Key result
A combined lacune score in the thalamus, basal ganglia, and deep white matter was associated with an increased risk of poststroke depression, explaining 25% of the variability in its occurrence.
Why the study?
Does the cumulative burden of lacunes and microvascular lesions predict poststroke depression in stroke patients?
Observational (n=41)
Does the cumulative burden of lacunes and microvascular lesions predict poststroke depression in stroke patients?
Cumulative vascular burden from lacunar infarcts in specific brain regions is a stronger predictor of poststroke depression than single macroinfarcts.
May flag higher poststroke depression risk for monitoring; extends microvascular lesion data but remains hypothesis-generating.
BACKGROUND AND PURPOSE: Previous studies have postulated that poststroke depression (PSD) might be related to cumulative vascular brain pathology rather than to the location and severity of a single macroinfarct. We performed a detailed analysis of all types of microvascular lesions and lacunes in 41 prospectively documented and consecutively autopsied stroke cases. METHODS: Only cases with first-onset depression <2 years after stroke were considered as PSD in the present series. Diagnosis of depression was established prospectively using DSM-IV criteria for major depression. Neuropathological evaluation included bilateral semiquantitative assessment of microvascular ischemic pathology and lacunes; statistical analysis included Fisher exact test, Mann-Whitney U test, and regression models. RESULTS: Macroinfarct site was not related to the occurrence of PSD for any of the locations studied. Thalamic and basal ganglia lacunes occurred significantly more often in PSD cases. Higher lacune scores in basal ganglia, thalamus, and deep white matter were associated with an increased PSD risk. In contrast, microinfarct and diffuse or periventricular demyelination scores were not increased in PSD. The combined lacune score (thalamic plus basal ganglia plus deep white matter) explained 25% of the variability of PSD occurrence. CONCLUSIONS: The cumulative vascular burden resulting from chronic accumulation of lacunar infarcts within the thalamus, basal ganglia, and deep white matter may be more important than single infarcts in the prediction of PSD.
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Santos et al. (2009) conducted an observational in Stroke (n=41). Lacunes and microvascular lesions vs. Lower burden of lacunes and microvascular lesions was evaluated on Occurrence of poststroke depression (PSD). A combined lacune score in the thalamus, basal ganglia, and deep white matter was associated with an increased risk of poststroke depression, explaining 25% of the variability in its occurrence.
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