Monday, 18 August 2003
This presentation is part of : Late-Life Mood Disorder: Significant Progress but Many Unanswered Questions

S013-001 Vascular Depression: A New Subtype of Geriatric Major Depression?

David Steffens, Duke University Medical Center, Durham, NC, USA

Depression with first onset in old age has been associated with vascular changes seen on neuroimaging, particular magnetic resonance imaging (MRI). The term “vascular depression” has been proposed as a diagnostic subtype of major depression occurring in the context of vascular disease. One area of active investigation is how the “vascular” component of vascular depression should be defined, i.e., should vascular disease be defined clinically or based on clear neuroimaging findings.

A clinical definition of vascular depression relies on several factors that suggest presence of cerebrovascular disease. These include presence of a focal neurological deficit evident from neurological examination or a documented neuropsychological impairment (e.g., executive dysfunction on cognitive testing). In addition, individuals should have a medical condition that represents a risk factor for cerebrovascular disease such as hypertension, insulin-dependent diabetes mellitus, or cardiovascular conditions like atrial fibrillation that increase stroke risk.

An imaging definition of vascular depression would require both a diagnosis of major depression and presence on cerebrovascular disease on MRI.

We have favored the latter approach. In this symposium, we will present data linking MRI-defined vascular depression to specific symptoms of depression and to vascular risk factors. These results are derived from a regression models comparing elderly depressive with and without MRI-defined vascular depression.

The implications for this approach for our diagnostic nomenclature and for patient management will be reviewed. A more precise diagnostic subtype, “subcortical ischemic vascular depression” will be proposed as a subtype for further study.

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