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(Stroke. 2009;40:3557.)
© 2009 American Heart Association, Inc.

Original Contributions

Differential Impact of Lacunes and Microvascular Lesions on Poststroke Depression

Micaela Santos, MD; Gabriel Gold, MD; Enikö Kövari, MD; Francois R. Herrmann, MD, MPH; Vasilis P. Bozikas, MD; Constantin Bouras, MD Panteleimon Giannakopoulos, MD

From Department of Psychiatry (M.S., E.K., C.B., P.G.), Department of Geriatrics (G.G., F.R.H.), University Hospitals and Faculty of Medicine of Geneva, Belle-Idée, Geneva, Switzerland; 1st Department of Psychiatry (V.B.), Aristotle University of Thessaloniki, Thessaloniki, Greece; Service of Old Age Psychiatry (P.G.), Department of Psychiatry, Hospices-CHUV, University of Lausanne School of Medicine, Lausanne, Switzerland.

Correspondence to Panteleimon Giannakopoulos, Division of Geriatric Psychiatry, 2 chemin du Petit-Bel-Air, CH-1225 Chêne-Bourg, Switzerland. E-mail Panteleimon.Giannakopoulos{at}hcuge.ch

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.

Key Words: behavioral neurology • brain ischemia • cerebral infarct • neuropathology