title: Reduced frontal perfusion in depressed postmenopausal women: a SPECT study with WCST.
abstract: OBJECTIVE
  To investigate frontal cerebral blood flow (CBF) in depressed postmenopausal women and its relation to cognitive function and the severity of depressive symptoms.
  
  
  METHODS
  Regional CBF of 20 unmedicated depressed postmenopausal women was measured using Tc-99m HMPAO SPECT, both at rest and during frontal activation using the Wisconsin card sorting test (WCST). Frontal CBF was semi-quantified by comparing the radioactivity in the prefrontal region to the cerebellum (F/C ratio). We measured the severity of the symptoms of depression using the hospital anxiety and depression scale (HADS) and cognitive function using the mini-mental status examination (MMSE).
  
  
  RESULTS
  At rest, there was no difference in frontal CBF between patients with moderate or severe (HADS> or =11) and patients with mild depressive symptoms (HADS<11). During the WCST, however, the HADS> or =11 group did not score as well as the HADS<11 group (P=0.03). The changes in F/C ratios were inversely correlated with HADS scores (r=-0.43, P=0.05) and positively correlated with MMSE scores (r=0.58, P=0.004). After adjusting for age, F/C ratios were significantly correlated with MMSE (P=0.002), but not with HADS scores.
  
  
  CONCLUSIONS
  Frontal CBF did not increase in postmenopausal women with moderate/severe symptoms of depression during the WCST activation task, and reduced frontal CBF was related to the impairment of cognitive function. The combination of the functional activation test and SPECT imaging powerfully revealed this functional disease, which remains undetectable using more common baseline measurements.
authors.affiliation: Department of Nuclear Medicine, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan 704, Taiwan. wjyao@mail.ncku.edu.tw
authors.forename: Wei-Jen
authors.initials: WJ
authors.lastname: Yao
authors.forename: Hsien-An
authors.initials: HA
authors.lastname: Pan
authors.forename: Yen-Kuang
authors.initials: YK
authors.lastname: Yang
authors.forename: Yuan-Hwa
authors.initials: YH
authors.lastname: Chou
authors.forename: Shan-Tair
authors.initials: ST
authors.lastname: Wang
authors.forename: Chin-Yin
authors.initials: CY
authors.lastname: Yu
authors.forename: Hong-Dun
authors.initials: HD
authors.lastname: Lin
mesh_terms: D003072:Cognition Disorders / Q000150:complications; D003863:Depression / Q000150:complications*; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply* / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D009483:Neuropsychological Tests; D017698:Postmenopause; D011569:Psychiatric Status Rating Scales; D019275:Radiopharmaceuticals; D012720:Severity of Illness Index; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime