Rao R, Jackson S, Howard R
Department of Old Age Psychiatry, Maudsley Hospital and Institute of Psychiatry, London, UK.
Int J Geriatr Psychiatry. 2001 Feb;16(2):175-83. doi: 10.1002/1099-1166(200102)16:2<175::aid-gps298>3.0.co;2-0.
Although depression has a recognised association with stroke, the role of "silent" cerebrovascular pathology associated with carotid stenosis and peripheral vascular disease remains unexplored.
Four groups of 25 community residents aged 65 and over were recruited, comprising first anterior circulation stroke, carotid stenosis accompanied by transient ischaemic attack, peripheral vascular disease and a non-vascular control group. All participants were interviewed using the Hamilton Rating Scale for Depression [HRSD] (including a modified version) and Geriatric Depression Scale. DSM IV criteria for major depression and measures of handicap, social support and physical illness were also administered. Head computerised tomography (CT) scans were performed on stroke patients to examine the relationship between lesion location and depression.
One hundred patients were interviewed. Stroke patients were more likely to live in a nursing home and had less social support than other groups. Mean scores on the modified Hamilton and Geriatric Depression Scales were higher in stroke and carotid stenosis groups than controls. Patients with stroke did not show a higher prevalence of DSM IV major depressive disorder than those with carotid stenosis. There was no relationship between the presence of lesions affecting the frontal/subcortical system and prevalence/severity of depression.
Small numbers, mortality of stroke patients in hospital, possible selection bias in the control group and use of a previously unvalidated depression rating scale all limit the study.
A possible role for carotid stenosis in the pathogenesis of depressive disorder is suggested. Larger studies incorporating brain imaging may be required to examine the mechanism of this association more closely. The use of a shorter version of the HRSD in older people with cerebrovascular disease may warrant further exploration.
尽管抑郁症与中风之间的关联已得到认可，但与颈动脉狭窄和外周血管疾病相关的“无症状”脑血管病变的作用仍未得到探索。
招募了四组25名65岁及以上的社区居民，包括首次发生前循环中风、伴有短暂性脑缺血发作的颈动脉狭窄、外周血管疾病和一个非血管对照组。所有参与者均使用汉密尔顿抑郁评定量表[HRSD]（包括修订版）和老年抑郁量表进行访谈。还采用了《精神疾病诊断与统计手册》第四版中重度抑郁症的标准以及残疾、社会支持和身体疾病的测量方法。对中风患者进行头部计算机断层扫描（CT），以检查病变位置与抑郁症之间的关系。
对100名患者进行了访谈。中风患者比其他组更有可能住在养老院，且社会支持较少。中风组和颈动脉狭窄组在修订版汉密尔顿和老年抑郁量表上的平均得分高于对照组。中风患者的《精神疾病诊断与统计手册》第四版重度抑郁症患病率并不高于颈动脉狭窄患者。影响额叶/皮质下系统的病变的存在与抑郁症的患病率/严重程度之间没有关系。
样本数量少、中风患者在医院的死亡率、对照组可能存在的选择偏倚以及使用先前未经验证的抑郁评定量表均限制了本研究。
提示颈动脉狭窄在抑郁症发病机制中可能起作用。可能需要进行纳入脑成像的更大规模研究，以更密切地研究这种关联的机制。在患有脑血管疾病的老年人中使用较短版本的HRSD可能值得进一步探索。
