Krishnan Mani S, O'Brien John T, Firbank Michael J, Pantoni Leonardo, Carlucci Giovanna, Erkinjuntti Timo, Wallin Anders, Wahlund Lars-Olof, Scheltens Philip, van Straaten Elisabeth C W, Inzitari Domenico
Institute for Ageing and Health, University of Newcastle upon Tyne, UK.
Int J Geriatr Psychiatry. 2006 Oct;21(10):983-9. doi: 10.1002/gps.1596.
Both types of cerebral white matter hyperintensities, periventricular (PVL) and deep white matter lesions (DWML) have been previously associated with the development of depression in older subjects. However, it remains controversial as to whether PVL, DWML, or both are most strongly associated with depression and this was the aim of the current study.
In a pan-European multicentre study of 626 older subjects, we examined the relationship between PVL and DWML, depressive symptoms (GDS quintile), cognitive status (MMSE), hypertension and history of stroke.
In univariate analysis we found that depressive symptoms as assessed by GDS were associated with both types of white matter lesions (Spearman rho = 0.12 p = 0.002 for DWML and rho = 0.09 p = 0.01 for PVL). Using ordinal logistic regression analysis the total DWML score (p = 0.041), rather than PVL (p = 0.9) was found to predict GDS scores.
DWML, but not PVL, were most strongly associated with depressive symptoms in this sample. As DWML (unlike PVL) are associated with vascular ischaemic damage, our findings are consistent with the 'vascular depression' hypothesis. Longitudinal studies are needed to clarify the time course of these relationships, in particular, whether modifying DWML alters the natural history of depression.
两种类型的脑白质高信号，即脑室周围白质病变（PVL）和深部白质病变（DWML），此前均被认为与老年受试者抑郁症的发生有关。然而，PVL、DWML或两者中哪一个与抑郁症的关联最为密切仍存在争议，这也是本研究的目的。
在一项针对626名老年受试者的泛欧洲多中心研究中，我们考察了PVL与DWML、抑郁症状（老年抑郁量表五分位数）、认知状态（简易精神状态检查表）、高血压及中风病史之间的关系。
在单变量分析中，我们发现通过老年抑郁量表评估的抑郁症状与两种类型的白质病变均有关联（深部白质病变的斯皮尔曼相关系数rho = 0.12，p = 0.002；脑室周围白质病变的rho = 0.09，p = 0.01）。使用有序逻辑回归分析发现，预测老年抑郁量表分数的是深部白质病变总分（p = 0.041），而非脑室周围白质病变（p = 0.9）。
在本样本中，与抑郁症状关联最为密切的是深部白质病变，而非脑室周围白质病变。由于深部白质病变（与脑室周围白质病变不同）与血管缺血性损伤有关，我们的研究结果与“血管性抑郁”假说一致。需要进行纵向研究以阐明这些关系的时间进程，特别是改变深部白质病变是否会改变抑郁症的自然病程。
