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vascular depression hypothesis alexopoulos - PubMed …

14. Sneed JR, Culang-Reinlieb ME. The vascular depression hypothesis: an update. 2011;19:99-103

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The vascular depression hypothesis: 10 years later.

The primary limitation of the study is the use of self-reported health data and lack of clinical evaluations for depression. However, this practice is common in population-based samples, and adequate agreement between self-reports of disease and medical chart reviews has been reported (; ). Use of clinically-defined cerebrovascular risk factors precludes analysis of how severity of a disorder such as diabetes may predict depression symptoms. Future research using continuous measures of blood pressure or blood sugars may further elucidate these relationships. A second limitation of this analysis is that the high rate of mortality in this sample resulted in listwise deletion of the most medically vulnerable elders. Consequently, it is probable that these findings underestimate the strength of the relationship between disability, vascular depression, and frailty. Our approach to measuring vascular depression could be viewed as both a strength and a weakness—yet it facilitates analysis of how concomitant vascular burden and probable depression predict the development of frailty. Because we know of no other studies using this strategy, integration of these findings with other work is not possible at this time. Future research may explore how vascular depression and frailty relate to longevity among the older-old. Another limitation of this study is that performance on measures of executive functioning is likely predictive of frailty, but cognition is not represented in these analyses. Unfortunately, the HRS data does not include robust measures of executive functioning, and this analysis was not possible. Future research should further explore relationships between cognitive functioning and frailty.

The vascular depression hypothesis: 10 years later

discussed the numerous theoretical and phenomenological connections between depression and varying models of frailty. He noted that white matter disease characterizes both late-onset depression and psychomotor deficits, which can be symptomatic of frailty. Katz did not, however, speculate as to whether vascular depression, as opposed to late-life depression, is related to frailty. reported that psychiatric disease is four times more common among frail elders than among the most robust elders. Interpretation of these results is limited, however, by the use of cross-sectional data and the identification of psychiatric illness based on retrospective self-report. Additionally, this study included CVB markers (hypertension, cardiac disease, and diabetes) as indicators of frailty, precluding analysis of these variables as risk factors for frailty. Other work has related depression to various correlates and indicators of frailty, including fall risk (), malnutrition ()—which can lead to wasting, steep decline in strength ()—and deficits in ADL functioning and mobility ().

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'Vascular Depression' Hypothesis - ResearchGate

Dr. AlexopoulosOur practice at Cornell is not to use antipsychotic medicines in nonpsychotic depression unless it is absolutely necessary. However, there is emerging evidence that there may be a role for antipsychotic medications in geriatric depression. A study was recently conducted in patients who had failed to respond to at least two antidepressants as well as a citalopram trial. These patients achieved good response with risperidone 0.5–1.5 mg/day.

Dr. AlexopoulosThe expert consensus guideline recommends sleep hygiene first, followed by trazodone. They did not recommend benzodiazepines or hypnotic medications. We sometimes use small doses (5 mg) of zolpidem in those who do not respond to trazodone.

termed ‘ vascular depression’ (Alexopoulos et al ..

The vascular depression hypothesis: Mechanisms linking vascular disease with depression.

Our first finding is that the prevalence of frailty in this demographically representative sample of stroke-free women over the age of 80 was 31.5%. Of the respondents who were not frail at baseline, the incidence of frailty after 4 years was 31.8%. The second finding was that vascular depression—characterized as the co-occurrence of high CVB and clinically significant depression symptoms— was a significant correlate of prevalent frailty and a significant predictor of incident frailty in a sample of women over 80. Importantly, those with vascular depression had significantly higher rates of frailty than either those with depression alone or vascular burden alone. The prevalence and incidence estimates are generally consistent with other estimates of frailty frequency in this demographic. For instance, reported frailty rates of 16.3% for respondents aged between 80 and 84 years, and 25.7% for those between 85 and 89 years. reported that 32% of participants age 90 and older were frail. predicted that depression precedes frailty in late life. Our findings support this hypothesis and build on Katz’s work by demonstrating that a specific subtype of depression (i.e., vascular depression) is a better predictor of new-onset frailty.

Vascular depression is a combination of high vascular burden and probable depression. While past work, as described above, has identified a causal effect of high vascular burden on the subsequent development of depressive symptoms, structure of the available data and theoretical considerations () informed our identification of vascular depression based on the co-occurrence of high CVB and probable depression. Following this rationale, three groups were identified. Participants were identified as having neither high CVB nor probable depression (group 1), either high CVB or probable depression (group 2), or as having vascular depression indicated by both probable depression and high CVB (group 3).

The vascular depression hypothesis: An update - …
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    Vascular Disease, Depression, and Dementia Vascular Disease, Depression, and Dementia Alexopoulos, George S

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et al, ‘Vascular depression’ hypothesis

Kalayam B, Alexopoulos GS, Musiek FE, Kakuma T, Toro A, Silbersweig D, Young R. Brainstem evoked response abnormalities in late life depression with vascular disease. Am J Psychiatry, 154: 970-975, 1997.

Guided by the "vascular depression" hypothesis…

Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. ‘Vascular Depression’ Hypothesis. Arch Gen Psychiatry, 54: 915-922, 1997.

The vascular depression hypothesis: ..

The hypothesis that there may exist a vascular depression subtype that is unique to late life was stated by Hickie in 1995,2 which stated that “cerebral vascular insufficiency in elderly people leads to major changes in their subcortical and basal ganglia structure. The resultant late-onset depressive disorders are characterized by deficits in functions that are dependent on intact cortical striatal connections (eg, psychomotor speed and interactiveness), as well as subcortical hyperintense lesions and reduced basal ganglia volumes.” The three criteria associated with vascular depression are late onset; vascular disease and hyperintensities as demonstrated by magnetic resonance imaging (MRI); and interference with cognitive capacities, such as sequencing, planning, organizing, and abstract thinking.

Alexopoulos GS: The vascular depression hypothesis: ..

Criteria for vascular depression include vascular disease, cognitive impairment, late age of onset, and depression. Definitions of these criteria have vary among studies. For example, some studies of vascular depression include patients with cardiovascular risk factors, while others require MRI lesions. Some studies have assessed impairment of activities of daily living,5 while others have defined executive dysfunction by neuropsychological testing.6 The age defining late onset differs from one study to the next (eg, 40, 50, or 60 years of age). Finally, most studies only include patients who meet criteria for major depressive disorder (MDD); however, many patients with vascular disease have dysthymia or subsyndromal symptoms. According to the post-MI literature, ~20% of patients develop MDD post-MI, and another 20% to 25% develop significant depressive symptomatology.7 The same is true in the post-stroke literature.

In their ‘vascular depression’ hypothesis, ..

One component of vascular depression is the executive dysfunction syndrome of late-life, and it is hypothesized that depression, executive dysfunction, and treatment resistance are all related to frontostriatal dysfunction. Furthermore, it is believed that dysfunction of the basal ganglia and their frontal connections contributes to poor and unstable treatment response in geriatric depression.

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