Elderly dépressives, and especially late-onset dépressives, have white matter liyperintensiti.es (WMHs) more frequently than nondepressed individuals.33-37 WMHs selleckchem correspond to areas of arteriolar ectasia, enlargement of perivascular spaces, and myelin pallor associated with arteriosclerotic changes of perforating arteries.38 In asymptomatic individuals, WMHs were found to be associated with extracranial carotid artery disease, reduced cerebral blood flow, and a history of hypertension,
diabetes, cardiac disease.39 Not all WMHs are due to vascular Inhibitors,research,lifescience,medical disease. However, geriatric depressed patients without cerebrovascular risk factors were found to have similar degree of WMHs to nondepressed controls.40 Inhibitors,research,lifescience,medical The temporal relationship between the formation of WMHs and development of depression has not been systematically investigated. However, in one case, depression developed following a large increase in WMHs.41 We used transcranial sonography to compare cerebral blood flow velocity between elderly patients with major depression and
normal elderly controls.42 Depressed patients had reduced blood flow velocity in the middle, anterior, and posterior cerebral artery (Figure 1). Blood flow velocity was strongly correlated with overall cognitive dysfunction, but the strongest correlations were those with initiation/perseveration scores of the Inhibitors,research,lifescience,medical Mattis Dementia Rating Scale.43 Figure 1. Blood flow velocity In the middle cerebral artery in an 82 -year-old patient with major depression (left) and a 79-year-old psychiatrically normal subject (right). Blood flow velocity was measured with transcranial sonography. Lesions in the basal ganglia are associated with Inhibitors,research,lifescience,medical depression. Approximately 40% to 75% of depressed elderly patients have lesions of the
thalamus and basal ganglia,36 while only 5% of normal elderly controls have such lesions, and their lesions are smaller than the lesions of elderly dépressives. The clinical presentation Inhibitors,research,lifescience,medical of vascular depression Vascular disease contributes to cognitive impairment. The incidence of dementia 1 year after the first cerebral infarct was found to be 9 times greater than expected.44 Lacunar infarcts in the basal ganglia, thalamus, and deep white matter, but not cortical infarcts, appear to be associated with high prevalence of dementia in Alzheimer’s patients.45 Declining cognitive performance, perhaps due to unrecognized vascular disease, was found to be a stroke risk factor.46 WMHs were correlated unless with impaired attention, mental speed, and executive functions47-50 in nondepressed subjects. Late-onset dépressives with vascular risk factors were reported to have greater cognitive impairment than elderly patients with early-onset depression without vascular risk factors.18,51 Executive functions were most affected. In vascular dementia, a subcortical syndrome frequently associated with depression, the extent of WMHs correlated with cognitive impairment.