Frontocingulate cerebral blood flow and cerebrovascular reactivity associated with antidepressant response in late-life depression.
Vascular pathology is common in late-life depression (LLD) and may contribute to alterations in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). In turn, such hemodynamic deficits may adversely affect brain function and clinical course. The goal of this study was to examine whether altered cerebral hemodynamics in depressed elders predicted antidepressant response.



21 depressed elders completed cranial 3T MRI, including a pseudo-continuous Arterial Spin Labeling (pcASL) acquisition on both room air and during a hypercapnia challenge. Participants then completed 12 weeks of open-label sertraline. Statistical analyses examined the relationship between regional normalized CBF and CVR values and change in Montgomery-Asberg Depression Rating Scale (MADRS) and tested for differences based on remission status.



10 participants remitted and 11 did not. After controlling for age and baseline MADRS, greater change in MADRS with treatment was associated with lower pre-treatment normalized CBF in the caudal anterior cingulate cortex (cACC) and lateral orbitofrontal cortex (OFC), as well as lower CVR with hypercapnia in the caudal medial frontal gyrus (cMFG). After controlling for age and baseline MADRS score, remitters exhibited lower CBF in the cACC and lower CVR in the cMFG.



Our sample was small, did not include a placebo arm, and we examined only specific regions of interest.



Our findings suggest that increased perfusion of the OFC and the ACC is associated with a poor antidepressant response. They do not support that vascular pathology as measured by CBF and CVR negatively affects acute treatment outcomes.
The Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
Margarita
M
Abi Zeid Daou
The Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
Brian D
BD
Boyd
The Department of Radiology, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
Manus J
MJ
Donahue
The Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37212, USA.
Kimberly
K
Albert
The Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University Medical Center, Nashville, TN 37212, USA; Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN 37212, USA. Electronic address: warren.d.taylor@vanderbilt.edu.
Warren D
WD
Taylor
D000328:Adult; D000368:Aged; D000375:Aging / Q000502:physiology / Q000523:psychology; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy* / Q000503:physiopathology*; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply*; D006179:Gyrus Cinguli / Q000098:blood supply*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D000067562:Late Onset Disorders / Q000188:drug therapy / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D020280:Sertraline / Q000627:therapeutic use*; D013113:Spin Labels; D016896:Treatment Outcome
D000928:Antidepressive Agents; D013113:Spin Labels; D020280:Sertraline
Aging; Depression; Geriatrics; MRI; Perfusion; Ssri