title: Depressive symptoms are associated with subclinical cerebrovascular disease among healthy older women, not men.
abstract: BACKGROUND
  Associations among diagnosed unipolar depression, depressive symptoms, and cerebrovascular disease are well known. However, minimal research has investigated whether sex may modify such associations, despite known sex differences in depression and depressive symptoms. This study examined whether depressive symptoms were disproportionately related to subclinical cerebrovascular disease (SCD) in women versus men.
  
  
  METHODS
  One hundred one older adults (58% men; mean age = 67 years), free of major comorbidities, completed the Beck Depression Inventory and underwent magnetic resonance imaging (MRI). MRI scans were neuroradiologist rated for markers of SCD (periventricular and deep white matter hyperintensities, and number of silent infarcts) and brain atrophy (ventricular enlargement and sulcal widening). Two rank-sum outcome variables (SCD and brain atrophy) were then created.
  
  
  RESULTS
  On average, depressive symptoms were relatively low in magnitude (mean = 3.8, standard deviation = 3.6, range = 0-17). Multiple regression analyses, adjusted for age, sex, education, systolic blood pressure, fasting glucose, maximal oxygen consumption, body mass index, average weekly alcohol consumption, and Mini-Mental State Examination performance revealed sex to be a significant effect modifier of depressive symptoms in the prediction of SCD. Sex-stratified regression analyses indicated depressive symptoms, and SCD was strongly related among women but not men. Depressive symptoms were not related to brain atrophy, regardless of inclusion of sex as an effect modifier.
  
  
  CONCLUSIONS
  Depressive symptoms, even in a subclinical range, are significantly associated with an MRI-derived index of SCD among women, but not men, in the present sample of relatively healthy older adults.
authors.affiliation: Department of Psychology, University of Maryland, Baltimore County, USA. rice3@umbc.edu
authors.forename: Carrington Rice
authors.initials: CR
authors.lastname: Wendell
authors.forename: Megan M
authors.initials: MM
authors.lastname: Hosey
authors.forename: David M
authors.initials: DM
authors.lastname: Lefkowitz
authors.forename: Leslie I
authors.initials: LI
authors.lastname: Katzel
authors.forename: Eliot L
authors.initials: EL
authors.lastname: Siegel
authors.forename: William F
authors.initials: WF
authors.lastname: Rosenberger
authors.forename: Shari R
authors.initials: SR
authors.lastname: Waldstein
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000473:pathology; D003863:Depression / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D012727:Sex Characteristics
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