title: Cerebrovascular risk factors, vascular disease, and neuropsychological outcomes in adults with major depression.
abstract: OBJECTIVE
  To investigate the relationship of cerebrovascular risk factors (CVRFs), endothelial function, carotid artery intima medial thickness (IMT), and neuropsychological performance in a sample of 198 middle-aged and older individuals with major depressive disorder (MDD). Neuropsychological deficits are common among adults with MDD, particularly among those with CVRFs and potentially persons with subclinical vascular disease.
  
  
  METHODS
  CVRFs were indexed by the Framingham Stroke Risk Profile (FSRP) and serum cholesterol levels obtained by medical history and physical examination. Patients completed a neuropsychological test battery including measures of executive functioning, working memory, and verbal recall. Vascular function was indexed by carotid artery IMT and brachial artery flow mediated dilation (FMD). Hierarchical multiple regression analyses were used to investigate the association between CVRFs, vascular disease, and neurocognitive performance.
  
  
  RESULTS
  Greater FSRP scores were associated with poorer executive functioning (b = -0.86; p = .041) and working memory (b = -0.90; p = .024). Lower high-density lipoprotein levels also were associated with poorer executive functioning (b = 1.03; p = .035). Higher IMT (b = -0.83; p = .028) and lower FMD (b = 1.29; p = .032) were associated with poorer executive functioning after controlling for CVRFs. Lower FMD was also associated with poorer working memory (b = 1.58; p = .015).
  
  
  CONCLUSIONS
  Greater CVRFs were associated with poorer neuropsychological performance. Vascular dysfunction also was associated with neuropsychological decrements independent of traditional CVRFs.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA. Smith562@mc.duke.edu
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Smith
authors.forename: James A
authors.initials: JA
authors.lastname: Blumenthal
authors.forename: Michael A
authors.initials: MA
authors.lastname: Babyak
authors.forename: Benson M
authors.initials: BM
authors.lastname: Hoffman
authors.forename: P Murali
authors.initials: PM
authors.lastname: Doraiswamy
authors.forename: Robert
authors.initials: R
authors.lastname: Waugh
authors.forename: Alan
authors.initials: A
authors.lastname: Hinderliter
authors.forename: Andrew
authors.initials: A
authors.lastname: Sherwood
mesh_terms: D050197:Atherosclerosis / Q000453:epidemiology / Q000503:physiopathology*; D002561:Cerebrovascular Disorders / Q000453:epidemiology / Q000503:physiopathology*; D003071:Cognition; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000503:physiopathology*; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D012307:Risk Factors; D014481:United States / Q000453:epidemiology