < 0.05) in linear regression analysis. These findings suggest that DWMH has a significant impact on the HRQoL of stroke survivors. The importance of DWMH in the long-term HRQoL in lacunar stroke warrants further investigation.
Collapse
|
24
|
Oppedal K, Aarsland D, Firbank MJ, Sonnesyn H, Tysnes OB, O'Brien JT, Beyer MK. White matter hyperintensities in mild lewy body dementia. Dement Geriatr Cogn Dis Extra 2012. [PMID: 23189084 PMCID: PMC3507264 DOI: 10.1159/000343480] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The objective of this study was to explore the load of white matter hyperintensities (WMH) in patients with Lewy body dementia (LBD) and compare to Alzheimer's disease (AD) and normal controls (NC). Methods Diagnosis of LBD and AD was made according to consensus criteria and cognitive tests were administered. MRI scans for 77 (61 AD and 16 LBD) patients and 37 healthy elderly control subjects were available for analysis. We segmented WMH from FLAIR images using an automatic thresholding technique and calculated the volume of WMH in several regions of the brain, using non-parametric tests to compare groups. Multivariate regression was applied. Results There were no significant differences in WMH between AD and LBD. We found a significant correlation between total and frontal WMH and Mini-Mental State Examination (MMSE) and verbal fluency scores in the AD group, but not in the LBD group. Conclusion The WMH load in LBD was similar to that of AD. A correlation between WMH load and cognition was found in the AD group, but not in the LBD group, suggesting that vascular disease contributes to cognitive impairment in AD but not LBD.
Collapse
Affiliation(s)
- K Oppedal
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway ; Department of Electrical Engineering and Computer Science, University of Stavanger, Stavanger, Norway
| | | | | | | | | | | | | |
Collapse
|
25
|
Petrovic IN, Stefanova E, Kozic D, Semnic R, Markovic V, Daragasevic NT, Kostic VS. White matter lesions and depression in patients with Parkinson's disease. J Neurol Sci 2012; 322:132-6. [DOI: 10.1016/j.jns.2012.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/01/2012] [Accepted: 07/10/2012] [Indexed: 10/28/2022]
|
26
|
Tang WK, Chen YK, Liang HJ, Chu WCW, Mok VCT, Ungvari GS, Wong KS. Cerebral microbleeds and suicidality in stroke. PSYCHOSOMATICS 2012; 53:439-45. [PMID: 22902084 DOI: 10.1016/j.psym.2012.04.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 03/28/2012] [Accepted: 03/30/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cerebral microbleeds (CMBs) are common in stroke survivors. The clinical significance of CMBs in the development of suicidality (SI) following stroke is unknown. This study examined the association between SI and CMBs. The aim of the study reported here was to determine the relationship between CMBs and SI in ischemic stroke survivors. METHODS A cohort of 367 patients with acute ischemic stroke admitted to the stroke unit of a university-affiliated regional hospital in Hong Kong was recruited. SI was assessed with the geriatric mental state examination at three months following the subjects' index stroke. Depressive symptoms were assessed using the geriatric depression scale (GDS). A qualified psychiatrist administered the Chinese version of the Structured Clinical Interview for DSM-IV to diagnose depressive disorders. The presence and location of CMBs were evaluated with magnetic resonance imaging (MRI). RESULTS Compared with the non-SI patients, SI patients were more likely to have CMBs in any brain region (36.6% vs. 20.2%, p = 0.017), specifically more lobar (29.3% vs. 13.5%, p = 0.008) and thalamic CMBs (19.5% vs. 7.5%, p = 0.018). Presence of CMBs (odds ratio was 2.5, p = 0.026) and lobar CMBs (odds ratio 2.6, p = 0.034) were independent predictors of SI in the multivariate analysis. CONCLUSIONS The results suggest that lobar CMBs may play roles in the development of SI. The importance of CMBs in the pathogenesis of SI in stroke survivors warrants further investigation.
Collapse
Affiliation(s)
- Wai Kwong Tang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China.
