Cerebrovascular disease basis of depression: Post-stroke depression and vascular depression

Department of Psychiatry, The Johns Hopkins Hospital, Baltimore, USA.
International Review of Psychiatry (Impact Factor: 1.8). 11/2006; 18(5):433-41. DOI: 10.1080/09540260600935447
Source: PubMed


The close association between cerebrovascular disease and depression has been known for more than a century, yet much of the progress in understanding the cerebrovascular basis of depression in late life has been spurred by development of two concepts: 'post-stroke depression' and 'vascular depression'. The purpose of this review is to examine the epidemiology, diagnostic features, course, pathophysiology and prognosis of post-stroke depression and vascular depression, to highlight their common features, and to contrast the distinct aspects of these two subtypes of geriatric depression.

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    • "Vascular depression was originally hypothesized to be chronic and persisting. Compared to vascular depression, the course of PSD seems even more complex and dependent on timing of onset [2]. The role of vascular risk factors in the etiology of PSD and vascular depression is less obvious than it appears. "
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    ABSTRACT: Most previous studies reported a close link between fresh infarcts and post-stroke depression. However, studies on the relation of depression and silent lacunar infarction (SLI) are limited. This study aims to analyze the effects of SLI and the vascular risk factors on depression. A total of 243 patients with SLI were divided into depression and non-depression groups. The presence and location of SLI were evaluated with magnetic resonance imaging. Depression was assessed with the Patient Health Questionnaire-9 and vascular risks factors were collected. We used t tests and χ 2 test to compare the baseline characteristics of the two groups and the multivariate logistic regression model to identify the risk factors for depression. Univariate analysis results showed that the proportion of patients with SLI in basal ganglia was significantly higher in the depression group (65.0 versus 32.8 %; P < 0.001) than in the non-depression group, and multiple prevalent factors had significant differences between the two groups. However, on multivariate logistic analysis, some of these factors were eliminated, and SLI in basal ganglia remained an independent predictor of depression with an odds ratio of 3.128 (P = 0.018). In addition, vascular risk factors, including high body mass index level, presence of inflammation markers (e.g., CRP, TNF-α, Hs-CRP, and IL-6), and lack of physical activity, were associated with depression. Our findings suggest that SLI in basal ganglia is associated with a higher risk of depression. Vascular risk factors, which are intertwined, may propose the pathological basis of depression in SLI.
    Neurological Sciences 04/2014; 35(10). DOI:10.1007/s10072-014-1794-5 · 1.45 Impact Factor
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    • "We excluded 177 men and 115 women who reported that a doctor had told them they had at least one of the following diseases: CVD, previous stroke, or cancer, or who were taking certain medications with a potential effect on the affective states including antidepressants, sedatives, and antipsychotic medications. The decision to exclude these participants was based on previous findings reporting an affect of these diseases and medications on depression [e.g., Newberg et al., 2006] Additionally, 112 men and 84 women were excluded from the study due to missing data for one of the study parameters. Thus, the final sample consisted of 3,880 apparently healthy employees (2,355 men and 1,525 women). "
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    ABSTRACT: This study was designed to test the extent to which depressive symptoms are associated with the presence of the metabolic syndrome (MS) and each of its components, and whether these relationships are gender dependent. Participants were apparently healthy employed men (N=2,355) and women (N=1,525) who underwent a routine health check between the years 2003 and 2005. We used logistic regression analysis, predicting the MS by depressive symptoms, as assessed by the Patient Health Questionnaire, and the following control variables: age, education, smoking status, physical exercise, anxiety, and burnout. As hypothesized, we found that depression among women, but not men, was associated with a 1.94-fold risk of having the MS, and with an elevated risk of having two of its five components: elevated waist circumference (odds ratio, OR=2.23) and elevated glucose levels (OR=2.44). In addition, a positive trend was observed toward an association with the other three components: low high-density lipoprotein, hypertension, and elevated triglycerides. Among men depression was associated with elevated waist circumference only (OR=1.77). These findings suggest that especially among women, the association between depression and cardiovascular diseases might be linked to metabolic processes. If replicated in longitudinal studies, these findings may have important health-care policy implications with regard to depression management interventions.
    Depression and Anxiety 08/2008; 25(8):661-9. DOI:10.1002/da.20379 · 4.41 Impact Factor
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    ABSTRACT: Poststroke depression (PSD) is a complication that occurs in up to 30% of the patients who have had a stroke. Its development is associated with a poor functional prognosis and a negative impact on the patient's quality of life. In the present review, we summarize the diagnostic criteria, prevalence, predisposing factors, the lesion site, the impact of PSD on the clinical evolution of the patient, the current therapeutic approaches and even the relationship between depression and cerebrovascular disease. There are differences in relation to prevalence, essentially due to the use of different diagnostic criteria. Also, there have been few studies focusing on the search for factors that are predictive of PSD (age, female sex, single vascular lesion independent of site) and the reluctance to initiate preventive treatments to minimize the effects on the clinical evolution of the patients. There have been several advances with respect to the treatment of PSD. It seems that treatments show improvement trends, but today there is not enough evidence to recommend a preventive therapy for depression in any stroke patient. We consider that the prevalence of PSD is relevant and that the risk factors as well as the early diagnosis are important for the best management and prognosis of stroke patients. Further studies are needed in this field in order to reduce PSD.
    Cerebrovascular Diseases 02/2007; 24 Suppl 1(1):181-8. DOI:10.1159/000107394 · 3.75 Impact Factor
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