Non-vascular Depression Research Articles

5 Vascular Depression in Older Black Adults: White Matter Hyperintensities, Cognition, and Gait Speed

Objective:brain white matter integrity as a result of vascular burden is associated with a form of late-life depression, known as vascular depression (VaDep). Black older adults may be particularly vulnerable to developing VaDep due to a higher prevalence of vascular conditions compared to White older adults. The current study examined whether clinical and imaging markers of vascular burden predicted depressive symptoms in an older Black sample. Based on the literature in primarily White samples, we expected greater clinical vascular burden and white matter hyperintensity (WMH) volume to predict greater depressive symptoms both cross-sectionally and over 4-year follow-up. We additionally hypothesized that participants with operationally-defined VaDep would have worse cognitive performance and slower gait speed compared to those without VaDep. Exploratory analyses examined race (Black vs. White) as an additional predictor.Participants and Methods:This study used publicly available data from 113 Black older adults who were followed for four years in the Healthy Brain Project (a substudy of the Health, Aging, and Body Composition Study). Clinical vascular burden was defined as the number of vascular conditions (e.g., hypertension, diabetes, stroke); total WMH volume and WMH volume in the uncinate fasciculus, superior longitudinal fasciculus, and cingulum were considered imaging markers of vascular burden. Clinical and imaging-defined vascular burden were used to predict baseline depressive symptoms and average depressive symptoms over follow-up as measured by the Center for Epidemiologic Studies Depression Scale (CES-D). We then formed groups based on cutoffs for vascular burden (two or more conditions) and depressive symptoms (upper tertile of CES-D scores) to compare cognitive (Digit Symbol Substitution Test and 15-Item Executive Interview) and gait speed performance at baseline and changes over four years in VaDep, non-vascular depression, vascular only, and healthy groups. Exploratory analyses included 179 White older adults from the Healthy Brain Project dataset to examine race differences.Results:Total WMH volume and WMH volume in the uncinate fasciculus predicted higher depressive symptoms both cross-sectionally and longitudinally. However, no similar pattern emerged when using clinically-defined vascular burden as the predictor. The VaDep group had the slowest processing speed but the trajectory of decline over time did not differ between groups. The non-vascular depression group’s executive performance improved over time while performance by the other groups remained stable. Both VaDep and non-vascular depression groups’ gait speed declined over time. There was a stronger association between depression and uncinate fasciculus WMH in Black compared to White individuals, and the Black VaDep group had the slowest baseline processing speed of all groups.Conclusions:This research supports the validity of the VaDep framework in Black older adults by showing the impact of WMH, particularly in the uncinate fasciculus, on depressive symptoms and identifying cognitive risks associated with VaDep in this population. Moreover, results suggest WMH may confer a greater risk for depression in Black compared to White older adults, and that VaDep disproportionately impacts processing speed in Black older adults. This work addresses an important gap in the VaDep literature by examining a group that has historically been underserved.

Investigation and Analysis of Sleep Status in Patients with Vascular Depression

Summary Background To investigate the sleep status of patients with vascular depression (VD) and analyze the characteristics of sleep by polysomnogram. Methods 50 VD patients, 30 patients with non-vascular depression (NVD) and 50 normal subjects were enrolled. All subjects were evaluated by the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Scale (HAM-A), Pittsburgh Sleep Quality Index (PSQI) and Epworth sleepiness scale (ESS). All these patients were monitored by polysomnography (PSG). Results The PSQI scores of the VD patients didn't show difference compared with that of NVD, but both of them were significantly higher than the normal. The ESS scores of VD patients were significantly higher than other groups. The total sleep time (TST), sleep efficiency (SE) and sleep maintenance (SMT) in NVD patients and VD patients were poorer, and the waking time after sleep onset (WASO) and sleep latency (SL) were significantly longer. The N1/N2 ratio was longer, and the N3/REM ratio was shorter in NVD patients and VD patients. The HAMD score was negatively correlated with RL and positively with RD, RA and RI. The RL of VD patients was longer than the normal, and RD and RI were higher in VD patients, there was no difference in RA. The obstructivity and apnea-hypopnea index (AHI) significantly increased in VD patients. Conclusion The characteristic PSG findings of the NVD patients were shortening REM sleep latency and REM disinhibition. Characteristics of VD with PSG patients were sleep-related breathing disorders (SRBD) and daytime sleepiness, and disorders of 24-h sleep structure.

Vascular depression: overrepresented among African Americans?

Our primary aim was to compare the rate of vascular depression among a clinical sample of African American and Caucasian depressed older adults. Secondary aims included characterizing the clinical and neuropsychological profile of vascular depression and comparing antidepressant response rates between patients with vascular and nonvascular depression. This was a two-site, multi-ethnic, open 8-week trial of antidepressant medication in older adults with depression. Men and women 50 years or older meeting DSM-IV criteria for nonpsychotic unipolar depression participated in this trial. Each participant underwent a comprehensive psychiatric and neuropsychological evaluation and a brain MRI, which were performed at baseline. Forty-six patients met inclusion and exclusion criteria. Forty-two of those patients received an MRI at baseline. Sixteen patients met criteria for vascular depression. Patients with vascular depression were significantly more likely to be African American and have a higher likelihood of being female, a higher rate of hypertension and psychomotor retardation, a lower rate of family history of affective illness, and frontal systems dysfunction on neuropsychological testing. The difference in response rates between patients with vascular and nonvascular depression did not reach statistical significance. This is the first study to document high rates of vascular depression in a clinical sample of African Americans and Caucasians. Our findings suggest that vascular depression may be overrepresented among African Americans, which is consistent with the high rates of cardiovascular disease, hypertension, and stroke in this population.

