ИСТИНА

Introduction Both alexithymia and depression are known to be associated with cardiovascular mortality, hypertension, and atherosclerosis. We hypothesized that these factors might also contribute to the cerebral small vessel disease (SVD)—age-related progressive vascular brain damage representing a major cause of cognitive impairment in elderly people. Since both alexithymia and depression can be corrected psychotherapeutically, evaluation of their role in SVD may open the road for psychotherapeutic prophylaxis of cognitive decline. Method We enrolled 193 adults aged 56±8 years with no history of cardiovascular events. Participants underwent brain MRI to define the presence or absence of SVD, were assessed for hypertension both anamnestically and with the use of 24h blood pressure monitoring, filled the Toronto alexithymia scale (TAS-20) and Beck Depression Inventory (BDI). Structural equational modelling (SEM) was used to explore the role of age, TAS-20 and BDI (observed exogenous variables) in hypertension and SVD (observed endogenous variables; presence or absence). Next, we performed single-item analysis for TAS-20 and BDI to explore the aspects of alexithymia and depressive attitude that contribute to the latent variable. The revelated item were classified with the use of hyperradical clustering and the relation between the resulting clusters were modelled with the use of SEM. Results The data of the relation of age, TAS-20 and BDI with SVD and hypertension were best explained by a model with latent variable mediating the relationship between observed exogenous and endogenous variables (perfect fit with chi-square=0.93, CFI=1.0, TLI=1.0, SRMSA=.015). We revealed 9 items from TAS-20 and 6 items from BDI that correlated with the latent variable. Hyperradical clustering of these items revealed four clusters that were interpreted and named the following way: “limited emotional and interoceptive insight”, “negative self-thoughts”, “low energy”, “difficulties communicating emotion”. SEM performed for these four phenomena allowed us to construct a model with limited insight and negative self-thoughts as co-dependent causes and low energy and difficulties communicating emotion as independent consequences, which perfectly explained the data (chi-square=0.0, CFI=1.0, TLI=1.0, SRMSA<.001). Discussion Our results indicate presence of a common dysfunction underlying psychosomatic mechanisms of hypertension and SVD. This disfunction is related to specific interrelated aspects of alexithymia and depressive attitude: limited emotional and interoceptive insight, negative self-thoughts, low energy, difficulties communicating emotion. Conclusion Our study for the first time demonstrates that emotional factors serve as risk factors for cerebral SVD. We proposed a model that can serve as a basis for developing of cognitive-behavioural intervention for prophylaxis of age-related cognitive decline.