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Raggi A, Serretti A, Ferri R. A comprehensive overview of post-stroke depression treatment options. Int Clin Psychopharmacol 2024; 39:127-138. [PMID: 38170802 DOI: 10.1097/yic.0000000000000532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Nearly one-third of all stroke patients develop depression at any time after a stroke, and its presence is associated with unfavorable outcomes. This narrative review aims to provide a synopsis of possible pharmacological and non-pharmacological treatment modalities for post-stroke depression (PSD). Several studies have demonstrated the efficacy and safety of selective serotonin reuptake inhibitors in treating the symptoms of this clinical condition. The treatment of PSD has been recently enhanced by innovative approaches, such as cognitive-behavioral therapy, virtual reality, telehealth, repetitive transcranial magnetic stimulation, and non-conventional therapies, which might improve depression treatment in stroke survivors. Future high-quality randomized controlled trials are necessary to confirm this hypothesis.
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Affiliation(s)
- Alberto Raggi
- Unit of Neurology, G.B. Morgagni - L. Pierantoni Civic Hospital, Forlì
| | | | - Raffaele Ferri
- Department of Neurology, Oasi Research Institute - IRCCS, Troina, Italy
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2
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Vassilaki M, Syrjanen JA, Krell-Roesch J, Graff-Radford J, Vemuri P, Scharf EL, Machulda MM, Fields JA, Kremers WK, Lowe VJ, Jack CR, Knopman DS, Petersen RC, Geda YE. Association of Cerebrovascular Imaging Biomarkers, Depression, and Anxiety, with Mild Cognitive Impairment. J Alzheimers Dis Rep 2023; 7:1237-1246. [PMID: 38025797 PMCID: PMC10657723 DOI: 10.3233/adr-230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
The study included 1,738 Mayo Clinic Study of Aging participants (≥50 years old; 1,460 cognitively unimpaired and 278 with mild cognitive impairment (MCI)) and examined the cross-sectional association between cerebrovascular (CVD) imaging biomarkers (e.g., white matter hyperintensities (WMH), infarctions) and Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) scores, as well as their association with MCI. High (abnormal) WMH burden was significantly associated with having BDI-II>13 and BAI > 7 scores, and both (CVD imaging biomarkers and depression/anxiety) were significantly associated with MCI when included simultaneously in the model, suggesting that both were independently associated with the odds of MCI.
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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jeremy A. Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Janina Krell-Roesch
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | | | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Walter K. Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yonas E. Geda
- Department of Neurology, and the Franke Barrow Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix, AZ, USA
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3
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Özge A, Ghouri R, Öksüz N, Taşdelen B. Predictive factors for Alzheimer's disease progression: a comprehensive retrospective analysis of 3,553 cases with 211 months follow-up. Front Neurol 2023; 14:1239995. [PMID: 37693748 PMCID: PMC10484751 DOI: 10.3389/fneur.2023.1239995] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background There is conflicting data regarding the predictors of Alzheimer's Disease (AD), the most common form of dementia. The main objective of the study is to evaluate potential predictors of AD progression using a comprehensive follow-up dataset that includes functional/cognitive assessments, clinical and neuropsychiatric evaluations, and neuroimaging biomarkers such as hippocampal atrophy or white matter intensities (WMIs). Method A total of 161 AD cases were recruited from a dementia database consisting of individuals who consulted the Dementia Outpatient Clinic of the Neurology Department at Mersin University Medical Faculty between 2000 and 2022, under the supervision of the same senior author have at least 3 full evaluation follow-up visit including functional, clinical, biochemical, neuropsychological, and radiological screening. Data were exported and analyzed by experts accordingly. Results Mean follow-up duration of study sample was 71.66 ± 41.98, min 15 to max 211 months. The results showed a fast and slow progressive subgroup of our AD cases with a high sensitivity (Entropy = 0.836), with a close relationship with several cofactors and the level of disability upon admittance. Hippocampal atrophy and WMIs grading via Fazekas were found to be underestimated predictors of AD progression, and functional capacity upon admittance was also among the main stakeholders. Conclusion The study highlights the importance of evaluating multiple potential predictors for AD progression, including functional capacity upon admittance, hippocampal atrophy, and WMIs grading via Fazekas. Our findings provide insight into the complexity of AD progression and may contribute to the development of effective strategies for managing and treating AD.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, School of Medicine, Mersin University, Mersin, Türkiye
| | - Reza Ghouri
- Department of Neurology, School of Medicine, Mersin University, Mersin, Türkiye
| | - Nevra Öksüz
- Department of Neurology, School of Medicine, Mersin University, Mersin, Türkiye
| | - Bahar Taşdelen
- Department of Biostatistics, School of Medicine, Mersin University, Mersin, Türkiye
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4
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Ozzoude M, Varriano B, Beaton D, Ramirez J, Adamo S, Holmes MF, Scott CJM, Gao F, Sunderland KM, McLaughlin P, Goubran M, Kwan D, Roberts A, Bartha R, Symons S, Tan B, Swartz RH, Abrahao A, Saposnik G, Masellis M, Lang AE, Marras C, Zinman L, Shoesmith C, Borrie M, Fischer CE, Frank A, Freedman M, Montero-Odasso M, Kumar S, Pasternak S, Strother SC, Pollock BG, Rajji TK, Seitz D, Tang-Wai DF, Turnbull J, Dowlatshahi D, Hassan A, Casaubon L, Mandzia J, Sahlas D, Breen DP, Grimes D, Jog M, Steeves TDL, Arnott SR, Black SE, Finger E, Rabin J, Tartaglia MC. White matter hyperintensities and smaller cortical thickness are associated with neuropsychiatric symptoms in neurodegenerative and cerebrovascular diseases. Alzheimers Res Ther 2023; 15:114. [PMID: 37340319 PMCID: PMC10280981 DOI: 10.1186/s13195-023-01257-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) are a core feature of most neurodegenerative and cerebrovascular diseases. White matter hyperintensities and brain atrophy have been implicated in NPS. We aimed to investigate the relative contribution of white matter hyperintensities and cortical thickness to NPS in participants across neurodegenerative and cerebrovascular diseases. METHODS Five hundred thirteen participants with one of these conditions, i.e. Alzheimer's Disease/Mild Cognitive Impairment, Amyotrophic Lateral Sclerosis, Frontotemporal Dementia, Parkinson's Disease, or Cerebrovascular Disease, were included in the study. NPS were assessed using the Neuropsychiatric Inventory - Questionnaire and grouped into hyperactivity, psychotic, affective, and apathy subsyndromes. White matter hyperintensities were quantified using a semi-automatic segmentation technique and FreeSurfer cortical thickness was used to measure regional grey matter loss. RESULTS Although NPS were frequent across the five disease groups, participants with frontotemporal dementia had the highest frequency of hyperactivity, apathy, and affective subsyndromes compared to other groups, whilst psychotic subsyndrome was high in both frontotemporal dementia and Parkinson's disease. Results from univariate and multivariate results showed that various predictors were associated with neuropsychiatric subsyndromes, especially cortical thickness in the inferior frontal, cingulate, and insula regions, sex(female), global cognition, and basal ganglia-thalamus white matter hyperintensities. CONCLUSIONS In participants with neurodegenerative and cerebrovascular diseases, our results suggest that smaller cortical thickness and white matter hyperintensity burden in several cortical-subcortical structures may contribute to the development of NPS. Further studies investigating the mechanisms that determine the progression of NPS in various neurodegenerative and cerebrovascular diseases are needed.
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Affiliation(s)
- Miracle Ozzoude
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Faculty of Health, York University, Toronto, ON, Canada
| | - Brenda Varriano
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | - Derek Beaton
- Data Science & Advanced Analytic, St. Michael's Hospital, Toronto, ON, Canada
| | - Joel Ramirez
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Sabrina Adamo
- Graduate Department of Psychological Clinical Science, University of Toronto Scarborough, Scarborough, ON, Canada
| | - Melissa F Holmes
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Christopher J M Scott
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | - Fuqiang Gao
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
| | | | | | - Maged Goubran
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Donna Kwan
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
- Queen's University, Kingston, ON, Canada
| | - Angela Roberts
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
- School of Communication Sciences and Disorders, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Robert Bartha
- Robarts Research Institute, Western University, London, ON, Canada
| | - Sean Symons
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Brian Tan
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Richard H Swartz
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mario Masellis
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Anthony E Lang
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Edmond J Safra Program for Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Connie Marras
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Edmond J Safra Program for Parkinson Disease, Movement Disorder Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Lorne Zinman
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Christen Shoesmith
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
| | - Michael Borrie
- Robarts Research Institute, Western University, London, ON, Canada
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Corinne E Fischer
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Andrew Frank
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Morris Freedman
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Division of Neurology, Baycrest Health Sciences, Toronto, ON, Canada
| | - Manuel Montero-Odasso
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Lawsone Health Research Institute, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, London, ON, Canada
| | - Sanjeev Kumar
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Stephen Pasternak
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stephen C Strother
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Tarek K Rajji
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Adult Neurodevelopment and Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Dallas Seitz
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David F Tang-Wai
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Memory Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - John Turnbull
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Dar Dowlatshahi
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Ayman Hassan
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| | - Leanne Casaubon
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Jennifer Mandzia
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- St. Joseph's Healthcare Centre, London, ON, Canada
| | - Demetrios Sahlas
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - David P Breen
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - David Grimes
- Department of Medicine (Neurology), University of Ottawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- London Health Sciences Centre, London, ON, Canada
| | - Thomas D L Steeves
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Stephen R Arnott
- Rotman Research Institute of Baycrest Centre, Toronto, ON, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Unit, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Heart & Stroke Foundation Canadian Partnership for Stroke Recovery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Elizabeth Finger
- Department of Clinical Neurological Sciences, Western University, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Jennifer Rabin
- Dr. Sandra Black Centre for Brain Resilience and Recovery, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, University of Toronto, Toronto, ON, Canada
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Krembil Discovery Tower, 60 Leonard Avenue, 6th floor 6KD-407, Toronto, ON, M5T 2S8, Canada.
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada.
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
- Memory Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
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5
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Golas AC, Salwierz P, Rajji TK, Bowie CR, Butters MA, Fischer CE, Flint AJ, Herrmann N, Mah L, Mulsant BH, Pollock BG, Taghdiri F, Wang W, Tartaglia MC. Assessing the Role of Past Depression in Patients with Mild Cognitive Impairment, with and without Biomarkers for Alzheimer's Disease. J Alzheimers Dis 2023; 92:1219-1227. [PMID: 36911939 DOI: 10.3233/jad-221097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Major depressive disorder (MDD) is a risk factor for Alzheimer's disease (AD). Cerebrovascular disease (CVD) is implicated in MDD and AD. Our study compared participants with AD positive and negative cerebrospinal fluid (CSF) biomarkers on neuropsychological performance, remitted MDD status, and CVD burden. Next, we compared AD-CSF biomarkers and white matter hyperintensities (WMH) burden among three groups: mild cognitive impairment (MCI) (n = 12), MCI with remitted MDD (MDD+MCI) (n = 12), and remitted MDD alone (MDD) (n = 7). Few participants (18%) with MCI+MDD exhibited AD(+) biomarkers. Nearly all participants had moderate-severe WMH. WMH may contribute to cognitive impairment or depression in MCI patients with AD(-) biomarkers.
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Affiliation(s)
- Angela C Golas
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Patrick Salwierz
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tarek K Rajji
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Christopher R Bowie
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Corinne E Fischer
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Alastair J Flint
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Linda Mah
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Rotman Research Institute, Baycrest Health Sciences, Toronto, ON, Canada
| | - Benoit H Mulsant
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bruce G Pollock
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Foad Taghdiri
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - M Carmela Tartaglia
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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6
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Alexopoulos GS. Mechanisms and Treatment of Late-Life Depression. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:340-354. [PMID: 34690604 DOI: 10.1176/appi.focus.19304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
(Appeared originally in Translational Psychiatry 2019; 9:188).
