Introduction: Cerebrovascular diseases have been considered as one of the most frequent causes of depressive mood in the elderly. In 1997, Alexopoulos launched the term vascular depression as the depression caused by stroke. It has been reported that 20 to 65% of cerebral infarction patients have depression (Kurumatani, 2001). Silent stroke without neurological signs is common in depressive elderly population. Elderly patients with depression have white matter hyperintensity more frequent than non-depressive patients. In assymptomatic patients, the hyperintensity was associated with extra cranial carotid artery disease, reduced cerebral blood flow and a history of hypertension, diabetes and cardiac disease. According to CT/MRI findings, vascular depression can be divided into two subtypes: type I (macroangiophaty) is similar to post-stroke-depression, and type II is characterized by microangiopathy in which clinical presentation resembles the vascular depression from Alexopoulos (1997).
Objectives: The purpose of this study is to show the association between depression and silent stroke characterizing the vascular depression entity and the symptoms of its clinical presentation.
Material and Methods: 16 patients were selected from the Geriatrics Outpatient Department between July 1999 and August 2002 with depressive complaints.
Results: There were 9 male and 7 female with mean age of 78.6 years. Patients were set for medical assistance being brought by their relatives complaining of their depressive mood. Most frequent symptoms were: indisposition to activities (100%), fatigability with weakness in legs (100%), lost of energy (75%), apathy (62.5%), decline in concentration capacity (50%), memory impairment (31.25%), humor alteration (25%), crying (25%), and absence of insight (12.5%). The 16 patients had normal neurological exam and scored for mild-to-moderate in Geriatrics Depression Scale. All elderly had abrupt beginning of symptoms, risk factors for cardiovascular disease and no anterior history of depression. Signs of microangiopathy were found in MRI in all patients.
Conclusion: Our study agrees with the literature. There is a link between silent stroke and depression. We should think in vascular depression as diagnosis for patients with abrupt beginning of symptoms, late onset depression and cardiovascular risk factors even without neurological or clinical signs of stroke (Alexopoulos, 1997).
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