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Resumo Contexto As doenças vasculares estão associadas a importantes sequelas e repercussões clínicas nas vidas dos pacientes acometidos e, em maior relevância, entre os idosos. Consequências da doença vascular como a perda de um membro, dor crônica, internamentos prolongados e a polifarmácia geram, nesses pacientes, perda de autonomia e um grau de dependência, que vão influenciar o bem-estar e a qualidade de vida. Objetivos Determinar a ocorrência de depressão e avaliar a capacidade funcional em pacientes com doenças vasculares internados em um serviço de cirurgia vascular. Métodos Trata-se de um estudo observacional, transversal, prospectivo, realizado no serviço de cirurgia vascular de um hospital terciário, com uma amostra não aleatória selecionada de forma consecutiva. Para avaliar a depressão, foi utilizada a escala de depressão geriátrica resumida e, para a avaliação funcional do indivíduo, foi utilizada a escala de Katz. Resultados A prevalência de depressão nesses pacientes foi de 60,6%. Foi observada associação entre depressão e: consulta com médico do Programa de Estratégia de Saúde da Família nos últimos 12 meses, etilismo, claudicação, diabetes e indivíduos que sofreram amputação. Já em relação à capacidade funcional do indivíduo avaliado através do índice de Katz, ocorreram associações significativas entre variáveis sociodemográficas, condições relacionadas a doença vascular e internamento. Conclusões Existem uma alta prevalência de depressão em pacientes com doenças vasculares internados em um serviço de cirurgia vascular e uma redução importante da capacidade funcional em alguns grupos, como os indivíduos de baixa escolaridade, os que sentiam dor crônica nos membros inferiores, os diabéticos e aqueles que sofreram amputação.
Abstract Background Vascular diseases are associated with significant sequelae and clinical repercussions for the lives of affected patients, which are more serious among the elderly. The consequences of vascular disease, such as limb loss, chronic pain, prolonged hospitalization, and polypharmacy, reduce these patients' autonomy and independence, influencing their wellbeing and quality of life. Objectives To determine the prevalence of depression and assess functional capacity in patients with vascular diseases admitted to a Vascular Surgery Service. Methods This is a descriptive, cross-sectional study, carried out at the Vascular Surgery Service of a tertiary hospital with a non-random sample of patients selected consecutively. The geriatric depression scale short form (GDS-15) was used to assess depression and the Katz scale was used for functional assessment. Results The prevalence of depression in these patients was 60.6%. Associations were observed between depression and consultation with a family doctor in the last 12 months, alcoholism, claudication, diabetes, and individuals who had had an amputation. Individuals' Katz index functional capacity scores were significantly associated with sociodemographic variables, conditions related to vascular disease, and hospitalization. Conclusions There was a high prevalence of depression in patients with vascular diseases admitted to a vascular surgery service and important reductions in functional capacity in some groups, such as individuals with low educational levels, those who had chronic pain in the lower limbs, patients with diabetes, and those who had had an amputation.
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Objective@#To understand the changes of serum transient receptor potential channel 1(TRPC1) in patients with vascular depression.@*Methods@#58 patients with vascular depression, 49 patients with major depressive disorder and 38 healthy controls were recruited.The TRPC1 of all subjects were detected by ELISA.Patients with vascular depression and patients with primary depression were scaled by HAMD-17.The level of TRPC1 was contrasted in different ages groups and in different nosogenesis (cerebral infarction, ischemic cerebrovascular disease, old cerebral hemorrhage, cerebral microbleeds, vascular risk factors, etc.) of vascular depression.The relationship between TRPC1 level and severity of depressive symptoms was further analyzed.@*Results@#(1)The level of TRPC1 of serum((643.76±118.43)pg/ml) was decreased in patients with vascular depression compared with that in healthy controls ((712.48± 98.75) pg/ml). The level of TRPC1 in patients with vascular depression over 60 years ((601.43±113.55)pg/ml)was lower than that in patients with major depressive disorder over 60 years ((626.32±125.46)pg/ml) and healthy controls over 60 years((721.84± 99.62)pg/ml) .(2) Among the various causes of vascular depression, the level of TRPC1 in patients with cerebral infarction, ischemic cerebrovascular disease and cerebral microbleeds was significantly lower (P<0.05). (3) The levels of TRPC1 in the patients with vascular depression (r=-0.962, P<0.05) and patients with major depressive disorder (r=-0.674, P<0.05) were negatively correlated with HAMD-17 score.@*Conclusion@#The level of TRPC1 is lower in patients with vascular depression, which is more obvious in patients with cerebral infarction, ischemic cerebrovascular disease, and cerebral microhaemorrhage.The lower the level of TRPC1, the more severe the depression.The neuroprotective effect of TRPC1 is reduced in patients with vascular depression.The TRPC1 can be used as a biomarker for vascular depression.
