Background:
Cerebrovascular disease is thought to play a role in the pathogenesis of geriatric major depression. one finding supporting such a "vascular depression" is the increased neuropathology in the form of white matter hyperintensities (wmh) found in patients diagnosed with a late-onset depression. however, at present there is little evidence that a longitudinal increase in wmh burden within an individual is associated with the onset of a late-life depression.
Methods:
This study examined three-year longitudinal change in wmh volume and in cognition in: (a) an older man who developed his first episode of major depression during the study period, and (b) a comparison group of twelve older individuals who remained depression free. all subjects received at baseline and three years later a structural magnetic resonance imaging (mri) using fast-flair technology. the images were analyzed with semi-automated computerized software to obtain wmh volumes. subjects also received at both time points the mini mental state exam (mmse) as well a series of cognitive tasks assessing executive abilities (verbal fluency, trail making test and stroop test) since executive dysfunction is thought to be characteristic of a vascular depression.
Results:
The individual who became depressed during the followup showed an increase in wmh volume that exceeded the 95% confidence intervals (ci) for change in the comparison group. this individual also showed a similar decline on the measures of executive function but not on the mmse.
Conclusions:
These results are consistent with cerebrovascular disease being a factor in the pathogenesis of late-onset depression (i.e. "vascular depression").