The “vascular depression” hypothesis postulates that cerebral ischaemic damage to frontal-subcortical circuits predisposes to and/or perpetuates depression in older people, but this concept has been criticized because community studies have failed to demonstrate a robust relationship between depression and vascular disease and because of the apparent inability to define the clinical entity of “vascular depression.” However, evidence clearly demonstrates that depression has a bidirectional relationship with vascular disease (Thomas et al., J Affect Disord 79(1–3):81–95, 2004) and that there is an increase in late-life depression in MRI WMH, which are ischaemic lesions. The explanation for the differences in these findings probably reflects the insensitivity of (peripherally measured) conventional VRFs for actual ischaemic disease in the brain and the differences in samples, with the MRI and pathology studies assessing major depression in secondary care patients while the community studies sample milder cases of depression and one’s which may have a different aetiology. More recent evidence supports a definition of “vascular depression” focusing on a subgroup defined by the burden of WMH and indicates such a subgroup is both robust and clinically important in that it appears to predict poor response to treatment, persistence of depressive symptoms and of neurocognitive impairments, and worse longer-term outcomes.
KeywordsDepression Late life Vascular Cerebrovascular disease MRI White matter hyperintensities
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