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AIM To aim at investigating the function of Kaixin Jieyu Pills (Ginseng Radix et Rhizoma,Bupleuri Radix,Morindae officinalis Radix,etc.) to vascular depression and their mechanism of action.METHODS A vascular depression model of rat was established by chronic unpredictable mild stress and separation after ligation of the bilateral common carotid arteries.The rats were treated with Kaixin Jieyu Pills and fluoxetine hydrochloride (FLU) for 28 days,respectively.The sucrose preference test and open-field test were performed.Cerebral perfusion was investigated with a Perfusion Speckle Imager.The monoamines including serotonin,dopamine and noradrenaline,and brain-derived neurotrophic factor (BDNF) were determined with ELISA and Western bolt,respectively.RESULTS Kaixin Jieyu Pills significantly increased sucrose preference,moving distance and cortical blood flow.Kaixin Jieyu Pills could upregulate,to different extents,the expressions of monoamines,including serotonin,noradrenaline and dopamine,and BDNF.Kaixin Jieyu Pills had a function similar to FLU in behavior,upregulating monoamines and BDNF,but it is superior to FLU in cortical blood flow.CONCLUSION Kaixin Jieyu Pills has the advantage of reducing the depression-like behavior and improving cerebral hypoperfusion,which might be mediated by the upregulation of the serotonin,noradrenaline and BDNF.
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Objective To compare the advantages and disadvantages between high performance liquid chromatography (HPLC)-ultraviolet (UV, HPLC-UV), HPLC-fluorescence detector (FLD, HPLC-FLD) and HPLC-mass spectrometry (MS, HPLC-MS) for determination of the monoamine neurotransmitters (MNs) in brain tissues of mice, and to determine the content of MNs in brain tissues of vascular depression mice using the optimal method. Methods We used the UV, FLD and MS detectors to establish different methods for determination of dopamine (DA), norepinephrine (NE) and 5-hydroxytryptamine (5-HT) in brain tissues. Then the methods was verified with methodology. The HPLC-FLD was applied for the content determination of DA, NE and 5-HT in different brain tissues of vascular depression mice. Results It was observed that the limits of quantification for HPLC-UV, HPLC-FLD and HPLC-MS were DA 103.5 ng/mL, NE 107.5 ng/mL and 5-HT 93.6 ng/mL; 10.35 ng/mL, 10.75 ng/mL and 9.36 ng/mL; and 10.35 ng/mL, 32.25 ng/mL and 9.36 ng/mL, respectively. Both HPLC-FLD and HPLC-MS for DA and 5-HT were superior to HPLC-UV. HPLC-FLD for NE was superior to HPLC-MS. Compared with HPLC-UV and HPLC-FLD, HPLC-MS showed remarkable matrix effects. HPLC-FLD determination results showed that content of DA was the lowest in hippocampus, 5-HT was the lowest in cerebral cortex, and NE did not differ in different brain tissues of vascular depression mice. Conclusion Compared with HPLC-UV and HPLC-MS, HPLC-FLD can more effectively determine the contents of MNs (DA, NE and 5-HT). DA and 5-HT can be used as the diagnostic markers of the vascular depression diseases.
