HOME HELP FEEDBACK SUBSCRIPTIONS ALL ISSUES SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a Colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kales, H. C. Articles by Mellow, A. M. Search for Related Content PubMed PubMed Citation Articles by Kales, H. C. Articles by Mellow, A. M.

Cerebrovascular Disease and Late-Life Depression

Received March 24, 2004; revised June 1, June 6, 2004; accepted June 10, 2004. From the Section on Geriatric Psychiatry, University of Michigan, Ann Arbor, MI (HCK,AMM), the VA Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (HCK), the Geriatric Research Education and Clinical Center, Department of Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI (HCK), the Electroconvulsive Therapy Program and Treatment-Resistant Depression Clinic, University of Michigan, Ann Arbor, MI (DFM), and the Mental Health Service Line, Veterans Healthcare Network 11, Department of Veterans Affairs (AMM). Please send correspondence and reprint requests to Dr. Helen Kales, Psychiatry Service (116A), VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105. e-mail: kales{at}umich.edu
© 2005 American Association for Geriatric Psychiatry

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.

Key Words: Depression • Stroke • Executive Functioning • Physical Comorbidity • Neuropathology

This article has been cited by other articles:

				J. M. Lyness Depression and Comorbidity: Objects in the Mirror are More Complex Than They Appear Am J Geriatr Psychiatry, March 1, 2008; 16(3): 181 - 185. [Full Text] [PDF]

				D. C. Steffens, G. G. Potter, D. R. McQuoid, J. R. MacFall, M. E. Payne, J. R. Burke, B. L. Plassman, and K. A. Welsh-Bohmer Longitudinal Magnetic Resonance Imaging Vascular Changes, Apolipoprotein E Genotype, and Development of Dementia in the Neurocognitive Outcomes of Depression in the Elderly Study Am J Geriatr Psychiatry, October 1, 2007; 15(10): 839 - 849. [Abstract] [Full Text] [PDF]

				C. K. Holley and B. T. Mast The Effects of Widowhood and Vascular Risk Factors on Late-Life Depression Am J Geriatr Psychiatry, August 1, 2007; 15(8): 690 - 698. [Abstract] [Full Text] [PDF]

				D. G. Kondo, M. C. Speer, K. R. Krishnan, D. R. McQuoid, S. H. Slifer, C. F. Pieper, A. V. Billups, and D. C. Steffens Association of AGTR1 With 18-Month Treatment Outcome in Late-Life Depression Am J Geriatr Psychiatry, July 1, 2007; 15(7): 564 - 572. [Abstract] [Full Text] [PDF]

				J. L. Warner-Schmidt and R. S. Duman VEGF is an essential mediator of the neurogenic and behavioral actions of antidepressants PNAS, March 13, 2007; 104(11): 4647 - 4652. [Abstract] [Full Text] [PDF]

				J. M. Lyness, A. Niculescu, X. Tu, C. F. Reynolds III, and E. D. Caine The Relationship of Medical Comorbidity and Depression in Older, Primary Care Patients Psychosomatics, October 1, 2006; 47(5): 435 - 439. [Abstract] [Full Text] [PDF]

				W. Mlekusch, I. Mlekusch, E. Minar, M. Haumer, C. W. Kopp, R. Ahmadi, J. Lehrner, and M. Schillinger Is There Improvement of "Vascular Depression" after Carotid Artery Stent Placement? Radiology, August 1, 2006; 240(2): 508 - 514. [Abstract] [Full Text] [PDF]

				C. Holley, S. A. Murrell, and B. T. Mast Psychosocial and Vascular Risk Factors for Depression in the Elderly Am J Geriatr Psychiatry, January 1, 2006; 14(1): 84 - 90. [Abstract] [Full Text] [PDF]

				R. G. Robinson Vascular Depression and Poststroke Depression: Where Do We Go From Here? Am J Geriatr Psychiatry, February 1, 2005; 13(2): 85 - 87. [Full Text] [PDF]