Cerebrovascular Disease and Evolution of Depressive Symptoms in the Cardiovascular Health Study

Abstract

Background and Purpose-Previous studies have reported an association between cerebrovascular disease and depressive symptoms. The Cardiovascular Health Study (CHS) provides an opportunity to examine the relationship between vascular brain pathology seen on neuroimaging and changes in depressive symptoms. Methods-The sample included 3236 CHS participants who had an MRI brain scan. Demographic variables, medical history, functional status, and apolipoprotein E genotype were obtained at baseline. Annual scores on a modified version of the Centers for Epidemiologic Studies Depression (CES-D) scale were obtained initially and up to 7 years subsequently. Results-After controlling for important covariates, occurrence of depressive symptoms (defined as modified CES-D score of Ͼ7) was associated with small lesions in the basal ganglia, large cortical white-matter lesions, and severe subcortical white-matter grade. Neuroimaging variables did not predict incident depression among those who were nondepressive at the time of MRI. Persistence of depressive symptoms across 2 consecutive time points was associated with small basal ganglia lesions and large cerebral cortical white-matter lesions. Worsening of depression (increase in CES-D score of Ն5) was associated with subcortical white-matter lesions. Conclusions-These findings suggest that cerebrovascular disease at baseline is related to depression symptoms over time.Further studies are needed to investigate the differential effects of subcortical white-versus gray-matter lesions on mood.

Temporal Lobe Atrophy and White Matter Lesions are Related to Major Depression over 5 years in the Elderly

“…Cross-sectional associations between WMLs and depression have been shown repeatedly, especially for MRI and mainly from clinical studies (Greenwald et al, 1998;Ikram et al, 2010;Kumar et al, 2000;Kumar et al, 2002), although not all studies support this association (Rainer et al, 2006;Skoog et al, 1994). Our finding that WMLs preceded major depression is in agreement with three previous longitudinal studies using MRI (Godin et al, 2008;Steffens et al, 2002;Teodorczuk et al, 2007). However, two longitudinal population-based studies did not support this association (Ikram et al, 2010;Versluis et al, 2006).…”

“…The results from longitudinal population-based studies are conflicting. Three studies using MRI reported that WMLs increased the risk of subsequent depression (Godin et al, 2008;Steffens et al, 2002;Teodorczuk et al, 2007) while two could not confirm these findings (Ikram et al, 2010;Versluis et al, 2006).…”

Comorbid Depression Is Associated with an Increased Risk of Dementia Diagnosis in Patients with Diabetes: A Prospective Cohort Study

“…49,50 Depression frequently occurs in the early stages of AD and may result from both cell loss in key areas of the brain controlling emotions as well as a psychological reaction to cognitive loss. 4 Vascular changes such as white matter hyperintensities are a risk factor for both depression 51,52 and dementia, 53 and are associated with a high prevalence of depression in cross-sectional studies 54 . In our sensitivity analysis that excluded patients with an ICD-9 diagnosis of dementia in the 2 years after baseline, depression remained associated with an increased risk of dementia, suggesting that depression was less likely to be a prodromal symptom or secondary to dementia.…”

White matter hyperintensities in patients with multiple system atrophy

“…A white matter hyperintensity (WMH) score was determined by grading the extent of increased white matter signal intensity on the fluid-attenuated inversion recovery sequence images in the periventricular and subcortical white matter area. The grading was based on a 10-point scale (0 to 9), with a higher score indicating more severe white matter grade [32,36]. An example of WMH grading in control subjects and patients with MSA is illustrated in Fig.…”