The Role of Vascular Risk Factors in the Development of DED Syndrome Among an Elderly Community Sample

Objectives: To clarify the role of vascular risk factors in the development of depression-executive dysfunction (DED) syndrome and to investigate the distinct clinical presentation of DED syndrome. Setting: A cross-sectional community-based study in South Korea. Participants: A total of 2,007 participants age 65 or older. Measurements: Depression was diagnosed with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria using a questionnaire based on the Korean version of the Composite International Diagnostic Interview. Executive dysfunction was evaluated by the Initiation/Perseveration subscale of the Korean version of the Dementia Rating Scale. Information about demography and vascular risk factors was assessed using questionnaires. Results: A total of 88 depressed elderly participants were identified. Previous cerebrovascular attack was found to increase the risk of DED syndrome, whereas hypertension, hyperlipidemia, and heart disease did not. A trend (p = 0.024) emerged, although it did not reach significance, suggesting an association between diabetes and DED. Depression without executive dysfunction was not associated with any vascular risk factors. In participants who reported two or more symptoms related to DSM-IV depression criteria (N = 335), executive dysfunction was associated with psychomotor retardation, feelings of worthlessness, and feelings of guilt. Conclusion: These findings suggest that the concept of DED syndrome is useful for identifying geriatric depression patients with a high risk of vascular risk factors. Attention to executive dysfunction in depressive elderly patients may help clinicians identify patients who need early intervention and careful follow-up for vascular risk factors. (Am J Geriatr Psychiatry 2011; 19: 104-114)