Regional cerebral blood flow abnormalities in depressed patients with cognitive impairment.

Depression with cognitive impairment, so called depressive pseudodementia, is commonly mistaken for a neurodegenerative dementia. Using positron emission tomography (PET) derived measures of regional cerebral blood flow (rCBF) a cohort of 33 patients with major depression was studied. Ten patients displayed significant and reversible cognitive impairment. The patterns of rCBF of these patients were compared with a cohort of equally depressed non-cognitively impaired depressed patients. In the depressed cognitively impaired patients a profile of rCBF abnormalities was identified consisting of decreases in the left anterior medial prefrontal cortex and increases in the cerebellar vermis. These changes were additional to those seen in depression alone and are distinct from those described in neurodegenerative dementia. The cognitive impairment seen in a proportion of depressed patients would seem to be associated with dysfunction of neural systems distinct from those implicated in depression alone or the neurodegenerative dementias.

[1]  R. Mathew,et al.  CEREBRAL BLOOD FLOW IN DEPRESSION , 1980, The Lancet.

[2]  J. Mazziotta,et al.  Reduction of prefrontal cortex glucose metabolism common to three types of depression. , 1989, Archives of general psychiatry.

[3]  C. Marsden,et al.  Outcome of Investigation of Patients with Presenile Dementia , 1972, British medical journal.

[4]  Karl J. Friston,et al.  The Relationship between Global and Local Changes in PET Scans , 1990, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[5]  C. Gaine.  On the Effects of Dental Disease , 1886, British medical journal.

[6]  S. Lippmann,et al.  Cerebellar vermis dimensions on computerized tomographic scans of schizophrenic and bipolar patients. , 1982, The American journal of psychiatry.

[7]  Karl J. Friston,et al.  Comparing Functional (PET) Images: The Assessment of Significant Change , 1991, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[8]  R. Kendell.  The Stability of Psychiatric Diagnoses , 1974, British Journal of Psychiatry.

[9]  S. Bellur.  Alzheimer's Disease: Senile Dementia and Related Disorders , 1979 .

[10]  M. Gilardi,et al.  Physical performance of the latest generation of commercial positron scanner , 1988 .

[11]  B. Rockstroh,et al.  The cerebellum contributes to mental skills. , 1989 .

[12]  P. Rabins,et al.  Criteria for Diagnosing Reversible Dementia Caused by Depression: Validation by 2-year Follow-up , 1984, British Journal of Psychiatry.

[13]  J. Decety,et al.  The cerebellum participates in mental activity: tomographic measurements of regional cerebral blood flow , 1990, Brain Research.

[14]  M. Reding,et al.  Depression in patients referred to a dementia clinic. A three-year prospective study. , 1985, Archives of neurology.

[15]  A. L. Leiner,et al.  Does the cerebellum contribute to mental skills? , 1986, Behavioral neuroscience.

[16]  R. Heath,et al.  Ascending projections of the cerebellar fastigial nucleus to the hippocampus, amygdala, and other temporal lobe sites: evoked potential and histological studies in monkeys and cats. , 1974, Experimental neurology.

[17]  J. Trojanowski,et al.  Prefrontal granular cortex of the rhesus monkey. II. Interhemispheric cortical afferents , 1977, Brain Research.

[18]  J. Endicott,et al.  A diagnostic interview: the schedule for affective disorders and schizophrenia. , 1978, Archives of general psychiatry.

[19]  L. DeLisi,et al.  Glucose utilization in the temporal cortex of affectively ill patients: Positron emission tomography , 1987, Biological Psychiatry.

[20]  R. S. J. Frackowiak,et al.  REGIONAL CEREBRAL OXYGEN SUPPLY AND UTILIZATION IN DEMENTIAA CLINICAL AND PHYSIOLOGICAL STUDY WITH OXYGEN-15 AND POSITRON TOMOGRAPHY A CLINICAL AND PHYSIOLOGICAL STUDY WITH OXYGEN - 15 AND POSITRON TOMOHRAPHY , 1981 .

[21]  John Q. Trojanowski,et al.  Prefrontal granular cortex of the rhesus monkey. I. Intrahemispheric cortical afferents , 1977, Brain Research.

[22]  Nonmotor functions of the cerebellum. , 1978, Psychological bulletin.

[23]  F. Huppert,et al.  CAMDEX: A Standardised Instrument for the Diagnosis of Mental Disorder in the Elderly with Special Reference to the Early Detection of Dementia , 1986, British Journal of Psychiatry.

[24]  M. Reivich,et al.  Brain function in psychiatric disorders. II. Regional cerebral blood flow in medicated unipolar depressives. , 1984, Archives of general psychiatry.

[25]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[26]  P T Fox,et al.  Neuroanatomical correlates of a lactate-induced anxiety attack. , 1989, Archives of general psychiatry.

[27]  R. Frackowiak,et al.  Quantitative Measurement of Regional Cerebral Blood Flow and Oxygen Metabolism in Man Using 15O and Positron Emission Tomography: Theory, Procedure, and Normal Values , 1980, Journal of computer assisted tomography.

[28]  M. D. O'Brien,et al.  Cerebral blood flow in dementia , 1986, Neurology.

[29]  E. Courchesne,et al.  Hypoplasia of cerebellar vermal lobules VI and VII in autism. , 1988, The New England journal of medicine.

[30]  Regional cerebral metabolic activity in chronic schizophrenia , 1990, Schizophrenia Research.

[31]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[32]  M. Ron,et al.  Diagnostic Accuracy in Presenile Dementia , 1979, British Journal of Psychiatry.

[33]  B. Rockstroh,et al.  The cerebellum contributes to mental skills , 1989 .

[34]  R A Koeppe,et al.  Cerebellar and frontal hypometabolism in alcoholic cerebellar degeneration studied with positron emission tomography , 1990, Annals of neurology.

[35]  T Jones,et al.  Regional cerebral oxygen supply and utilization in dementia. A clinical and physiological study with oxygen-15 and positron tomography. , 1981, Brain : a journal of neurology.

[36]  R. Butler,et al.  Focal changes in cerebral blood flow produced by monetary incentive during a mental mathematics task in normal and depressed subjects , 1984, Brain and Cognition.

[37]  J. Talairach,et al.  Co-Planar Stereotaxic Atlas of the Human Brain: 3-Dimensional Proportional System: An Approach to Cerebral Imaging , 1988 .

[38]  J R Moeller,et al.  Regional cerebral blood flow in mood disorders. I. Comparison of major depressives and normal controls at rest. , 1990, Archives of general psychiatry.

[39]  J. J. Fleminger,et al.  PRESENILE DEMENTIA: THE DIFFICULTIES OF EARLY DIAGNOSIS , 1975, Acta psychiatrica Scandinavica.