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Affiliation(s)
- George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605, USA
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7
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Zhang R, Yu W, Wu X, Jiaerken Y, Wang S, Hong H, Li K, Zeng Q, Luo X, Yu X, Xu X, Zhang M, Huang P. Disentangling the pathologies linking white matter hyperintensity and geriatric depressive symptoms in subjects with different degrees of vascular impairment. J Affect Disord 2021; 282:1005-1010. [PMID: 33601672 DOI: 10.1016/j.jad.2020.12.171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/27/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND White matter hyperintensity (WMH) is closely associated with geriatric depressive symptoms, but its underlying neural mechanism is unclear. We aim to disentangle the contribution of vascular degeneration and fiber disruption to depressive symptoms in elderly subjects at different clinical status. METHODS One hundred and thirty-three normal elderly subjects, as well as 43 patients with cerebral small vessel disease (CSVD) were included. The Hamilton Depression Rating Scale (HAMD) was used to measure depressive symptoms. Based on the diffusion tensor imaging data, a free water elimination analytical model was adopted to reflect fiber tract disruption (measure: tissue fractional anisotropy, tFA) and increased white matter water content (measure: free water fraction, FW). RESULTS We found that WMH severity was significantly correlated with decreased tFA and increased FW in all subjects. In normal elderly subjects, the HAMD score was correlated with mean tFA, but not FW. Compared to the traditional fractional anisotropy measure, tFA showed stronger correlation with clinical symptoms. In CSVD subjects, the correlation was only significant for FW, and marginally significant for tFA. LIMITATIONS Most subjects had only mild to moderate depressive symptoms. Further validation in patients with major depressive disorder is needed to confirm these findings. CONCLUSIONS The neural mechanisms of depressive symptoms may be different in elderly people with or without severe vascular damage. The free water elimination model may disentangle the effects of fiber disruption and increased free water, providing sensitive imaging markers that could potentially be used on monitoring disease treatment.
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Affiliation(s)
- Ruiting Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Wenke Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Xiao Wu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Yeerfan Jiaerken
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Shuyue Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Hui Hong
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Kaicheng Li
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Qingze Zeng
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Xiao Luo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Xinfeng Yu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Xiaopei Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China.
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, 310000, Hangzhou, China.
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8
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Magnetic resonance imaging manifestations of cerebral small vessel disease: automated quantification and clinical application. Chin Med J (Engl) 2020; 134:151-160. [PMID: 33443936 PMCID: PMC7817342 DOI: 10.1097/cm9.0000000000001299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The common cerebral small vessel disease (CSVD) neuroimaging features visible on conventional structural magnetic resonance imaging include recent small subcortical infarcts, lacunes, white matter hyperintensities, perivascular spaces, microbleeds, and brain atrophy. The CSVD neuroimaging features have shared and distinct clinical consequences, and the automatic quantification methods for these features are increasingly used in research and clinical settings. This review article explores the recent progress in CSVD neuroimaging feature quantification and provides an overview of the clinical consequences of these CSVD features as well as the possibilities of using these features as endpoints in clinical trials. The added value of CSVD neuroimaging quantification is also discussed for researches focused on the mechanism of CSVD and the prognosis in subjects with CSVD.
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9
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Chan LLY, Okubo Y, Brodie MA, Lord SR. Mobility performance predicts incident depression: A systematic review and meta-analysis. Exp Gerontol 2020; 142:111116. [PMID: 33086078 DOI: 10.1016/j.exger.2020.111116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 09/30/2020] [Accepted: 10/09/2020] [Indexed: 01/11/2023]
Abstract
Impaired mobility often co-occurs with depression. However, there is no systematic review evidence as to whether mobility impairments precede the onset of depression. The objective of this systematic review and meta-analysis was to evaluate whether mobility impairment could predict incident depression. A systematic search of cohort studies were performed in MEDLINE, EMBASE, CINAHL and PsycINFO. The target population was people with no depressive symptoms at baseline and follow-up for depression or depressive symptoms of at least three months. Of 1061 identified abstracts, 13 studies met the review eligibility criteria. The majority of included studies (8 out of 13) were of high methodological quality. Follow-up periods ranged from 12 months to 16 years. Gait speed was the most consistently reported mobility measure. Participants with slow gait speed were at higher risk of developing depressive symptoms (pooled OR = 1.93, 95%CI: 1.54 to 2.42, 11 studies). This review shows that slow gait speed is predictive of the onset of depressive symptoms. Systematic review registration number: CRD42020153791.
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Affiliation(s)
- L L Y Chan
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Y Okubo
- Neuroscience Research Australia, Sydney, New South Wales, Australia
| | - M A Brodie
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - S R Lord
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
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10
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Spalletta G, Iorio M, Vecchio D, Piras F, Ciullo V, Banaj N, Sensi SL, Gianni W, Assogna F, Caltagirone C, Piras F. Subclinical Cognitive and Neuropsychiatric Correlates and Hippocampal Volume Features of Brain White Matter Hyperintensity in Healthy People. J Pers Med 2020; 10:jpm10040172. [PMID: 33076372 PMCID: PMC7712953 DOI: 10.3390/jpm10040172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
White matter hyperintensities (WMH) are associated with brain aging and behavioral symptoms as a possible consequence of disrupted white matter pathways. In this study, we investigated, in a cohort of asymptomatic subjects aged 50 to 80, the relationship between WMH, hippocampal atrophy, and subtle, preclinical cognitive and neuropsychiatric phenomenology. Thirty healthy subjects with WMH (WMH+) and thirty individuals without (WMH−) underwent comprehensive neuropsychological and neuropsychiatric evaluations and 3 Tesla Magnetic Resonance Imaging scan. The presence, degree of severity, and distribution of WMH were evaluated with a semi-automated algorithm. Volumetric analysis of hippocampal structure was performed through voxel-based morphometry. A multivariable logistic regression analysis indicated that phenomenology of subclinical apathy and anxiety was associated with the presence of WMH. ROI-based analyses showed a volume reduction in the right hippocampus of WMH+. In healthy individuals, WMH are associated with significant preclinical neuropsychiatric phenomenology, as well as hippocampal atrophy, which are considered as risk factors to develop cognitive impairment and dementia.
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Affiliation(s)
- Gianfranco Spalletta
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
- Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA
- Correspondence: (G.S.); (F.P.); Tel.: +39-06-5150-1575; Fax: +39-06-5150-1575
| | - Mariangela Iorio
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
- Molecular Neurology Unit, Center of Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Daniela Vecchio
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
- Department of Psychology, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy
| | - Federica Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Valentina Ciullo
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Nerisa Banaj
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Stefano L. Sensi
- Molecular Neurology Unit, Center of Advanced Studies and Technology (CAST), G. d’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy;
- Department of Neuroscience, Imaging, and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, 66100 Chieti, Italy
- Institute for Mind Impairments and Neurological Disorders, University of California-Irvine, Irvine, CA 92697, USA
| | - Walter Gianni
- II Division of Internal Medicine and Geriatrics, Sapienza University of Rome, Policlinico Umberto I, 00161 Rome, Italy;
| | - Francesca Assogna
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Carlo Caltagirone
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
| | - Fabrizio Piras
- Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, 00179 Rome, Italy; (M.I.); (D.V.); (F.P.); (V.C.); (N.B.); (F.A.); (C.C.)
- Correspondence: (G.S.); (F.P.); Tel.: +39-06-5150-1575; Fax: +39-06-5150-1575
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11
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Wong A, Yiu S, Lam BYK, Leung KT, Shi L, Lo E, Abrigo J, Au LW, Lau A, Mok V. Physical activities attenuate the negative cognitive impact from white matter hyperintensities in stroke and TIA patients with low education. Int J Geriatr Psychiatry 2019; 34:1792-1798. [PMID: 31407822 DOI: 10.1002/gps.5194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/05/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The objective of this study is to examine the effects of recent regular participation leisure activities upon cognitive functions between 3 and 6 months after stroke or transient ischemic attack (TIA). We also explored whether the cognitive effects interacted with the severity of white matter hyperintensities (WMH), a marker of cerebral white matter disease, in patients with low or high education. METHODS Two-hundred and ninety-two subjects with mean age of 66.1 (11.0) years were recruited at median 161(131-180) days post index event. WMH volume was evaluated using a semi-automated method on MRI brain. Cognitive functions were measured using the Montreal Cognitive Assessment (MoCA). Multivariable linear regression analysis was conducted to explore the associations between leisure activity participation with WMH and the moderating effects of leisure activities upon relationship between WMH and MoCA. Analyses were further stratified by low (<6 years) or high education (≥6 years). All models were adjusted with age, sex, and years of education. RESULTS Physical activity (PA), but not intellectual activity (IA), was negatively related to WMH volume (P < .05). IA exerted a main effect on MoCA performance (b = 3.21, P < .001). PA, but not IA, significantly interacted with WMH volume (b = -0.18, P < .01) on MoCA performance, but the interaction was only significant in the lower education group (b = 0.28, P < .01) but not in the higher education group. CONCLUSIONS In patients with stroke/TIA, IA confers general cognitive benefits. Regular participation in PA negatively correlated with WMH volume. In patients with low education, PA increases resilience against vascular cognitive impairment.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Stanley Yiu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bonnie Yin Ka Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Kam Tat Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Eugene Lo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Lisa Wc Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Gerald Choa Neuroscience Centre, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
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12
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Yatawara C, Lee D, Ng KP, Chander R, Ng D, Ji F, Shim HY, Hilal S, Venketasubramanian N, Chen C, Zhou J, Kandiah N. Mechanisms Linking White Matter Lesions, Tract Integrity, and Depression in Alzheimer Disease. Am J Geriatr Psychiatry 2019; 27:948-959. [PMID: 31109898 DOI: 10.1016/j.jagp.2019.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 04/04/2019] [Accepted: 04/12/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Late-life depression involves the disconnection of white matter tracts that regulate mood. A pathogenic link between poor tract integrity and depressive symptoms is believed to be white matter lesions (WML), however the mechanisms linking tract integrity, WML, and depression remains unexplored. The authors sought to identify whether the association between reduced tract integrity and depressive symptoms is mediated by WML in patients with Alzheimer disease (AD), and whether individual characteristics moderate this effect. METHODS This was a cross-sectional study in a tertiary memory clinic. A total of 91 patients with mild AD and 79 healthy elderly, comparable in depressive symptoms, white matter hyperintensities (WMH) volume, cardiovascular risk, age, and sex were chosen. Tract integrity was assessed using diffusion tensor imaging, WML were indexed as WMH, measured using fluid-attenuation inversion recovery imaging, and depressive symptoms were measured with the informant-based Geriatric Depression Scale. RESULTS In patients with mild AD, reduced tract integrity in right hemispheric cortical-subcortical tracts and the genu of the corpus callosum was moderately associated with depressive symptoms. This association was fully mediated by WML. Moderation analysis indicated that old age strengthened the association between all tracts and depressive symptoms, as mediated by WML. In cognitively healthy elderly, neither tracts nor WML were related to depressive symptoms. CONCLUSION Reduced tract integrity may be important but not sufficient for the manifestation of depressive symptoms in mild AD. Instead, WML may drive the pathogenic link between reduced tract integrity and depressive symptoms.
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Affiliation(s)
- Chathuri Yatawara
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Daryl Lee
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Russell Chander
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Debby Ng
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore
| | - Fang Ji
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program (FJ, HYS, JZ, NK), Duke-NUS Medical School, Singapore
| | - Hee Youn Shim
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program (FJ, HYS, JZ, NK), Duke-NUS Medical School, Singapore
| | - Saima Hilal
- National University Health System (SH, CC), Memory Aging & Cognition Centre, Singapore
| | | | - Christopher Chen
- National University Health System (SH, CC), Memory Aging & Cognition Centre, Singapore
| | - Juan Zhou
- Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program (FJ, HYS, JZ, NK), Duke-NUS Medical School, Singapore
| | - Nagaendran Kandiah
- Department of Neurology (CY, DL, KPN, RC, DN, NK), National Neuroscience Institute, Singapore, Singapore; Center for Cognitive Neuroscience, Neuroscience and Behavioral Disorders Program (FJ, HYS, JZ, NK), Duke-NUS Medical School, Singapore.