| | | | | | | | | | | | | |
Collapse
|
27
|
Poggesi A, Pantoni L, Inzitari D, Fazekas F, Ferro J, O'Brien J, Hennerici M, Scheltens P, Erkinjuntti T, Visser M, Langhorne P, Chabriat H, Waldemar G, Wallin A, Wahlund A. 2001-2011: A Decade of the LADIS (Leukoaraiosis And DISability) Study: What Have We Learned about White Matter Changes and Small-Vessel Disease? Cerebrovasc Dis 2011; 32:577-88. [PMID: 22277351 DOI: 10.1159/000334498] [Citation(s) in RCA: 208] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 10/18/2011] [Indexed: 11/19/2022] Open
Abstract
Over the last 20 years, evidence about the clinical correlates of cerebral white matter changes (WMC; also called leukoaraiosis) has been accumulating. WMC are now listed among the neuroimaging expressions of cerebral small-vessel disease and are no longer considered an innocuous finding because they are associated, in cross-sectional surveys, with various disturbances and, in follow-up studies, with poor prognosis. The Leukoaraiosis And DISability (LADIS) study has contributed substantially to this body of knowledge. LADIS is a European multicenter collaboration that was started in 2001 with the aim of assessing the independent role of WMC in predicting disability in subjects aged 65-84. The main results of the LADIS study have been released in 2009 with the demonstration that severe WMC more than double the risk of transition from an autonomous to a dependent status after 3 years of follow-up. The LADIS study has also contributed more focused substudies assessing the possible role of WMC in the decline of cognitive and motor performances, depressive symptoms associated with aging and cerebrovascular diseases, urinary disturbances, and also the role of other brain lesions (lacunar infarcts, cerebral atrophy, and corpus callosum morphology). The LADIS study provides a good example of harmonization of instruments (MRI protocol, clinical, neuropsychological, and functional scales) within an international collaboration. Currently, the LADIS study is providing data about the natural history of WMC. In this paper, we review the background and the main results of the LADIS study. This review puts forward some considerations for future studies in the field.
Collapse
|
28
|
Brommelhoff JA, Spann BM, Go JL, Mack WJ, Gatz M. Striatal Hypodensities, Not White Matter Hypodensities on CT, Are Associated with Late-Onset Depression in Alzheimer's Disease. J Aging Res 2011; 2011:187219. [PMID: 21949906 PMCID: PMC3178151 DOI: 10.4061/2011/187219] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Accepted: 07/22/2011] [Indexed: 11/20/2022] Open
Abstract
This study examined whether there were neuroanatomical differences evident on CT scans of individuals with dementia who differed on depression history. Neuroanatomical variables consisted of visual ratings of frontal lobe deep white matter, subcortical white matter, and subcortical gray matter hypodensities in the CT scans of 182 individuals from the Study of Dementia in Swedish Twins who were diagnosed with dementia and had information on depression history. Compared to individuals with Alzheimer's disease and no depression, individuals with Alzheimer's disease and late-onset depression (first depressive episode at age 60 or over) had a greater number of striatal hypodensities (gray matter hypodensities in the caudate nucleus and lentiform nucleus). There were no significant differences in frontal lobe deep white matter or subcortical white matter. These findings suggest that late-onset depression may be a process that is distinct from the neurodegenerative changes caused by Alzheimer's disease.
Collapse
Affiliation(s)
- Jessica A Brommelhoff
- Department of Psychology, University of Southern California, Los Angeles, CA 90089, USA
| | | | | | | | | |
Collapse
|
29
|
Cerebral microbleeds and quality of life in acute ischemic stroke. Neurol Sci 2011; 32:449-54. [DOI: 10.1007/s10072-011-0571-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 03/24/2011] [Indexed: 10/18/2022]
|
30
|
Berlow YA, Wells WM, Ellison J, Sung YH, Renshaw PF, Harper DG. Neuropsychiatric correlates of white matter hyperintensities in Alzheimer's disease. Int J Geriatr Psychiatry 2010; 25:780-8. [PMID: 19946864 PMCID: PMC3975914 DOI: 10.1002/gps.2418] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the association of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD) and magnetic resonance imaging (MRI) measures of brain atrophy and white matter hyperintensities (WMH). METHODS Thirty-seven patients with probable AD received the Neuropsychiatric Inventory (NPI), the Mini Mental Status Exam (MMSE), and an MRI scan as part of their initial evaluation at the Outpatient Memory Diagnostic Clinic at McLean Hospital. MRI-based volumetric measurements of whole brain atrophy, hippocampal volumes, and WMH were obtained. Analysis of covariance models, using age as a covariate and the presence of specific BPSD as independent variables, were used to test for differences in whole brain volumes, hippocampal volumes and WMH volumes. RESULTS Increased WMH were associated with symptoms of anxiety, aberrant motor behavior, and night time disturbance, while symptoms of disinhibition were linked to lower WMH volume. No associations were found for whole brain or hippocampal volumes and BPSD. CONCLUSIONS These findings suggest that white matter changes are associated with the presence of BPSD in AD.
