title: Baseline characteristic of patients presenting with lacunar stroke and cerebral small vessel disease may predict future development of depression.
abstract: OBJECTIVE
  Cerebral small vessel disease (SVD) is associated with late-onset depression and increases the risk for depression after stroke. We aimed to investigate baseline predictors of depression after long-term follow-up in patients with SVD, initially presenting with first-ever lacunar stroke, free of depression and cognitive impairment.
  
  
  METHODS
  A total of 294 patients with SVD were evaluated 3-5 years after the qualifying event. We analyzed baseline demographic data, vascular risk factors, functional status expressed as a score on modified Rankin Scale (mRS), cognitive status, presence of depression, total number of lacunar infarcts and severity of white matter hyperintensities (WMH) on MRI with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores.
  
  
  RESULTS
  On follow-up, depression was registered in 117 (39.8%) SVD patients. At the baseline, patients with depression compared with non-depressed were older (64.4 vs 60.9 years; p = 0.007), had higher mRS score (2.8 ± 0.7 vs 1.5 ± 0.7; p < 0.0001) and had more severe lesions on MRI scales (p < 0.0001 for all parameters). On follow-up, depressed patients more frequently exhibited cognitive decline (75.2% depressed vs 56.5% non-depressed; p = 0.003). No difference was detected in risk factor frequency between groups. Multivariate Cox regression analysis adjusted by age and gender revealed independent predictors of depression: baseline mRS >2 (HR 2.17, 95%CI 1.74-2.72; p < 0.0001) and tARWMC (HR 1.05, 95%CI 1.02-1.09; p = 0.005), and cognitive decline on follow-up (HR 1.80, 95%CI 1.12-2.89; p = 0.015).
  
  
  CONCLUSIONS
  Baseline functional status and severity of WMH and development of cognitive decline predict the occurence of late-onset depression in patients with SVD.
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Aleksandra M
authors.initials: AM
authors.lastname: Pavlovic
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Pekmezovic
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Jasna
authors.initials: J
authors.lastname: Zidverc Trajkovic
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Tamara
authors.initials: T
authors.lastname: Svabic Medjedovic
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Nikola
authors.initials: N
authors.lastname: Veselinovic
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Radojicic
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Milija
authors.initials: M
authors.lastname: Mijajlovic
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Gordana
authors.initials: G
authors.lastname: Tomic
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Zagorka
authors.initials: Z
authors.lastname: Jovanovic
authors.affiliation: Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Norton
authors.affiliation: Faculty of Medicine, Neurology Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Nada
authors.initials: N
authors.lastname: Sternic
mesh_terms: D000368:Aged; D059345:Cerebral Small Vessel Diseases / Q000150:complications* / Q000473:pathology / Q000523:psychology; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D059409:Stroke, Lacunar / Q000150:complications* / Q000473:pathology / Q000523:psychology; D066127:White Matter / Q000473:pathology
keywords: lacunar infarct; late-onset depression; post-stroke depression; small vessel disease; vascular cognitive impairment; white matter hyperintensities