title: Cerebrovascular disease and evolution of depressive symptoms in the cardiovascular health study.
abstract: OBJECTIVE
  Previous studies have reported an association between cerebrovascular disease and depressive symptoms. The Cardiovascular Health Study (CHS) provides an opportunity to examine the relationship between vascular brain pathology seen on neuroimaging and changes in depressive symptoms.
  
  
  METHODS
  The sample included 3236 CHS participants who had an MRI brain scan. Demographic variables, medical history, functional status, and apolipoprotein E genotype were obtained at baseline. Annual scores on a modified version of the Centers for Epidemiologic Studies Depression (CES-D) scale were obtained initially and up to 7 years subsequently.
  
  
  RESULTS
  After controlling for important covariates, occurrence of depressive symptoms (defined as modified CES-D score of >7) was associated with small lesions in the basal ganglia, large cortical white-matter lesions, and severe subcortical white-matter grade. Neuroimaging variables did not predict incident depression among those who were nondepressive at the time of MRI. Persistence of depressive symptoms across 2 consecutive time points was associated with small basal ganglia lesions and large cerebral cortical white-matter lesions. Worsening of depression (increase in CES-D score of > or =5) was associated with subcortical white-matter lesions.
  
  
  CONCLUSIONS
  These findings suggest that cerebrovascular disease at baseline is related to depression symptoms over time. Further studies are needed to investigate the differential effects of subcortical white- versus gray-matter lesions on mood.
authors.affiliation: Duke University Medical Center, Department of Psychiatry, Durham, NC 27710, USA. steff001@mc.duke.edu
authors.forename: David C
authors.initials: DC
authors.lastname: Steffens
authors.forename: K Ranga Rama
authors.initials: KR
authors.lastname: Krishnan
authors.forename: Casey
authors.initials: C
authors.lastname: Crump
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D020144:Basal Ganglia Cerebrovascular Disease / Q000175:diagnosis / Q000453:epidemiology; D001921:Brain / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D016017:Odds Ratio; D014481:United States / Q000453:epidemiology