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Location of cerebrovascular and degenerative changes, depressive symptoms and cognitive functioning in later life: the SMART-Medea study
  1. Anne M Grool1,
  2. Yolanda van der Graaf1,
  3. Willem P T M Mali2,
  4. Mirjam I Geerlings1
  5. on behalf of the SMART Study Group
  1. 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Dr M I Geerlings, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Stratenum 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands; m.geerlings{at}


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.

  • Atherosclerosis
  • MRI
  • atrophy
  • cerebral infarction
  • cognition
  • cerebrovascular disease
  • depression

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  • Funding This study was supported by a programme grant from The Netherlands Heart Foundation (NHF: project no 2007B027).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Medical Ethics Committee University Medical Center Utrecht, The Netherlands.

  • Provenance and peer review Not commissioned; externally peer reviewed.