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The paper was aimed to summarize the development of vascular depression (VD) in functional magnetic resonance imaging (fMRI) of brain research,including diffusion tensor imaging and blood oxygenation level dependentfMRI.Through the real-time imaging of brain tissues and brain function in VD patients,it was found that the neurological and brain function in the brain regions related to depression were changed.The main pathologic changes were abnormal white matter hyperintensities of the brains.The key link of VD pathogenesis was that limbic systemcortex-striatum-thalamus circuits were destroyed.And the main performance of VD in fMRI was abnormal brain function connection in prefrontal cortex,limbic cortex (i.e.,cingulate gyrus,hippocampal gyrus),amygdala,cerebellum,and etc.in fMRI.The pathogenesis of VD was complex.As a noninvasive living brain function detection technique,fMRI will play an important role in the comprehensive understanding of VD and provide new ideas in clinical diagnosis and treatment.
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Background Stroke is a major cause of morbidity and mortality worldwide. Neuropsychiatric disorders are often associated with stroke and, among them, depression is the most prevalent. Post-stroke Depression (PSD) is related to disability, failure in returning to work, impairment in interpersonal functioning and mortality. Its etiopathogenesis is still uncertain, as well as its treatment. In Brazil, there are few data on the impact of PSD. Objective This work is dedicated to conduct a comprehensive review of the concept of PSD, its pathophysiology, morbidity and treatment. Methods PubMed, Medline and Lilacs searches of relevant terms yielded 3,265 papers in the last 10 years. We selected original studies and reviews that addressed the aspects mentioned above. Results We present the history of the notion of PSD and describe its epidemiology, looking to highlight Brazilian studies. Diagnostic criteria and clinical presentation were detailed, with emphasis on cognitive aspects. The four main pathophysiological theories proposed to PSD are presented and we discuss the various treatment strategies, involving psychopharmacologic options, brain stimulation techniques and psychotherapy. Discussion This work provides comprehensive information on PSD, of great utility for clinical practice and research in this topic.
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Humanos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Depressão , Transtornos CerebrovascularesRESUMO
OBJECTIVES: The aim of this study is to investigate correlation between the location of white matter hyperintensities (WMH) and neurocognitive dysfunction in non-demented Korean vascular depression patients. METHODS: A total of 148 subjects diagnosed with first major depressive episode after the age of 60 were included in this study. Subjects were divided into the vascular depression group (n=83) and the non-vascular depression group (n=65) according to the degree of WMH. The degree and location of WMH on T2-weighted images were measured using the Scheltens scale. In addition, several clinical features, including cognitive functions and depression severities, were evaluated. Correlation analysis was performed for examination of the relationships between the location of WMH and neuropsychological functions. RESULTS: Capsular frontal periventricular hyperintensities showed correlation with poorer performance of the word list memory test, constructional recall test, and trail making test A and B. Lateral ventricular hyperintensities showed correlation with poorer performance of verbal fluency test, word list recognition test, and trail making test B. Deep WMH, especially parietal and occipital lesions, showed an association with poorer performance on trail making test B. In addition, deep WMH, but not periventricular WMH, showed an association with Hamilton Depression Scale score. CONCLUSION: Our results suggest that subjects with vascular depression showed significantly poorer performance on neurocognitive tests than those with non-vascular depression. In addition, WMH, depending on their locations, showed different correlations according to details of cognitive dysfunction and severity of depressive symptoms.
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Humanos , Depressão , Memória , Teste de Sequência AlfanuméricaRESUMO
INTRODUCTION: The geriatric depression (GD) represents one of the most frequent psychiatric disorders in outpatient services specialized in old-age treatment. OBJECTIVE: The course of two illustrative cases of GD is discussed, highlighting its clinical picture after antidepressant treatment and underlining variables related to disease prognosis, treatment effectiveness and conversion to major cognitive disorders such as vascular dementia (VD). METHODS: The cognitive performance, depressive symptoms, autonomy and brain structural measurements as white matter hyperintensities (WMH) and hippocampal size, and microstructural integrity of WM with diffusion tensor imaging were followed during four years. RESULTS: Case 1, with a severe degree of WMH, was associated with worsening cognition and increasing functional disability. Case 2, with mild WMH, an improvement of cognitive functioning could be seen. CONCLUSIONS: The existence of different subtypes of GD, as presented in this report, points a pathophysiological heterogeneity of GD, and suggests a possible continuum vascular depression (VaDp) and vascular cognitive impairment (VCI).
