Background factors and clinical symptoms of major depression with silent cerebral infarction.

Abstract

We previously reported that major depression developing during or after the presenile period is frequently combined with silent cerebral infarction and that these patients have a high risk of stroke. Therefore, we investigated whether the background factors and clinical symptoms of patients with major depression with silent cerebral infarction [SCI(+)] different from those in patients with major depression without silent cerebral infarction [SCI(-)] before medical treatment. Patients with major depression with onset after 50 years of age were classified based on magnetic resonance imaging findings into the SCI(+) (n = 37) or SCI(-) (n = 20) group. The diagnostic criteria for major depression were those of the American Psychiatry Association (DSM-III-R). Patients with stroke or focal neurological symptoms were excluded. The SCI(+) group was subclassified according to whether the infarction area was perforating, cortical, or mixed artery. Family history of affective disorder, risk factors for stroke, and Zung's Self-rated Depression Scale (SDS) score before medical treatment of the group were compared. The SCI(+) group had a significantly lower (P < .05) frequency of family history of affective disorder but a significantly higher (P < .01) frequency of hypertension than did the SCI(-) group. The mean SDS score in the SCI(+) group was significantly higher than that in the SCI(-) group (P < .01). The mean SDS score of the mixed artery infarction group was higher than that of the perforating artery infarction group (P < .05). Patients with major depression with silent cerebral infarction present more marked neurological factors and more severe depressive symptoms than do those without silent cerebral infarction. Because these features were more prominent in the patients with mixed artery infarction with broad obstructions, we consider that the area of brain damage caused by cerebral infarction is positively related to the severity of depressive symptoms.

Neuroanatomic Localization of Magnetic Resonance Imaging Signal Hyperintensities in Geriatric Depression

“…The present results in geriatric depressives without transient ischemic attacks or stroke implicate possible "silent stroke" lesions 11,28 (ie, hyperintensities) occurring in brain regions (left frontal lobe, left putamen) that are remarkably similar to infarct locations reported in stroke patients with poststroke depression. 15 As such, hypotheses that invoke a cerebrovascular etiology or contribution in some late-life depressives 29,30 are buttressed.…”

Associations of Brachial-Ankle Pulse Wave Velocity and Carotid Atherosclerotic Lesions with Silent Cerebral Lesions

“…SCI generally is detected by MRI, and is thought to be a risk factor for stroke. The presence of SCI frequently is associated with symptomatic stroke (14-18), cognitive dysfunction (24,25), and both psychiatric and neurological disorders (17,26,27). Age, hypertension, smoking, diabetes, and atrial fibrillation are known as SCI risk factors.…”

Cerebrovascular disease and late life depression: an age old association revisited

“…Chronic changes in cerebral vasculature secondary to hypertension may also result in frontal/ subcortical brain dysfunction (Rao and Howard, 1998). It is possible that this may be responsible for the association between raised blood pressure and depression observed in other studies (Rabkin et al, 1983;Fujikawa et al, 1994a;Krishnan et al, 1994a).…”