Collapse
Affiliation(s)
- Yosef A. Berlow
- Geriatric Psychiatry Program, McLean Hospital, Belmont,
MA,Psychiatry, Harvard Medical School, Boston, MA
| | - William M. Wells
- Radiology, Brigham and Women's Hospital, Boston,
MA,Radiology, Harvard Medical School, Boston, MA,Computer Science and Artificial Intelligence Laboratory,
Massachusetts Institute of Technology, Cambridge, MA
| | - James Ellison
- Geriatric Psychiatry Program, McLean Hospital, Belmont,
MA,Psychiatry, Harvard Medical School, Boston, MA
| | - Young Hoon Sung
- Brain Imaging Center, McLean Hospital, Belmont, MA,Psychiatry, Harvard Medical School, Boston, MA
| | - Perry F. Renshaw
- Brain Imaging Center, McLean Hospital, Belmont, MA,Psychiatry, Harvard Medical School, Boston, MA
| | - David G. Harper
- Geriatric Psychiatry Program, McLean Hospital, Belmont,
MA,Psychiatry, Harvard Medical School, Boston, MA
| |
Collapse
|
31
|
The impact of subcortical white matter disease on mood in euthymic older adults: a diffusion tensor imaging study. Am J Geriatr Psychiatry 2010; 18:634-42. [PMID: 20220594 DOI: 10.1097/jgp.0b013e3181cabad1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Clinical depression in the elderly is associated with cerebral small vessel disease. It is less certain whether the endorsement of depressive symptoms in the absence of clinical depression, relatively common in euthymic older adults, is also associated with white matter damage. The majority of studies exploring this issue have produced mixed results, perhaps due, in part, to differences in defining the threshold for depression, notating vascular risk factors, and/or the neuroimaging tools used to quantify white matter damage. We aimed to address these issues with non-demented euthymic older adults. DESIGN AND PARTICIPANTS We performed diffusion tensor imaging (DTI) and T2-weighted magnetic resonance imaging (MRI) in a population based cohort of 79 individuals (mean age = 68 years). MEASUREMENTS In addition to neuroimaging, the authors report assessments of overall cognition, executive functioning, and depression. RESULTS Scores on the Geriatric Depression Scale 15-item (GDS-15) correlated with DTI measures of mean diffusivity (r [77] = 0.23, p = 0.039) and fractional anisotropy (r [77] = -0.22, p = 0.045) but only approached significance for T2-weighted MRI measures of white matter hyperintensities (WMH; r [77] = 0.21, p = 0.053). After adjusting for factors known to influence the development of WMH and depression, including age and vascular risks, DTI-derived indices of white matter integrity remained significantly associated with GDS-15 scores. Furthermore, only DTI-derived measures of white matter integrity contributed to the variance in GDS-15 scores in logistical regression modeling. CONCLUSIONS These findings demonstrate an association between white matter damage and the endorsement of depressive symptoms in euthymic older adults and suggest that DTI may be more sensitive to this damage than T2-WMH in an aging cohort with multiple vascular risk factors.
Collapse
|
32
|
Jonsson M, Edman A, Lind K, Rolstad S, Sjögren M, Wallin A. Apathy is a prominent neuropsychiatric feature of radiological white-matter changes in patients with dementia. Int J Geriatr Psychiatry 2010; 25:588-95. [PMID: 19852002 DOI: 10.1002/gps.2379] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cerebral white-matter changes (WMCs) are frequently found in dementia and have been proposed to be related to vascular factors and a certain symptomatological profile. However, few studies have included both vascular factors and a broad spectrum of cognitive, neurological and psychiatric symptoms, easily detectable by the physician in the everyday clinical work. The objective was to study the relationships between WMCs on MRI/CT and neuropsychiatric symptoms and vascular factors in patients with cognitive impairment. METHODS One hundred and seventy-six patients with Alzheimer's disease, vascular dementia, mixed dementia, and mild cognitive impairment were included. All patients underwent a standardized examination including medical history, clinical examinations, laboratory tests and brain imaging (CT or MRI). The identification and severity degree of WMCs was assessed blindly to clinical findings, using a semi-quantitative scale. For statistical analyses, patients were grouped based on absence or presence of WMCs. Significant variables in bivariate analyses were included as predictors in stepwise multiple logistic regression analyses. RESULTS Bivariate analyses showed significant associations between WMCs and age, gender, blood pressure, hypertension, ischaemic heart disease and TIA/RIND. Furthermore, there were significant associations between WMCs and apathy, mental slowness, disinhibition, gait disturbance and focal neurologic symptoms. The multivariate logistic model revealed apathy, mental slowness and age as the most consistent predicting factors for WMCs, together with MRI as a radiological method for the detection of WMCs. CONCLUSIONS The findings indicate that WMCs in patients with dementia are associated with a dysexecutive-related behavioural symptom profile, vascular factors related to small and large vessel diseases and age.
