Brain Advance Access originally published online on February 28, 2007
Brain 2007 130(7):1799-1807; doi:10.1093/brain/awm017
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Parkinson's disease-like midbrain sonography abnormalities are frequent in depressive disorders
Departments of 1Neurology and 2Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
Correspondence to: Dr Uwe Walter, Department of Neurology, University of Rostock, Gehlsheimer Strasse 20, D-18147 Rostock, Germany E-mail: uwe.walter{at}med.uni-rostock.de
Substantia nigra (SN) hyperechogenicity is a characteristic transcranial sonography (TCS) finding in idiopathic Parkinson's disease. SN hyperechogenicity, found also in 
10% of healthy adults, was related to a subclinical malfunction of the nigrostriatal dopaminergic system on PET studies and is, therefore, thought to represent a risk marker for Parkinson's disease. Epidemiological findings suggest an increased risk in subjects with depression. To find out whether frequency of SN hyperechogenicity is increased in depression, we performed TCS of brainstem and basal ganglia in 200 subjects: 55 controls without depression and without Parkinson's disease, 55 subjects with depression without Parkinson's disease (D+PD–), 45 Parkinson's disease patients without depression (D–PD+) and 45 Parkinson's disease patients with depression (D+PD+). Marked SN hyperechogenicity was found in 13% of controls, 40% of D+PD– (
2 test, P = 0.001), 69% of D–PD+ (vs D+PD–, P = 0.004) and 87% of D+PD+ patients (vs D–PD+, P = 0.04). Reduced echogenicity of brainstem raphe, thought to reflect alteration of the serotonergic system, was more frequent in depressed than in non-depressed subjects, irrespective of presence of Parkinson's disease, confirming earlier reports. The combined finding of marked SN hyperechogenicity and reduced raphe echogenicity in Parkinson's disease patients, however, was clearly associated with a history of depression prior to Parkinson's disease onset, whereas in D+PD– patients this combined TCS abnormality was related to motor asymmetry. In D+PD+ patients with depression prior to Parkinson's disease onset (n = 12), larger SN echogenic sizes correlated with younger age at Parkinson's disease onset (Spearman test, r = –0.607, P = 0.036). TCS findings of other basal ganglia did not differ between the groups studied. Data suggest that in subjects with depression nigrostriatal vulnerability is frequent, and that TCS might be useful to detect individuals at risk for developing Parkinson's disease.
Key Words: transcranial sonography; major depression; adjustment disorder with depressed mood; Parkinson's disease; substantia nigra
Abbreviations: SN, substantia nigra; TCS, transcranial sonography
Received September 28, 2006. Revised January 15, 2007. Accepted January 17, 2007.