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Published on: May 22, 2019
Cerebrovascular disease and evolution of depressive symptoms in the cardiovascular health study
David C Steffens1, K Ranga Rama Krishnan, Casey Crump
1Duke University Medical Center, Department of Psychiatry, Durham, NC 27710, USA. steff001@mc.duke.edu
Insights
Cerebrovascular disease, including white-matter lesions, is linked to the development and persistence of depressive symptoms over time. Brain imaging reveals specific lesion types associated with worsening depression.
Area of Science:
- Neurology
- Psychiatry
- Neuroimaging
Background:
- Previous research indicates a link between cerebrovascular disease and depressive symptoms.
- The Cardiovascular Health Study (CHS) offers a unique dataset to explore this association.
Purpose of the Study:
- To investigate the relationship between vascular brain pathology on neuroimaging and changes in depressive symptoms.
- To determine if specific neuroimaging markers predict the onset, persistence, or worsening of depression.
Main Methods:
- Analysis of MRI brain scans from 3236 CHS participants.
- Collection of demographic, medical history, functional status, and apolipoprotein E genotype data.
- Annual assessment of depressive symptoms using a modified Centers for Epidemiologic Studies Depression (CES-D) scale for up to 7 years.
Main Results:
- Depressive symptoms were associated with basal ganglia lesions and white-matter lesions (cortical and subcortical).
- Neuroimaging findings did not predict new-onset depression in non-depressed individuals.
- Persistence and worsening of depression correlated with specific types of white-matter lesions.
Conclusions:
- Cerebrovascular disease identified via neuroimaging is associated with depression symptoms over time.
- Further research is needed to understand the impact of white-matter versus gray-matter lesions on mood disorders.
Background And Purpose:
Previous studies have reported an association between cerebrovascular disease and depressive symptoms. The Cardiovascular Health Study (CHS) provides an opportunity to examine the relationship between vascular brain pathology seen on neuroimaging and changes in depressive symptoms.
Methods:
The sample included 3236 CHS participants who had an MRI brain scan. Demographic variables, medical history, functional status, and apolipoprotein E genotype were obtained at baseline. Annual scores on a modified version of the Centers for Epidemiologic Studies Depression (CES-D) scale were obtained initially and up to 7 years subsequently.
Results:
After controlling for important covariates, occurrence of depressive symptoms (defined as modified CES-D score of >7) was associated with small lesions in the basal ganglia, large cortical white-matter lesions, and severe subcortical white-matter grade. Neuroimaging variables did not predict incident depression among those who were nondepressive at the time of MRI. Persistence of depressive symptoms across 2 consecutive time points was associated with small basal ganglia lesions and large cerebral cortical white-matter lesions. Worsening of depression (increase in CES-D score of > or =5) was associated with subcortical white-matter lesions.
Conclusions:
These findings suggest that cerebrovascular disease at baseline is related to depression symptoms over time. Further studies are needed to investigate the differential effects of subcortical white- versus gray-matter lesions on mood.
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