O'Brien John T, Firbank Michael J, Krishnan Mani S, van Straaten Elisabeth C W, van der Flier Wiesje M, Petrovic Katja, Pantoni Leonardo, Simoni Michela, Erkinjuntti Timo, Wallin Anders, Wahlund Lars-Olof, Inzitari Domenico
Institute for Ageing and Health, University of Newcastle upon Tyne, UK.
Am J Geriatr Psychiatry. 2006 Oct;14(10):834-41. doi: 10.1097/01.JGP.0000214558.63358.94.
Both white matter hyperintensities (WMH) and lacunar infarcts have been associated with the development of depression in older subjects, although the relative importance of the two and the influence of lesion location and concomitant vascular disease are unclear. This study investigates the relationship between location and burden of WMH and lacunes on depressive features in older people.
In a pan-European multicenter study of 626 older subjects, the authors examined the relationship between regional magnetic resonance imaging white matter hyperintensities, number of lacunar infarcts, depressive symptoms as assessed by the 15-item geriatric depression scale (GDS), cognitive status (Mini-Mental Status Examination), hypertension, and self-perceived health quality of life (QoL).
The authors found depressive symptoms to be correlated with WMH rating in the frontal (N=626; Spearman's rho=0.161, p <0.001) and temporal (rho=0.14, p <0.001) but not occipitoparietal region (rho=0.07, p=0.07). Basal ganglia lacunes were only weakly correlated with GDS (rho=0.09, p=0.03), and lacunes in other regions showed no association. In a ordinal logistic regression model (controlling for QoL, Mini-Mental Status Examination, age, and with an interaction between WMH and hypertension), temporal WMH in the absence of hypertension independently predicted GDS, whereas neither history of stroke nor number of lacunar infarcts did. The authors compared left- versus right-sided WMH and found no effect of laterality on depressive symptoms.
The results suggest that in this population of nondisabled older people, WMH have a greater influence on depressive symptoms than infarcts.
白质高信号（WMH）和腔隙性脑梗死均与老年受试者抑郁症的发生有关，尽管二者的相对重要性以及病变位置和伴发血管疾病的影响尚不清楚。本研究调查了WMH和腔隙的位置及负荷与老年人抑郁特征之间的关系。
在一项针对626名老年受试者的泛欧洲多中心研究中，作者研究了区域磁共振成像白质高信号、腔隙性脑梗死数量、由15项老年抑郁量表（GDS）评估的抑郁症状、认知状态（简易精神状态检查表）、高血压以及自我感知的健康生活质量（QoL）之间的关系。
作者发现抑郁症状与额叶（N = 626；Spearman等级相关系数rho = 0.161，p <0.001）和颞叶（rho = 0.14，p <0.001）的WMH分级相关，而与枕顶叶区域无关（rho = 0.07，p = 0.07）。基底节腔隙仅与GDS弱相关（rho = 0.09，p = 0.03），其他区域的腔隙则无关联。在一个有序逻辑回归模型中（控制QoL、简易精神状态检查表、年龄以及WMH与高血压之间的相互作用），无高血压时颞叶WMH可独立预测GDS，而卒中病史和腔隙性脑梗死数量均不能。作者比较了左侧与右侧WMH，发现左右侧性对抑郁症状无影响。
结果表明，在这群无残疾的老年人中，WMH对抑郁症状的影响大于脑梗死。
