title: Mood problems increase the risk of mortality in patients with lacunar infarcts: the SMART-MR study.
abstract: OBJECTIVE
  A relationship between depression and mortality has been well established, but underlying mechanisms remain unclear. We investigated the influence of cerebral small vessel disease (CSVD), characterized by white matter lesions (WMLs) and lacunar infarcts, on the relationship between mood mortality during 6 years follow-up.
  
  
  METHODS
  Mood problems were assessed with the mental component summary of the 36-item Short-Form Medical Outcomes Study in 1110 patients with symptomatic atherosclerotic disease (mean age 59 years). Volumetric WML estimates were obtained with 1.5-T magnetic resonance imaging; lacunar infarcts were scored visually. Cox regression models were adjusted for age, sex, vascular risk, physical functioning, antidepressants and infarcts. We adjusted for CSVD to examine whether it may be an intermediate or confounding factor. Second, we added interaction terms to investigate whether associations differed between patients with CSVD (absent/present).
  
  
  RESULTS
  Patients in the lowest quartile of mental functioning, representing most severe mood problems, were at higher, although not significant, risk of death (hazard ratio [HR] = 1.47, 95% confidence interval [CI] = 0.94-2.30) compared with patients in higher quartiles. Adjustment for CSVD did not change this association. Lacunar infarcts, not WML, modified the association of mood problems with mortality (p value for interaction = .01); mood problems strongly increased the risk of mortality in patients with lacunar infarcts (HR = 2.75, 95% CI = 1.41-5.38) but not in those without it (HR = 0.78, 95% CI = 0.39-1.57).
  
  
  CONCLUSIONS
  Patients with lacunar infarcts may be especially vulnerable for the effect of mood problems on mortality.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Stratenum 6.131, PO Box 85500, 3508 GA Utrecht, the Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Grool
authors.forename: Yolanda
authors.initials: Y
authors.lastname: van der Graaf
authors.forename: Willem P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: Theo D
authors.initials: TD
authors.lastname: Witkamp
authors.forename: Koen L
authors.initials: KL
authors.lastname: Vincken
authors.forename: Mirjam I
authors.initials: MI
authors.lastname: Geerlings
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000401:mortality* / Q000473:pathology; D001921:Brain / Q000473:pathology; D059345:Cerebral Small Vessel Diseases / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000401:mortality* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000401:mortality / Q000473:pathology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000401:mortality* / Q000473:pathology / Q000523:psychology