title: MRI-defined versus clinically-defined vascular depression; comparison of prediction of functional disability in the elderly.
abstract: We compared the validity of models of subcortical ischemic depression (SID) and depression-executive dysfunction syndrome (DED) in predicting functional disability in the elderly.
  
  
  
  We obtained data from elderly Korean subjects (n=1356) aged 60 years or older at baseline from the CREDOS study from November 2005 to July 2014. A generalized estimating equation (GEE) model was constructed to measure functional disability using instrumental activity of daily living as a primary outcome. A risk factor of interest was SID and DED evaluated by a visual rating scale of deep white matter hyperintensity in MRI, Stroop test and Geriatric Depression Scale (GDS) score. Receiver-operating-characteristic plots and area under the curve (AUC) test were applied to examine the difference of the two definitions of vascular depression with predicted values of functional disability outcome.
  
  
  
  The mean (SD) follow-up duration of the participants was 1.7 (0.9) years. The GEE model showed that presence of SID at baseline predicted functional disability compared to non-depressed subjects (GDS score: Odds ratio [OR] 1.76; 95% CI 1.23, 2.53; p=0.002). The association was also statistically significant among the DED group (OR 1.48; 95% CI 1.15, 1.92; p=0.003). There were no significant differences in predicting functional disability (95% CI: -0.003 to 0.009, p=0.366) according to AUC differences between SID and DED.
  
  
  
  The results will be useful in evaluating the cardinal features of the vascular depression hypothesis in predicting functional disability.
authors.affiliation: Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Ki Jung
authors.initials: KJ
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea; Memory Impairment Center, Ajou University Hospital, Suwon, Republic of Korea.
authors.forename: Chang Hyung
authors.initials: CH
authors.lastname: Hong
authors.affiliation: Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Si Heon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, CHA University School of Medicine, CHA Hospital, Gangnam, Republic of Korea.
authors.forename: Kang Soo
authors.initials: KS
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Hyun Woong
authors.initials: HW
authors.lastname: Roh
authors.affiliation: Department of Biostatstics, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Dae Ryong
authors.initials: DR
authors.lastname: Kang
authors.affiliation: Department of Neurology, Inha University college of Medicine, Incheon, Republic of Korea.
authors.forename: Seong Hye
authors.initials: SH
authors.lastname: Choi
authors.affiliation: Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Seong Yoon
authors.initials: SY
authors.lastname: Kim
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Duk L
authors.initials: DL
authors.lastname: Na
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Seo
authors.affiliation: Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Do-Kwan
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea; Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea.
authors.forename: Yunhwan
authors.initials: Y
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Young Ki
authors.initials: YK
authors.lastname: Chung
authors.affiliation: Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Ki Young
authors.initials: KY
authors.lastname: Lim
authors.affiliation: Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea.
authors.forename: Jai Sung
authors.initials: JS
authors.lastname: Noh
authors.affiliation: Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea. Electronic address: sjsonpsy@ajou.ac.kr.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Son
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000523:psychology; D003863:Depression / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000523:psychology; D056344:Executive Function; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D056910:Republic of Korea; D012307:Risk Factors; D066127:White Matter / Q000000981:diagnostic imaging*
keywords: Executive dysfunction; Functional disability; Vascular depression; WMH