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. 2017 Jun:215:103-110.
doi: 10.1016/j.jad.2017.03.027. Epub 2017 Mar 16.

Frontocingulate cerebral blood flow and cerebrovascular reactivity associated with antidepressant response in late-life depression

Margarita Abi Zeid Daou  1 , Brian D Boyd  1 , Manus J Donahue  2 , Kimberly Albert  1 , Warren D Taylor  3
Affiliations

Frontocingulate cerebral blood flow and cerebrovascular reactivity associated with antidepressant response in late-life depression

Margarita Abi Zeid Daou et al. J Affect Disord. 2017 Jun.

Abstract

Background: Vascular pathology is common in late-life depression (LLD) and may contribute to alterations in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). In turn, such hemodynamic deficits may adversely affect brain function and clinical course. The goal of this study was to examine whether altered cerebral hemodynamics in depressed elders predicted antidepressant response.

Methods: 21 depressed elders completed cranial 3T MRI, including a pseudo-continuous Arterial Spin Labeling (pcASL) acquisition on both room air and during a hypercapnia challenge. Participants then completed 12 weeks of open-label sertraline. Statistical analyses examined the relationship between regional normalized CBF and CVR values and change in Montgomery-Asberg Depression Rating Scale (MADRS) and tested for differences based on remission status.

Results: 10 participants remitted and 11 did not. After controlling for age and baseline MADRS, greater change in MADRS with treatment was associated with lower pre-treatment normalized CBF in the caudal anterior cingulate cortex (cACC) and lateral orbitofrontal cortex (OFC), as well as lower CVR with hypercapnia in the caudal medial frontal gyrus (cMFG). After controlling for age and baseline MADRS score, remitters exhibited lower CBF in the cACC and lower CVR in the cMFG.

Limitations: Our sample was small, did not include a placebo arm, and we examined only specific regions of interest.

Conclusions: Our findings suggest that increased perfusion of the OFC and the ACC is associated with a poor antidepressant response. They do not support that vascular pathology as measured by CBF and CVR negatively affects acute treatment outcomes.

Keywords: Aging; Depression; Geriatrics; MRI; Perfusion; Ssri.

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Figures

Fig. 1
Fig. 1
Example of CBF and CVR Images, Images from a representative subject displaying the T1-weighted image (left) with the corresponding normocapnia CBF image (center) and hypercapnia CBF image (right). Darker red colors indicate higher levels of CBF, while blue indicates low CBF. CBF scales between 0–60 ml/100g/min.
Fig. 2
Fig. 2
Relationship between cerebral blood flow on room air and change in depression severity, Figures show relationship between regional cerebral blood flow (x-axis) and change in depression severity by MADRS (calculated as baseline MADRS – final MADRS). Both figures demonstrate that individuals with the highest CBF in the lateral OFC and caudal ACC exhibited the least change in depression severity with sertraline treatment.
Fig. 3
Fig. 3
Relationship between cerebrovascular reactivity and change in depression severity, Figure shows the relationship between caudal middle frontal gyrus CVR (calculated as the difference in CBF between hypercapnic normoxia and medical air conditions, divided by CBF on medical air) and change in depression severity by MADRS (calculated as baseline MADRS – final MADRS). Individuals with the highest CVR exhibited the least change in depression severity with sertraline treatment.
See this image and copyright information in PMC

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