Purpose of the study: Several studies supported the idea that mood disorders in late life can be related to neurobiological abnormalities such as cerebrovascular disease. The vascular depression hypothesis describes a subtype of late onset depression that occurs as a consequence of cerebrovascular disease and that is characterized by the absence of a family history of affective disorders, lassitude, more retardation and less agitation, less guilt feelings, a greater lack of insight, more apathy and tendency to social isolation than elderly individuals with a history of recurrent major depression. In recurrent late life depression first episode occurs during adulthood; affected individuals have a high anxiety trait and variable patterns of circadian, sleep, energy and appetite disturbance. The possible link between the vascular burden and a first episode of depression in old age was supported by magnetic resonance imaging studies that reported an increased prevalence and severity of white matter lesions (WMLS) of vascular origin. Objectives: The aim of this study was to compare the neuropsychological and the cortical excitability pattern between vascular depressed patients (VD) and recurrent major depressed patients (MD) . Methods: Eleven recurrent MD patients without subcortical vascular disease (SVD) at MRI, eleven VD patients fulfilled the brain MRI criteria for SVD and eleven healthy controls were recruited from the Cerebrovascular Disease Center and from the Department of Psychiatry of the University of Catania (Italy). VD patients had a primary diagnosis of a current major depressive episode as assessed by the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and MD patients met the DSM-IV clinical criteria for Recurrent MD assessed by the SCID I. All patients were receiving antidepressant medication at the time of the study. Participants underwent an evaluation of neuropsychological battery including the Mini Mental State Examination (MMSE), the Clinical Dementia Rating Scale, the Frontal Assessment Battery, the Stroop Color Word Test interference, the Hamilton Depression Rating Scale 21-item (HAM-D) and also they underwent a bilateral study of resting motor threshold (rMT), intracortical inhibition (ICI) and facilitation (ICF). ICI and ICF were studied using the conditioning-test paradigm consisting of applying two magnetic stimuli in rapid succession through two a couple of magnetic stimulators connected to each other. The Interstimulus Intervals (ISIs) tested were 2, 3, 10 and 15 ms . Results: Results showed a reduced excitability of the left motor cortex as indexed by an higher rMT in MD patients and an enhancement of ICF at ISI of 15 ms in the right hemisphere of VD patients, probably related to a vascular damage of the frontal cortical–subcortical loops implicated in mood regulation and cognition. The asymmetry in cortical excitability, as indexed by the rMT, in MD patients is consistent with a global imbalance of both excitatory and inhibitory circuits. Conclusions: Our study provides that VD patients show distinctive neurophysiological profile of cortical excitability, supporting the ‘vascular depression hypothesis’ as a different syndrome also at the level of Transcranial Magnetic Stimulation.
|Titolo:||P.2.h.003 Transcranial magnetic stimulation in major depression and vascular depression|
CONCERTO, CARMEN (Primo) (Corresponding)
PENNISI, MANUELA (Penultimo)
AGUGLIA, Eugenio (Ultimo)
|Data di pubblicazione:||2013|
|Appare nelle tipologie:||1.5 Abstract in rivista|