INTRODUÇÃO: A depressão geriátrica (DG) representa um dos mais frequentes transtornos psiquiátricos em ambulatórios especializados em idosos. OBJETIVO: Discutir a evolução da DG por meio de dois casos ilustrativos, destacando-se as variáveis relacionadas ao prognóstico da doença e à conversão para quadros cognitivos mais graves como demência vascular (DV). MÉTODOS: Os casos foram acompanhados por quatro anos com medidas do desempenho cognitivo, funcional, sintomas depressivos, juntamente com as alterações de estruturas cerebrais, como hiperintensidades da substância branca (HSB), dimensões hipocampais, e a integridade microestrutural da SB, por meio de imagens com tensor de difusão. RESULTADOS: Caso 1, com grave intensidade de HSB, evoluiu com piora cognitiva e funcional. Caso 2, com leve intensidade de HSB, evoluiu com melhora cognitiva após o tratamento da depressão. CONCLUSÕES: A existência de diferentes subtipos de DG, como apresentado neste relato, aponta para a heterogeneidade da fisiopatologia da DG, sugerindo um possível continuum entre depressão vascular (DpVa) e comprometimento cognitivo vascular (CCV).
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OBJECTIVES: This study was done in Korean elderly people in order to examine the relationship of white matter hyperintensity with clinical neuropsychological function and depression symptom severity. METHODS: A total of 148 subjects diagnosed first major depressive episode after age of 60 years were included. Brain magnetic resonance imaging scan was rated with the modified Fazekas White Matter Rating Scale by researcher blinded to clinical information. Cognitive function was evaluated with a comprehensive neurological battery and depression severity was assessed by Hamilton Depression Scale. Subjects were divided into vascular depression group and non vascular group according to the degree of white matter hyperintensity. Independent t-test was used to compare clinical difference between two groups and correlation analysis was used to identify whether white matter hyperintensity severity is correlated with neuropsychological function and depressive symptom. RESULTS: Vascular depression group was significantly poorer performance in verbal fluency, Boston naming test, Mini-Mental State Examination, trail making test B and stroop test (p<0.05). Furthermore, trail making test B and stroop test performance was correlated with white matter hyperintensity severity. However, Hamilton Depression Scale score was not significantly different between two groups. CONCLUSION: Several findings from our study suggest that white matter hyperintensity is associated with neuropsychological performance, especially executive function. Moreover, executive dysfunction might contribute to poor treatment outcome of vascular depression group.
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Idoso , Humanos , Boston , Encéfalo , Depressão , Função Executiva , Imageamento por Ressonância Magnética , Teste de Stroop , Teste de Sequência Alfanumérica , Resultado do TratamentoRESUMO
The 'vascular depression' hypothesis is supported by the high incidence of depression among patients with hypertension, diabetes mellitus, coronary artery disease or stroke, and the association of geriatric depression with silent stroke or white matter hyperintensity on neuroimaging scans. The vascular depression might be a valid new concept, making it worthwhile to be a new subtype of depression with different etiology, clinical manifestation, treatment method, and prognosis. Additionally, it can be suggested that the primary and secondary prevention of depression related with cerebrovascular disease can be possible by reducing the risk factors of cerebrovascular disease. The further study should be carried out to verify the diagnostic criteria of vascular depression and to develop pharmacotherapy for prevention and treatment. The more effort to understand and investigate vascular depression should be made in Korea where the cerebrovascular disease ranks first in cause of death and there may have been many untreated vascular depression patients.
