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Grey-matter lesions and dementia

2000; Elsevier BV; Volume: 356; Issue: 9242 Linguagem: Inglês

10.1016/s0140-6736(05)70393-7

1474-547X

David C. Steffens, James R. MacFall, Martha E. Payne, Kathleen A. Welsh‐Bohmer, Kousik Krishnan,

Cerebrovascular and Carotid Artery Diseases

Ellen Garde and colleagues (Aug 19, p 628)1Garde E Mortensen EL Krabbe K Rostrup E Larsson HB Relation between age-related decline in intelligence and cerebral white-matter hyperintensities in healthy octogenarians: a longitudinal study.Lancet. 2000; 356: 628-634Summary Full Text Full Text PDF PubMed Scopus (233) Google Scholar show a relation between periventricular and deep white-matter hyperintensities and intellectual decline among healthy octogenarians. They focus on subcortical white matter. We have investigated subcortical grey matter lesions (SCG) in older depressives, another group at risk for cognitive decline.Geriatric depression, especially with late age of onset, has been associated with cerebrovascular changes of the subcortical white and grey matter on magnetic resonance imaging.2Krishnan KR Hayes JC Blazer DG MRI-defined vascular depression.Am J Psychiatry. 1997; 154: 497-501PubMed Google Scholar We tested the hypothesis that non-demented depressed elderly with SCG, compared with those without SCG, would have an increased dementia risk.We enrolled 182 non-demented depressed elderly patients in the Duke Mental Health Clinical Research Centre (MHCRC) geriatric depression study. Included patients had major depression, were aged at least 60 years, and consented to undergo brain magnetic resonance imaging. Exclusion criteria were another major psychiatric illness; alcohol or drug abuse; clinically diagnosed primary neurological illness, including dementia; and medications, medical illness, or physical disability that affected cognitive function.Trained interviewers assessed patients with the diagnostic interview schedule depression section and geriatric psychiatrists did clinical assessments by use of the Hamilton depression rating scale. To ensure patients did not meet dementia criteria at baseline, MHCRC psychiatrists clinically examined all patients, administered the mini-mental state examination, reviewed medical records, and conferred with referring physicians.Magnetic resonance imaging was done with a 1·5 Tesla whole-body system. We obtained a dual-echo fast spin-echo acquisition in the axial plane with pulse sequence parameters (TR 4000 ms, TE 30, 135 ms, 32 KHz [SD 16] full imaging bandwidth, echo train length 16, 256X256 matrix, 3 mm slice thickness [no interslice gaps]). Lesions were identified by signal intensity and anatomical region, and volume was quantified with MrX software (version 9·5).3MacFall JR Krishnan R Payne ME Locating white matter lesions in late life depression: an MRI morphometry and statistical mapping (SPM) approach. International Society for Magnetic Resonance in Medicine, Denver, COApril 4, 2000Google Scholar, 4Kikinis R Shenton ME Gerig G et al.Routine quantitative analysis of brain and cerebrospinal fluid spaces with MR imaging.J Magn Reson Imaging. 1992; 2: 619-629Crossref PubMed Scopus (216) Google ScholarWe assessed patients every 3 months for 1–5 years. Diagnoses of dementia were assigned by MHCRC psychiatrists, confirmed by neuropsychological testing, and, for some patients, by referral to a neurologist.We compared demographic, clinical, cognitive, and imaging variables by bivariate analyses in individuals who later became demented (n=26) and of non-demented participants. Older age, lower baseline mini-mental state examination score, older age of onset, and higher volume of grey-matter lesions were associated with later dementia (Alzheimer's disease, vascular dementia, or both), whereas education, sex, race, and total cerebral volume were not. In survival analyses, age (hazard ratio 1·093 [95% CI 1·022–1·168], baseline mini-mental score 0·833 [0·714–0·972]), and volume of grey-matter lesion (2·232 [1·337–3·725]) were associated with subsequent dementia. By contrast, in separate analyses, white-matter lesions were not associated with later dementia when controlling for other factors.Our findings and those of Garde and colleagues point to the importance of white-matter lesions and SCG in ageing and dementing diseases.We thank H Ryan Wagner for statistical analysis. Ellen Garde and colleagues (Aug 19, p 628)1Garde E Mortensen EL Krabbe K Rostrup E Larsson HB Relation between age-related decline in intelligence and cerebral white-matter hyperintensities in healthy octogenarians: a longitudinal study.Lancet. 