Vascular depression consensus report - a critical update.
BACKGROUND
Vascular depression is regarded as a subtype of late-life depression characterized by a distinct clinical presentation and an association with cerebrovascular damage. Although the term is commonly used in research settings, widely accepted diagnostic criteria are lacking and vascular depression is absent from formal psychiatric manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5thedition - a fact that limits its use in clinical settings. Magnetic resonance imaging (MRI) techniques, showing a variety of cerebrovascular lesions, including extensive white matter hyperintensities, subcortical microvascular lesions, lacunes, and microinfarcts, in patients with late life depression, led to the introduction of the term "MRI-defined vascular depression".


CONCLUSIONS
This diagnosis, based on clinical and MRI findings, suggests that vascular lesions lead to depression by disruption of frontal-subcortical-limbic networks involved in mood regulation. However, despite multiple MRI approaches to shed light on the spatiotemporal structural changes associated with late life depression, the causal relationship between brain changes, related lesions, and late life depression remains controversial. While postmortem studies of elderly persons who died from suicide revealed lacunes, small vessel, and Alzheimer-related pathologies, recent autopsy data challenged the role of these lesions in the pathogenesis of vascular depression. Current data propose that the vascular depression connotation should be reserved for depressed older patients with vascular pathology and evident cerebral involvement. Based on current knowledge, the correlations between intra vitam neuroimaging findings and their postmortem validity as well as the role of peripheral markers of vascular disease in late life depression are discussed.


CONCLUSIONS
The multifold pathogenesis of vascular depression as a possible subtype of late life depression needs further elucidation. There is a need for correlative clinical, intra vitam structural and functional MRI as well as postmortem MRI and neuropathological studies in order to confirm the relationship between clinical symptomatology and changes in specific brain regions related to depression. To elucidate the causal relationship between regional vascular brain changes and vascular depression, animal models could be helpful. Current treatment options include a combination of vasoactive drugs and antidepressants, but the outcomes are still unsatisfying.
Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Howard J
HJ
Aizenstein
Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA.
Andrius
A
Baskys
Department of Psychiatry, Columbia University, New York, NY, USA.|Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA.
Maura
M
Boldrini
Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, PA, USA.
Meryl A
MA
Butters
Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA.
Breno S
BS
Diniz
Department of Psychiatry, Columbia University, New York, NY, USA.|Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York, NY, USA.
Manoj Kumar
MK
Jaiswal
Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria. kurt.jellinger@univie.ac.at.
Kurt A
KA
Jellinger
Department of Geriatric Psychiatry of the St. Petersburg Psychoneurological Research Institute named after V. M. Bekhterev, Medical Faculty of St. Petersburg University, St. Petersburg, Russia.
Lev S
LS
Kruglov
Clinical Department, Scientific and Practical Center of Psychoneurology named after V. M. Soloviev, St. Petersburg, Russia.
Ivan A
IA
Meshandin
Neurology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Belgrade, Serbia.
Milija D
MD
Mijajlovic
University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany.
Guenter
G
Niklewski
Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA.
Sarah
S
Pospos
Consultant in Old Age Psychiatry, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK.
Keerthy
K
Raju
University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany.|Faculty for Social Sciences, Technical University of Nuremberg Georg Simon Ohm, Nuremberg, Germany.
Kneginja
K
Richter
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA.
David C
DC
Steffens
Department of Psychiatry, The Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.|Department of Veterans Affairs Medical Center, The Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, USA.
Warren D
WD
Taylor
Departments of Neurology and Psychiatry, Tel Aviv Medical Center, Tel Aviv, Israel.|Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel.
Oren
O
Tene
D000368:Aged; D001921:Brain / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D032921:Consensus; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male
Cerebrovascular lesions; Clinicopathological correlations; Late-life depression; Neuropathology; Peripheral markers; Structural neuroimaging; Vascular depression; White matter lesions