The external validity of MRI‐defined vascular depression

Pimontel, Monique A.; Reinlieb, Michelle E.; Johnert, Lauren C.; Garcon, Ernst; Sneed, Joel R.; Roose, Steven P.

doi:10.1002/gps.3943

Cited by 27 publications

(16 citation statements)

References 46 publications

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“…This may be related to differences in age of depression onset [20, 43, 44], as individuals with VaDep tend to have a later age of initial onset of depression [19]. However, even individuals with EOD may be at risk of transitioning to VaDep since some studies have implied a bi-directional link between vascular disease and depression [45, 46].…”

Section: Resultsmentioning

confidence: 99%

“…Observations of VaDep being associated with greater disability, poorer outcomes, and executive dysfunction [20, 21, 49] led to a reconceptualization of VaDep, with subsequent proposals of the “depressive–executive dysfunction syndrome” [37, 50, 51] or “depression–cognitive impairment disease” [52]. However, although these conceptualizations overlap, they are not necessarily synonymous.…”

Section: Resultsmentioning

confidence: 99%

“…Boosted by modern neuroimaging techniques, Krishnan et al [18] coined the entity of “MRI-defined VaDep”, which by definition includes CVD findings on MRI. Patients with VaDep were suggested to have a distinct clinical and neuropsychological profile and a positive association with hypertension [19], supporting the notion that VaDep represents a unique and valid subtype of LLD [20–22], although this has not been confirmed by others [23–27]. The MRI literature supporting the VaDep hypothesis shows that loss of brain volume and white matter integrity are associated with poor clinical treatment outcomes [28, 29].…”

Section: Introductionmentioning

confidence: 97%

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Vascular depression consensus report – a critical update

Aizenstein

Baskys

Boldrini

et al. 2016

BMC Med

188

145

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BackgroundVascular depression is regarded as a subtype of late-life depression characterized by a distinct clinical presentation and an association with cerebrovascular damage. Although the term is commonly used in research settings, widely accepted diagnostic criteria are lacking and vascular depression is absent from formal psychiatric manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition – a fact that limits its use in clinical settings. Magnetic resonance imaging (MRI) techniques, showing a variety of cerebrovascular lesions, including extensive white matter hyperintensities, subcortical microvascular lesions, lacunes, and microinfarcts, in patients with late life depression, led to the introduction of the term “MRI-defined vascular depression”.DiscussionThis diagnosis, based on clinical and MRI findings, suggests that vascular lesions lead to depression by disruption of frontal–subcortical–limbic networks involved in mood regulation. However, despite multiple MRI approaches to shed light on the spatiotemporal structural changes associated with late life depression, the causal relationship between brain changes, related lesions, and late life depression remains controversial. While postmortem studies of elderly persons who died from suicide revealed lacunes, small vessel, and Alzheimer-related pathologies, recent autopsy data challenged the role of these lesions in the pathogenesis of vascular depression. Current data propose that the vascular depression connotation should be reserved for depressed older patients with vascular pathology and evident cerebral involvement. Based on current knowledge, the correlations between intra vitam neuroimaging findings and their postmortem validity as well as the role of peripheral markers of vascular disease in late life depression are discussed.ConclusionThe multifold pathogenesis of vascular depression as a possible subtype of late life depression needs further elucidation. There is a need for correlative clinical, intra vitam structural and functional MRI as well as postmortem MRI and neuropathological studies in order to confirm the relationship between clinical symptomatology and changes in specific brain regions related to depression. To elucidate the causal relationship between regional vascular brain changes and vascular depression, animal models could be helpful. Current treatment options include a combination of vasoactive drugs and antidepressants, but the outcomes are still unsatisfying.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Vascular depression consensus report – a critical update

Aizenstein

Baskys

Boldrini

et al. 2016

BMC Med

188

145

View full text Add to dashboard Cite

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“…However, in the literature, these 2 disorders are typically kept separate. Research focused on MCI tends to exclude depression by excluding affective disorders, and research on late‐life depression tends to exclude memory disorders and cognitive impairment by using a cutoff score for the Mini‐Mental State Examination . This creates a bias against the study of comorbid depression and cognitive impairment in older adults.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological characteristics of early versus late mild cognitive impairment in patients with comorbid depressive disorder

Motter

Pelton

D’Antonio

et al. 2018

Int J Geriat Psychiatry

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“…Our findings suggest that the presence of motivational symptoms in depressed older people could direct the clinician towards a more cerebrovascular involvement. Recently, others found a similar clinical presentation and vascular risk factors in MRI-proven vascular depressed subjects (Pimontel et al, 2013). Furthermore, one should bear in mind that silent strokes are not included and that these are about five times more common than symptomatic stroke; thus, some of the subjects in the non-stroke group would actually have cerebrovascular damage and this will have some impact on our results and can probably explain why we did not find differences in executive and cognitive functioning in the two vascular groups.…”

Section: Discussionmentioning

confidence: 81%