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13
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Alexopoulos GS. Mechanisms and treatment of late-life depression. Transl Psychiatry 2019; 9:188. [PMID: 31383842 PMCID: PMC6683149 DOI: 10.1038/s41398-019-0514-6] [Citation(s) in RCA: 255] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/26/2018] [Accepted: 01/01/2019] [Indexed: 01/25/2023] Open
Abstract
Depression predisposes to medical illnesses and advances biological aging indicated by shorter telomere length, accelerated brain aging and advanced epigenetic aging. Medical illnesses also increase the risk of late-life depression. The reciprocal relationships of depression with aging-related and disease-related processes have generated pathogenetic hypotheses and provided treatment targets. Targeting risk factors of vascular disease in mid-life is a logical approach in prevention of vascular depression. The depression-executive dysfunction and the vascular depression syndromes have clinical presentations and neuroimaging findings consistent with frontostriatal abnormalities. Dopamine D2/3 agonists are effective in depression of Parkinson's disease and their efficacy needs to be assessed in these two syndromes. Computerized cognitive remediation targeting functions of the cognitive control network may improve both executive functions and depressive symptoms of late-life major depression. Significant progress has been made in neurostimulation treatments in depressed younger adults. TMS targeting deep structures responsible for mood regulation is well tolerated by older adults and its efficacy in syndromes of late-life depression needs to be studied. Efficacious psychotherapies for late-life depression exist, but are underutilized in part because of their complexity. Streamlined, stepped psychotherapies targeting behaviors assumed to result from dysfunction of brain networks implicated in late-life depression can be easy to learn and have potential for dissemination. However, their effectiveness needs further investigation. Depression increases the risk of dementing disorders. Antidepressants are rather ineffective in treating depression of demented patients, but long-term use of antidepressants may reduce the risk of dementia. However, confirmation studies are needed.
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Affiliation(s)
- George S. Alexopoulos
- 000000041936877Xgrid.5386.8Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605 USA
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14
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de Havenon A, Meyer C, McNally JS, Alexander M, Chung L. Subclinical Cerebrovascular Disease: Epidemiology and Treatment. Curr Atheroscler Rep 2019; 21:39. [PMID: 31350593 DOI: 10.1007/s11883-019-0799-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Subclinical cerebrovascular disease (sCVD) is highly prevalent in older adults. The main neuroimaging findings of sCVD include white matter hyperintensities and silent brain infarcts on T2-weighted MRI and cerebral microbleeds on gradient echo or susceptibility-weighted MRI. In this paper, we will review the epidemiology of sCVD, the current evidence for best medical management, and future directions for sCVD research. RECENT FINDINGS Numerous epidemiologic studies show that sCVD, in particular WMH, is an important risk factor for the development of dementia, stroke, worse outcomes after stroke, gait instability, late-life depression, and death. Effective treatment of sCVD could have major consequences for the brain health of a substantial portion of older Americans. Despite the link between sCVD and many vascular risk factors, such as hypertension or hyperlipidemia, the optimal medical treatment of sCVD remains uncertain. Given the clinical equipoise about the risk versus benefit of aggressive medical management for sCVD, clinical trials to examine pragmatic, evidence-based approaches to management of sCVD are needed. Such a trial could provide much needed guidance on how to manage a common clinical scenario facing internists and neurologists in practice.
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Affiliation(s)
- Adam de Havenon
- Department of Neurology, University of Utah, Salt Lake City, UT, USA.
| | - Chelsea Meyer
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
| | - J Scott McNally
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Matthew Alexander
- Department of Radiology, University of Utah, Salt Lake City, UT, USA
| | - Lee Chung
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
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15
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Nociceptive Primitive Reflexes in Neurologically and Cognitively Healthy Aging Subjects. Can J Neurol Sci 2019; 46:199-208. [PMID: 30761966 DOI: 10.1017/cjn.2018.388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND To assess the prevalence of three nociceptive primitive reflexes (nPR), i.e., glabellar tap, snout reflex, and palmomental reflex, in neurologically and cognitively healthy (NCH) aging subjects. OBJECTIVE To investigate whether nPR are cross-sectionally associated with white matter hyperintensities (WMH), lacunes, atrophy of the caudate nuclei, and global brain atrophy. METHODS A total of 1246 NCH subjects aged 45-91 years were included in the study and underwent standard brain MRI. Atrophy of the caudate nuclei and global brain atrophy were assessed through the bicaudate ratio (BCr) and lateral ventricles to brain ratio (LVBr), respectively. WMH were assessed through visual rating scales. Lacunes were also rated. Association of nPR with vascular risk factors/diseases and imaging findings was evaluated using logistic regression analysis. RESULTS nPR were exhibited by 33.1% of subjects and increased with age. Subjects with nPR performed less than subjects without nPR in tests evaluating global cognition, executive functions, attention, and language. Snout reflex was the most common nPR, followed by glabellar tap and palmomental reflex. Glabellar tap was associated with parieto-temporal WMH, BCr, and LVBr; snout reflex was associated with frontal lacunes, temporal WMH, BCr, and LVBr; palmomental reflex was associated with parieto-occipital WMH, basal ganglia lacunes, BCr, and LVBr. CONCLUSIONS This study demonstrates that in NCH aging individuals, nPR are associated with WMH, lacunes, BCr, and LVBr and are probably a warning sign of incipient cognitive decline. Therefore, NCH subjects presenting nPR should manage their vascular risk factors/vascular diseases rigorously in order to prevent or delay progression of small vessel disease, and future neurological and cognitive disabilities.
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Holmegaard L, Jensen C, Redfors P, Blomstrand C, Jern C, Jood K. Long-term progression of white matter hyperintensities in ischemic stroke. Acta Neurol Scand 2018; 138:548-556. [PMID: 30152523 DOI: 10.1111/ane.13019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/27/2018] [Accepted: 08/10/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES Studies on long-term progression of white matter hyperintensities (WMH) after ischemic stroke are scarce. Here, we sought to investigate this progression and its predictors in a cohort presenting with ischemic stroke before 70 years of age. MATERIALS AND METHODS Participants in the Sahlgrenska Academy Study on Ischemic Stroke who underwent magnetic resonance imaging (MRI) of the brain at index stroke were examined by MRI again after 7 years (n = 188, mean age 53 years at index stroke, 35% females). WMH at index stroke and progression were assessed according to Fazekas' grades and the WMH change scale. Stroke subtype was classified according to TOAST. RESULTS Marked WMH at index stroke were present in 20% of the participants and were significantly associated with age, hypertension, and subtype. Progression of WMH after 7 years was observed in 63% and 35% of the participants for subcortical and periventricular locations, respectively. Significant independent predictors of progression were age and marked WMH at baseline for both locations, whereas no significant associations were detected for vascular risk factors or subtype in multivariable analyses. In participants with no or only mild WMH at baseline, 20% showed marked WMH at follow-up. Age and hypertension, but not subtype, were independently associated with this acquisition of marked WMH. CONCLUSIONS Age and marked WMH at index stroke, but not stroke subtype, predicted long-term WMH progression after ischemic stroke before 70 years of age, whereas age and hypertension predicted acquisition of marked WMH in those with no or only mild WMH at baseline.
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Affiliation(s)
- Lukas Holmegaard
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Christer Jensen
- Department of Radiology; Institute of Clinical Sciences; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Petra Redfors
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Christian Blomstrand
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Christina Jern
- Department of Clinical Pathology and Genetics; Institute of Biomedicine; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology; Sahlgrenska Academy at University of Gothenburg; Gothenburg Sweden
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Jingwen J, Han J, Yu Z, Xiaojun H, Junpeng Z, Fanxia S, Jianrong L. Quality of life among patients during subacute phase following stroke during hospitalisation period in Shanghai. Int J Psychiatry Clin Pract 2018; 22:296-303. [PMID: 29457918 DOI: 10.1080/13651501.2018.1432763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: This study aimed to investigate the factors influencing the quality of life of in-hospital subacute stroke patients. Methods: The patients of subacute stroke (within four weeks) in our institution between 2015 and 2016 were recruited. Patients' characteristics and QOL were obtained from medical charts and stroke-specific quality of life scale (SS-QOL). Associations of each domain in SS-QOL with socio-demographic, clinical factors and patient satisfaction were investigated using the linear regression models. Results: Among the 203 subjects, 60 were diagnosed as large artery atherosclerosis (LAA), 80 were small-artery occlusion (SAO), 28 were cardioembolism (CE) and 35 were intracranial haemorrhage (ICH). The ICH group had the worst self-care ability and upper extremity function. Worse severity of stroke was associated with lower levels of language ability, mobility, mood status and upper-extremity function. Participants who had better satisfaction had high levels of capability of conducting family roles, positive emotions, personality consistency, self-care ability and capacity of conducting social roles. Conclusions: The level of patient satisfaction, duration of hospitalisation and the severity of stroke were found to be the three important factors associated with SS-QOL at hospital discharge, indicating doctors might assist patients adjust to the consequences of stroke and improve the QOL of subacute stroke.
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Affiliation(s)
- Jiang Jingwen
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Jin Han
- b Centre for Mental Health Research , The Australian National University , Canberra , Australia
| | - Zhang Yu
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Huang Xiaojun
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Zhuang Junpeng
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Shen Fanxia
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
| | - Liu Jianrong
- a Department of Neurology , Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine , Shanghai , PR China
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18
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Leeuwis AE, Prins ND, Hooghiemstra AM, Benedictus MR, Scheltens P, Barkhof F, van der Flier WM. Microbleeds are associated with depressive symptoms in Alzheimer's disease. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2017; 10:112-120. [PMID: 29780860 PMCID: PMC5956804 DOI: 10.1016/j.dadm.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Co-occurrence of cerebrovascular disease and depression led to the "vascular depression hypothesis". White matter hyperintensities (WMHs) have been associated with depressive symptoms in population-based studies. We studied the association between small vessel disease and depressive symptoms in a memory clinic population. METHODS We included >2000 patients with subjective cognitive decline (SCD), mild cognitive impairment, and Alzheimer's disease (AD). Magnetic resonance imaging was rated for WMHs, lacunes, and microbleeds. Depressive symptoms were assessed using the Geriatric Depression Scale. We performed logistic regression analysis. RESULTS Depressive symptoms were present in AD: 17%; mild cognitive impairment: 25%; and SCD: 23%. SCD patients with WMHs showed higher propensity of depressive symptoms than AD patients with WMHs. AD patients with microbleeds were more likely to have depressive symptoms compared with AD patients without microbleeds (odds ratio = 1.70; 95% confidence interval: 1.08-2.68). DISCUSSION Microbleeds are associated with depressive symptoms in AD, supporting a potential role of cerebral amyloid angiopathy in the occurrence of depressive symptoms in AD.
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Affiliation(s)
- Anna E. Leeuwis
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Niels D. Prins
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Astrid M. Hooghiemstra
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Marije R. Benedictus
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Philip Scheltens
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
- Institutes of Neurology and Healthcare Engineering, University College London, London, United Kingdom
| | - Wiesje M. van der Flier
- Alzheimer Center and Department of Neurology, Amsterdam Neuroscience, VU University Medical Center, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
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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.
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20
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Douven E, Köhler S, Rodriguez MMF, Staals J, Verhey FRJ, Aalten P. Imaging Markers of Post-Stroke Depression and Apathy: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2017; 27:202-219. [PMID: 28831649 PMCID: PMC5613051 DOI: 10.1007/s11065-017-9356-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/27/2017] [Indexed: 01/15/2023]
Abstract
Several brain imaging markers have been studied in the development of post-stroke depression (PSD) and post-stroke apathy (PSA), but inconsistent associations have been reported. This systematic review and meta-analysis aims to provide a comprehensive and up-to-date evaluation of imaging markers associated with PSD and PSA. Databases (Medline, Embase, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews) were searched from inception to July 21, 2016. Observational studies describing imaging markers of PSD and PSA were included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated to examine the association between PSD or PSA and stroke lesion laterality, type, and location, also stratified by study phase (acute, post-acute, chronic). Other imaging markers were reviewed qualitatively. The search retrieved 4502 studies, of which 149 studies were included in the review and 86 studies in the meta-analyses. PSD in the post-acute stroke phase was significantly associated with frontal (OR 1.72, 95% CI 1.34–2.19) and basal ganglia lesions (OR 2.25, 95% CI 1.33–3.84). Hemorrhagic stroke related to higher odds for PSA in the acute phase (OR 2.58, 95% CI 1.18–5.65), whereas ischemic stroke related to higher odds for PSA in the post-acute phase (OR 0.20, 95% CI 0.06–0.69). Frequency of PSD and PSA is modestly associated with stroke type and location and is dependent on stroke phase. These findings have to be taken into consideration for stroke rehabilitation programs, as this could prevent stroke patients from developing PSD and PSA, resulting in better clinical outcome.
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Affiliation(s)
- Elles Douven
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Maria M F Rodriguez
- Hospital Alvaro Cunqueiro, Department of Psychiatry, Complexo Universitario de Vigo, Vigo, Spain
| | - Julie Staals
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands.
