Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
J Neurol Neurosurg Psychiatry. 2011 Oct;82(10):1093-100. doi: 10.1136/jnnp.2010.232413. Epub 2011 Apr 1.
Depression and cognitive impairment are highly prevalent in later life and frequently co-occur. Structural changes in critical brain regions may underlie both conditions. The authors examined associations of infarcts, white-matter lesions (WML) and atrophy at different locations with depressive symptoms and cognitive functioning.
Within the Second Manifestations of Arterial Disease-Memory, Depression and Aging (SMART-Medea) study, cross-sectional analyses were performed in 585 non-demented patients aged ≥50 years with symptomatic atherosclerotic disease. Volumetric measures of WML and atrophy were obtained with 1.5 T MRI; infarcts were rated visually. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (score ≥6). z Scores of executive functioning, memory and processing speed were calculated. Analyses were adjusted for age, sex, education, intelligence, vascular disease, physical functioning and co-occurring brain changes.
Depressive symptoms were present in 102 (17%) patients and were associated with poorer memory (B=-0.26, 95% CI -0.47 to -0.06). Large subcortical infarcts and lacunar infarcts in deep white-matter tracts were both associated with depressive symptoms (RR=2.66, 95% CI 1.28 to 5.54; RR=2.02, 95% CI 1.14 to 3.59) and poorer executive functioning and memory. Periventricular WML volume was associated with poorer executive functioning; cortical infarcts in the left hemisphere and media flow region, ventricular volume and cortical atrophy were associated with a slower processing speed.
In this sample of non-demented older persons, subcortical infarcts contributed to an increased risk of depressive symptoms as well as cognitive impairment. This depended on location in projecting white-matter tracts, and not on infarct size.
抑郁和认知障碍在晚年人群中高发且常同时发生。关键大脑区域的结构变化可能是这两种情况的基础。作者研究了不同部位的梗死、脑白质病变（WML）和萎缩与抑郁症状和认知功能的关系。
在动脉粥样硬化性疾病症状患者的第二次表现（SMART-Medea）研究中，对 585 名年龄≥50 岁、无痴呆的患者进行了横断面分析。使用 1.5T MRI 获得 WML 和萎缩的容积测量值；通过视觉评定梗死。使用患者健康问卷-9（评分≥6）评估抑郁症状。计算执行功能、记忆和处理速度的 z 分数。分析调整了年龄、性别、教育、智力、血管疾病、身体功能和并存的脑改变。
102 名（17%）患者存在抑郁症状，与记忆较差相关（B=-0.26，95%CI-0.47 至-0.06）。较大的皮质下梗死和深白质束中的腔隙性梗死均与抑郁症状相关（RR=2.66，95%CI1.28 至 5.54；RR=2.02，95%CI1.14 至 3.59），以及执行功能和记忆较差。脑室周围 WML 体积与执行功能较差相关；左半球和中动脉区域的皮质梗死、脑室容积和皮质萎缩与处理速度较慢相关。
在本项非痴呆老年人样本中，皮质下梗死增加了抑郁症状和认知障碍的风险。这取决于投射白质束的位置，而不是梗死大小。