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Humanos , Causas de Morte , Doença da Artéria Coronariana , Depressão , Diabetes Mellitus , Tratamento Farmacológico , Hipertensão , Incidência , Coreia (Geográfico) , Neuroimagem , Prognóstico , Fatores de Risco , Prevenção Secundária , Acidente Vascular CerebralRESUMO
Silent cerebral infarction (SCI) is often detected by magnetic resonance imaging (MRI) in patients with depression in late life. The late-life depression combined with SCI is known as MRI-defined vascular depression. Many studies have shown that this type of depression is likely to develop both psychiatric and neurological disorders in the course of time. Based on the previous findings, we made a 3-year follow-up study of patients with MRI-defined vascular depression in order to clarify risk factors that help develop complications such as delirium, dementia and parkinsonism. In this study, vascular risk factors (i.e., hypertension, diabetes mellitus etc.) were investigated retrospectively using clinical charts. Because of the small sample size, we could not find anything new about risk factors critical for either psychiatric or neurological disorders in patients with MRI-defined vascular depression. To demonstrate that preventing lifestyle-related diseases could reduce chances of having both psychiatric and neurological disorders, prospective studies are needed.
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This article reviews the recent literature of 'vascular depression' hypothesis. The 'vascular depression' hypothesis is supported by the evidence for associations between vascular disease and late-onset depression and between ischemic brain lesions and distinctive depressive symptoms. Patients with vascular depression is characterized by late-onset, absence of family history of mood disorders, evidence of vascular disease or vascular risk factors, cognitive impairment, psychomotor retardation, limited depressive ideation, poor insight, and disability. Vascular depression may be the entity suitable for studies of mechanism of depression. Depression in later life is often under-diagnosed and under-treated. Drugs used in the prevention and treatment of cerebrovascular disease may be shown to be beneficial influences for the prevention of vascular depression. Combined treatment with antidepressant and cognitive-behavioral rehabilitation will be more helpful. In the future, developments in structural and functional imaging, electrophysiology, chronobiology, and genetics will permit the knowledge of the association between mood disorders and brain lesions.
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Humanos , Encéfalo , Depressão , Eletrofisiologia , Genética , Transtornos do Humor , Transtornos Psicomotores , Reabilitação , Fatores de Risco , Doenças VascularesRESUMO
OBJECTIVES: The aims of this study were to identify the frequency and severity of white matter lesions on MRIs of late-life depression and deppression due to cerebrovascular diseases (vascular depression), to evaluate the relation with cerebrovascular risk factors, and finally to understand an important cause of late-life depression. DESIGN: The frequency and severity of the periventricular hyperintensity and the deep white matter hyperintensity were measured on the brain MRIs in the patients with major depression, vascular depression and neurotic controls over 50 yrs of age. The association of the white matter lesions with cerebrovascular risk factors were evaluated. MATERIALS AND METHODS: The MRI films of 32 patients (15 males & 17 females) with major depression over 50 yrs of age, 25 patients (17 males & 8 females) with vascular depression, and 25 neurotic controls (6 males & 19 females) were analyzed for the white matter lesions according to the modified Fazekas criteria. The cerebrovascular risk factors including hypertension, arteriosclerosis, obesity, smoking, diabetes mellitus, thyroid function abnoramlities, EKG abnormality, stroke, etc were also assessed. RESULTS: 1) The frequency of periventricular lesions or deep white matter lesions were significantly higher in patients with vascular depression and major depression than in neurotic controls. 2) The intracerebral hyperintensities or classical infarctions were prevalent in frontal cortex (32.0%) and in basal ganglia (40.0%). 3) Among cerebrovascular risk factors, stroke (p<0.005), hypertension (p<0.025), EKG abnormality (p<0.005) and smoking (p<0.05) were significantly prevalent in the patients with vascular depression and major depression as compared with neurotic controls. 4) The severity of white matter lesions were significantly associated with the cerebrovascular risk factors (p<0.005) in patients with major depression over 50 yrs of age. CONCLUSIONS: The white matter hyperintensities on brain MRIs of patients with major depression over 50 yrs of age were significantly associated with cerebrovascular risk factors, which suggested a vascular origin of pathogenesis of late-life depression.