Collapse
Affiliation(s)
- M Jonsson
- Institute of Neuroscience and Physiology, Section of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Mölndal, Sweden.
| | | | | | | | | | | |
Collapse
|
33
|
Teodorczuk A, Firbank MJ, Pantoni L, Poggesi A, Erkinjuntti T, Wallin A, Wahlund LO, Scheltens P, Waldemar G, Schrotter G, Ferro JM, Chabriat H, Bazner H, Visser M, Inzitari D, O'Brien JT. Relationship between baseline white-matter changes and development of late-life depressive symptoms: 3-year results from the LADIS study. Psychol Med 2010; 40:603-610. [PMID: 19671212 DOI: 10.1017/s0033291709990857] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Growing evidence suggests that cerebral white-matter changes and depressive symptoms are linked directly along the causal pathway. We investigated whether baseline severity of cerebral white-matter changes predict longer-term future depressive outcomes in a community sample of non-disabled older adults. METHOD In the Leukoaraiosis and Disability in the Elderly (LADIS) study, a longitudinal multi-centre pan-European study, 639 older subjects underwent baseline structural magnetic resonance imaging (MRI) and clinical assessments. Baseline severity of white-matter changes was quantified volumetrically. Depressive outcomes were assessed in terms of depressive episodes and depressive symptoms, as measured by the Geriatric Depression Scale (GDS). Subjects were clinically reassessed annually for up to 3 years. Regression models were constructed to determine whether baseline severity of white-matter changes predicted future depressive outcomes, after controlling for confounding factors. RESULTS Baseline severity of white-matter changes independently predicted depressive symptoms at both 2 (p<0.001) and 3 years (p=0.015). Similarly, white-matter changes predicted incident depression (p=0.02). Over the study period the population became significantly more disabled (p<0.001). When regression models were adjusted to account for the influence of the prospective variable transition to disability, baseline severity of white-matter changes no longer predicted depressive symptoms at 3 years (p=0.09) or incident depression (p=0.08). CONCLUSIONS Our results support the vascular depression hypothesis and strongly implicate white-matter changes in the pathogenesis of late-life depression. Furthermore, the findings indicate that, over time, part of the relationship between white-matter changes and depression may be mediated by loss of functional activity.
Collapse
Affiliation(s)
- A Teodorczuk
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne NE4 5PL, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Baune BT, Schmidt WP, Roesler A, Berger K. Functional consequences of subcortical white matter lesions and MRI-defined brain infarct in an elderly general population. J Geriatr Psychiatry Neurol 2009; 22:266-73. [PMID: 19690323 DOI: 10.1177/0891988709342722] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The impact of single and combined effects of subcortical white matter lesions (WMLs) and magnetic resonance imaging (MRI)-defined brain infarct on activities of daily living (ADL), depression, and health status perception was analyzed in community-dwelling elderly individuals. The study included 268 participants from the Memory and Morbidity in Augsburg Elderly (MEMO) project, a population-based study on individuals aged 65 to 83 years, conducted in Augsburg, Germany. Cerebral MRI was performed, and 2 geriatric performance tests, scales to assess ADL, depressive symptoms, and self-perceived health status were assessed. The prevalence of large (>10 mm) subcortical WML was 37.7% and of MRI-defined infarct-like lesions was 15.3%. Both vascular lesion types combined were found in 9% of the participants. Large WMLs were associated with significantly more impairments in basic ADL, inferior results in the performance tests, and a worse self-perceived health status compared to those without large WML. Magnetic resonance imaging-defined brain infarct was associated with impairments in performance tests. Participants with both lesion types were limited in all domains and were 2 to 3 times more likely to have impairments in all examined functions. Their risk of impairment in a specific function was considerably higher than the sum of the single risks associated with each lesion type alone. This study suggests that the single and especially the combined occurrence of common vascular brain lesions are associated with functional impairment. Identifying individuals with severe WML combined with MRI-defined brain infarct can help better understand the development of marked impairments in old age.
Collapse
|
35
|
Bipolar and major depressive disorder: neuroimaging the developmental-degenerative divide. Neurosci Biobehav Rev 2009; 33:699-771. [PMID: 19428491 DOI: 10.1016/j.neubiorev.2009.01.004] [Citation(s) in RCA: 361] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 01/14/2009] [Indexed: 01/30/2023]
Abstract
Both major depressive disorder and bipolar disorder are the subject of a voluminous imaging and genetics literature. Here, we attempt a comprehensive review of MRI and metabolic PET studies conducted to date on these two disorders, and interpret our findings from the perspective of developmental and degenerative models of illness. Elevated activity and volume loss of the hippocampus, orbital and ventral prefrontal cortex are recurrent themes in the literature. In contrast, dorsal aspects of the PFC tend to display hypometabolism. Ventriculomegaly and white matter hyperintensities are intimately associated with depression in elderly populations and likely have a vascular origin. Important confounding influences are medication, phenotypic and genetic heterogeneity, and technological limitations. We suggest that environmental stress and genetic risk variants interact with each other in a complex manner to alter neural circuitry and precipitate illness. Imaging genetic approaches hold out promise for advancing our understanding of affective illness.
