RESUMO
BACKGROUND: Several studies suggest that patients with late-onset major depression (MD) have an increased load of cerebral white-matter lesions (WMLs) compared with age-matched controls. Vascular risk factors such as hypertension and smoking may confound such findings. Our aim was to investigate the association between the localization and load of WMLs in late-onset MD with respect to vascular risk factors. METHOD: We examined 22 consecutive patients with late-onset first-episode MD and 22 age- and gender-matched controls using whole-brain magnetic resonance imaging (MRI). The localization, number and volume of WMLs were compared between patients and controls, while testing the effect of vascular risk factors. RESULTS: Among subjects with one or more WMLs, patients displayed a significantly higher WML density in two white-matter tracts: the left superior longitudinal fasciculus and the right frontal projections of the corpus callosum. These tracts are part of circuitries essential for cognitive and emotional functions. Analyses revealed no significant difference in the total number and volume of WMLs between groups. Patients and controls showed no difference in vascular risk factors, except for smoking. Lesion load was highly correlated with smoking. CONCLUSIONS: Our results indicate that lesion localization rather than lesion load differs between patients with late-onset MD and controls. Increased lesion density in regions associated with cognitive and emotional functions may be crucial in late-onset MD, and vascular risk factors such as smoking may play an important role in the pathophysiology of late-onset MD, consistent with the vascular depression hypothesis.
Assuntos
Pressão Sanguínea/fisiologia , Encéfalo/patologia , Infarto Cerebral/diagnóstico , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/patologia , Processamento de Imagem Assistida por Computador , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Fibras Nervosas Mielinizadas/patologia , Fumar/efeitos adversos , Idoso , Antidepressivos/uso terapêutico , Infarto Cerebral/patologia , Corpo Caloso/patologia , Transtorno Depressivo Maior/tratamento farmacológico , Dominância Cerebral/fisiologia , Feminino , Lobo Frontal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Vias Neurais/patologia , Córtex Pré-Frontal/patologia , Valores de Referência , Fatores de Risco , Estatística como AssuntoRESUMO
An extended covariogram model is discussed for estimating the precision of circular systematic sampling. The extension is motivated by recent developments in shape analysis of featureless planar objects. Preliminary simulation results indicate that it is important to consider the extended covariogram model.
