Depression in late life remains common, despite the declining importance of aetiological factors such as genetics and personality. While psychosocial factors remain important, an accumulating body of evidence suggests cerebral organic factors may be important, particularly in “late-onset” depression. Subtle vascular disease may be important in this regard. There is known to be a strong and bidirectional link between vascular disease and depression: depression is associated with concurrent vascular disease, depression predicts subsequent development of cardiovascular and cerebrovascular disease and depression is associated with white matter changes on MRI which may have a vascular basis. The theoretical importance of fronto-striatal-thallamo loops in the regulation of mood suggests that disruption of such neuronal loops, due to vascular disease, may be an important factor in the aetiology and maintenance of late life depression – the “vascular depression” hypothesis. Such dysfunction may also explain enduring executive impairments which have been associated with depression.
The concept of Vascular Depression
The presence of white matter lesions on MRI is associated with a poor outcome and more recent studies from our group show quite widespread structural changes in elderly patients with depression, particularly in “late-onset” cases. Conversely, psychosocial factors such as life events were more common in early-onset cases. Using material from non-demented subjects in the Newcastle Brain bank (20 subjects with a history of DSM-IV depression and 20 controls) we are investigating neuropathological changes in depression. Results to date confirm our initial findings and indicate increased rates of atheromatous disease, increased inflammatory markers of ischaemia and an increase in ischaemic white matter lesions in dorsolateral prefrontal cortex. Such work strongly supports the view that vascular damage to fronto-striatal areas, particularly the dorsolateral prefrontal cortex, is associated with late life depression.
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