Collapse
|
36
|
Schmahmann JD, Smith EE, Eichler FS, Filley CM. Cerebral white matter: neuroanatomy, clinical neurology, and neurobehavioral correlates. Ann N Y Acad Sci 2008; 1142:266-309. [PMID: 18990132 DOI: 10.1196/annals.1444.017] [Citation(s) in RCA: 336] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Lesions of the cerebral white matter (WM) result in focal neurobehavioral syndromes, neuropsychiatric phenomena, and dementia. The cerebral WM contains fiber pathways that convey axons linking cerebral cortical areas with each other and with subcortical structures, facilitating the distributed neural circuits that subserve sensorimotor function, intellect, and emotion. Recent neuroanatomical investigations reveal that these neural circuits are topographically linked by five groupings of fiber tracts emanating from every neocortical area: (1) cortico-cortical association fibers; (2) corticostriatal fibers; (3) commissural fibers; and cortico-subcortical pathways to (4) thalamus and (5) pontocerebellar system, brain stem, and/or spinal cord. Lesions of association fibers prevent communication between cortical areas engaged in different domains of behavior. Lesions of subcortical structures or projection/striatal fibers disrupt the contribution of subcortical nodes to behavior. Disconnection syndromes thus result from lesions of the cerebral cortex, subcortical structures, and WM tracts that link the nodes that make up the distributed circuits. The nature and the severity of the clinical manifestations of WM lesions are determined, in large part, by the location of the pathology: discrete neurological and neuropsychiatric symptoms result from focal WM lesions, whereas cognitive impairment across multiple domains--WM dementia--occurs in the setting of diffuse WM disease. We present a detailed review of the conditions affecting WM that produce these neurobehavioral syndromes, and consider the pathophysiology, clinical effects, and broad significance of the effects of aging and vascular compromise on cerebral WM, in an attempt to help further the understanding, diagnosis, and treatment of these disorders.
Collapse
Affiliation(s)
- Jeremy D Schmahmann
- Ataxia Unit, Cognitive/Behavioral Neurology Unit, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
| | | | | | | |
Collapse
|
37
|
Poggesi A, Pracucci G, Chabriat H, Erkinjuntti T, Fazekas F, Verdelho A, Hennerici M, Langhorne P, O'Brien J, Scheltens P, Visser MC, Crisby M, Waldemar G, Wallin A, Inzitari D, Pantoni L. Urinary Complaints in Nondisabled Elderly People with Age-Related White Matter Changes: The Leukoaraiosis And DISability (LADIS) Study. J Am Geriatr Soc 2008; 56:1638-43. [PMID: 18691285 DOI: 10.1111/j.1532-5415.2008.01832.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Poggesi
- Department of Neurological and Psychiatric Sciences, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Schillerstrom JE, Royall DR, Palmer RF. Depression, disability and intermediate pathways: a review of longitudinal studies in elders. J Geriatr Psychiatry Neurol 2008; 21:183-97. [PMID: 18838741 DOI: 10.1177/0891988708320971] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cross-sectional studies demonstrate depression is associated with disability in elders. These studies also report that disability in depressed elders is associated with greater medical illness burden, cognitive impairment, and behavioral changes. Only longitudinal studies, however, can determine the impact of depression and its comorbidities on functional decline. This review summarizes the findings of 20 longitudinal studies examining the relationship between baseline or incident depression and functional decline. However, the mediational effects of potential risk factors identified by cross-sectional studies cannot be derived from the current literature. We propose a mediational effects model for future longitudinal studies, incorporating measures sensitive to both mood symptoms and the medical, cognitive, and behavioral comorbidities of depression to better understand the impact of each on functional decline and to focus future clinical interventions.
