Greenwald B S, Kramer-Ginsberg E, Bogerts B, Ashtari M, Aupperle P, Wu H, Allen L, Zeman D, Patel M
Division of Geriatric Psychiatry, Hillside Hospital, Glen Oaks, New York 11004, USA.
Psychol Med. 1997 Mar;27(2):421-31. doi: 10.1017/s0033291796004576.
Several clinical and neuroimaging investigations support the notion that underlying brain changes may relate to depression in older patients, especially those with a later-age initial episode. However uncertainty still exists about diagnostic and pathogenic significance of structural brain abnormalities in aged depressives, in part because many studies lack all-elderly and age-similar normal comparison populations.
Brain morphology of elderly depressives (N = 30) and normal controls (N = 36) was compared by assessing magnetic resonance imaging (MRI) brain scans with qualitative criteria-based scales. Ratings included lateral and third ventricle enlargement, and cortical, medial temporal, and caudate atrophy.
Significant differences between depressed and control groups were not demonstrated. Later-onset depressives had significantly more left medial temporal and left caudate atrophy than early-onset counterparts of similar age. Medial temporal atrophy significantly correlated with cognitive impairment and was not related to physical illness. Depressives with medial temporal atrophy (N = 7) were older and had later age at onset of depression than those without such changes. Cerebrovascular disease risk factors did not predict MRI abnormalities.
Results indicate non-specificity and lack of homogeneity of qualitatively measured structural brain changes in geriatric depression, but suggest that pathology of specific, lateralized brain regions may be implicated in some later-onset patients. The relationship between medial temporal atrophy and late-onset depression raises the possibility that such patients may suffer from as-yet undeclared Alzheimer's disease. Lack of association between cerebrovascular disease risk factors and brain changes suggests other pathophysiological contributions.
多项临床和神经影像学研究支持这样一种观点，即潜在的脑部变化可能与老年患者的抑郁症有关，尤其是那些首发于晚年的患者。然而，老年抑郁症患者脑部结构异常的诊断和致病意义仍存在不确定性，部分原因是许多研究缺乏全老年人群和年龄匹配的正常对照人群。
通过基于定性标准的量表评估磁共振成像（MRI）脑部扫描，比较老年抑郁症患者（N = 30）和正常对照组（N = 36）的脑形态。评分包括侧脑室和第三脑室扩大，以及皮质、内侧颞叶和尾状核萎缩。
抑郁症组和对照组之间未显示出显著差异。晚发性抑郁症患者比年龄相似的早发性抑郁症患者有更多的左侧内侧颞叶和左侧尾状核萎缩。内侧颞叶萎缩与认知障碍显著相关，与躯体疾病无关。有内侧颞叶萎缩的抑郁症患者（N = 7）比没有这种变化的患者年龄更大，抑郁症发病年龄更晚。脑血管疾病危险因素不能预测MRI异常。
结果表明老年抑郁症患者定性测量的脑部结构变化具有非特异性和缺乏同质性，但提示特定脑区的病变可能与一些晚发性患者有关。内侧颞叶萎缩与晚发性抑郁症之间的关系增加了这些患者可能患有尚未确诊的阿尔茨海默病的可能性。脑血管疾病危险因素与脑部变化之间缺乏关联提示存在其他病理生理机制。
