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Differential impact of lacunes and microvascular lesions on poststroke depression

Micaela Santos1, Gabriel Gold, Enikö Kövari

  • 1Department of Psychiatry, University Hospitals and Faculty of Medicine of Geneva, Belle-Idée, Geneva, Switzerland.

Stroke
|August 22, 2009
PubMed

Insights

Poststroke depression (PSD) is linked to the cumulative burden of small, deep brain lesions (lacunes), particularly in the thalamus and basal ganglia, rather than the location of large strokes. This finding helps predict depression risk after stroke.

Area of Science:

  • Neurology
  • Neuroscience
  • Pathology

Background:

  • Poststroke depression (PSD) is a common complication following stroke.
  • Previous research suggested a link between PSD and vascular brain pathology.

Purpose of the Study:

  • To investigate the association between microvascular lesions, lacunes, and PSD.
  • To determine if cumulative vascular pathology predicts PSD occurrence.

Main Methods:

  • Analysis of 41 autopsied stroke cases with prospective depression diagnosis (DSM-IV criteria).
  • Neuropathological assessment of microvascular ischemic pathology and lacunes.
  • Statistical analysis using Fisher exact test, Mann-Whitney U test, and regression models.

Main Results:

  • No association found between macroinfarct location and PSD.
  • Thalamic and basal ganglia lacunes were more frequent in PSD cases.
  • Increased lacune scores in the thalamus, basal ganglia, and deep white matter correlated with higher PSD risk.
  • Microinfarcts and demyelination were not linked to PSD.

Conclusions:

  • Cumulative lacunar infarcts in specific brain regions (thalamus, basal ganglia, deep white matter) are key predictors of PSD.
  • The overall burden of lacunar pathology is more significant for PSD prediction than single large infarcts.
Abstract

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