Collapse
Affiliation(s)
- Jason E Schillerstrom
- Department of Psychiatry The University of Texas Health Seience Center, San Antonio, TX 78229, USA.
| | | | | |
Collapse
|
39
|
Oosterman J, van Harten B, Vogels R, Gouw A, Weinstein H, Scheltens P, Scherder E. Distortions in rest–activity rhythm in aging relate to white matter hyperintensities. Neurobiol Aging 2008; 29:1265-71. [PMID: 17368870 DOI: 10.1016/j.neurobiolaging.2007.02.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 02/07/2007] [Accepted: 02/07/2007] [Indexed: 11/21/2022]
Abstract
Distortions in the rest-activity rhythm in aging are commonly observed. Neurodegenerative changes of the suprachiasmatic nucleus have been proposed to underlie this disrupted rhythm. However, based on previous studies, it can be proposed that white matter hyperintensities (WMH) may also play a role in the altered rest-activity rhythm in aging. The present study focused on the rest-activity rhythm, as assessed with actigraphy, and WMH in nondemented aging. With regard to the rest-activity rhythm, the interdaily stability (IS), intradaily variability (IV) and the amplitude (AMP) of the rhythm were of interest. The white matter hyperintensities were examined separately for the periventricular (PVH) and deep white matter (DWMH) regions, while distinguishing between the various locations within these regions (e.g. occipital PVH). The results indicated that frontal DWMH related to both IS and AMP. A reduction in the most active 10-h period mediated the relationship between frontal DWMH and AMP. Possible underlying mechanisms of these associations are discussed.
Collapse
Affiliation(s)
- J Oosterman
- Department of Clinical Neuropsychology, Vrije Universiteit, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
40
|
Alexopoulos GS, Gunning-Dixon FM, Latoussakis V, Kanellopoulos D, Murphy CF. Anterior cingulate dysfunction in geriatric depression. Int J Geriatr Psychiatry 2008; 23:347-55. [PMID: 17979214 DOI: 10.1002/gps.1939] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although several brain abnormalities have been identified in geriatric depression, their relationship to the pathophysiological mechanisms leading to the development and perpetuation of this syndrome remain unclear. METHODS This paper reviews findings on the anterior cingulate cortex (ACC) function and on the relationship of ACC abnormalities to the clinical presentation and the course of geriatric depression in order to elucidate the pathophysiological role of ACC in this disorder. RESULTS The ACC is responsible for conflict detection and emotional evaluation of error and is connected to brain structures that regulate mood, emotional valence of thought and autonomic and visceral responses, which are functions disturbed in depression. Geriatric depression often is accompanied by abnormalities in some executive functions and has a clinical presentation consistent with ACC abnormalities. Indices of ACC dysfunction are associated with adverse outcomes of geriatric depression. CONCLUSIONS Converging findings suggest that at least some ACC functions are abnormal in depression and these abnormalities are pathophysiologically meaningful. Indices of ACC dysfunction may be used to identify subgroups of depressed elderly patients with distinct illness course and treatment needs and serve as the theoretical background for novel treatment development.
Collapse
Affiliation(s)
- George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Department Of Psychiatry, Weill Cornell Medical College, New York, USA.
| | | | | | | | | |
Collapse
|
41
|
Gouw A, van der Flier W, van Straaten E, Pantoni L, Bastos-Leite A, Inzitari D, Erkinjuntti T, Wahlund L, Ryberg C, Schmidt R, Fazekas F, Scheltens P, Barkhof F. Reliability and Sensitivity of Visual Scales versus Volumetry for Evaluating White Matter Hyperintensity Progression. Cerebrovasc Dis 2008; 25:247-53. [DOI: 10.1159/000113863] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Accepted: 10/02/2007] [Indexed: 11/19/2022] Open
|
42
|
Teodorczuk A, O'Brien JT, Firbank MJ, Pantoni L, Poggesi A, Erkinjuntti T, Wallin A, Wahlund LO, Gouw A, Waldemar G, Schmidt R, Ferro JM, Chabriat H, Bäzner H, Inzitari D. White matter changes and late-life depressive symptoms: longitudinal study. Br J Psychiatry 2007; 191:212-7. [PMID: 17766760 DOI: 10.1192/bjp.bp.107.036756] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Evidence from cross-sectional studies suggests a link between cerebral age-related white matter changes and depressive symptoms in older people, although the temporal association remains unclear. AIMS To investigate age-related white matter changes on magnetic resonance imaging (MRI) as an independent predictor of depressive symptoms at 1 year after controlling for known confounders. METHOD In a pan-European multicentre study of 639 older adults without significant disability, MRI white matter changes and demographic and clinical variables, including cognitive scores, quality of life, disability and depressive symptoms, were assessed at baseline. Clinical assessments were repeated at 1 year. RESULTS Using logistic regression analysis, severity of white matter changes was shown to independently and significantly predict depressive symptoms at 1 year after controlling for baseline depressive symptoms, quality of life and worsening disability (P<0.01). CONCLUSIONS White matter changes pre-date and are associated with the development of depressive symptoms. This has implications for treatment and prevention of depression in later life.
