Location of Cerebrovascular and Degenerative Changes, Depressive Symptoms and Cognitive Functioning in Later Life: The SMART-Medea Study

J Neurol Neurosurg Psychiatry. 2011 Oct;82(10):1093-100. doi: 10.1136/jnnp.2010.232413. Epub 2011 Apr 1.


Objectives: Depression and cognitive impairment are highly prevalent in later life and frequently co-occur. Structural changes in critical brain regions may underlie both conditions. The authors examined associations of infarcts, white-matter lesions (WML) and atrophy at different locations with depressive symptoms and cognitive functioning.

Methods: Within the Second Manifestations of Arterial Disease-Memory, Depression and Aging (SMART-Medea) study, cross-sectional analyses were performed in 585 non-demented patients aged ≥50 years with symptomatic atherosclerotic disease. Volumetric measures of WML and atrophy were obtained with 1.5 T MRI; infarcts were rated visually. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (score ≥6). z Scores of executive functioning, memory and processing speed were calculated. Analyses were adjusted for age, sex, education, intelligence, vascular disease, physical functioning and co-occurring brain changes.

Results: Depressive symptoms were present in 102 (17%) patients and were associated with poorer memory (B=-0.26, 95% CI -0.47 to -0.06). Large subcortical infarcts and lacunar infarcts in deep white-matter tracts were both associated with depressive symptoms (RR=2.66, 95% CI 1.28 to 5.54; RR=2.02, 95% CI 1.14 to 3.59) and poorer executive functioning and memory. Periventricular WML volume was associated with poorer executive functioning; cortical infarcts in the left hemisphere and media flow region, ventricular volume and cortical atrophy were associated with a slower processing speed.

Conclusion: In this sample of non-demented older persons, subcortical infarcts contributed to an increased risk of depressive symptoms as well as cognitive impairment. This depended on location in projecting white-matter tracts, and not on infarct size.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Amnesia / diagnosis
  • Amnesia / epidemiology
  • Amnesia / physiopathology
  • Atrophy
  • Brain / pathology*
  • Cerebral Infarction / diagnosis*
  • Cerebral Infarction / epidemiology
  • Cerebral Infarction / physiopathology
  • Cognition Disorders / diagnosis*
  • Cognition Disorders / epidemiology
  • Cognition Disorders / physiopathology
  • Cohort Studies
  • Cross-Sectional Studies
  • Depressive Disorder / diagnosis*
  • Depressive Disorder / epidemiology
  • Depressive Disorder / physiopathology
  • Dominance, Cerebral / physiology
  • Executive Function / physiology
  • Female
  • Humans
  • Incidence
  • Intracranial Arteriosclerosis / diagnosis
  • Intracranial Arteriosclerosis / epidemiology
  • Intracranial Arteriosclerosis / physiopathology
  • Leukoencephalopathies / diagnosis*
  • Leukoencephalopathies / epidemiology
  • Leukoencephalopathies / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Netherlands
  • Neurodegenerative Diseases / diagnosis*
  • Neurodegenerative Diseases / epidemiology
  • Neurodegenerative Diseases / physiopathology
  • Neuropsychological Tests / statistics & numerical data
  • Psychometrics
  • Reaction Time / physiology
  • Statistics as Topic