White matter microstructural damage and depressive symptoms in patients with mild cognitive impairment and cerebral small vessel disease: the VMCI‐Tuscany Study

Pasi, Marco; Poggesi, Anna; Salvadori, Emilia; Diciotti, Stefano; Ciolli, Laura; Bene, Alessandra Del; Marini, Sandro; Nannucci, Serena; Pescini, Francesca; Valenti, Raffaella; Ginestroni, Andrea; Toschi, Nicola; Mascalchi, Mario; Inzitari, Domenico; Pantoni, Leonardo

doi:10.1002/gps.4368

Cited by 20 publications

(16 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The association with depressive symptoms is stronger for the MCI subtype with memory impairment [79], but this was independent of underlying vascular disease [80–82]. Some studies suggested an association between white matter microstructural damage and depressive symptoms in MCI patients with small vessel disease [74, 83], whereas others showed no association between depressive symptoms and the rate of incident MCI [84]. The path from CVD to VaDep and to vascular dementia appears to be likely reciprocal and not direct or sequential [85], whereas others suggested that depression is an independent risk factor for subsequent vascular dementia [86].…”

Section: Resultsmentioning

confidence: 99%

Vascular depression consensus report – a critical update

Aizenstein

Baskys

Boldrini

et al. 2016

BMC Med

220

145

View full text Add to dashboard Cite

BackgroundVascular 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”.DiscussionThis 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.ConclusionThe 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.

show abstract

Section: Resultsmentioning

confidence: 99%

Vascular depression consensus report – a critical update

Aizenstein

Baskys

Boldrini

et al. 2016

BMC Med

220

145

View full text Add to dashboard Cite

show abstract

“…In this large cohort, the microstructural integrity of both WMH and NAWM was related to global cognitive function, memory, and executive function. 33 Moreover, TBSS postprocessing analyses were performed and corpus callosum especially in the genu and splenium showed the highest significant relation with global cognitive index. Analyses for each cognitive domain showed the strongest relationship between (1) cingulum bundle microstructural integrity and verbal memory performance and (2) frontal WM and psychomotor speed.…”

Section: June 2016mentioning

confidence: 99%

White Matter Microstructural Damage on Diffusion Tensor Imaging in Cerebral Small Vessel Disease

Pasi

Uden

Tuladhar

et al. 2016

Stroke

Self Cite

View full text Add to dashboard Cite

C erebral small vessel disease (SVD) is a major health problem for its contribution to ≈45% of dementias, and about a fifth of all strokes worldwide, representing one of the most important causes of disabilities.1 The term SVD refers to a group of pathological processes with various etiologies that affect the small arteries, arterioles, venules, and capillaries of the brain. The most common forms are age-and hypertensionrelated SVD and cerebral amyloid angiopathy (CAA).2 Vessel wall changes may lead to both ischemic and hemorrhagic consequences: (1) a state of chronic hypoperfusion or vascular dysfunction responsible for incomplete infarction, 3,4 (2) acute focal necrosis (lacunar infarct), or (3) vessel rupture manifesting as hemorrhagic SVD. The clinical consequences of SVD are various and mainly consist of cognitive, mood, and motor dysfunctions leading to functional disability in the late stages of the disease.Magnetic resonance imaging (MRI) has become crucial in the diagnosis of SVD enabling the evaluation of the disease progression both in the clinical and research settings. However, correlations between clinical features of SVD and conventional MRI measures have been partially discordant. Some authors suggested that the cumulative effect of SVD lesions, rather than the individual lesions themselves determines the clinical impact, 5 whereas others suggested that the presence and severity of alterations nonvisible on conventional MRI might also be an explanation. 6 In the past decade, diffusion tensor imaging (DTI) has been increasingly used for the evaluation of SVD patients because it is sensitive to tissue damage and can show abnormalities in both areas of white matter hyperintensities (WMH) and in normal appearing WM (NAWM). Despite the high sensitivity in detecting cerebral damage, DTI has a low specificity in detecting the underlying cause. In fact, we can only infer that DTI changes reflect a loss of WM integrity because of damage to structures that restrict molecular movement along the primary axis of the axons, such as axonal cell membranes, myelin sheaths, and neurofilaments. Growing evidences indicate definite structural vascular abnormalities associated with WMH, strengthening the argument that WMH have a vascular pathogenesis.7 DTI is suited to study cortical disconnection because it provides indices of microstructural integrity within interconnected neural networks. Most DTI studies evaluated WM microstructural damage in aging, Alzheimer disease and mild cognitive impairment patients, but recently, studies in SVD patients have documented a significant association between WM microstructural damage and clinical features, providing new insight in the biological basis of this condition. 8-10The aim of this review is to analyze the evidence of the role of WM microstructural damage beyond the standard structural MRI sequences, evaluated with DTI, in the clinical consequences of cerebral SVD. Although some definitions have been proposed, 11 it is explicitly not our intention to clinically define...

show abstract

“…The etiology of depression is incompletely understood, whereas evidence suggests a “vascular depression” hypothesis ( 2 ). Several studies have indicated that cerebral small vessel disease (CSVD) might play an important role in the etiologic factors of depression ( 3 – 5 ).…”

Section: Introductionmentioning

confidence: 99%

Association Between Cerebral Microbleeds and Depression in the General Elderly Population: A Meta-Analysis

Wang

Liu

et al. 2018

Front. Psychiatry

View full text Add to dashboard Cite

BackgroundIt remains unclear whether cerebral microbleeds (CMBs) are associated with depression in the general elderly population. We thus performed a meta-analysis to evaluate the relationship between depression and CMBs.MethodsA systematic literature search was conducted in EBSCO, PubMed, and Web of Science for relevant studies that assessed the relationship between depression and the prevalence of CMBs.ResultsFive eligible studies including 7,328 patients were pooled in meta-analysis. The prevalence of CMBs was 18.0%. The prevalence of depression was 11.1%. The pooled analysis demonstrated odds ratio for CMBs and depression to be 1.187 (95% confidence interval 1.005–1.403; p = 0.043) with no evidence of statistical heterogeneity (I2 = 0.0%, p = 0.621).ConclusionOur meta-analysis of available published data indicated an increased prevalence of depression in the subjects with pre-existing CMBs. This finding supports the vascular depression hypothesis. Further studies are needed to investigate the role of CMBs in the pathogenesis and progression of depression, which might provide a potential target for the prevention and treatment.

show abstract

White matter microstructural damage and depressive symptoms in patients with mild cognitive impairment and cerebral small vessel disease: the VMCI‐Tuscany Study

Abstract: These results outline the presence of an association between WM microstructural damage and depressive symptoms in MCI patients with SVD. This relationship does not seem to be mediated by disability, cognitive, and motor impairment, thus supporting the vascular depression hypothesis.

Cited by 20 publications

References 35 publications

Vascular depression consensus report – a critical update

Vascular depression consensus report – a critical update

White Matter Microstructural Damage on Diffusion Tensor Imaging in Cerebral Small Vessel Disease

Association Between Cerebral Microbleeds and Depression in the General Elderly Population: A Meta-Analysis

Contact Info

Product

Resources

About