Severe deep white matter lesions and outcome in elderly patients with major depressive disorder: follow up study

O’Brien, John T.; Ames, David; Chiu, Edmond; Schweitzer, Isaac; Desmond, Patricia; Tress, Brian M.

doi:10.1136/bmj.317.7164.982

Cited by 210 publications

(139 citation statements)

References 10 publications

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“…The presence and severity of psychiatric symptoms correlated strongly with the degree of atrophy, as well as with volumetric MTR measures, such as MTR m and H rpb , that are independent of brain volume and atrophy, suggesting that both atrophy and damage of the remaining brain parenchyma contribute to the development of psychiatric symptoms. These observations are consistent with those of recent studies of patients with psychiatric signs but without SLE, in which an association between measures of structural brain damage and the presence and severity of psychiatric symptoms was demonstrated (29)(30)(31).…”

Section: Resultssupporting

confidence: 92%

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus

Bosma¹,

Middelkoop²,

Rood³

et al. 2002

Arthritis & Rheumatism

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Objective. To investigate the relationship between quantitative estimates of global brain damage based on magnetization transfer imaging (MTI) and cerebral functioning, as measured by neurologic, psychiatric, and cognitive assessments, as well as disease duration in patients with a history of neuropsychiatric systemic lupus erythematosus (NPSLE).Methods. In patients with systemic lupus erythematosus (SLE), neurologic, psychiatric, and psychological symptoms often occur. The frequency of nervous system involvement has been reported to range from 11% to 60% (1). Infection, drug side effects, hypertension, or metabolic derangements, as well as an intrinsic brain manifestation of SLE (i.e., neuropsychiatric SLE [NPSLE]), can cause such symptoms. The uncertain pathogenesis and the wide variety of manifestations of NPSLE complicate the development of a uniform diagnostic decision-making protocol and a uniform method of monitoring a patient with this type of SLE. Findings of routine brain imaging studies are often unremarkable in patients with NPSLE, or the studies reveal abnormalities, such as cerebral atrophy and white matter hyperintensities (on magnetic resonance imaging [MRI]), that can also be found in SLE patients without neuropsychiatric symptoms. Furthermore, no correlation has thus far been demonstrated between quantitative measures of such nonspecific abnormalities and measures of brain function (2-5).Recently, magnetization transfer ratio (MTR) histogram analysis, a quantitative MRI technique based on magnetization transfer imaging (MTI), was applied in patients with primary NPSLE but without abnormalities on MRI that could account for the clinical picture. With this technique, cerebral abnormalities were identified in these patients (6,7). Such abnormalities were found in SLE patients who had had episodes of neuropsychiatric symptoms in the past (chronic NPSLE) as well as in patients who were experiencing an active phase of neuropsychiatric symptoms (active NPSLE) (6,7). The

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Section: Resultssupporting

confidence: 92%

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus

Bosma¹,

Middelkoop²,

Rood³

et al. 2002

Arthritis & Rheumatism

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“…Multiple clinical studies have found that WML are irreversible and relate to cognitive impairment, dementia, depression, and gait disturbances. 17,[20][21][22] Fig . 2.…”

Section: Discussionmentioning

confidence: 99%

Decreased white matter lesion volume and improved cognitive function after liver transplantation

et al. 2007

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Focal T2-weighted white matter lesions (WML) on brain magnetic resonance imaging (MRI), mimicking those seen in cerebrovascular small-vessel disease described in patients with persistent hepatic encephalopathy, decreased in volume with the improvement of hepatic encephalopathy. This outcome has been interpreted as a decrease in the edema that it is proposed to be involved in the pathogenesis of hepatic encephalopathy. We designed a study to further investigate potential changes in focal WML in the brains of patients with cirrhosis following liver transplantation and to study the relationship between these changes and overall cognitive function. We used MRI to measure the volume of supratentorial focal WML and a neuropsychological examination to assess cognitive function before and after liver transplantation in 27 patients with cirrhosis without signs of overt hepatic encephalopathy. Baseline MRI identified focal T2-weighted lesions in 19 patients (70.3%). The presence of WML was associated with older age but not with vascular risk factors, severity of liver function, or psychometric tests. A significant reduction in lesion volume was observed after liver transplantation (from a median of 1.306 cm 3 to 0.671 cm 3 , P ‫؍‬ 0.001). This decrease correlated with an improvement in an index of global cognitive function (r ‫؍‬ ؊0.663; P < 0.001). This evolution indicates that lesion volume is partially related to a reversible type of tissue damage, which is compatible with brain edema. F ocal white matter lesions (WML) secondary to cerebrovascular small-vessel disease are commonly found in the general population over 60 years of age. 1 In a previous report, we described focal brain WML on T2-weighted images in patients with hepatic encephalopathy (HE). 2 This abnormality, which is radiologically indistinguishable from the features of small-vessel disease or normal aging, was partially reversible with improvements in HE. This evolution pattern contrasts with what occurs in focal WML attributable to small-vessel disease or brain aging, which remain stable or progress in number and size over time, but never decrease. [3][4][5] The most plausible explanation for decreasing the volume of WML with improvement of HE is a decrease in the edema component of WML.There is a large body of evidence indicating an increase in the amount of water in the brain of patients with liver cirrhosis that is related to the development of HE. 6 The most accepted hypothesis for this low-grade brain edema is that astrocytic accumulation of glutamine induces edema as a result of ammonia detoxification. This hypothesis is supported by experimental data showing astrocyte swelling and changes in brain organic osmolytes in models of HE, 7 and by brain proton magnetic resonance spectroscopy studies in patients with liver cirrhosis, which consistently show increases in the glutamine/glutamate signal accompanied by myoinositol depletion, 8

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“…16,18 Apesar destas lesões não apresentarem valor diagnóstico, há achados recentes sugerindo que as hiperintensidades, quando graves, podem estar associadas a pior prognóstico e pior resposta à medicação em pacientes depressivos idosos. 19,20 Este tipo de informação, se confirmada em outros estudos, pode reforçar a utilidade prática do uso da RM na avaliação prognóstica de pacientes com transtornos afetivos.…”

Section: Novas Técnicas De Ressonância Magnética (Rm)unclassified

Novas técnicas de neuroimagem em psiquiatria: qual o potencial de aplicações na prática clínica?

Rocha

Alves

Garrido

et al. 2001

Rev. Bras. Psiquiatr.

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Severe deep white matter lesions and outcome in elderly patients with major depressive disorder: follow up study

Cited by 210 publications

References 10 publications

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus

Association of global brain damage and clinical functioning in neuropsychiatric systemic lupus erythematosus

Decreased white matter lesion volume and improved cognitive function after liver transplantation

Novas técnicas de neuroimagem em psiquiatria: qual o potencial de aplicações na prática clínica?

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