Background: Depression is a prevalent and disabling condition in older persons (≥60 years) that increases the risk of mortality and negatively influences quality

/pdf/depression-and-quality-of-life-in-older-persons-a-review-1ndnuv1p2t.pdf

Depression and Quality of Life in Older Persons: A Review

OBJECTIVE: Theories of human behavior from Plato to Freud have repeatedly emphasized links between emotion and reason, a relationship now commonly attributed to pathways connecting phylogenetically “old” and “new” brain regions. Expanding on this theory, this study examined functional interactions between specific limbic and neocortical regions accompanying normal and disease-associated shifts in negative mood state. METHOD: Regions of concordant functional change accompanying provocation of transient sadness in healthy volunteers and resolution of chronic dysphoric symptoms in depressed patients were examined with two positron emission tomography techniques: [15O]water and [18F]fluorodeoxyglucose, respectively. RESULTS: With sadness, increases in limbic-paralimbic blood flow (subgenual cingulate, anterior insula) and decreases in neocortical regions (right dorsolateral prefrontal, inferior parietal) were identified. With recovery from depression, the reverse pattern, involving the same regions, was seen—...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.156.5.675

Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness

• Objective. —This synthetic review was performed to demonstrate the utility of frontal-subcortical circuits in the explanation of a wide range of human behavioral disorders. Data Sources. —Reports of patients with degenerative disorders or focal lesions involving frontal lobe or linked subcortical structures were chosen from the English literature. Individual case reports and group investigations from peer-reviewed journals were evaluated. Study Selection. —Studies were included if they described patient behavior in detail or reported pertinent neuropsychological findings and had compelling evidence of a disorder affecting frontal-subcortical circuits. Data Extraction. —Information was used if the report from which it was taken met study selection criteria. Data Synthesis. —Five parallel segregated circuits link the frontal lobe and subcortical structures. Clinical syndromes observed with frontal lobe injury are recapitulated with lesions of subcortical member structures of the circuits. Each prefrontal circuit has a signature behavioral syndrome: executive function deficits occur with lesions of the dorsolateral prefrontal circuit, disinhibition with lesions of the orbitofrontal circuit, and apathy with injury to the anterior cingulate circuit. Depression, mania, and obsessivecompulsive disorder may also be mediated by frontalsubcortical circuits. Movement disorders identify involvement of the basal ganglia component of frontal-subcortical circuits. Conclusions. —Frontal-subcortical circuits mediate many aspects of human behavior.

Frontal-subcortical circuits and human behavior.

The functional neuroanatomy of emotion and affective style.

A working model of depression implicating failure of the coordinated interactions of a distributed network of limbic-cortical pathways is proposed. Resting state patterns of regional glucose metabolism in idiopathic depressed patients, changes in metabolism with antidepressant treatment, and blood flow changes with induced sadness in healthy subjects were used to test and refine this hypothesis. Dorsal neocortical decreases and ventral paralimbic increases characterize both healthy sadness and depressive illness; concurrent inhibition of overactive paralimbic regions and normalization of hypofunctioning dorsal cortical sites characterize disease remission. Normal functioning of the rostral anterior cingulate, with its direct connections to these dorsal and ventral areas, is postulated to be additionally required for the observed reciprocal compensatory changes, since pretreatment metabolism in this region uniquely predicts antidepressant treatment response. This model is offered as an adaptable framework to facilitate continued integration of clinical imaging findings with complementary neuroanatomical, neurochemical, and electrophysiological studies in the investigation of the pathogenesis of affective disorders.

https://neuro.psychiatryonline.org/doi/pdfplus/10.1176/jnp.9.3.471

Limbic-cortical dysregulation: a proposed model of depression.

In a selected group of right-handed patients with single stroke lesions of either the right (n=14) or left (n=22) hemisphere and no predisposing factors for psychiatric disorder, we found that the severity of depression was significantly increased in patients with left anterior lesions as opposed to any other lesion location. In addition, the severity of depression correlated significantly with proximity of the lesion on CT scan to the frontal pole in the left anterior group. The right hemisphere lesion group showed the reverse trend: patients with right posterior lesions were more depressed than patients with right anterior lesions, who were unduly cheerful and apathetic. These findings suggest that intrahemispheric lesion location is in some way related to mood disorder in stroke patients and that there is a graded effect of lesion location on severity of mood change. The neuroanatomy of the biogenic amine-containing pathways in the cerebral cortex might explain this graded effect and provide a neurochemical basis for the mood change.

Mood disorders in stroke patients: importance of location of lesion

Nortriptyline treatment of post-stroke depression: a double-blind study

Mood changes in stroke patients: Relationship to lesion location

Dexamethasone suppression tests (DSTs) were given to 65 acute and chronic stroke patients. For patients who had had a stroke less than 1 year earlier, nonsuppression on the DST was significantly associated with the presence of poststroke depression. The authors, who used the DSM-III symptom criteria for major depression, found that DST sensitivity was 67% but specificity was only 70%. False positive tests in the stroke patients seemed related to large lesion volume. The DST, although of limited clinical utility in this population because of false positive tests, may help define more homogeneous subtypes of poststroke depression for research.

The dexamethasone suppression test and mood following stroke.

Thirty left-handed patients hospitalized for stroke were examined for mood disorders. Patients with left hemisphere lesions and nondominant hand impairments had significantly higher depression scores and more depressive diagnoses than patients with right hemisphere lesions and dominant hand impairments. Major depression was strongly associated with left anterior brain injury, and depression severity was significantly correlated with proximity of the lesion on CAT scan to the left frontal pole. These findings are almost identical to previously reported results from right-handed patients and suggest that cerebral lateralization of poststroke mood disorders may be independent of cerebral motor dominance and language dominance.

Krishna Rao

Papers

Mood disorders in stroke patients: importance of location of lesion

Nortriptyline treatment of post-stroke depression: a double-blind study

Mood changes in stroke patients: Relationship to lesion location

The dexamethasone suppression test and mood following stroke.

Mood disorders in left-handed stroke patients.