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Depressive Symptoms in Hemodialysis Patients With Silent Cerebral Infarction

TO THE EDITOR: Several psychiatric studies have reported a relationship between depression and cerebrovascular diseases, including cerebral infarction.^1,2 Several studies have shown that silent cerebral infarction is frequently seen in elderly patients with depressive symptoms.³ However, to our knowledge, there has been no report on the relationship between depression and silent cerebral infarction in patients with end-stage renal disease who undergo hemodialysis. In this study, therefore, we examined depressive symptoms in hemodialysis patients with silent cerebral infarction.

The subjects were 36 patients who underwent hemodialysis therapy at a dialysis center in Nagoya, Japan. There were 23 men and 13 women with a mean age of 67.8 years (SD=9.0). All of the subjects were over 50 years of age. The average duration of hemodialysis therapy was 8.8 years (SD=7.6). The cause of renal failure in 10 patients was diabetic nephropathy and, in 26 patients, nondiabetic nephropathy, such as chronic glomerulonephritis.

After obtaining their informed consent, we administered the Hospital Anxiety and Depression Scale⁴ to all of the subjects in order to assess their anxiety and depressive symptoms. Magnetic resonance imaging (MRI) was also performed to check the presence or absence of silent cerebral infarction.

The prevalence of silent cerebral infarction was approximately 55.6% (20 of 36 patients), indicating that more than one-half of the patients receiving hemodialysis exhibited cerebral infarction. The patients with silent cerebral infarction (N=20) scored significantly higher on the Hospital Anxiety and Depression Scale for depressive symptoms than those without silent cerebral infarction (N=16) (mean=6.9, SD= 3.0, versus mean=4.2, SD=3.1) (F= 6.9, df=1, 34, p<0.02). On the other hand, there was no significant difference between the groups on anxiety scores on the Hospital Anxiety and Depression Scale. The patients' ages were significantly and positively correlated with scores for depressive symptoms on the Hospital Anxiety and Depression Scale but not with those for anxiety. The results of this study suggest that the severity of depressive symptoms in elderly hemodialysis patients is positively related to brain damage caused by silent cerebral infarction, although all of the depressive symptoms did not result from silent cerebral infarction. Therefore, MRIs seem to be extremely useful in hemodialysis medicine. The dialysis staff should pay close attention to the existence of silent cerebral infarction.

REFERENCES

1. Shimoda K, Robinson RG: The relationship between poststroke depression and lesion location in long-term follow-up. Biol Psychiatry 1999; 45:187-192[CrossRef][Medline]
2. Paradiso S, Robinson RG: Minor depression after stroke: an initial validation of the DSM-IV construct. Am J Geriatr Psychiatry 1999; 7:244-251[Abstract/Free Full Text]
3. Fujikawa T, Yamawaki S, Touhouda Y: Background factors and clinical symptoms of major depression with silent cerebral infarction. Stroke 1994; 25:798-801[Abstract]
4. Bjelland I, Dahl AA, Haug TT, Neckelmann D: The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 2002; 52:69-77[CrossRef][Medline]

Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Articles & Searches Download to citation manager Citing Articles via Google Scholar Articles by Fukunishi, I. Articles by Miyashita, Y. Search for Related Content PubMed Citation Articles by Fukunishi, I. Articles by Miyashita, Y. Syndromes Secondary to General Medical Disorders

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