Fujikawa T, Yamawaki S, Touhouda Y
Department of Psychiatry and Neurosciences, Hiroshima University School of Medicine, Japan.
Stroke. 1995 Jun;26(6):946-9. doi: 10.1161/01.str.26.6.946.
Previously we have studied the relationship between senile depression and silent cerebral infarctions (SCIs). The goal of this study was to clarify the relationship between late-onset mania and SCIs using MR imaging.
Twenty manic patients who developed a bipolar disorder after 50 years of age (late-onset mania) were selected prospectively. These patients were compared with 20 age- and sex-matched patients who developed an affective disorder while younger than 50 years of age (early-onset affective disorder) and with 20 patients who developed major depression after 50 years of age (late-onset major depression). Patients with focal neurological symptoms were excluded from the study. All patients underwent MR imaging to assess the incidence of SCIs. Patients diagnosed with SCIs were subclassified according to whether the infarction type was perforating, cortical, or mixed.
The incidence of SCIs in patients with late-onset mania was 65.0%; this incidence was significantly higher than that of patients with early-onset affective disorders (P < .05). The incidence of the mixed type of SCI was 50.0% in patients with late-onset mania; this was significantly higher than that in patients with late-onset major depression (P < .05).
Our findings suggest that approximately half of the cases of late-onset mania might be secondary mania related to SCIs. Because the mixed type of SCI is more prevalent in the patients with late-onset mania than in those with late-onset major depression, mania may be associated with the larger areas of brain damage and hence may be a more serious form of affective illness than major depression.
此前我们研究了老年抑郁症与无症状性脑梗死（SCI）之间的关系。本研究的目的是利用磁共振成像（MR成像）阐明晚发性躁狂与SCI之间的关系。
前瞻性地选取了20例50岁以后发病的双相情感障碍躁狂患者（晚发性躁狂）。将这些患者与20例年龄和性别匹配、50岁之前发病的情感障碍患者（早发性情感障碍）以及20例50岁以后发病的重度抑郁症患者（晚发性重度抑郁症）进行比较。有局灶性神经症状的患者被排除在研究之外。所有患者均接受MR成像以评估SCI的发生率。被诊断为SCI的患者根据梗死类型是穿支型、皮质型还是混合型进行亚分类。
晚发性躁狂患者中SCI的发生率为65.0%；这一发生率显著高于早发性情感障碍患者（P <.05）。晚发性躁狂患者中混合型SCI的发生率为50.0%；这一发生率显著高于晚发性重度抑郁症患者（P <.05）。
我们的研究结果表明，大约一半的晚发性躁狂病例可能是与SCI相关的继发性躁狂。由于混合型SCI在晚发性躁狂患者中比在晚发性重度抑郁症患者中更常见，躁狂可能与更大面积的脑损伤有关，因此可能是一种比重度抑郁症更严重的情感疾病形式。