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21
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Park JH, Jeon BH, Lee JS, Newhouse PA, Taylor WD, Boyd BD, Kim KW, Kim MD. CADASIL as a Useful Medical Model and Genetic Form of Vascular Depression. Am J Geriatr Psychiatry 2017; 25:719-727. [PMID: 28434675 DOI: 10.1016/j.jagp.2017.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 02/06/2017] [Accepted: 03/14/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The main magnetic resonance imaging (MRI) findings of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) are white matter hyperintensities (WMHs), lacunar infarctions, and cerebral microbleeds (CMBs). The purpose of this study was to investigate the effects of these three neuroimaging markers of CADASIL on depression to determine whether CADASIL is a useful medical model supporting the vascular depression hypothesis. METHODS Eighty-four subjects with CADASIL, aged 34-86 years, participated in this study. They underwent comprehensive clinical evaluation, including 3T MRI and genotyping of NOTCH3. The effects of WMH, lacunar infarctions, and CMBs were analyzed by path analyses and multivariate logistic regression analyses. RESULTS Patients with CADASIL exhibited frequencies of 17.9% for major depressive disorder (MDD) and 10.7% for minor depressive disorder. The frequency of MDD increased from 5.0% to 46.2% as WMH volume increased from first quartile to fourth quartile. WMH volume (OR: 1.03, 95% CI: 1.003-1.06) in patients with CADASIL was associated with the current depressive disorder. Path analyses demonstrated that only WMH volume was associated with the Korean version of the short form Geriatric Depression Scale score, Center for Epidemiologic Studies Depression Scale score, and 17-item Hamilton depression scale score. The effects of lacunar infarctions and CMBs on depression were not significant in path analyses and multivariate logistic regression analyses. CONCLUSIONS This study demonstrates that WMHs are closely associated with depression in patients with CADASIL. This supports that CADASIL might be a useful medical model and genetic form of vascular depression.
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Affiliation(s)
- Joon Hyuk Park
- Department of Psychiatry, Jeju National University School of Medicine, Jeju National University Hospital, Jejudo, Republic of Korea
| | - Bong-Hee Jeon
- Department of Psychiatry, Naju National Hospital, Naju, Republic of Korea
| | - Jung Seok Lee
- Department of Neurology, Jeju National University School of Medicine, Jeju National University Hospital, Jejudo, Republic of Korea
| | - Paul A Newhouse
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA; Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Warren D Taylor
- Geriatric Research, Education, and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA; Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Brian D Boyd
- Center for Cognitive Medicine, Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Moon-Doo Kim
- Department of Psychiatry, Jeju National University School of Medicine, Jeju National University Hospital, Jejudo, Republic of Korea.
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22
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Jorgensen DR, Rosano C, Novelli EM. Can Neuroimaging Markers of Vascular Pathology Explain Cognitive Performance in Adults With Sickle Cell Anemia? A review of the Literature. Hemoglobin 2017; 40:381-387. [PMID: 27689914 DOI: 10.1080/03630269.2016.1242493] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Adults with homozygous sickle cell anemia have, on average, lower cognitive function than unaffected controls. The mechanisms underlying cognitive deterioration in this population are poorly understood, but cerebral small vessel disease (CSVD) is likely to be implicated. We conducted a systematic review using the Prisma Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of articles that included both measures of cognitive function and magnetic resonance imaging (MRI) neuroimaging markers of small vessel disease. While all five studies we identified reported small vessel disease by MRI, only two of them found a significant relationship between structural changes and cognitive performance. Differences in methodologies and small sample sizes likely accounted for the discrepancies between the studies. We conclude that while MRI is a valuable tool to identify markers of CSVD in this population, larger studies are needed to definitely establish a link between MRI-detectable abnormalities and cognitive function in sickle cell anemia.
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Affiliation(s)
- Dana R Jorgensen
- a Department of Epidemiology , University of Pittsburgh School of Public Health , Pittsburgh , PA , USA
| | - Caterina Rosano
- a Department of Epidemiology , University of Pittsburgh School of Public Health , Pittsburgh , PA , USA
| | - Enrico M Novelli
- b Adult Sickle Cell Program, Division of Hematology/Oncology , University of Pittsburgh , Pittsburgh , PA , USA
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23
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Schwichtenberg J, Al-Zghloul M, Kerl HU, Wenz H, Hausner L, Frölich L, Groden C, Förster A. Late-onset major depression is associated with age-related white matter lesions in the brainstem. Int J Geriatr Psychiatry 2017; 32:446-454. [PMID: 27113993 DOI: 10.1002/gps.4487] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 02/22/2016] [Accepted: 03/15/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Age-related white matter lesions (ARWMLs) have been identified in various clinical conditions such as reduced gait speed, cognitive impairment, urogenital dysfunction, and mood disturbances. Previous studies indicated an association between ARWML and late-onset major depression. However, most of these focused on the extent of supratentorial ARWML and neglected presence and degree of infratentorial lesions. METHODS In 45 patients (mean age 73.7 ± 6.3 years, 17 (37.8%) men, 28 (62.2%) women) with late-onset major depression, MRI findings (3.0-T MR system, Magnetom Trio, Siemens Medical Systems, Erlangen, Germany) were analyzed with emphasis on the extent of supratentorial and infratentorial, as well as brainstem ARWMLs, and compared with control subjects. ARWMLs were determined by semiquantitative rating scales (modified Fazekas rating scale, Scheltens' rating scale), as well as a semiautomatic volumetric assessment, using a specific software (MRIcron). Supratentorial and infratentorial, as well as brainstem ARWMLs, were assessed both on fluid attenuated inversion recovery and T2-weighted images. RESULTS Patients with late-onset major depression had significantly higher infratentorial ARWML rating scores (5 (5-7) vs 4.5 (3-6), p = 0.003) on T2-weighted images and volumes (1.58 ± 1.35 mL vs 1.05 ± 0.81 mL, p = 0.03) on T2-weighted images, as well as fluid attenuated inversion recovery images (2.07 ± 1.35 mL vs 1.52 ± 1.10 mL, p = 0.04), than normal controls. In more detail, in particular, the pontine ARWML rating subscore was significantly higher in patients with late-onset major depression (1 (1-2) vs 1 (1-1), p = 0.004). CONCLUSIONS The extent and localization of brainstem ARWML might be of importance for the pathophysiology of late-onset major depression. In particular, this may hold true for pontine ARWML. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Johannes Schwichtenberg
- Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Mansour Al-Zghloul
- Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hans U Kerl
- Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Holger Wenz
- Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lucrezia Hausner
- Department of Geriatric Psychiatry, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Lutz Frölich
- Department of Geriatric Psychiatry, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christoph Groden
- Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alex Förster
- Department of Neuroradiology, Universitätsmedizin Mannheim Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Zhang X, Tang Y, Xie Y, Ding C, Xiao J, Jiang X, Shan H, Lin Y, Li C, Hu D, Li T, Sheng L. Total magnetic resonance imaging burden of cerebral small-vessel disease is associated with post-stroke depression in patients with acute lacunar stroke. Eur J Neurol 2016; 24:374-380. [PMID: 27933697 DOI: 10.1111/ene.13213] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- X. Zhang
- Department of Neurology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
| | - Y. Tang
- Department of Neurology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
| | - Y. Xie
- Department of Neurology; Jinling Hospital; Nanjing University School of Medicine; Nanjing Jiangsu China
| | - C. Ding
- Department of Neurology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
| | - J. Xiao
- Department of Neurology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
| | - X. Jiang
- Department of Neurology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
| | - H. Shan
- Department of Radiology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
| | - Y. Lin
- Department of Radiology; Hainan General Hospital; Haikou Hainan China
| | - C. Li
- Department of Neurology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
| | - D. Hu
- Department of Neurology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
| | - T. Li
- Department of Neurology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
| | - L. Sheng
- Department of Neurology; Second Affiliated Hospital of Nanjing University of Chinese Medicine; Nanjing Jiangsu China
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25
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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.
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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
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26
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Tsubota-Utsugi M, Satoh M, Tomita N, Hara A, Kondo T, Hosaka M, Saito S, Asayama K, Inoue R, Hirano M, Hosokawa A, Murakami K, Murakami T, Metoki H, Kikuya M, Izumi SI, Imai Y, Ohkubo T. Lacunar Infarcts Rather than White Matter Hyperintensity as a Predictor of Future Higher Level Functional Decline: The Ohasama Study. J Stroke Cerebrovasc Dis 2016; 26:376-384. [PMID: 28029606 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/16/2016] [Accepted: 09/22/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to determine the associations between silent cerebrovascular lesions, characterized by lacunar infarcts and white matter hyperintensity, and future decline in higher level functional capacity in older community-dwelling adults. MATERIALS AND METHODS For this observational study, we selected individuals from the general population of Ohasama, a rural Japanese community. Three hundred thirty-one participants who were free of functional decline at baseline and who were at least 60 years old underwent brain magnetic resonance imaging and answered a questionnaire on higher level functional capacity derived from the Tokyo Metropolitan Institute of Gerontology Index of Competence. Weassessed the relationship between silent cerebrovascular lesions with a decline in higher level functional capacity at 7 years using multiple logistic regression analysis adjusted for possible confounding factors. RESULTS During the follow-up, 22.1% reported declines in higher level functional capacity. After adjustment for putative confounding factors, the presence of silent cerebrovascular lesions (odds ratio [95% confidence interval], 2.10 [1.05-4.21]) and both lacunar infarcts (2.04 [1.05-3.95]) and white matter hyperintensity (2.02 [1.02-3.95]) was significantly associated with the risk of functional decline at 7-year follow-up. In subscale analysis, specifically lacunar infarcts were strongly associated with the future risk of decline in intellectual activity (3.16 [1.27-7.84]). CONCLUSION Silent cerebrovascular lesions are associated with future risk of decline in higher level functional capacity. Appropriate management of health risk factors to prevent silent cerebrovascular lesions may prevent higher level functional decline in the elderly population.
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Affiliation(s)
- Megumi Tsubota-Utsugi
- Department of Hygiene and Preventive Medicine, Iwate Medical University School of Medicine, Iwate, Japan.
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Naoki Tomita
- Institute of Development, Aging and Cancer, Department of Geriatrics and Gerontology, Tohoku University, Sendai, Japan
| | - Azusa Hara
- Department of Social Pharmacy and Public Health, Showa Pharmaceutical University, Tokyo, Japan
| | - Takeo Kondo
- Physical Medicine and Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Miki Hosaka
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Sho Saito
- Division of Aging and Geriatric Dentistry, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryusuke Inoue
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mikio Hirano
- Department of Community Medical Support, Tohoku University, Sendai, Japan
| | - Aya Hosokawa
- Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Keiko Murakami
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Masahiro Kikuya
- Tohoku Medical Megabank organization, Tohoku University, Sendai, Japan
| | - Shin-Ichi Izumi
- Physical Medicine and Rehabilitation, Tohoku University Hospital, Sendai, Japan
| | - Yutaka Imai
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
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27
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Shibata K, Nishimura Y, Otsuka K, Sakura H. Influence of cerebral white matter hyperintensities on cognitive impairment in elderly medical patients. Geriatr Gerontol Int 2016; 17:1488-1493. [PMID: 27680506 DOI: 10.1111/ggi.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/28/2016] [Accepted: 07/24/2016] [Indexed: 11/28/2022]
Abstract
AIM We investigated the characteristics of elderly medical patients with white matter hyperintensities on magnetic resonance imaging. METHODS A total of 213 patients (123 men and 90 women; mean age 74.8 years) reported their history of hypertension, diabetes, dyslipidemia, previous stroke, coronary heart disease and chronic kidney disease (CKD). All patients completed the Mini-Mental State Examination and Geriatric Depression Scale. White matter hyperintensities were evaluated for the periventricular region, basal ganglia (BGH), deep white matter and infratentorial region, and brain atrophy was calculated as bicaudate ratios. RESULTS Patients with cognitive impairment (Mini-Mental State Examination score < 24) were significantly older (P = 0.001), had periventricular region hyperintensities (P = 0.029) and BGH (P = 0.0015), and showed atrophy (P < 0.0001). Logistic regression showed that cognitive impairment was predicted by stroke (OR 2.5, 95% CI 0.033-0.894, P = 0.036) and atrophy (OR 8.43, 95% CI 5.71-37.0, P = 0.0109). Multiple regressions showed that BGH was associated with CKD (β = 0.213; P = 0.003), and infratentorial region was associated with stroke (β = 0.157; P =0.035) and CKD (β = 0.172; P = 0.016). Periventricular region was associated with age (β = 0.2; P = 0.011) and Geriatric Depression Scale (β = 0.151; P = 0.037), and deep white matter hyperintensities with age (β = 0.189; P = 0.016). CONCLUSIONS Although cognitive impairment in elderly medical patients is associated with stroke and brain atrophy, white matter hyperintensities, especially BGH and infratentorial region, are associated with cognitive decline in relation to CKD. Geriatr Gerontol Int 2017; 17: 1488-1493.