2649 – White matter hyperintensities are an independent predictor of future depressive disorders: 3-year results from epidemiological study of vascular depression in korean elderly

The purposes of this study were to estimate the prevalence rates of subtypes of late life depression (LLD) including (vascular depression and non-vascular depression) in the baseline study, to examine the natural course of LLD and to investigate influence of white matter hyperintensities (WMH) volume on depression and neurocognitive function in the 3-year follow-up study. WMH was rated by the modified Fazekas scale and the volume of WMH was also calculated by an automated quantification method. Patients were classified as having vascular depression if they suffered from any type of depressive disorders and had a score of 2 or more on either deep white matter hyperintensity or subcortical gray matter ratings. In the 3- year follow-up study, the participants of the in the baseline were follow-uped with the same methodology of the baseline study. The prevalence rates of vascular major depressive disorder (MDD) and vascular non-major depressive disorder (nMDD) were 2.39% (53.6% of MDD) and 4.24% (34.0% of nMDD), respectively, in the baseline study. Among non-depressive group in the baseline study, subjects with WMH(+) had 13.5 times (OR=13.5, 95% CI=1.10-165.97) risk of developing depressive disorder in the 3-year follow-up study, as compared to those without WMH(+). Log WMH volume (OR=5.78, 95 CI=1.04-31.72) in the baseline study was an independent predictor for depressive disorder in the 3-year follow-up study WMH is a crucial predictor for future depressive disorder, which supports the previous vascular depression hypothesis. Vascular depression is a useful construct accounting for clinical characteristics of LLD.

A Correlation Analysis between the Location of White Matter Hyperintensities and Cognitive Functions in Korean Vascular Depression Patients

MethodsZZA total of 148 subjects diagnosed with first major depressive episode after the age of 60 were included in this study. Subjects were divided into the vascular depression group (n=83) and the non-vascular depression group (n=65) according to the degree of WMH. The degree and location of WMH on T2-weighted images were measured using the Scheltens scale. In addition, several clinical features, including cognitive functions and depression severities, were evaluated. Correlation analysis was performed for examination of the relationships between the location of WMH and neuropsychological functions.

Vascular depression: where do we go from here?

Vascular depression has been the topic of many studies since its revival at the end of the last century. Several important conclusions can be drawn from this research. First, from a conceptual point of view, it is a potentially valuable eiotological based new entity. Second, vascular depression encompasses not only depression with small vessel disease of the brain, but also poststroke depression, and depression related to myocardial infarction should be placed in this same category of vascular depression. Third, the treatment outcome and natural course of vascular depression have been much worse than that of the nonvascular depression. Fourth, more research on vascular depression is needed, especially on interventions. Poststroke antidepressant and psychoeducation therapy and vascular preventive interventions can probably improve outcome.

Cerebrovascular Disease and Late-Life Depression

Depression may occur as a result of vascular disease in a significant subpopulation of elderly persons. Indirect support for vascular disease as an underlying etiology of late-life depression includes the high rate of depression in patients with vascular disease, the frequency of silent stroke and white-matter hyperintensities in late-life depression, and the lower frequency of positive family histories of depression in such patients. The authors evaluate the associations of late-life depression with cerebrovascular disease by reviewing the existing pathophysiological, prognosis, and treatment-outcomes studies. Findings are based on review of the current literature systematically searched in electronic databases. Review of such studies indicates a high frequency of depression in older patients with cardiovascular and cerebrovascular diseases, and the possibility of a bidirectional relationship between depression and vascular disease. Studies examining patients with vascular depression have found that such patients have different symptom profiles, greater disability, and higher risk for poorer outcomes than those with nonvascular depression. Since the vascular depression hypothesis was proposed as a conceptual framework, evidence has accumulated that patients with vascular depression may have poorer outcomes that may be related in part to executive dysfunction and consequent disability. However, the association of vascular risk factors with geriatric depression has not been consistent in the studies to-date. Although an association between a subset of late-life depression and vascular disease is clear, significant gaps remain in our understanding. Further research is needed to establish the precise linkages and interactions between vascular disease and geriatric depression.

