Neuroimaging investigation Vascular Depression

越来越多的证据表明，脑血管疾病与老年抑郁症之间存在关联。“血管性抑郁症”一词被用来描述发生在生命后期的一种抑郁症，其特征是大脑的变化可能与抑郁症的发作有关。脑血管改变的存在可能影响老年人群抑郁症的病程。关于脑血管改变对老年抑郁症治疗效果的影响已有大量文献报道。然而，很少有研究涉及脑血管改变的存在与老年抑郁症的长期预后之间的关系。1)老年脑卒中后脑血管改变部位与抑郁症状临床特征的关系。2)脑血管改变对老年抑郁症患者10年左右抑郁症状病程、痴呆率和死亡率的影响；3)老年抑郁症患者的脑功能及其与抑郁发作次数的关系；4)老年卒中后抑郁情绪和兴趣丧失对身体功能恢复的影响。结果1)情感性抑郁的严重程度（SDS评分）与左额叶（基底节区）损伤相关，而非基底节区；麻木性抑郁的严重程度（AS评分）与双侧基底节区（额叶）损伤相关。2)长期随访无症状性脑梗死与抑郁症预后不良相关。3)与单次抑郁发作的患者和对照组相比，多次抑郁发作的患者前扣带皮层的激活明显减弱，4)。老年中风患者出现抑郁情绪和丧失兴趣会降低身体功能的恢复

Growing evidence has been reported an association between cerebrovascular disease and geriatric depression. The term "vascular depression" has been used to describe a subtype of depression occurring later in, life and characterized by the brain changes that may be related depression onset.The presence of cerebrovascular change may affect the course of depression in geriatric population. There is lots of literature about the effects of cerebrovascular change on treatment response in geriatric depression. However, few studies addressed the relationship between the presence of cerebrovascular change and long term prognosis of geriatric depression.We have investigated1) Relationship between location of cerebrovascular change and clinical features of the depressive symptoms in elderly patients after stroke. 2) The effects of cerebrovascular change on the course of depressive symptoms, rate of dementia and mortality approximately 10 years in geriatric depression, 3) Cerebral brain function in depressed elderly and the relationship between this brain function and the number of depressive episodes using functional magnetic resonance imaging, 4) the effects of depressive mood and loss of interest on physical functional recovery in elderly patients after stroke.Result1) The severity of affective depression (SDS score) was associated with left frontal lobe (but not basal ganglia) damage, and that of apathetic depression (AS score) was related to damage to the bilateral basal ganglia (but not to the frontal lobe). 2) The presence of silent cerebral infarction was associated with poor prognosis of depression in long term follow up. 3) Activation in the anterior cingulate cortex was significantly attenuated in patients who had experienced multiple depressive episodes, compared with patients with single depressive episode and control group, 4). The presence of depressive mood and loss of interest decreased physical functional recovery in elderly patients after stroke