Collapse
Affiliation(s)
- A Teodorczuk
- Institute for Ageing and Health, Newcastle General Hospital, Westgate Road, Newcastle upon Tyne NE4 6BE, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Medina KL, Nagel BJ, Park A, McQueeny T, Tapert SF. Depressive symptoms in adolescents: associations with white matter volume and marijuana use. J Child Psychol Psychiatry 2007; 48:592-600. [PMID: 17537075 PMCID: PMC2269707 DOI: 10.1111/j.1469-7610.2007.01728.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Depressed mood has been associated with decreased white matter and reduced hippocampal volumes. However, the relationship between brain structure and mood may be unique among adolescents who use marijuana heavily. The goal of this study was to examine the relationship between white matter and hippocampal volumes and depressive symptoms among adolescent marijuana users and controls. METHODS Data were collected from marijuana users (n = 16) and demographically similar controls (n = 16) aged 16-18. Extensive exclusionary criteria included psychiatric and neurologic disorders, including major depression. Substance use, mood, and anatomical measures were collected after 28 days of monitored abstinence. RESULTS Marijuana (MJ) users demonstrated more depressive symptoms than controls (p < .05). MJ use (beta = .42, p < .005) and smaller white matter volume (beta = -.34, p < .03) each predicted higher levels of depressive symptoms on the Hamilton Depression Rating Scale. MJ use interacted with white matter volume (beta = -.55, p < .03) in predicting depression scores on the Beck Depression Inventory: among MJ users, but not controls, white matter volume was negatively associated with depressive symptoms. CONCLUSIONS Marijuana use and white matter volume were additive and interactive in predicting depressive symptoms among adolescents. Subtle neurodevelopmental white matter abnormalities may disrupt the connections between areas involved in mood regulation.
Collapse
|
44
|
O'Brien JT, Firbank MJ, Krishnan MS, van Straaten ECW, van der Flier WM, Petrovic K, Pantoni L, Simoni M, Erkinjuntti T, Wallin A, Wahlund LO, Inzitari D. White matter hyperintensities rather than lacunar infarcts are associated with depressive symptoms in older people: the LADIS study. Am J Geriatr Psychiatry 2006; 14:834-41. [PMID: 17001023 DOI: 10.1097/01.jgp.0000214558.63358.94] [Citation(s) in RCA: 113] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Both white matter hyperintensities (WMH) and lacunar infarcts have been associated with the development of depression in older subjects, although the relative importance of the two and the influence of lesion location and concomitant vascular disease are unclear. This study investigates the relationship between location and burden of WMH and lacunes on depressive features in older people. METHOD In a pan-European multicenter study of 626 older subjects, the authors examined the relationship between regional magnetic resonance imaging white matter hyperintensities, number of lacunar infarcts, depressive symptoms as assessed by the 15-item geriatric depression scale (GDS), cognitive status (Mini-Mental Status Examination), hypertension, and self-perceived health quality of life (QoL). RESULTS The authors found depressive symptoms to be correlated with WMH rating in the frontal (N=626; Spearman's rho=0.161, p <0.001) and temporal (rho=0.14, p <0.001) but not occipitoparietal region (rho=0.07, p=0.07). Basal ganglia lacunes were only weakly correlated with GDS (rho=0.09, p=0.03), and lacunes in other regions showed no association. In a ordinal logistic regression model (controlling for QoL, Mini-Mental Status Examination, age, and with an interaction between WMH and hypertension), temporal WMH in the absence of hypertension independently predicted GDS, whereas neither history of stroke nor number of lacunar infarcts did. The authors compared left- versus right-sided WMH and found no effect of laterality on depressive symptoms. CONCLUSIONS The results suggest that in this population of nondisabled older people, WMH have a greater influence on depressive symptoms than infarcts.
Collapse
Affiliation(s)
- John T O'Brien
- Institute for Ageing and Health, University of Newcastle upon Tyne, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Krishnan MS, O'Brien JT, Firbank MJ, Pantoni L, Carlucci G, Erkinjuntti T, Wallin A, Wahlund LO, Scheltens P, van Straaten ECW, Inzitari D. Relationship between periventricular and deep white matter lesions and depressive symptoms in older people. The LADIS Study. Int J Geriatr Psychiatry 2006; 21:983-9. [PMID: 16955428 DOI: 10.1002/gps.1596] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Both types of cerebral white matter hyperintensities, periventricular (PVL) and deep white matter lesions (DWML) have been previously associated with the development of depression in older subjects. However, it remains controversial as to whether PVL, DWML, or both are most strongly associated with depression and this was the aim of the current study. METHODS In a pan-European multicentre study of 626 older subjects, we examined the relationship between PVL and DWML, depressive symptoms (GDS quintile), cognitive status (MMSE), hypertension and history of stroke. RESULTS In univariate analysis we found that depressive symptoms as assessed by GDS were associated with both types of white matter lesions (Spearman rho = 0.12 p = 0.002 for DWML and rho = 0.09 p = 0.01 for PVL). Using ordinal logistic regression analysis the total DWML score (p = 0.041), rather than PVL (p = 0.9) was found to predict GDS scores. CONCLUSIONS DWML, but not PVL, were most strongly associated with depressive symptoms in this sample. As DWML (unlike PVL) are associated with vascular ischaemic damage, our findings are consistent with the 'vascular depression' hypothesis. Longitudinal studies are needed to clarify the time course of these relationships, in particular, whether modifying DWML alters the natural history of depression.