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Affiliation(s)
- Koichi Shibata
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yoshiko Nishimura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Kuniaki Otsuka
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Hiroshi Sakura
- Department of Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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28
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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.
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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
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Wong A, Lau AYL, Yang J, Wang Z, Liu W, Lam BYK, Au L, Shi L, Wang D, Chu WCW, Xiong YY, Lo ESK, Law LSN, Leung TWH, Lam LCW, Chan AYY, Soo YOY, Leung EYL, Wong LKS, Mok VCT. Neuropsychiatric Symptom Clusters in Stroke and Transient Ischemic Attack by Cognitive Status and Stroke Subtype: Frequency and Relationships with Vascular Lesions, Brain Atrophy and Amyloid. PLoS One 2016; 11:e0162846. [PMID: 27632159 PMCID: PMC5025073 DOI: 10.1371/journal.pone.0162846] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/29/2016] [Indexed: 02/01/2023] Open
Abstract
Background The objectives of this study are 1) to examine the frequencies of neuropsychiatric symptom clusters in patients with stroke or transient ischemic attack (TIA) by cognitive level and stroke subtype; and 2) to evaluate effect of demographic, clinical, and neuroimaging measures of chronic brain changes and amyloid upon neuropsychiatric symptom clusters. Methods Hospital-based, cross-sectional study. 518 patients were administered the Neuropsychiatric Inventory (NPI) 3–6 months post index admission. NPI symptoms were classified into four symptom clusters (Behavioral Problems, Psychosis, Mood Disturbance & Euphoria) derived from a confirmatory factor analysis of the 12 NPI items. Multivariable logistic regression was used to determine independent associations between demographic, clinical and neuroimaging measures of chronic brain changes (white matter changes, old infarcts, whole brain atrophy, medial temporal lobe atrophy [MTLA] and frontal lobe atrophy [FLA]) with the presence of NPI symptoms and all symptom clusters except euphoria. 11C-Pittsburg Compound B Positron Emission Tomography (11C-PiB PET) was performed in 24 patients to measure amyloid retention for Alzheimer’s Disease (AD) pathology. Results 50.6% of the whole sample, including 28.7% cognitively normal and 66.7% of patients with mild cognitive symptoms, had ≥1 NPI symptoms. Frequencies of symptom clusters were largely similar between stroke subtypes. Compared to patients with cardioembolic stroke and intracranial haemorrhage, those with TIA had less frequent mood disturbance. Stroke severity at admission and MTLA were the most robust correlates of symptoms. FLA was associated with behavioral problems cluster only. Frequency of symptom clusters did not differ between patients with and without significant amyloid retention. Conclusion Frequency of neuropsychiatric symptoms increased with level of cognitive impairment but was largely similar between stroke subtypes. Stroke severity and MTLA were associated with neuropsychiatric symptoms. AD pathology appeared to be unrelated to neuropsychiatric manifestations but further studies with larger sample size are required to substantiate this finding.
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Affiliation(s)
- Adrian Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Alexander Y. L. Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Jie Yang
- Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Guangzhou, 510260, China
| | - Zhaolu Wang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Wenyan Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Bonnie Y. K. Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lisa Au
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie C. W. Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Yun-yun Xiong
- Department of Neurology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Eugene S. K. Lo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Lorraine S. N. Law
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W. H. Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Linda C. W. Lam
- Department of Psychiatry, Lui Che Woo Institute of Innovative Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Anne Y. Y. Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yannie O. Y. Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Eric Y. L. Leung
- Department of Nuclear Medicine, Hong Kong Sanatorium and Hospital, Hong Kong, China
| | - Lawrence K. S. Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C. T. Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
- Therese Pei Fong Chow Research Centre for Prevention of Dementia, The Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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30
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Graziane JA, Beer JC, Snitz BE, Chang CCH, Ganguli M. Dual Trajectories of Depression and Cognition: A Longitudinal Population-Based Study. Am J Geriatr Psychiatry 2016; 24:364-73. [PMID: 26560510 PMCID: PMC4841743 DOI: 10.1016/j.jagp.2015.08.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2015] [Revised: 08/09/2015] [Accepted: 08/11/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the relationships over time between dual trajectories of depressive symptoms and several cognitive domains. METHODS In a 5-year longitudinal study, 1,978 randomly selected individuals aged 65+ years at recruitment were assessed annually. Repeated measures were of depressive symptoms on the modified Center for Epidemiologic Studies Depression Scale and composite scores in the cognitive domains of attention, executive function, memory, language, and visuospatial function. Latent class trajectories were identified for depression and for each cognitive domain and their associations investigated using dual trajectory modeling. Cognitive trajectories with z scores below -1 were designated as persistently low. RESULTS Five depressive symptom trajectories were observed: rarely depressed (60.5%); low-grade, decreasing symptoms (18.5%); low-grade, increasing symptoms (9.6%); moderate-grade symptoms (7.4%); and consistent higher-grade symptoms (4.0%). For each cognitive domain six trajectories were observed. The rarely depressed and low-grade decreasing symptom groups were the least likely to have persistently low cognition. The symptom trajectory most strongly associated with persistently low functioning in each domain was not the higher-grade group but rather the low-grade increasing group in the case of attention and the moderate-grade trajectory in the other four domains. CONCLUSION Consistently higher-grade depressive symptoms are less strongly associated with poor cognitive functioning than with either moderate- or low-grade increasing depressive symptom trajectories, over time and across different domains. Examining both depression and cognition longitudinally allows heterogeneity of both to be addressed, revealing latent groups with potential diagnostic and prognostic implications.
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Affiliation(s)
- Julie A. Graziane
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - Joanne C. Beer
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - Beth E. Snitz
- University of Pittsburgh School of Medicine, Department of Neurology
| | - Chung-Chou H. Chang
- University of Pittsburgh School of Medicine, Department of Medicine,University of Pittsburgh Graduate School of Public Health, Department of Biostatistics
| | - Mary Ganguli
- University of Pittsburgh School of Medicine, Department of Psychiatry,University of Pittsburgh School of Medicine, Department of Neurology,University of Pittsburgh Graduate School of Public Health, Department of Epidemiology
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Sivertsen H, Bjørkløf GH, Engedal K, Selbæk G, Helvik AS. Depression and Quality of Life in Older Persons: A Review. Dement Geriatr Cogn Disord 2016; 40:311-39. [PMID: 26360014 DOI: 10.1159/000437299] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Depression is a prevalent and disabling condition in older persons (≥ 60 years) that increases the risk of mortality and negatively influences quality of life (QOL). The relationship between depression, or depressive symptoms, and QOL has been increasingly addressed by research in recent years, but a review that can contribute to a better understanding of this relationship in older persons is lacking. Against this background, we undertook a literature review to assess the relationship between depression and QOL in older persons. SUMMARY Extensive electronic database searches revealed 953 studies. Of these, 74 studies fulfilled our criteria for inclusion, of which 52 were cross-sectional studies and 22 were longitudinal studies. Thirty-five studies were conducted in a clinical setting, while 39 were community-based epidemiological studies. A clear definition of the QOL concept was described in 25 studies, and 24 different assessment instruments were employed to assess QOL. Depressed older persons had poorer global and generic health-related QOL than nondepressed individuals. An increase in depression severity was associated with a poorer global and generic health-related QOL. The associations appeared to be stable over time and independent of how QOL was assessed. KEY MESSAGES This review found a significant association between severity of depression and poorer QOL in older persons, and the association was found to be stable over time, regardless which assessment instruments for QOL were applied. The lack of a definition of the multidimensional and multilevel concept QOL was common, and the large variety of QOL instruments in various studies make a direct comparison between the studies difficult.
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Affiliation(s)
- Heidi Sivertsen
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Sato S, Delcourt C, Heeley E, Arima H, Zhang S, Al-Shahi Salman R, Stapf C, Woo D, Flaherty ML, Vagal A, Levi C, Davies L, Wang J, Robinson T, Lavados PM, Lindley RI, Chalmers J, Anderson CS. Significance of Cerebral Small-Vessel Disease in Acute Intracerebral Hemorrhage. Stroke 2016; 47:701-7. [PMID: 26846860 DOI: 10.1161/strokeaha.115.012147] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/08/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE The significance of structural changes associated with cerebral small-vessel disease (SVD), including white matter lesions (WML), lacunes, and brain atrophy, to outcome from acute intracerebral hemorrhage is uncertain. We determined associations of computed tomographic radiological manifestations of cerebral SVD and outcomes, and in terms of any differential effect of early intensive blood pressure-lowering treatment, in the large-scale Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). METHODS We graded WML (van Swieten scale), the presence of lacunes, and brain atrophy (2 linear measurements and visual rating) for 2069 of 2839 patients with available baseline brain computed tomography (<6 hours of intracerebral hemorrhage onset) by 3 independent neurologists blind to clinical data. RESULTS WML grade and 2 linear measurements of brain atrophy were associated with death or major disability at 90 days: multivariable-adjusted odds ratios for WML (grade 3 and 4 versus 0), frontal ratio, and third ventricle Sylvian fissure distance (most versus least severe atrophy quartile) were 1.42 (95% confidence interval, 1.02-1.98), 1.47 (1.08-1.99), and 1.64 (1.21-2.22), respectively (all P for trend <0.05). There was no association between lacunes and outcomes. There were no significant differences in the effects of intensive blood pressure-lowering across subgroups of cerebral SVD. CONCLUSIONS Preexisting cerebral SVD manifestations of WML and brain atrophy predict poor outcome in acute intracerebral hemorrhage. There is no apparent hazard of early intensive lowering of blood pressure according to the INTERACT2 protocol, in patients with underlying cerebral SVD. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00716079.
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Affiliation(s)
- Shoichiro Sato
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Candice Delcourt
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Emma Heeley
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Hisatomi Arima
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Shihong Zhang
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Rustam Al-Shahi Salman
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Christian Stapf
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Daniel Woo
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Matthew L Flaherty
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Achala Vagal
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Christopher Levi
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Leo Davies
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Jiguang Wang
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Thompson Robinson
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Pablo M Lavados
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Richard I Lindley
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - John Chalmers
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.)
| | - Craig S Anderson
- From the Neurological and Mental Health Division, George Institute for Global Health, Sydney, New South Wales, Australia (S.S., C.D., E.H., H.A., R.I.L., J.C., C.S.A.); Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan (S.S.); Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia (C.D., E.H., H.A., L.D., R.I.L., J.C., C.S.A.); Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia (C.D., L.D., J.C., C.S.A.); Center for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga, Japan (H.A.); Department of Neurology, West China Hospital, Sichuan University, Chengdu, China (S.Z.); Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom (R.A.-S.S.); Département Hospitalo-Universitaire (DHU) NeuroVasc, Hôpital Lariboisière, Paris, France (C.S.); Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Département de Neurosciences, Université de Montréal, Montréal, Quebec, Canada (C.S.); Department of Neurology (D.W., M.L.F.) and Radiology (A.V.), University of Cincinnati Academic Health Center, OH; Department of Neurology, John Hunter Hospital, University of Newcastle/Hunter Medical Research Institute, Newcastle, New South Wales, Australia (C.L.); The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University, Shanghai, China (J.W.); Department of Cardiovascular Sciences and NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, United Kingdom (T.R.); Servicio de Neurología, Departamento de Medicina, Clínica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Santiago, Chile (P.M.L.); Facultad de Medicina, Universidad de Chile, Santiago, Chile (P.M.L.); and Department of Medicine, Westmead Hospital Clinical School, Westmead, New South Wales, Australia (R.I.L.). canderson@geor
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Pavlovic AM, Pekmezovic T, Zidverc Trajkovic J, Svabic Medjedovic T, Veselinovic N, Radojicic A, Mijajlovic M, Tomic G, Jovanovic Z, Norton M, Sternic N. Baseline characteristic of patients presenting with lacunar stroke and cerebral small vessel disease may predict future development of depression. Int J Geriatr Psychiatry 2016; 31:58-65. [PMID: 25821003 DOI: 10.1002/gps.4289] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/19/2015] [Accepted: 03/04/2015] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cerebral small vessel disease (SVD) is associated with late-onset depression and increases the risk for depression after stroke. We aimed to investigate baseline predictors of depression after long-term follow-up in patients with SVD, initially presenting with first-ever lacunar stroke, free of depression and cognitive impairment. METHODS A total of 294 patients with SVD were evaluated 3-5 years after the qualifying event. We analyzed baseline demographic data, vascular risk factors, functional status expressed as a score on modified Rankin Scale (mRS), cognitive status, presence of depression, total number of lacunar infarcts and severity of white matter hyperintensities (WMH) on MRI with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores. RESULTS On follow-up, depression was registered in 117 (39.8%) SVD patients. At the baseline, patients with depression compared with non-depressed were older (64.4 vs 60.9 years; p = 0.007), had higher mRS score (2.8 ± 0.7 vs 1.5 ± 0.7; p < 0.0001) and had more severe lesions on MRI scales (p < 0.0001 for all parameters). On follow-up, depressed patients more frequently exhibited cognitive decline (75.2% depressed vs 56.5% non-depressed; p = 0.003). No difference was detected in risk factor frequency between groups. Multivariate Cox regression analysis adjusted by age and gender revealed independent predictors of depression: baseline mRS >2 (HR 2.17, 95%CI 1.74-2.72; p < 0.0001) and tARWMC (HR 1.05, 95%CI 1.02-1.09; p = 0.005), and cognitive decline on follow-up (HR 1.80, 95%CI 1.12-2.89; p = 0.015). CONCLUSIONS Baseline functional status and severity of WMH and development of cognitive decline predict the occurence of late-onset depression in patients with SVD.
