Ankara University Faculty of Medicine Department of Psychiatry, Geriatric Psychiatry Unit, Ankara, Turkey.
Ankara University Faculty of Medicine Department of Neurology, Ankara, Turkey.
Int J Geriatr Psychiatry. 2020 Jul;35(7):702-711. doi: 10.1002/gps.5287. Epub 2020 Mar 9.
Geriatric depression is a special condition associated with a chronic course, treatment resistance and vascular processes. However, its neurobiology has not been fully elucidated. There is no study in geriatric depression evaluating deep brain structures with transcranial sonography (TCS) which is a low-cost, non-invasive and practical tool. The present study aimed to evaluate the changes in the echogenicity of brainstem raphe (BR), substantia nigra (SN) and ventricular diameters by TCS in association with cognitive dysfunctions in patients with geriatric depression.
Echogenicity of BR and SN were assessed and transverse diameters of the third ventricle and frontal horns of the lateral ventricles were measured by TCS in 34 patients with DSM-5 major depression and 31 healthy volunteers aged 60 and older. Cognitive functions were evaluated by using Mini Mental State Examination, Montreal Cognitive Assessment Tool, Clock Drawing Test and Subjective Memory Complaints Questionnaire.
Although depressed patients had more subjective memory complaints than controls, they had similar cognitive performances. Reduced echogenicity (interrupted/invisible echogenic line) of BR was found to be significantly higher and the ventricular diameters were larger in the depressed group. There was no difference between the groups in terms of SN echogenicity. There was no correlation between ventricular diameters and depression severity or cognitive functions.
Results of the present study are important in terms of pointing out neurobiological changes related to geriatric depression which are in parallel with the results of the studies in younger patients with depression. However, long-term follow-up studies are required for accurate differentiation of neurocognitive disorders.
老年抑郁症是一种与慢性病程、治疗抵抗和血管过程相关的特殊疾病。然而，其神经生物学尚未完全阐明。目前还没有研究使用经颅超声（TCS）评估老年抑郁症患者深部脑结构的变化，TCS 是一种成本低、非侵入性且实用的工具。本研究旨在通过 TCS 评估老年抑郁症患者的脑桥中缝核（BR）、黑质（SN）回声强度以及脑室直径的变化与认知功能障碍的相关性。
使用 TCS 评估 34 名符合 DSM-5 标准的重度抑郁症患者和 31 名年龄在 60 岁及以上的健康志愿者的 BR 和 SN 的回声强度，并测量第三脑室横径和侧脑室额角横径。使用简易精神状态检查、蒙特利尔认知评估工具、画钟试验和主观记忆抱怨问卷评估认知功能。
尽管抑郁患者的主观记忆抱怨比对照组多，但他们的认知表现相似。抑郁组的 BR 回声减弱（中断/不可见的回声线）明显更高，脑室直径更大。两组间 SN 回声强度无差异。脑室直径与抑郁严重程度或认知功能之间无相关性。
本研究结果对于指出与老年抑郁症相关的神经生物学变化非常重要，这些变化与年轻抑郁症患者的研究结果一致。然而，需要进行长期随访研究以准确区分神经认知障碍。
