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Impaired cerebral hemodynamics in late-onset depression: computed tomography angiography, computed tomography
Jinhong Wang1, Renren Li2, Meng Liu2
1Department of Medical Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
Late-onset depression (LOD) is linked to brain blood flow issues and white matter changes. Imaging biomarkers like middle cerebral artery stenosis and hypoperfusion can indicate cerebrovascular pathology in LOD.
Area of Science:
- Neuroscience
- Radiology
- Psychiatry
Background:
- Late-onset depression (LOD) presents diagnostic challenges, often lacking family history or severe psychopathology.
- Cerebrovascular comorbidities and cerebral microvascular lesions are increasingly implicated in LOD development and progression.
Purpose of the Study:
- To investigate the association between late-onset depression and macrovascular and microvascular brain changes.
- To explore the pathomechanism and course of late-onset depression using multi-imaging techniques.
Main Methods:
- 116 participants (LOD group and age/sex-matched controls) underwent evaluation.
- Methods included CT angiography (CTA) for arterial stenosis, CT perfusion (CTP) for cerebral blood flow (CBF), and FLAIR MRI for white matter hyperintensities (WMH).
- Cognitive/mood status and depression severity (Hamilton Depression Scale) were assessed.
Main Results:
- Participants with LOD showed higher rates of intracranial arterial stenosis, particularly in the middle cerebral artery (MCA).
- Significant global and regional cerebral hypoperfusion was observed in the LOD group, especially in frontal and parietal lobes.
- Increased white matter hyperintensity (WMH) loads in deep white matter were significantly associated with LOD.
Conclusions:
- Imaging biomarkers such as hypoperfusion, MCA stenosis, and high WMH loads can identify cerebrovascular pathology in LOD.
- These findings suggest macrovascular and microvascular changes are key in the pathophysiology of late-onset depression.
Background:
Late-onset depression (LOD) is often difficult to recognize when there is an absence of a family history of depression and less severe psychopathology. Increasing evidence has shown that the development and course of LOD symptomatology are associated with cerebrovascular comorbidities and cerebral microvascular lesions. This study was designed to evaluate the associations of LOD with macrovascular and microvascular changes in the brain by using a multi-imaging method, including computed tomography angiography (CTA), CT perfusion (CTP), and magnetic resonance imaging (MRI), to explore the course and pathomechanism of LOD.
Methods:
A total of 116 participants were divided into two groups. Participants older than 60 years who met the diagnostic criteria of depression [International Classification of Diseases (ICD), 10th Edition] were enrolled in the LOD group, and the remainder were age- and sex-matched into the control group. The cognitive/mood status of all participants was evaluated by an experienced neuropsychologist. Global and regional mean cerebral blood flow (CBF) were measured by CT cerebrovascular perfusion imaging; the stenosis of the bilateral intracranial large arteries (internal carotid artery, anterior cerebral artery, middle cerebral artery, posterior cerebral artery, and vertebral artery) was recorded by CTA; regional white matter hyperintensity (WMH) loads were evaluated by fluid-attenuated inversion recovery (FLAIR) MRI; and the Hamilton Depression Scale (HAMD) was used to evaluate depression status.
Results:
Our key findings were the following: (I) participants in the LOD group were more prone to intracranial arterial stenosis (81.1% vs. 74.6%), had more severe stenotic arteries compared with controls (Z=2.024, P<0.05), and significantly more participants with LOD had severe stenosis of the middle cerebral artery (MCA) (9.4% vs. 0%, P<0.05); (II) there was a significant difference in hypoperfusion of the frontal and parietal lobes superposed on global cerebral hypoperfusion between the two groups (P<0.001); (III) and there was a significant difference in high WMH loads in deep white matter (DWM) between the two groups (P<0.05).
Conclusions:
A low global or regional perfusion state, moderate-to-severe stenosis of MCAs, and high WMH loads could be used as imaging biomarkers to indicate diffuse or localized cerebral macrovascular and microvascular pathology in LOD.