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Affiliation(s)
- Aleksandra M Pavlovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jasna Zidverc Trajkovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Tamara Svabic Medjedovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Nikola Veselinovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Radojicic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milija Mijajlovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Gordana Tomic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Zagorka Jovanovic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Melanie Norton
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nada Sternic
- Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
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Alzheimer's disease--subcortical vascular disease spectrum in a hospital-based setting: Overview of results from the Gothenburg MCI and dementia studies. J Cereb Blood Flow Metab 2016; 36. [PMID: 26219595 PMCID: PMC4702291 DOI: 10.1038/jcbfm.2015.148] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The ability to discriminate between Alzheimer's disease (AD), subcortical vascular disease, and other cognitive disorders is crucial for diagnostic purposes and clinical trial outcomes. Patients with primarily subcortical vascular disease are unlikely to benefit from treatments targeting the AD pathogenic mechanisms and vice versa. The Gothenburg mild cognitive impairment (MCI) and dementia studies are prospective, observational, single-center cohort studies suitable for both cross-sectional and longitudinal analysis that outline the cognitive profiles and biomarker characteristics of patients with AD, subcortical vascular disease, and other cognitive disorders. The studies, the first of which started in 1987, comprise inpatients with manifest dementia and patients seeking care for cognitive disorders at an outpatient memory clinic. This article gives an overview of the major published papers (neuropsychological, imaging/physiology, and neurochemical) of the studies including the ongoing Gothenburg MCI study. The main findings suggest that subcortical vascular disease with or without dementia exhibit a characteristic neuropsychological pattern of mental slowness and executive dysfunction and neurochemical deviations typical of white matter changes and disturbed blood-brain barrier function. Our findings may contribute to better healthcare for this underrecognized group of patients. The Gothenburg MCI study has also published papers on multimodal prediction of dementia, and cognitive reserve.
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Hollocks MJ, Lawrence AJ, Brookes RL, Barrick TR, Morris RG, Husain M, Markus HS. Differential relationships between apathy and depression with white matter microstructural changes and functional outcomes. Brain 2015; 138:3803-15. [PMID: 26490330 PMCID: PMC4655344 DOI: 10.1093/brain/awv304] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 08/26/2015] [Indexed: 01/30/2023] Open
Abstract
Small vessel disease is a stroke subtype characterized by pathology of the small perforating arteries, which supply the sub-cortical structures of the brain. Small vessel disease is associated with high rates of apathy and depression, thought to be caused by a disruption of white matter cortical-subcortical pathways important for emotion regulation. It provides an important biological model to investigate mechanisms underlying these key neuropsychiatric disorders. This study investigated whether apathy and depression can be distinguished in small vessel disease both in terms of their relative relationship with white matter microstructure, and secondly whether they can independently predict functional outcomes. Participants with small vessel disease (n = 118; mean age = 68.9 years; 65% male) defined as a clinical and magnetic resonance imaging confirmed lacunar stroke with radiological leukoaraiosis were recruited and completed cognitive testing, measures of apathy, depression, quality of life and diffusion tensor imaging. Healthy controls (n = 398; mean age = 64.3 years; 52% male) were also studied in order to interpret the degree of apathy and depression found within the small vessel disease group. Firstly, a multilevel structural equation modelling approach was used to identify: (i) the relationships between median fractional anisotropy and apathy, depression and cognitive impairment; and (ii) if apathy and depression make independent contributions to quality of life in patients with small vessel disease. Secondly, we applied a whole-brain voxel-based analysis to investigate which regions of white matter were associated with apathy and depression, controlling for age, gender and cognitive functioning. Structural equation modelling results indicated both apathy (r = -0.23, P ≤ 0.001) and depression (r = -0.41, P ≤ 0.001) were independent predictors of quality of life. A reduced median fractional anisotropy was significantly associated with apathy (r = -0.38, P ≤ 0.001), but not depression (r = -0.16, P = 0.09). On voxel-based analysis, apathy was associated with widespread reduction in white matter integrity, with the strongest effects in limbic association tracts such as the anterior cingulum, fornix and uncinate fasciculus. In contrast, when controlling for apathy, we found no significant relationship between our white matter parameters and symptoms of depression. In conclusion, white matter microstructural changes in small vessel disease are associated with apathy but not directly with depressive symptoms. These results suggest that apathy, but not depression, in small vessel disease is related to damage to cortical-subcortical networks associated with emotion regulation, reward and goal-directed behaviour.
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Affiliation(s)
- Matthew J Hollocks
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Andrew J Lawrence
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Rebecca L Brookes
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Thomas R Barrick
- 2 St. Georges, University of London, Neurosciences Research Centre, Cardiovascular and Cell Sciences Research Institute, London, UK
| | - Robin G Morris
- 3 King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK
| | - Masud Husain
- 4 University of Oxford, Nuffield Department of Clinical Neurosciences, Oxford, UK
| | - Hugh S Markus
- 1 Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, R3, Box 183, Addenbrooke's Biomedical Campus, Cambridge, CB2 0QQ, UK
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Murray A, McNeil C, Salarirad S, Deary I, Phillips L, Whalley L, Staff R. Brain hyperintensity location determines outcome in the triad of impaired cognition, physical health and depressive symptoms: A cohort study in late life. Arch Gerontol Geriatr 2015; 63:49-54. [PMID: 26791171 DOI: 10.1016/j.archger.2015.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 07/30/2015] [Accepted: 10/14/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE OF THE STUDY Brain hyperintensities, detectable with MRI, increase with age. They are associated with a triad of impairment in cognitive ability, depression and physical health. Here we test the hypothesis that the association between hyperintensities and cognitive ability, physical health and depressive symptoms depends on lesion location. DESIGN AND METHODS 244 members of the Aberdeen 1936 Birth Cohort were recruited to this study. 227 participants completed brain MRI and their hyperintensities were scored using Scheltens's scale. 205 had complete imaging, cognitive, physical health and depressive symptom score data. The relationships between hyperintensity location and depressive symptoms, cognitive ability and physical health were examined by correlation and structural equation analysis. RESULTS We found that depressive symptoms correlated with hyperintensity burden in the grey matter (r=0.14, p=0.04) and infratentorial regions (r=0.17, p=0.01). Infratentorial hyperintensities correlated with reduced peak expiratory flow rate (r=-0.26, p<0.001) and impaired gait (r=0.13, p=0.05). No relationship was found between white matter and periventricular (supratentoral) hyperintensities and depressive symptoms. Hyperintensities in the supratentorial and infratentorial regions were associated with reduced cognitive performance. Using structural equation modelling we found that the association between hyperintensities and depressive symptoms was mediated by negative effects on physical health and cognitive ability. CONCLUSIONS Hyperintensities in deep brain structures are associated with depressive symptoms, mediated via impaired physical health and cognitive ability. Participants with higher cognitive ability and better physical health are at lower risk of depressive symptoms.
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Affiliation(s)
| | | | | | - Ian Deary
- University of Edinburgh, Edinburgh, UK.
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Birner A, Seiler S, Lackner N, Bengesser SA, Queissner R, Fellendorf FT, Platzer M, Ropele S, Enzinger C, Schwingenschuh P, Mangge H, Pirpamer L, Deutschmann H, McIntyre RS, Kapfhammer HP, Reininghaus B, Reininghaus EZ. Cerebral White Matter Lesions and Affective Episodes Correlate in Male Individuals with Bipolar Disorder. PLoS One 2015; 10:e0135313. [PMID: 26252714 PMCID: PMC4529150 DOI: 10.1371/journal.pone.0135313] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/20/2015] [Indexed: 12/21/2022] Open
Abstract
Background Cerebral white matter lesions (WML) have been found in normal aging, vascular disease and several neuropsychiatric conditions. Correlations of WML with clinical parameters in BD have been described, but not with the number of affective episodes, illness duration, age of onset and Body Mass Index in a well characterized group of euthymic bipolar adults. Herein, we aimed to evaluate the associations between bipolar course of illness parameters and WML measured with volumetric analysis. Methods In a cross-sectional study 100 euthymic individuals with BD as well as 54 healthy controls (HC) were enrolled to undergo brain magnetic resonance imaging using 3T including a FLAIR sequence for volumetric assessment of WML-load using FSL-software. Additionally, clinical characteristics and psychometric measures including Structured Clinical Interview according to DSM-IV, Hamilton-Depression, Young Mania Rating Scale and Beck’s Depression Inventory were evaluated. Results Individuals with BD had significantly more (F = 3.968, p < .05) WML (Mdn = 3710mm3; IQR = 2961mm3) than HC (Mdn = 2185mm3; IQR = 1665mm3). BD men (Mdn = 4095mm3; IQR = 3295mm3) and BD women (Mdn = 3032mm3; IQR = 2816mm3) did not significantly differ as to the WML-load or the number and type of risk factors for WML. However, in men only, the number of manic/hypomanic episodes (r = 0.72; p < .001) as well as depressive episodes (r = 0.51; p < .001) correlated positively with WML-load. Conclusions WML-load strongly correlated with the number of manic episodes in male BD patients, suggesting that men might be more vulnerable to mania in the context of cerebral white matter changes.
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Affiliation(s)
- Armin Birner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Stephan Seiler
- Department of Neurology, Medical University of Graz, Graz, Austria
- * E-mail:
| | - Nina Lackner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | - Robert Queissner
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | | | - Martina Platzer
- Department of Psychiatry, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Petra Schwingenschuh
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Harald Mangge
- Research Unit on Lifestyle and Inflammation-associated Risk Biomarkers, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University Graz, Graz, Austria
| | - Lukas Pirpamer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Hannes Deutschmann
- Division of Neuroradiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit at the University Health Network, University of Toronto, Toronto, Canada
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van Uden IWM, Tuladhar AM, de Laat KF, van Norden AGW, Norris DG, van Dijk EJ, Tendolkar I, de Leeuw FE. White matter integrity and depressive symptoms in cerebral small vessel disease: The RUN DMC study. Am J Geriatr Psychiatry 2015; 23:525-35. [PMID: 25151438 DOI: 10.1016/j.jagp.2014.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 07/01/2014] [Accepted: 07/12/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Depressive symptoms are common in elderly with cerebral small vessel disease (SVD). As not every individual with SVD experiences depressive symptoms, other factors might play a role. We therefore investigated the white matter (WM) integrity of the white matter tracts in elderly with depressive symptoms, independent of global cognitive function, by applying the tract-based spatial statistics (TBSS). DESIGN Prospective cohort study with cross-sectional baseline data. SETTING Radboud University Nijmegen Medical Centre, The Netherlands. PARTICIPANTS 438 individuals aged between 50-85 years, with SVD without dementia. MEASUREMENTS Diffusion tensor imaging parameters and depressive symptoms, assessed with the Center for Epidemiologic Studies Depression Scale. RESULTS Compared with non-depressed participants (N = 287), those with depressive symptoms (N = 151) had lower fractional anisotropy in the genu and body of the corpus callosum, bilateral inferior fronto-occipital fasciculus, uncinate fasciculus, and corona radiata. These differences disappeared after adjustment for white matter hyperintensities (WMH) and lacunar infarcts. Mean-, axial- and radial diffusivity were higher in these areas in participants with depressive symptoms. After additional adjustment for WMH and lacunar infarcts, the changes observed in radial diffusivity also disappeared. Adding global cognition as confounding variable altered the diffusion parameters only slightly. CONCLUSION This study indicates that elderly with depressive symptoms show a lower WM integrity, independent of global cognitive function, and that the presence of SVD is mostly responsible, affecting the fronto-subcortical regions and hereby disrupting the neural circuitry involved in mood regulation.
