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Location and progression of cerebral small-vessel disease and atrophy, and depressive symptom profiles: The Second Manifestations of ARTerial disease (SMART)-Medea study

Published online by Cambridge University Press:  11 August 2011

A. M. Grool ,
Y. van der Graaf ,
W. P. Th. M. Mali ,
Th. D. Witkamp ,
K. L. Vincken  and
M. I. Geerlings
A. M. Grool
Affiliation:
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
Y. van der Graaf
Affiliation:
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
W. P. Th. M. Mali
Affiliation:
Department of Radiology, University Medical Center Utrecht, The Netherlands
Th. D. Witkamp
Affiliation:
Department of Radiology, University Medical Center Utrecht, The Netherlands
K. L. Vincken
Affiliation:
Image Sciences Institute, University Medical Center Utrecht, The Netherlands
M. I. Geerlings*
Affiliation:
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
*
*Address for correspondence: M. I. Geerlings, Ph.D., University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Stratenum 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands. (Email: m.geerlings@umcutrecht.nl)
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Abstract

Background

The ‘vascular depression’ hypothesis states that brain changes located in frontal-subcortical pathways increase vulnerability for specific depressive symptom profiles, but studies examining locations of small-vessel and degenerative changes with individual symptoms are scarce. We examined whether location and progression of white-matter lesions (WMLs), lacunar infarcts and atrophy were associated with motivational and mood symptoms in patients with symptomatic atherosclerotic disease.

Method

In 578 patients [63 (s.d.=8) years] of the Second Manifestations of ARTerial disease (SMART)-Medea study, volumes of WMLs and atrophy and visually rated infarcts were obtained with 1.5 T magnetic resonance imaging at baseline and after 3.9 (s.d.=0.4) years' follow-up. Depressive symptoms were assessed with Patient Health Questionnaire-9 at follow-up and categorized into motivational and mood symptoms.

Results

Regression analyses adjusted for age, gender, education, Mini-Mental State Examination, physical functioning, antidepressant use and vascular risk factors showed that location in mainly deep white-matter tracts and progression of WMLs were associated with symptoms of anhedonia, concentration problems, psychomotor retardation and appetite disturbance. Lacunar infarcts in deep white matter were associated with greater motivational [Incidence rate ratio (IRR) 1.7, 95% confidence interval (CI) 1.2–2.4] and mood (IRR 1.7, 95% CI 1.1–2.6) sumscores, and with symptoms of psychomotor retardation, energy loss and depressed mood; lacunar infarcts in the thalamus were associated with psychomotor retardation only. Cortical atrophy was associated with symptoms of anhedonia and appetite disturbance. Excluding patients with major depression did not materially change the results.

Conclusions

Our findings suggest that disruption of frontal-subcortical pathways by small-vessel lesions leads to a symptom profile that is mainly characteristic of motivational problems, also in the absence of major depression.

Keywords

AtherosclerosiscerebrovasculardepressionMRI
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 2 , February 2012 , pp. 359 - 370
Copyright
Copyright © Cambridge University Press 2011

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