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Mood problems increase the risk of mortality in patients with lacunar infarcts: the SMART-MR study

Anne M Grool1, Yolanda van der Graaf, Willem P Th M Mali

  • 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.

Psychosomatic Medicine
|March 22, 2012
PubMed

Insights

Mood problems increase mortality risk, especially in patients with lacunar infarcts. Cerebral small vessel disease (CSVD) and white matter lesions (WMLs) did not significantly alter this relationship.

Area of Science:

  • Neurology
  • Psychiatry
  • Cardiovascular Medicine

Background:

  • The link between depression and mortality is established, but mechanisms are unclear.
  • Cerebral small vessel disease (CSVD), including white matter lesions (WMLs) and lacunar infarcts, is common in patients with atherosclerotic disease.

Purpose of the Study:

  • To investigate the role of CSVD in the association between mood problems and mortality.
  • To determine if WMLs or lacunar infarcts mediate or confound the mood-mortality relationship.

Main Methods:

  • 1110 patients with symptomatic atherosclerotic disease underwent mood assessment and brain MRI.
  • Volumetric WMLs and visual scoring of lacunar infarcts were performed.
  • Cox regression models analyzed mood, CSVD, and mortality over 6 years, with interaction terms for CSVD presence.

Main Results:

  • Severe mood problems showed a non-significant increased risk of mortality (HR=1.47).
  • Adjustment for CSVD did not alter the mood-mortality association.
  • Lacunar infarcts, not WMLs, significantly modified this association (p=0.01), with higher mortality risk in patients with lacunar infarcts (HR=2.75).

Conclusions:

  • Mood problems pose a significantly higher mortality risk for patients with lacunar infarcts.
  • Lacunar infarcts may identify individuals particularly vulnerable to the adverse effects of mood on survival.
Abstract

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