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Cerebral haemodynamics and depression in the elderly
H Tiemeier1, S L M Bakker, A Hofman
1Department of Epidemiology & Biostatistics, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands.
Insights
Late-life depression is linked to altered cerebral blood flow and reactivity. Transcranial Doppler ultrasonography reveals reduced blood flow velocity and impaired vasomotor reactivity in older adults with depressive symptoms.
Area of Science:
- Neuroscience
- Gerontology
- Psychiatry
Background:
- Epidemiological and neuroimaging studies suggest a link between cerebrovascular disease and depression in the elderly.
- The precise contribution of cerebrovascular factors to the pathogenesis of late-life depression remains unclear.
Purpose of the Study:
- To investigate the relationship between cerebral hemodynamics and depression in a population-based cohort.
- Utilized transcranial Doppler ultrasonography to assess cerebral blood flow and reactivity.
Main Methods:
- Measured middle cerebral artery blood flow velocity and CO2-induced vasomotor reactivity in 2093 participants of the Rotterdam Study.
- Screened for depressive symptoms using the Center for Epidemiological Studies Depression scale; diagnosed depressive and subthreshold depressive disorders via semistructured interviews.
- Controlled for age, sex, stroke, cognitive score, and cardiovascular risk factors in analyses of covariance.
Main Results:
- Individuals with depressive symptoms exhibited reduced blood flow velocities and lower vasomotor reactivity.
- Blood flow velocity was significantly lower in subjects with DSM-IV depressive disorder.
- Reduced CO2-induced vasomotor reactivity was primarily observed in subjects with subthreshold depressive disorder.
Conclusions:
- Late-life depression is associated with measurable cerebral hemodynamic changes, detectable via transcranial Doppler ultrasonography.
- Reduced cerebral blood flow velocity may reflect reduced demand in severe depression (DSM-IV disorder).
- Impaired CO2-induced vasomotor reactivity could be a causal factor in subthreshold depressive disorder.
Background:
Evidence from epidemiological and neuroimaging studies suggests that cerebrovascular disease is associated with depressive disorders in the elderly, but the extent to which it contributes to the pathogenesis of late life depression is unclear.
Objective:
To investigate the relation between cerebral haemodynamics and depression in a population based study, using transcranial Doppler ultrasonography.
Methods:
Cerebral blood flow velocity and CO2 induced vasomotor reactivity in the middle cerebral artery were measured in 2093 men and women who participated in the Rotterdam study. All subjects were screened for depressive symptoms using the Center of Epidemiological Studies Depression scale, and those with a score of 16 or over had a psychiatric work up. In a semistructured interview, diagnoses of depressive disorders according to the DSM-IV and subthreshold depressive disorder were established. Analyses of covariance controlled for age, sex, stroke, cognitive score, and cardiovascular risk factors were used to compare means of haemodynamic variables.
Results:
Subjects with depressive symptoms had reduced blood flow velocities (mean difference, -2.9 cm/s; 95% confidence interval (CI), -5.0 to -0.8; p = 0.008) and lower vasomotor reactivity (mean difference -0.5%/kPa; 95% CI, -1.0 to -0.05; p = 0.03). Blood flow velocity was reduced most in subjects suffering from a DSM-IV depressive disorder (mean difference, -4.9 cm/s; 95% CI, -8.5 to -1.4; p = 0.006). The overall reduction in vasomotor reactivity was accounted for by subjects with subthreshold depressive disorder.
Conclusions:
Depression in late life is associated with cerebral haemodynamic changes that can be assessed by transcranial Doppler ultrasonography. The observed reduction in cerebral blood flow velocity could be a result of reduced demand in more seriously depressed cases with a DSM-IV disorder, whereas reduced CO2 induced cerebral vasomotor reactivity is a possible causal factor for subthreshold depressive disorder.