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Depression in small-vessel disease relates to white matter ultrastructural damage, not disability.

Brookes, RL; Herbert, V; Lawrence, AJ; Morris, RG; Markus, HS (2014) Depression in small-vessel disease relates to white matter ultrastructural damage, not disability. Neurology, 83 (16). pp. 1417-1423. ISSN 1526-632X https://doi.org/10.1212/WNL.0000000000000882
SGUL Authors: Brookes, Rebecca Louise Lawrence, Andrew John

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Abstract

OBJECTIVE: To determine whether cerebral small-vessel disease (SVD) is a specific risk factor for depression, whether any association is mediated via white matter damage, and to study the role of depressive symptoms and disability on quality of life (QoL) in this patient group. METHODS: Using path analyses in cross-sectional data, we modeled the relationships among depression, disability, and QoL in patients with SVD presenting with radiologically confirmed lacunar stroke (n = 100), and replicated results in a second SVD cohort (n = 100). We then compared the same model in a non-SVD stroke cohort (n = 50) and healthy older adults (n = 203). In a further study, to determine the role of white matter damage in mediating the association with depression, a subgroup of patients with SVD (n = 101) underwent diffusion tensor imaging (DTI). RESULTS: Reduced QoL was associated with depression in patients with SVD, but this association was not mediated by disability or cognition; very similar results were found in the replication SVD cohort. In contrast, the non-SVD stroke group and the healthy older adult group showed a direct relationship between disability and depression. The DTI study showed that fractional anisotropy, a marker of white matter damage, was related to depressive symptoms in patients with SVD. CONCLUSION: These results suggest that in stroke patients without SVD, disability is an important causal factor for depression, whereas in SVD stroke, other factors specific to this stroke subtype have a causal role. White matter damage detected on DTI is one factor that mediates the association between SVD and depression.

Item Type: Article
Additional Information: © 2014 American Academy of Neurology. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Article Processing Charge was paid by the Wellcome Trust.
Keywords: Aged, Aged, 80 and over, Anisotropy, Brain, Brain Ischemia, Cerebral Small Vessel Diseases, Cognition, Cross-Sectional Studies, Depression, Diffusion Magnetic Resonance Imaging, Diffusion Tensor Imaging, Female, Humans, Male, Middle Aged, Models, Neurological, Quality of Life, Severity of Illness Index, Stroke, Lacunar, Time Factors, White Matter, Neurology & Neurosurgery, 1103 Clinical Sciences, 1109 Neurosciences, 1702 Cognitive Science
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Neuroscience (INCCNS)
Journal or Publication Title: Neurology
ISSN: 1526-632X
Language: eng
Dates:
DateEvent
14 October 2014Published
PubMed ID: 25230999
Web of Science ID: WOS:000344850500009
Go to PubMed abstract
URI: http://sgultest.da.ulcc.ac.uk/id/eprint/107299
Publisher's version: https://doi.org/10.1212/WNL.0000000000000882

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