Differential impact of lacunes and microvascular lesions on poststroke depression.
OBJECTIVE
Previous studies have postulated that poststroke depression (PSD) might be related to cumulative vascular brain pathology rather than to the location and severity of a single macroinfarct. We performed a detailed analysis of all types of microvascular lesions and lacunes in 41 prospectively documented and consecutively autopsied stroke cases.


METHODS
Only cases with first-onset depression <2 years after stroke were considered as PSD in the present series. Diagnosis of depression was established prospectively using DSM-IV criteria for major depression. Neuropathological evaluation included bilateral semiquantitative assessment of microvascular ischemic pathology and lacunes; statistical analysis included Fisher exact test, Mann-Whitney U test, and regression models.


RESULTS
Macroinfarct site was not related to the occurrence of PSD for any of the locations studied. Thalamic and basal ganglia lacunes occurred significantly more often in PSD cases. Higher lacune scores in basal ganglia, thalamus, and deep white matter were associated with an increased PSD risk. In contrast, microinfarct and diffuse or periventricular demyelination scores were not increased in PSD. The combined lacune score (thalamic plus basal ganglia plus deep white matter) explained 25% of the variability of PSD occurrence.


CONCLUSIONS
The cumulative vascular burden resulting from chronic accumulation of lacunar infarcts within the thalamus, basal ganglia, and deep white matter may be more important than single infarcts in the prediction of PSD.
Santos
Micaela
M
Department of Psychiatry, University Hospitals and Faculty of Medicine of Geneva, Belle-Idée, Geneva, Switzerland.
Gold
Gabriel
G
Kövari
Enikö
E
Herrmann
Francois R
FR
Bozikas
Vasilis P
VP
Bouras
Constantin
C
Giannakopoulos
Panteleimon
P
D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000150:complications* / Q000523:psychology*; D003865:Major Depressive Disorder / Q000209:etiology* / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation; D011446:Prospective Studies; D020521:Stroke / Q000150:complications* / Q000523:psychology*