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CADASIL as a Useful Medical Model and Genetic Form of Vascular Depression
Joon Hyuk Park1, Bong-Hee Jeon2, Jung Seok Lee3
1Department of Psychiatry, Jeju National University School of Medicine, Jeju National University Hospital, Jejudo, Republic of Korea.
Insights
White matter hyperintensities (WMHs) in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) are linked to depression. This finding supports CADASIL as a model for vascular depression.
Area of Science:
- Neurology
- Genetics
- Psychiatry
Background:
- Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is characterized by white matter hyperintensities (WMHs), lacunar infarctions, and cerebral microbleeds (CMBs).
- Vascular depression hypothesis suggests a link between cerebrovascular disease and depression.
Purpose of the Study:
- To investigate the association between neuroimaging markers (WMHs, lacunar infarctions, CMBs) in CADASIL and depression.
- To determine if CADASIL serves as a model for vascular depression.
Main Methods:
- Eighty-four CADASIL patients underwent 3T MRI and NOTCH3 genotyping.
- Path analyses and logistic regression analyzed the effects of WMHs, lacunar infarctions, and CMBs on depression.
Main Results:
- 17.9% of CADASIL patients had major depressive disorder; 10.7% had minor depressive disorder.
- Increased WMH volume correlated with higher depression frequency and severity.
- WMH volume was significantly associated with depressive disorders, unlike lacunar infarctions and CMBs.
Conclusions:
- WMHs are strongly associated with depression in CADASIL patients.
- CADASIL represents a potential genetic model for vascular depression.
Objective:
The main magnetic resonance imaging (MRI) findings of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) are white matter hyperintensities (WMHs), lacunar infarctions, and cerebral microbleeds (CMBs). The purpose of this study was to investigate the effects of these three neuroimaging markers of CADASIL on depression to determine whether CADASIL is a useful medical model supporting the vascular depression hypothesis.
Methods:
Eighty-four subjects with CADASIL, aged 34-86 years, participated in this study. They underwent comprehensive clinical evaluation, including 3T MRI and genotyping of NOTCH3. The effects of WMH, lacunar infarctions, and CMBs were analyzed by path analyses and multivariate logistic regression analyses.
Results:
Patients with CADASIL exhibited frequencies of 17.9% for major depressive disorder (MDD) and 10.7% for minor depressive disorder. The frequency of MDD increased from 5.0% to 46.2% as WMH volume increased from first quartile to fourth quartile. WMH volume (OR: 1.03, 95% CI: 1.003-1.06) in patients with CADASIL was associated with the current depressive disorder. Path analyses demonstrated that only WMH volume was associated with the Korean version of the short form Geriatric Depression Scale score, Center for Epidemiologic Studies Depression Scale score, and 17-item Hamilton depression scale score. The effects of lacunar infarctions and CMBs on depression were not significant in path analyses and multivariate logistic regression analyses.
Conclusions:
This study demonstrates that WMHs are closely associated with depression in patients with CADASIL. This supports that CADASIL might be a useful medical model and genetic form of vascular depression.
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