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Affiliation(s)
- Ingeborg W M van Uden
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Anil M Tuladhar
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Centre for Cognitive Neuroimaging, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Karlijn F de Laat
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Neurology, HagaZiekenhuis, The Hague, The Netherlands
| | - Anouk G W van Norden
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; Department of Neurology, Amphia Ziekenhuis, Breda, The Netherlands
| | - David G Norris
- Centre for Cognitive Neuroimaging, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands; Erwin L. Hahn Institute for Magnetic Resonance Imaging, University of Duisburg-Essen, Essen, Germany
| | - Ewoud J van Dijk
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands.
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Auning E, Selnes P, Grambaite R, Šaltytė Benth J, Haram A, Løvli Stav A, Bjørnerud A, Hessen E, Hol PK, Muftuler løndalen A, Fladby T, Aarsland D. Neurobiological correlates of depressive symptoms in people with subjective and mild cognitive impairment. Acta Psychiatr Scand 2015; 131:139-47. [PMID: 25346330 DOI: 10.1111/acps.12352] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To test the hypothesis that depressive symptoms correlate with Alzheimer's disease (AD) type changes in CSF and structural and functional imaging including hippocampus volume, cortical thickness, white matter lesions, Diffusion tensor imaging (DTI), and fluoro-deoxy-glucose positron emission tomography (FDG-PET) in patient with subjective (SCI) and mild (MCI) cognitive impairment. METHOD In 60 patients, depressive symptoms were assessed using the Geriatric Depression Scale. The subjects underwent MRI, 18F-FDG PET imaging, and lumbar CSF extraction. RESULTS Subjects with depressive symptoms (n=24) did not have more pathological AD biomarkers than non-depressed. Uncorrected there were trends towards larger hippocampal volumes (P=0.06), less orbital WM damage measured by DTI (P=0.10), and higher orbital glucose metabolism (P=0.02) in the depressed group. The findings were similar when SCI and MCI were analyzed separately. Similarly, in patients with pathological CSF biomarkers (i.e., predementia AD, n=24), we found that correlations between scores on GDS and CSF Aß42 and P-tau indicated less severe AD-specific CSF changes with increasing depression. CONCLUSION Depressive symptoms are common in SCI/MCI, but are not associated with pathological imaging or CSF biomarkers of AD. Depression can explain cognitive impairment in SCI/MCI or add to cognitive impairment leading to an earlier clinical investigation in predementia AD.
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Affiliation(s)
- E Auning
- Department of Geriatric Psychiatry, Akershus University Hospital, Ahus campus, Lørenskog, Norway; Institute of Clinical Medicine, Ahus campus University of Oslo, Oslo, Norway
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Kirton JW, Resnick SM, Davatzikos C, Kraut MA, Dotson VM. Depressive symptoms, symptom dimensions, and white matter lesion volume in older adults: a longitudinal study. Am J Geriatr Psychiatry 2014; 22:1469-77. [PMID: 24211028 PMCID: PMC3984387 DOI: 10.1016/j.jagp.2013.10.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 09/18/2013] [Accepted: 10/07/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE White matter lesions (WMLs) are associated with depressive symptoms in older adults. However, it is not clear whether different symptom dimensions of depression have distinct associations with WMLs. The authors assessed the longitudinal relationships of the Center for Epidemiologic Studies Depression Scale (CES-D) total score and subscale scores with WML volume in the Baltimore Longitudinal Study of Aging. METHODS Using a prospective observational design, the authors examined WML volume and depressive symptoms at 1- to 2-year intervals for up to 9 years in 116 dementia-free participants (mean age: 68.78 ± 7.68). At each visit, depressive symptoms were measured with the CES-D and WML volumes were quantified from structural magnetic resonance imaging scans. RESULTS Higher CES-D full-scale scores were associated with greater WML volume and with a faster rate of volume increases over time in women, especially at older ages. Higher depressed mood and somatic symptoms subscale scores were associated with greater increases in WML volume over time at older ages. In men, depressed mood and somatic symptoms were associated with larger WML volume at baseline. CONCLUSION Findings confirm an association between WMLs and depressive symptoms and suggest that depressed mood and somatic symptoms may be stronger predictors of depression-related brain changes than lack of well-being. Age and sex may moderate the relationships between depressive symptoms and WMLs. Understanding particular symptom dimensions of depressive symptoms has implications for treatment and may lead to targeted interventions and more precise knowledge of mechanisms underlying depression.
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Affiliation(s)
- Joshua W Kirton
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL
| | - Susan M Resnick
- Laboratory of Behavioral Neuroscience, National Institute on Aging, Baltimore, MD
| | - Christos Davatzikos
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Michael A Kraut
- Department of Radiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Vonetta M Dotson
- Department of Clinical & Health Psychology, University of Florida, Gainesville, FL.
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Brookes RL, Herbert V, Lawrence AJ, Morris RG, Markus HS. Depression in small-vessel disease relates to white matter ultrastructural damage, not disability. Neurology 2014; 83:1417-23. [PMID: 25230999 PMCID: PMC4206159 DOI: 10.1212/wnl.0000000000000882] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To determine whether cerebral small-vessel disease (SVD) is a specific risk factor for depression, whether any association is mediated via white matter damage, and to study the role of depressive symptoms and disability on quality of life (QoL) in this patient group. Methods: Using path analyses in cross-sectional data, we modeled the relationships among depression, disability, and QoL in patients with SVD presenting with radiologically confirmed lacunar stroke (n = 100), and replicated results in a second SVD cohort (n = 100). We then compared the same model in a non-SVD stroke cohort (n = 50) and healthy older adults (n = 203). In a further study, to determine the role of white matter damage in mediating the association with depression, a subgroup of patients with SVD (n = 101) underwent diffusion tensor imaging (DTI). Results: Reduced QoL was associated with depression in patients with SVD, but this association was not mediated by disability or cognition; very similar results were found in the replication SVD cohort. In contrast, the non-SVD stroke group and the healthy older adult group showed a direct relationship between disability and depression. The DTI study showed that fractional anisotropy, a marker of white matter damage, was related to depressive symptoms in patients with SVD. Conclusion: These results suggest that in stroke patients without SVD, disability is an important causal factor for depression, whereas in SVD stroke, other factors specific to this stroke subtype have a causal role. White matter damage detected on DTI is one factor that mediates the association between SVD and depression.
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Affiliation(s)
- Rebecca L Brookes
- From the Stroke and Dementia Research Centre (R.L.B., V.H., A.J.L.), St George's, University of London; University of Cambridge (H.S.M.), Department of Neurology, Cambridge Biomedical Campus; and Department of Psychology (R.G.M.), Institute of Psychiatry, King's College London, UK.
| | - Vanessa Herbert
- From the Stroke and Dementia Research Centre (R.L.B., V.H., A.J.L.), St George's, University of London; University of Cambridge (H.S.M.), Department of Neurology, Cambridge Biomedical Campus; and Department of Psychology (R.G.M.), Institute of Psychiatry, King's College London, UK
| | - Andrew J Lawrence
- From the Stroke and Dementia Research Centre (R.L.B., V.H., A.J.L.), St George's, University of London; University of Cambridge (H.S.M.), Department of Neurology, Cambridge Biomedical Campus; and Department of Psychology (R.G.M.), Institute of Psychiatry, King's College London, UK
| | - Robin G Morris
- From the Stroke and Dementia Research Centre (R.L.B., V.H., A.J.L.), St George's, University of London; University of Cambridge (H.S.M.), Department of Neurology, Cambridge Biomedical Campus; and Department of Psychology (R.G.M.), Institute of Psychiatry, King's College London, UK
| | - Hugh S Markus
- From the Stroke and Dementia Research Centre (R.L.B., V.H., A.J.L.), St George's, University of London; University of Cambridge (H.S.M.), Department of Neurology, Cambridge Biomedical Campus; and Department of Psychology (R.G.M.), Institute of Psychiatry, King's College London, UK
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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.
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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
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Nelson LA, Noonan CJ, Goldberg J, Buchwald DS. Social engagement and physical and cognitive health among American Indian participants in the health and retirement study. J Cross Cult Gerontol 2014; 28:453-3. [PMID: 24122523 DOI: 10.1007/s10823-013-9213-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Social engagement has many demonstrated benefits for aging non-Hispanic Whites in the U.S. This study examined data from the U.S. Health and Retirement Study to determine whether these benefits were similar among American Indians and Alaska Natives older than 50 years. Linear regression techniques were used to examine the associations between level of social engagement, scores for memory and mental status, and self-reported health among 203 American Indian and Alaska Native elders who participated in the Health and Retirement Study and had data available between 1998 and 2010. Level of social engagement was significantly associated with memory, mental status, and self-reported health. However, only the association of social engagement with mental status and self-reported health remained significant (p = 0.04 and p = 0.05, respectively) after adjusting for sociodemographic variables, number of known health conditions, and scores on the Center for Epidemiologic Studies Depression scale. Level of social engagement was not associated with patterns of decline across time in cognitive or physical health. Higher levels of social engagement are associated with better physical and cognitive functioning in American Indian and Alaska Native elders. Future studies should examine whether this association acts through cognitive stimulation, increase in physical activity resulting from social engagement, or access to resources that support physical and cognitive health.
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Abstract
BACKGROUND Lacunar stroke is a small (<2 cm) infarction that accounts for approximately 20% of all strokes. While a third of all stroke patients experience depressive symptoms, the prevalence of depression in the lacunar stroke patient population is unclear. This meta-analysis aimed to synthesize the evidence on the effect of lacunar stroke and deep white matter disease on depressive symptoms. METHODS A systematic search of electronic databases was conducted, resulting in the inclusion of 12 studies. Analyses were performed on the effects of lacunar stroke, volume and location of lacunes on depression prevalence, and the effect on depression severity. The effects estimates were calculated in random-effects models. RESULTS None of the analyses produced statistically significant results. Lacunar stroke patients had a non-significantly higher prevalence of depression compared to patients with non-lacunar cerebrovascular diseases (OR = 1.46, 95% CI: 0.88-2.43, p = 0.15). Neither thalamic (OR = 1.37 (0.85-2.20), p = 0.19), deep white matter (RR = 1.16 (0.85-1.57), p = 0.35), multiple lacunes (OR = 1.34 (0.81-2.22), p = 0.25), or the volume of lacunes (MD = -4.71 (-351.59-342.18), p = 0.98) had an effect on depression prevalence. Lastly, lacunar stroke did not influence depressive symptom severity (MD = 0.96 (-1.57-3.48), p = 0.46). CONCLUSIONS The pooled group of patients with lacunar stroke and deep white matter disease appear to have a similar prevalence of depression compared to those with other types of cerebrovascular diseases. However, the small number of studies, heterogeneous comparison groups, and high statistical heterogeneity between studies posed an obstacle to the meta-analysis. To determine appropriate screening and treatment approaches, future research will need to separate lacunar stroke and deep white matter disease patients, and include larger sample sizes and healthy control groups to determine their distinct contributions to depression.
