Geriatric depression and vascular diseases:: what are the links?

Background: The term vascular depression has been proposed to describe a subset of depressive disorders that occurs in old age as a consequence of cerebrovascular disease. However, depression has been shown to result from other cardiovascular diseases such as coronary heart diseases, as well as to precipitate, worsen or precede vascular diseases. Depression also increases the likelihood of the incidence of vascular risk factors such as diabetes. Aims: To review clinical and epidemiological evidence linking geriatric depression and vascular diseases, and to discuss the potential mechanisms that could underlie this association. Method: Systematic review of the literature of the last 5 years through Medline database search. Results: Papers report the following potential ways of association: (1) there is a direct influence of vascular disease, in particular, arteriosclerosis, on the incidence of depression; (2) depressive disorders have a direct impact on the cardiovascular system;, (3) depression and vascular disease share either a common pathophysiological process or genetic determinants. Discussion: Depression can be understood as the direct consequence of brain damage in neurodegenerative disorders such as Parkinson's or Huntington's diseases. Similarly, vascular depression is mostly considered to be the consequence of microvascular lesions on prefrontal and subcortical regions. However, this functional neuroanatomical model offers no explanation for cases where depression has been shown to precede vascular diseases. Since cardiovascular diseases develop in a context of acquired environmental factors together with genetically determined disease, it may be postulated that geriatric depression could both result from brain lesions of vascular origin and also share some pathogenic or genetic determinants. (C) 2003 Elsevier B.V. All rights reserved.