Department of Neurology (J.P.C., M.P., P.K., J.R.A., A.C., C.K., Z.D., K.S., C.D.A., M.E.G., S.M.G., J.R., A.V., A.B.), Massachusetts General Hospital, Boston.
Hemorrhagic Stroke Research Program (J.P.C., P.K., J.R.A., A.C., C.K., Z.D., K.S., C.D.A., M.E.G., S.M.G., J.R., A.V., A.B.), Massachusetts General Hospital, Boston.
Stroke. 2022 Feb;53(2):523-531. doi: 10.1161/STROKEAHA.121.035488. Epub 2021 Sep 30.
Intracerebral hemorrhage (ICH) is an acute manifestation of cerebral small vessel disease (CSVD), usually cerebral amyloid angiopathy or hypertensive arteriopathy. CSVD-related imaging findings are associated with increased depression incidence in the general population. Neuroimaging may, therefore, provide insight on depression risk among ICH survivors. We sought to determine whether CSVD CT and magnetic resonance imaging markers are associated with depression risk (before and after ICH), depression remission, and effectiveness of antidepressant treatment.
We analyzed data from the single-center longitudinal ICH study conducted at Massachusetts General Hospital. Participants underwent CT and magnetic resonance imaging imaging and were followed longitudinally. We extracted information for neuroimaging markers of CSVD subtype and severity. Outcomes of interest included pre-ICH depression, new-onset depression after ICH, resolution of depressive symptoms, and response to antidepressant treatment.
We followed 612 ICH survivors for a median of 47.2 months. Multiple CSVD-related markers were associated with depression risk. Survivors of cerebral amyloid angiopathy-related lobar ICH were more likely to be diagnosed with depression before ICH (odds ratio, 1.68 [95% CI, 1.14-2.48]) and after ICH (sub-hazard ratio, 1.52 [95% CI, 1.12-2.07]), less likely to achieve remission of depressive symptoms (sub-hazard ratio, 0.69 [95% CI, 0.51-0.94]), and to benefit from antidepressant therapy (=0.041). Cerebral amyloid angiopathy disease burden on magnetic resonance imaging was associated with depression incidence and treatment resistance (interaction =0.037), whereas hypertensive arteriopathy disease burden was only associated with depression incidence after ICH.
CSVD severity is associated with depression diagnosis, both before and after ICH. Cerebral amyloid angiopathy-related ICH survivors are more likely to experience depression (both before and after ICH) than patients diagnosed with hypertensive arteriopathy-related ICH, and more likely to report persistent depressive symptoms and display resistance to antidepressant treatment.
脑出血（ICH）是脑小血管病（CSVD）的急性表现，通常为脑淀粉样血管病或高血压性动脉病。CSVD 相关的影像学表现与普通人群中抑郁发生率的增加有关。因此，神经影像学可以为 ICH 幸存者的抑郁风险提供深入了解。我们旨在确定 CSVD CT 和磁共振成像标志物是否与抑郁风险（ICH 发生前后）、抑郁缓解以及抗抑郁治疗的效果相关。
我们分析了在马萨诸塞州综合医院进行的单中心纵向 ICH 研究的数据。参与者接受了 CT 和磁共振成像检查，并进行了纵向随访。我们提取了 CSVD 亚型和严重程度的神经影像学标志物信息。感兴趣的结局包括 ICH 发生前的抑郁、ICH 后新发抑郁、抑郁症状缓解和抗抑郁治疗的反应。
我们对 612 名 ICH 幸存者进行了中位数为 47.2 个月的随访。多种 CSVD 相关标志物与抑郁风险相关。脑淀粉样血管病相关的脑叶 ICH 幸存者在 ICH 发生前（比值比，1.68[95%可信区间，1.14-2.48]）和发生后（亚危险比，1.52[95%可信区间，1.12-2.07]）更易被诊断为抑郁，更不易缓解抑郁症状（亚危险比，0.69[95%可信区间，0.51-0.94]），并且对抗抑郁治疗的反应（=0.041）。磁共振成像上的脑淀粉样血管病负担与抑郁发生率和治疗抵抗相关（交互作用=0.037），而高血压性动脉病负担仅与 ICH 后抑郁发生率相关。
CSVD 严重程度与 ICH 发生前后的抑郁诊断相关。与高血压性动脉病相关的 ICH 幸存者相比，脑淀粉样血管病相关的 ICH 幸存者更易发生抑郁（ICH 发生前后），且更易报告持续性抑郁症状并对抗抑郁治疗产生抵抗。