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Shimizu A, Sakurai T, Mitsui T, Miyagi M, Nomoto K, Kokubo M, Bando YK, Murohara T, Toba K. Left ventricular diastolic dysfunction is associated with cerebral white matter lesions (leukoaraiosis) in elderly patients without ischemic heart disease and stroke. Geriatr Gerontol Int 2014; 14 Suppl 2:71-6. [DOI: 10.1111/ggi.12261] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Atsuya Shimizu
- Department of Cardiology; National Center for Geriatrics and Gerontology; Obu Japan
- Department of Cardiology; Nagoya University; Nagoya Japan
| | - Takashi Sakurai
- Department of Gerontology; National Center for Geriatrics and Gerontology; Obu Japan
| | - Toko Mitsui
- Department of Cardiology; National Center for Geriatrics and Gerontology; Obu Japan
- Department of Cardiology; Nagoya University; Nagoya Japan
| | - Motohiro Miyagi
- Department of Cardiology; National Center for Geriatrics and Gerontology; Obu Japan
- Department of Cardiology; Nagoya University; Nagoya Japan
| | - Kenichiro Nomoto
- Department of Cardiology; National Center for Geriatrics and Gerontology; Obu Japan
- Department of Cardiology; Nagoya University; Nagoya Japan
| | - Manabu Kokubo
- Department of Cardiology; National Center for Geriatrics and Gerontology; Obu Japan
- Department of Cardiology; Nagoya University; Nagoya Japan
| | - Yasuko K Bando
- Department of Cardiology; Nagoya University; Nagoya Japan
| | | | - Kenji Toba
- Department of Gerontology; National Center for Geriatrics and Gerontology; Obu Japan
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46
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de Zwarte SMC, Johnston JAY, Cox Lippard ET, Blumberg HP. Frontotemporal White Matter in Adolescents with, and at-Risk for, Bipolar Disorder. J Clin Med 2014; 3:233-54. [PMID: 26237259 PMCID: PMC4449671 DOI: 10.3390/jcm3010233] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 12/13/2022] Open
Abstract
Frontotemporal neural systems are highly implicated in the emotional dysregulation characteristic of bipolar disorder (BD). Convergent genetic, postmortem, behavioral and neuroimaging evidence suggests abnormalities in the development of frontotemporal white matter (WM) in the pathophysiology of BD. This review discusses evidence for the involvement of abnormal WM development in BD during adolescence, with a focus on frontotemporal WM. Findings from diffusion tensor imaging (DTI) studies in adults and adolescents are reviewed to explore possible progressive WM abnormalities in the disorder. Intra- and interhemispheric frontotemporal abnormalities were reported in adults with BD. Although evidence in children and adolescents with BD to date has been limited, similar intrahemispheric and interhemispheric findings have also been reported. The findings in youths suggest that these abnormalities may represent a trait marker present early in the course of BD. Functional connectivity studies, demonstrating a relationship between WM abnormalities and frontotemporal dysfunction in BD, and DTI studies of vulnerability in first-degree relatives of individuals with BD, are discussed. Together, findings suggest the involvement of abnormal frontotemporal WM development in the pathophysiology of BD and that these abnormalities may be early trait markers of vulnerability; however, more studies are critically needed.
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Affiliation(s)
- Sonja M C de Zwarte
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Jennifer A Y Johnston
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Elizabeth T Cox Lippard
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
| | - Hilary P Blumberg
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, USA.
- Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT 06511, USA.
- Child Study Center, Yale School of Medicine, New Haven, CT 06511, USA.
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Hong YJ, Yoon B, Shim YS, Han IW, Han SH, Park KH, Choi SH, Ku BD, Yang DW. Do Alzheimer's disease (AD) and subcortical ischemic vascular dementia (SIVD) progress differently? Arch Gerontol Geriatr 2013; 58:415-9. [PMID: 24332770 DOI: 10.1016/j.archger.2013.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Revised: 11/12/2013] [Accepted: 11/14/2013] [Indexed: 10/26/2022]
Abstract
Our study aimed to compare cognitive status and declines in AD with/without small vessel disease (SVD) and SIVD at baseline and 1-year follow-up. Patients with Alzheimer's disease without small vessel disease (AD(-)SVD) (n=148), Alzheimer's disease with small vessel disease (AD(+)SVD) (n=94) and SIVD (n=60) were recruited from database of multiple centers in Korea. Basic demographics and detailed neuropsychological results were compared. AD, regardless of SVD, showed worse memory and better executive function than SIVD at baseline. Mini-Mental State Examination scores and visual memory function declined more in AD than those in SIVD whereas Barthel Activities of Daily Living (B-ADL) scores declined more in SIVD. AD showed different patterns of cognitive impairment compared with SIVD. After 1 year, AD showed more rapid cognitive decline in some domains. Further investigations with longer follow-up duration may be needed to confirm the cumulative effects of SVD in AD and different patterns of decline between AD and SIVD.
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Affiliation(s)
- Yun Jeong Hong
- Department of Neurology, Yong-In Hyoja Geriatric Hospital, 33 Sangha-dong, Giheung-gu, Yongin 446-769, Republic of Korea
| | - Bora Yoon
- Department of Neurology, Konyang University College of Medicine, 685 Gawuwon-dong, Seo-gu, Daejeon 302-718, Republic of Korea
| | - Yong S Shim
- Department of Neurology, Catholic University of Korea, The College of Medicine, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Republic of Korea
| | - Il-Woo Han
- Department of Neurology, Yong-In Hyoja Geriatric Hospital, 33 Sangha-dong, Giheung-gu, Yongin 446-769, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine, Hwayang-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea
| | - Kee Hyung Park
- Department of Neurology, Gachon University Gil Medical Center, Guwol 1-dong, Namdong-gu, Incheon 405-760, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Sinheung-dong 3 ga, Jung-gu, Incheon 400-711, Republic of Korea
| | - Bon D Ku
- Department of Neurology, Myongji Hospital, Kwandong University College of Medicine, Hwajeong 1-dong, Deogyang-gu, Goyang 412-826, Republic of Korea
| | - Dong Won Yang
- Department of Neurology, Catholic University of Korea, The College of Medicine, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Republic of Korea.
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48
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Concerto C, Lanza G, Cantone M, Pennisi M, Giordano D, Spampinato C, Ricceri R, Pennisi G, Aguglia E, Bella R. Different patterns of cortical excitability in major depression and vascular depression: a transcranial magnetic stimulation study. BMC Psychiatry 2013; 13:300. [PMID: 24206945 PMCID: PMC4226249 DOI: 10.1186/1471-244x-13-300] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 10/29/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Clinical and functional studies consider major depression (MD) and vascular depression (VD) as different neurobiological processes. Hypoexcitability of the left frontal cortex to transcranial magnetic stimulation (TMS) is frequently reported in MD, whereas little is known about the effects of TMS in VD. Thus, we aimed to assess and compare motor cortex excitability in patients with VD and MD. METHODS Eleven VD patients, 11 recurrent drug-resistant MD patients, and 11 healthy controls underwent clinical, neuropsychological and neuroimaging evaluations in addition to bilateral resting motor threshold, cortical silent period, and paired-pulse TMS curves of intracortical excitability. All patients continued on psychotropic drugs, which were unchanged throughout the study. RESULTS Scores on one of the tests evaluating frontal lobe abilities (Stroop Color-Word interference test) were worse in patients compared with controls. The resting motor threshold in patients with MD was significantly higher in the left hemisphere compared with the right (p < 0.05), and compared with the VD patients and controls. The cortical silent period was bilaterally prolonged in MD patients compared with VD patients and controls, with a statistically significant difference in the left hemisphere (p < 0.01). No differences were observed in the paired-pulse curves between patients and controls. CONCLUSIONS This study showed distinctive patterns of motor cortex excitability between late-onset depression with subcortical vascular disease and early-onset recurrent drug resistant MD. The data provide a TMS model of the different processes underlying VD and MD. Additionally, our results support the "Vascular depression hypothesis" at the neurophysiological level, and confirm the inter-hemispheric asymmetry to TMS in patients with MD. We were unable to support previous findings of impaired intracortical inhibitory mechanisms to TMS in patients with MD, although a drug-induced effect on our results cannot be excluded. This study may aid the understanding of the pathogenetic differences underlying the clinical spectrum of depressive disorders.
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Affiliation(s)
- Carmen Concerto
- Unit of Psychiatry, Department of Clinical and Molecular Biomedicine, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Giuseppe Lanza
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Mariagiovanna Cantone
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Manuela Pennisi
- Department of Chemistry, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy
| | - Daniela Giordano
- Department of Electrical, Electronics and Informatics Engineering, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy
| | - Concetto Spampinato
- Department of Electrical, Electronics and Informatics Engineering, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy
| | - Riccardo Ricceri
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Giovanni Pennisi
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Eugenio Aguglia
- Unit of Psychiatry, Department of Clinical and Molecular Biomedicine, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
| | - Rita Bella
- Department “G.F. Ingrassia”, Section of Neurosciences, University of Catania, Via Santa Sofia, 78-95123 Catania, Italy
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Dalby RB, Elfving B, Poulsen PHP, Foldager L, Frandsen J, Videbech P, Rosenberg R. Plasma brain-derived neurotrophic factor and prefrontal white matter integrity in late-onset depression and normal aging. Acta Psychiatr Scand 2013; 128:387-96. [PMID: 23350796 DOI: 10.1111/acps.12085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To explore the relationship between brain-derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF), cerebral deep white matter lesions (DWMLs), and measures of white matter integrity in patients with late-onset depression, with respect to vascular risk factors. METHOD We examined 22 patients with late-onset depression and 22 matched controls. Quantification of plasma BDNF and VEGF levels were performed with enzyme-linked immunosorbent assay (ELISA) kits. Measures of white matter integrity comprised apparent diffusion coefficient (ADC) and fractional anisotropy (FA), obtained by diffusion tensor imaging (DTI). Effects of DWMLs, FA, ADC, and vascular risk factors on BDNF and VEGF were assessed using multiple linear regression. RESULTS The BDNF and VEGF levels did not differ significantly between groups. With pooled data for patients and controls, the BDNF level was positively associated with both number (t = 2.14, P = 0.039) and volume (t = 2.04, P = 0.048) of prefrontal DWMLs and negatively associated with FA in prefrontal normal-appearing white matter (t = -2.40, P = 0.02), adjusted for age and gender. Smoking and hypercholesterolemia was positively associated with the BDNF (t = 2.36, P = 0.023) and VEGF levels (t = 2.28, P = 0.028), respectively. CONCLUSION Our results suggest a role for BDNF in the complex pathophysiologic mechanisms underlying DWMLs in both normal aging and late-onset depression.
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Affiliation(s)
- R B Dalby
- Centre for Psychiatric Research, Aarhus University Hospital, Risskov, Denmark; MINDLab, Aarhus University, Aarhus, Denmark
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50
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Verdelho A, Madureira S, Moleiro C, Ferro JM, O'Brien JT, Poggesi A, Pantoni L, Fazekas F, Scheltens P, Waldemar G, Wallin A, Erkinjuntti T, Inzitari D. Depressive symptoms predict cognitive decline and dementia in older people independently of cerebral white matter changes: the LADIS study. J Neurol Neurosurg Psychiatry 2013; 84:1250-4. [PMID: 23715914 DOI: 10.1136/jnnp-2012-304191] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Depressive symptoms (DS) have been associated with increased risk of cognitive decline. Our aim was to evaluate the longitudinal influence of DS on cognition in independent older people, accounting for the severity of white matter changes (WMC). METHODS The LADIS (Leukoaraiosis And DISability in the elderly) prospective study evaluated the impact of WMC on the transition of independent older subjects into disability. Subjects were evaluated annually over a 3 year period with a comprehensive clinical and neuropsychological evaluation. Previous episodes of depression and current DS were assessed during each interview. Severity of DS was assessed using the self-rated 15 item Geriatric Depression Scale. A neuropsychological battery and clinical criteria for cognitive impairments were applied in all clinical visits, and cognitive compound measures were made based on neuropsychological results. MRI was performed at baseline and at year 3. RESULTS 639 subjects were included (74.1 ± 5 years old, 55% women, 9.6 ± 3.8 years of schooling). Dementia was diagnosed in 90 patients and cognitive impairment not dementia in 147 patients at the last clinical evaluation. DS were an independent predictor of cognitive impairment (dementia and not dementia) during follow-up, independent of the effect of the severity of WMC, medial temporal lobe atrophy, age, education or global cognitive function at baseline. CONCLUSIONS DS are associated with an increase risk of cognitive decline, independent of the effect of WMC, probably due to an additive or synergistic effect. In this context, DS probably represent a subtle ongoing organic dysfunction.
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Affiliation(s)
- Ana Verdelho
- Department of Neurociences, University of Lisbon, Santa Maria Hospital, , Lisbon, Portugal
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