Objective: To examine the impact of subcortical cerebrovascular disease diagnosed by MRI on psychiatric symptoms in subjects with or without cognitive impairment.
Design: Cross-sectional MRI study.
Materials and Methods: 503 elderly subjects (243 men and 260 women; mean age of 73 years, (SD=8.5), range 54-92 y.o.) were recruited to participate in the multi-center collaborative study of subcortical ischemic vascular disease (SIVD). They received a comprehensive neurobehavioral evaluation. All subjects were categorized as normal, cognitively impaired without dementia or with dementia according to the Clinical Dementia Rating score (CDR). Behavioral ratings were based upon clinician ratings using the Psychiatric Evaluation section of the Minimum Uniform Dataset (MUDS-PSY) of the California Alzheimer's Disease Centers Program. DSM-III-R criteria for Major Depression based on duration and severity, as follows: 0=not present, 1=questionable; 2=present but does not meet the DSM-III-R criteria; 3= present and meets the DSM-III-R criteria; or 9=not determined. All subjects underwent MRI and were classified as having or not having subcortical lacunar infarcts based on the standard quantitative procedures and diagnosis.
Results: 266 subjects had no cognitive impairment while 106 were classified as having cognitive impairment, and 131 subjects were diagnosed with dementia. 157 had lacunar infarctions, and 346 did not. Subjects with dementia had significantly more psychotic symptoms compared to subjects without dementia. Both cognitive impairment and lacunes were associated with a greater rate of affective symptoms, such as depression, anhedonia, loss of energy, and apathy.
Conclusion: Subcortical cerebrovascular disease, if present, is associated with affective spectrum symptoms, but not with symptoms of psychosis and agitation in patients with or without cognitive impairment.
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