Hamada T, Murata T, Omori M, Takahashi T, Kosaka H, Wada Y, Yoshida H
Department of Clinical and Laboratory Science, Fukui Medical University, Matsuoka, Fukui 910-1193, Japan.
Neuropsychobiology. 2003;47(4):187-91. doi: 10.1159/000071213.
Recent studies have shown that the complication rate of silent cerebral infarction (SCI) in patients with geriatric depression increases with the age at the onset of depression. This study investigated the cardiovascular factors involved in the development of SCI in geriatric depression. Thirty-six patients with geriatric depression were classified according to the age at onset into 16 who developed depression at the age of <50 years (early-onset group) and 20 who developed depression at the age of > or =50 years (late-onset group). The incidence of SCI assessed by subcortical hyperintensity on MRI images, office blood pressure (BP), nocturnal systolic BP fall pattern examined by 24-hour ambulatory BP monitoring, and the severity of carotid atherosclerosis examined by B-mode ultrasonography were compared between the two groups. Furthermore, the association between the presence or absence of SCI and the nocturnal systolic BP fall pattern or the severity of carotid atherosclerosis was evaluated. The SCI complication rate was higher in the late-onset group (55.0%) than in the early-onset group (18.7%). The office BP and mean 24-hour BP did not differ significantly between the two groups. Abnormal nocturnal systolic BP fall patterns were observed in 85.0% (nondipper type showing a fall of <10% in 60.0%, extreme-dipper type showing a fall of > or =20% in 25.0%) in the late-onset group, which was significantly higher than the incidence in the early-onset group (18.7%). No significant difference was observed in any parameter of carotid atherosclerosis between the two groups. In addition, the patients with SCI more frequently showed abnormal nocturnal systolic BP fall patterns than those without SCI. These results suggest that abnormal nocturnal BP fall patterns appear to be involved in the development of SCI in senile-onset depression.
近期研究表明，老年抑郁症患者中无症状脑梗死（SCI）的并发症发生率随抑郁症发病年龄的增加而升高。本研究调查了老年抑郁症患者发生SCI的心血管相关因素。36例老年抑郁症患者根据发病年龄分为两组，16例在50岁之前发病（早发组），20例在50岁及以后发病（晚发组）。比较两组患者通过MRI图像上的皮质下高信号评估的SCI发生率、诊室血压（BP）、通过24小时动态血压监测检查的夜间收缩压下降模式以及通过B型超声检查的颈动脉粥样硬化严重程度。此外，评估有无SCI与夜间收缩压下降模式或颈动脉粥样硬化严重程度之间的关联。晚发组的SCI并发症发生率（55.0%）高于早发组（18.7%）。两组的诊室血压和24小时平均血压无显著差异。晚发组中85.0%观察到异常夜间收缩压下降模式（非勺型下降<10%的占60.0%，极端勺型下降≥20%的占25.0%），显著高于早发组的发生率（18.7%）。两组在颈动脉粥样硬化的任何参数上均未观察到显著差异。此外，与无SCI的患者相比，有SCI的患者更频繁地出现异常夜间收缩压下降模式。这些结果表明，异常夜间血压下降模式似乎与老年期抑郁症患者发生SCI有关。