2000; 356: 628-634Summary Full Text Full Text PDF PubMed Scopus (233) Google Scholar show a relation between periventricular and deep white-matter hyperintensities and intellectual decline among healthy octogenarians. They focus on subcortical white matter. We have investigated subcortical grey matter lesions (SCG) in older depressives, another group at risk for cognitive decline. Geriatric depression, especially with late age of onset, has been associated with cerebrovascular changes of the subcortical white and grey matter on magnetic resonance imaging.2Krishnan KR Hayes JC Blazer DG MRI-defined vascular depression.Am J Psychiatry. 1997; 154: 497-501PubMed Google Scholar We tested the hypothesis that non-demented depressed elderly with SCG, compared with those without SCG, would have an increased dementia risk. We enrolled 182 non-demented depressed elderly patients in the Duke Mental Health Clinical Research Centre (MHCRC) geriatric depression study. Included patients had major depression, were aged at least 60 years, and consented to undergo brain magnetic resonance imaging. Exclusion criteria were another major psychiatric illness; alcohol or drug abuse; clinically diagnosed primary neurological illness, including dementia; and medications, medical illness, or physical disability that affected cognitive function. Trained interviewers assessed patients with the diagnostic interview schedule depression section and geriatric psychiatrists did clinical assessments by use of the Hamilton depression rating scale. To ensure patients did not meet dementia criteria at baseline, MHCRC psychiatrists clinically examined all patients, administered the mini-mental state examination, reviewed medical records, and conferred with referring physicians. Magnetic resonance imaging was done with a 1·5 Tesla whole-body system. We obtained a dual-echo fast spin-echo acquisition in the axial plane with pulse sequence parameters (TR 4000 ms, TE 30, 135 ms, 32 KHz [SD 16] full imaging bandwidth, echo train length 16, 256X256 matrix, 3 mm slice thickness [no interslice gaps]). Lesions were identified by signal intensity and anatomical region, and volume was quantified with MrX software (version 9·5).3MacFall JR Krishnan R Payne ME Locating white matter lesions in late life depression: an MRI morphometry and statistical mapping (SPM) approach. International Society for Magnetic Resonance in Medicine, Denver, COApril 4, 2000Google Scholar, 4Kikinis R Shenton ME Gerig G et al.Routine quantitative analysis of brain and cerebrospinal fluid spaces with MR imaging.J Magn Reson Imaging. 1992; 2: 619-629Crossref PubMed Scopus (216) Google Scholar We assessed patients every 3 months for 1–5 years. Diagnoses of dementia were assigned by MHCRC psychiatrists, confirmed by neuropsychological testing, and, for some patients, by referral to a neurologist. We compared demographic, clinical, cognitive, and imaging variables by bivariate analyses in individuals who later became demented (n=26) and of non-demented participants. Older age, lower baseline mini-mental state examination score, older age of onset, and higher volume of grey-matter lesions were associated with later dementia (Alzheimer's disease, vascular dementia, or both), whereas education, sex, race, and total cerebral volume were not. In survival analyses, age (hazard ratio 1·093 [95% CI 1·022–1·168], baseline mini-mental score 0·833 [0·714–0·972]), and volume of grey-matter lesion (2·232 [1·337–3·725]) were associated with subsequent dementia. By contrast, in separate analyses, white-matter lesions were not associated with later dementia when controlling for other factors. Our findings and those of Garde and colleagues point to the importance of white-matter lesions and SCG in ageing and dementing diseases. We thank H Ryan Wagner for statistical analysis.