title: Location of cerebrovascular and degenerative changes, depressive symptoms and cognitive functioning in later life: the SMART-Medea study.
abstract: OBJECTIVE
  Depression and cognitive impairment are highly prevalent in later life and frequently co-occur. Structural changes in critical brain regions may underlie both conditions. The authors examined associations of infarcts, white-matter lesions (WML) and atrophy at different locations with depressive symptoms and cognitive functioning.
  
  
  METHODS
  Within the Second Manifestations of Arterial Disease-Memory, Depression and Aging (SMART-Medea) study, cross-sectional analyses were performed in 585 non-demented patients aged ≥50 years with symptomatic atherosclerotic disease. Volumetric measures of WML and atrophy were obtained with 1.5 T MRI; infarcts were rated visually. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (score ≥6). z Scores of executive functioning, memory and processing speed were calculated. Analyses were adjusted for age, sex, education, intelligence, vascular disease, physical functioning and co-occurring brain changes.
  
  
  RESULTS
  Depressive symptoms were present in 102 (17%) patients and were associated with poorer memory (B=-0.26, 95% CI -0.47 to -0.06). Large subcortical infarcts and lacunar infarcts in deep white-matter tracts were both associated with depressive symptoms (RR=2.66, 95% CI 1.28 to 5.54; RR=2.02, 95% CI 1.14 to 3.59) and poorer executive functioning and memory. Periventricular WML volume was associated with poorer executive functioning; cortical infarcts in the left hemisphere and media flow region, ventricular volume and cortical atrophy were associated with a slower processing speed.
  
  
  CONCLUSIONS
  In this sample of non-demented older persons, subcortical infarcts contributed to an increased risk of depressive symptoms as well as cognitive impairment. This depended on location in projecting white-matter tracts, and not on infarct size.
authors: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors: Anne M
authors: AM
authors: Grool
authors: Yolanda
authors: Y
authors: van der Graaf
authors: Willem P T M
authors: WP
authors: Mali
authors: Mirjam I
authors: MI
authors: Geerlings
mesh_terms: D000367:Age Factors; D000368:Aged; D000647:Amnesia / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D004292:Dominance, Cerebral / Q000502:physiology; D056344:Executive Function / Q000502:physiology; D005260:Female; D006801:Humans; D015994:Incidence; D002537:Intracranial Arteriosclerosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D056784:Leukoencephalopathies / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D019636:Neurodegenerative Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011594:Psychometrics; D011930:Reaction Time / Q000502:physiology; D013223:Statistics as Topic