The Vascular Depression Hypothesis: An Update

Abstract

Since being proposed as a unique subtype of late-life depression (LLD), the vascular depression hypothesis has received considerable research attention. Although this effort has generated considerable empirical support for the validity of the subtype, fundamental questions remain including how the illness is defined, whether cerebrovascular disease and executive dysfunction (ED) define two separate entities or one underlying subtype, and whether ED is responsible for poor response to antidepressant treatment. In this guest editorial, we explore these and other issues (i.e., the role of personality and social support, psychosocial treatments targeting cognitive abilities frequently impaired in LLD) using a number of important papers that are either directly or indirectly related to the vascular depression hypothesis. In so doing we highlight a range of critical problems facing the vascular depression hypothesis and the effort to establish the illness as a unique diagnostic entity in late-life.

Depressive signs and cognitive performance in patients with a right hemisphere stroke

“…Thus, there is still a prominent lack of epidemiologic data on depression unilateral following post-stroke.Considering the aim to verify whether there is an influence of post-RHD depression in eight cognitive functions, in a general perspective RHD+ adults presented cognitive changes in at least one subtest in all neuropsychological domains assessed. These findings corroborate the literature which investigates the relationship between post-stroke depression and cognitive performance, even when they do not consider the isolated contribution of each cerebral hemisphere in the execution of the tasks adopted (12) . Despite of the fact that this has not been the main aim of Barker-Collo's (23) study, for instance, RHD patients with a diagnosis of depression presented lower performance in late recall in semantic-verbal memory.…”

“…Among those studies, the research conducted by Alexopoulos (11) , for instance, emphasizes that lesions in the frontolimbic and frontoestriatic networks are associated withwith executive functions deficits; however, the contributions of each hemisphere are not considered in this process. According to Sneed and Culang-Reinlieb (12) , post-stroke depression is also associated withwith executive dysfunction, although independently of lesion type. Brodaty et al (13) identified that apathy following stroke is linked to low performance in tasks measuring concentrated attention, working memory and processing speed.…”

“…Therefore, vascular lesions in this hemisphere may impair the patient's mental and emotional state, as well as negatively affecting motivation, comprehension and prosodic emotional, metaphoric and humor expression (10) . Some few existing studies (6,(11)(12)(13) propose to discuss the relationship between cognitive dysfunctions and post-stroke depression, but not followed by the association's investigation of the neurocognitive deficits of this comorbidity with the affected hemisphere. Among those studies, the research conducted by Alexopoulos (11) , for instance, emphasizes that lesions in the frontolimbic and frontoestriatic networks are associated withwith executive functions deficits; however, the contributions of each hemisphere are not considered in this process.…”

Psychopathological evaluation and use of the Hospital Anxiety and Depression Scale in a sample of Brazilian patients with post-stroke depression

“…In a large cohort of 157,243 Danish patients with stroke, diabetes was found as a risk factor for PSD 34 . The findings of an association between the occurrence of a depressive syndrome in the elderly population and the presence of white matter lesions of vascular origin, particularly in the frontal regions, have led to the hypothesis of the existence of a "vascular depression", which would be linked to microangiopathy 35 . Based on that, one could speculate whether patients with diabetes are more susceptible to the development of depressive symptoms after a major vascular insult superimposed on chronic vascular microlesions.…”

Vascular Depression: Re-evaluated on the Base of Brain Metabolism in a Sample of Patients With “Organic Brain Syndromes”

“…It is known that also a high rate of depression in patients, who have had a stroke, demonstrated also White Matter Hyperintensities (WMIs). The notable infrequent family history of mood disorders in depression occurring in the context of silent stroke should be mentioned (Sneed & Culang-Reinlieb, 2011).…”