Collapse
Affiliation(s)
- Mani S Krishnan
- Institute for Ageing and Health, University of Newcastle upon Tyne, UK.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Roriz-Cruz M, Rosset I, Wada T, Sakagami T, Ishine M, De Sá Roriz-Filho J, Cruz TRS, Hosseinkhani M, Rodrigues RP, Sudoh S, Arai H, Wakatsuki Y, Souza AC, Nakagawa M, Kita T, Matsubayashi K. Cognitive impairment and frontal-subcortical geriatric syndrome are associated with metabolic syndrome in a stroke-free population. Neurobiol Aging 2006; 28:1723-36. [PMID: 16962212 DOI: 10.1016/j.neurobiolaging.2006.07.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 07/07/2006] [Accepted: 07/17/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Metabolic syndrome (Met.S) consists of a conglomeration of obesity, hypertension, glucose intolerance, and dislipidemia. Frontal-subcortical geriatric syndrome (FSCS) is caused by ischemic disruption of the frontal-subcortical network. It is unknown if Met.S is associated with FSCS. METHODS We evaluated 422 community-dwelling elderly (> or =60) in Brazil. FSCS was defined as the presence of at least one frontal release sign (grasping, palmomental, snout, or glabellar) plus coexistence of > or =3 the following criteria: (1) cognitive impairment, (2) late-onset depression, (3) neuromotor dysfunction, and (4) urgency incontinence. All values were adjusted to age and gender. RESULTS Met.S was present in 39.3% of all subjects. Cases without any of the FSCS components represented 37.2% ('successful neuroaging' group). People with 1-3 of the FSCS components ('borderline pathological neuroaging' group) were majority (52.6%), whereas those with 4-5 of these components (FSCS group) were minority (10.2%). Met.S was significantly associated with FSCS (OR=5.9; CI: 1.5-23.4) and cognitive impairment (OR=2.2; CI: 1.1-4.6) among stroke-free subjects. Number of Met.S components explained 30.7% of the variance on the number of FSCS criteria (P<0.001). If Met.S were theoretically removed from this population, prevalence of FSCS would decline by 31.6% and that of cognitive impairment by 21.4%. CONCLUSIONS Met.S was significantly associated with a 5.9 and 2.2 times higher chance of FSCS and cognitive impairment, respectively. Met.S might be a major determinant of 'successful' or 'pathological' neuroaging in western societies.
Collapse
|
47
|
Versluis CE, van der Mast RC, van Buchem MA, Bollen ELEM, Blauw GJ, Eekhof JAH, van der Wee NJA, de Craen AJM. Progression of cerebral white matter lesions is not associated with development of depressive symptoms in elderly subjects at risk of cardiovascular disease: The PROSPER Study. Int J Geriatr Psychiatry 2006; 21:375-81. [PMID: 16534770 DOI: 10.1002/gps.1477] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Cerebral white matter hyperintensities on magnetic resonance imaging (MRI) scans have been associated with vascular disease and late-life depression, both in the general population and in psychiatric patients. Therefore, a cerebrovascular etiology for late-onset depression has been hypothesized. However, longitudinal studies on the causal role of white matter hyperintensities in the development of depressive symptoms in elderly adults are lacking. OBJECTIVE To investigate the relation between white matter hyperintensities and depressive symptoms in elderly subjects at risk of cardiovascular disease. METHODS In the Dutch sample of the PROSPER (PROspective Study of Pravastatine in the Elderly at Risk of cardiovascular disease) cohort, 527 non-demented elderly, all aged 70 years or older, received a cranial MRI scan and the 15-item Geriatric Depression Scale, at baseline and 33 months (SD 1.6) later. RESULTS Presence of white matter hyperintensities at baseline was not related to baseline depressive symptoms nor to the development of depressive symptoms during follow-up. Moreover, no association was found between progression of white matter lesion volume and progression of depressive symptoms. CONCLUSION This longitudinal study does not confirm the involvement of cerebrovascular disease expressed as MRI white matter hyperintensities in the development of depressive symptoms in elderly subjects.
Collapse
Affiliation(s)
- C E Versluis
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|