Vascular depression consensus report – a critical update

Aizenstein, Howard J.; Baskys, Andrius; Boldrini, Maura; Butters, Meryl A.; Diniz, Breno S.; Jaiswal, Manoj Kumar; Jellinger, K. A.; Круглов, Лев Саввич; Meshandin, I. A.; Mijajlović, Milija; Niklewski, Guenter; Pospos, Sarah; Raju, Keerthy; Richter, Kneginja; Steffens, David C.; Taylor, Warren D.; Tene, Oren

doi:10.1186/s12916-016-0720-5

Cited by 187 publications

(165 citation statements)

References 227 publications

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“…In older adults, depression’s dire consequences, including cognitive decline (Zahodne 2014), increased health care utilization (Shao 2017), functional decline (Callahan 1998, Barry 2009), and increased overall mortality (Laursen 2016) have prompted an aggressive search for predictors of therapeutic response, such as cerebrovascular disease (Taylor 2013, Aizenstein 2016), genetic factors (Marshe 2017), peripheral biomarkers and symptomatic phenotypes (Rutherford 2016, Nelson 2009). Gallo et al (2016) recently demonstrated that management of depression reduces mortality among depressed older adults with multimorbidity.…”

Section: Introductionmentioning

confidence: 99%

Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance

Mulvahill

Nicol

Dixon

et al. 2017

J American Geriatrics Society

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Background Metabolic syndrome (MetSyn) is the co-occurrence of obesity with metabolic derangements. Prior research implicates MetSyn in prolonging the course of depression in older adults, but MetSyn’s effect on antidepressant response is unknown in this population. Objectives To determine if MetSyn and related metabolic dyscrasias are associated with decreased remission from depression among older adults treated pharmacologically for depression. Design Secondary analysis of a randomized controlled trial. Participants Adults 60 years and older with major depressive disorder (MDD, n=435) recruited from three academic medical centers in North America. Intervention Open-label, protocolized treatment with venlafaxine extended-release for twelve or more weeks. Main Measures Time-to-remission from depression, with remission defined as Montgomery-Åsberg Depression Rating Scale (MADRS) score ≤ 10 at last two visits. Key Results Of 435 participants (mean age 69.1 years), 222 (51%) met criteria for MetSyn at baseline; MetSyn was associated with greater severity (MADRS score) and chronicity of depression at baseline. Remission was achieved in 182 participants (42%). In the unadjusted analysis, MetSyn was associated with prolonged time-to-remission (hazard ratio for remission 0.71, 95% CI 0.52 – 0.95) but this relationship was not significant in the adjusted model; greater number of MetSyn components and lower HDL cholesterol had similar effects. Only diastolic blood pressure (DBP) was a significant predictor of time-to-remission before and after adjustment, with higher DBP predicting prolonged time-to-remission. Insulin sensitivity did not predict time-to-remission. Conclusion The presence of MetSyn in depressed, older adults is associated with greater symptom severity and chronicity of depression in our sample, which appear to account for the decreased antidepressant response observed among those with MetSyn. Additionally, our preliminary finding relating higher DBP with decreased antidepressant response bears further examination and replication.

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Section: Introductionmentioning

confidence: 99%

Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance

Mulvahill

Nicol

Dixon

et al. 2017

J American Geriatrics Society

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“…MRI is usually used to rule out organic causes for psychiatric symptoms. Specially, it is usefulness for diagnosis by exclusion of vascular depression or vascular dementia [13]. Therefore, MRI was very useful in our case (Fig.…”

Section: Anorexia Due Tomentioning

confidence: 99%

Anorexia due to Depression in the Elderly From the Viewpoint of Primary Care

et al. 2017

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Japan is currently an aging society with a huge proportion of elderly citizens. Consequently, the incidence and severity of anorexia and depression are predicted to increase in the future. In fact, at present, anorexia is common in the elderly. Anorexia is one of the major symptoms of depression in the elderly. More than 90% of patients with depression are thought to visit primary care physicians and the departments such as general medicine first instead of psychiatrists. Therefore, primary care physicians need to be vigilant for signs of depressive disorder to prevent suicide. Elderly patients have few negative emotions, such as feeling depressed, sad, or any other subjective drops in mood; this implies that elderly individuals might find it difficult to explain their symptoms to others and that the people around them might hardly notice any symptoms of depression. An 84-year-old woman started to gradually lose appetite. She has undergone various examinations, but an obvious physical organic abnormality was not found. Upon admission to our hospital, her weight was 38 kg and body mass index was 16.9 kg/m 2 . Based on diagnostic criteria and further evaluation, we diagnosed her as anorexia due to depression. After biopsychosocial approach including appropriate social support, as well as medical and mental therapies, her appetite improved gradually and she was able to regain her weight eventually. Elderly individuals have a tendency to get depression due to biologic and psychosocial causes. Many patients with depression are thought to visit primary care physicians and the departments such as general medicine first instead of psychiatrists. Therefore, the efficiency of primary care is underscored and primary care physicians need to be vigilant in detecting depression and preventing suicide. We think that general medicine will have a more important part in medical practice in the future in Japan.

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“…However, the pathophysiological details of VCI/VaD and of vascular depression (VaDep -see consensus paper [45]) are beyond the scope of this mini-review.…”

Section: Other Pathological Substrates Of Vci Includementioning

confidence: 99%

“…The detrimental effects of social isolation on CVDs and related cognitive disorders have been discussed recently [49], and the role of vascular depression as a subtype of late-life depression and its relations to cerebrovascular disorders has been reviewed in a recent consensus report [45,50]. Psychosocial stressors have been shown to exacerbate disease-related morbidity and mortality [51].…”

Section: Risk Factors For Cvi/vadmentioning

confidence: 99%

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Current Pathogenetic Concepts of Vascular Cognitive Impairment

Jellinger¹

2016

J Neurol Neurol Sci Disord

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The term vascular cognitive impairment designates a heterogenous group of disorders ranging from mild cognitive impairment to full-blown dementia -vascular dementia -resulting from cerebrovascular lesions involving various brain areas. Current clinical criteria show moderate sensitivity (50-56%) and variable specifi city (range 64-98%). The prevalence in autopsy series ranges from 0.03 to 58% (mean 8-15% in Western series, 22-35% in Japan). Major morphological types -multi-infarct and subcortical vascular encephalopathy, strategic infarct dementia, lacunar state, cortical granular atrophy (rare), and ischemic encephalopathy -are caused by atherosclerosis of major cerebral arteries and small vessel disease, resulting from systemic, cardiac and local vascular disease or cerebral amyloid angiopathy. Pathogenesis of vascular dementia is multifactorial, and pathophysiology affects brain areas and neurological networks involved in cognition, memory, behavior, and executive functions. Vascular brain injury in elderly persons often coexists with Alzheimer-type lesions and other pathologies resulting in mixed dementia. However, these lesions are also present in many non-demented elderly subjects. The heterogeneity of clinical manifestations, cerebrovascular pathology and their pathogenic factors result in limitations of the accuracy of diagnostic criteria for vascular dementia. Therefore, standardized and reproducible neuropathological criteria for the assessment of cerebrovascular lesions associated with cognitive impairment in order to elucidate contribution of cerebrovascular disease to cognitive impairment are urgently needed.

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Vascular depression consensus report – a critical update

Cited by 187 publications

References 227 publications

Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance

Effect of Metabolic Syndrome on Late‐Life Depression: Associations with Disease Severity and Treatment Resistance

Anorexia due to Depression in the Elderly From the Viewpoint of Primary Care

Current Pathogenetic Concepts of Vascular Cognitive Impairment

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