Cerebrovascular Disease and Late-Life Depression

Depression may occur as a result of vascular disease in a significant subpopulation of elderly persons. Indirect support for vascular disease as an underlying etiology of late-life depression includes the high rate of depression in patients with vascular disease, the frequency of "silent stroke" and white-matter hyperintensities in late-life depression, and the lower frequency of positive family histories of depression in such patients. The authors evaluate the associations of late-life depression with cerebrovascular disease by reviewing the existing pathophysiological, prognosis, and treatment-outcomes studies. Findings are based on review of the current literature systematically searched in electronic databases. Review of such studies indicates a high frequency of depression in older patients with cardiovascular and cerebrovascular diseases, and the possibility of a bidirectional relationship between depression and vascular disease. Studies examining patients with vascular depression have found that such patients have different symptom profiles, greater disability, and higher risk for poorer outcomes than those with nonvascular depression. Since the vascular depression hypothesis was proposed as a conceptual framework, evidence has accumulated that patients with vascular depression may have poorer outcomes that may be related in part to executive dysfunction and consequent disability. However, the association of vascular risk factors with geriatric depression has not been consistent in the studies to-date. Although an association between a subset of late-life depression and vascular disease is clear, significant gaps remain in our understanding. Further research is needed to establish the precise linkages and interactions between vascular disease and geriatric depression.

Regional cerebral blood flow in vascular depression assessed by 123I-IMP SPECT.

As the prevalence of white matter hyperintensities detected on T2 weighted MRI scans in patients with late-onset depression is higher than that in nondepressed patients, the concept of"vascular depression" (VDep) was introduced in 1997. However, the pathology of vascular depression has not been clarified. This study examined the differences in functional imaging between vascular and non-vascular depression (non-VDep). We utilized (123)I-IMP single photon emission computed tomography (SPECT) to compare regional cerebral blood flows (rCBF) between 9 patients with VDep (Krishnan criteria) and 11 age- and sex-matched patients with non-VDep in both depressed and remitted states. In both VDep and non-VDep patients, mean rCBF increased significantly as depression improved, partially aided by changes in left anterior temporal blood flow. In addition, compared to non-VDep patients, the left anterior frontal rCBF for VDep patients was significantly lower in both depressed and remitted states. Left anterior temporal rCBF therefore appears to represent a state marker that increases as symptoms associated with late-onset depression improve, regardless of vascular changes. Furthermore, in VDep patients, left anterior frontal rCBF was low in both states compared to non-VDep patients, and might not only represent a trait marker, but also correlated with the duration of disease and likelihood of recurrence and relapse.

Changes in regional cerebral blood flow on recovery from depression—comparison of vascular depression and non-vascular depression

Cerebrovascular or vascular change is frequent in elderly patients with depression. The concept of vascular depression (VD) has been a topic of interest in neuropsychiatry. During the last decade, functional neuroimaging studies have reported that recovery from depression was associated with increased regional cerebral blood flow (rCBF) in specific regions. However, the majority of studies have been confined to depression without cerebrovascular changes. Therefore, this study was undertaken to examine changes in rCBF on recovery from vascular depression. We measured rCBF in nine patients with ‘vascular depression’ and 11 patients with ‘non-vascular depression’ using 123I-IMP single photon emission computed tomography (SPECT) during illness and after recovery. The results showed that VD has significantly lower mean rCBF than non-VD during both depressed and remitted state, localized to the left anterior frontal region. This suggested that persisting left frontal hypoperfusion may lead to longer duration or higher frequency of relapse. Both VD and non-VD showed significantly higher mean rCBF in remitted state than in depressed state, especially left anterior temporal rCBF correlated with recovery from depression. This suggested that left temporal activity might be a state or episode-dependent marker for both VD and non-VD

Six-month outcomes for MRI-related vascular depression.

The purpose of this paper is to estimate the relative probabilities of 6-month recovery from an index episode of major depression for subjects with and without MRI-confirmed vascular brain changes. In this cohort study, 57 depressed subjects from the Duke University Mental Health Clinical Research Center (MHCRC) for Depression in Late Life who presented with MRI-related vascular and non-vascular depression were followed for 6 months, and the rates of recovery in the two risk groups were compared. Overall, the recovery rate in this sample was 57.9%. Subjects with MRI-related vascular depression demonstrated outcomes similar to subjects with non-vascular depression (crude RR = 0.67 [0.32, 1.43]). There was a trend that demonstrated that MRI-related vascular depression placed elderly subjects and subjects with first onset of depression after age 40 at increased risk of non-recovery. The study demonstrates overall no significant difference in course between patients with and without vascular depression. It also suggests that patients with vascular depression may have a different course depending on their age and age of onset of the disease.

Clinically defined vascular depression.

The authors' goal was to examine the clinical presentation of a group of depressed elderly patients with clinically defined risk factors for vascular depression compared with a group of elderly depressed patients without such risk factors. Cognitive deficits, disability, and depressive symptoms were examined in 33 consecutively recruited elderly patients defined as having vascular depression and 32 patients defined as having nonvascular depression according to their scores on the Cumulative Illness Rating Scale-Geriatrics. The patients with vascular depression had greater overall cognitive impairment and disability than those with nonvascular depression. Fluency and naming were more impaired in patients with vascular depression, and they had more retardation and less agitation as well as less guilt feelings and greater lack of insight. The symptoms of vascular depression are consistent with lesions that may damage striato-pallido-thalamo-cortical pathways and other areas. The concept of vascular depression can provide the impetus for investigations of prevention and treatment of cerebrovascular disease and for studies of the course of vascular depression and selection of antidepressants.