The current approach to psychiatric diagnoses involves identifying symptom clusters
that fit a specific syndrome. Although this approach has facilitated the field’s development,
advances in genetics and neuroimaging raise the question of how causality may fit
into the diagnostic process. One approach would be a two-axial system, wherein clinical
presentation is on one axis and putative risk factors are on the other. This approach
applies to subcortical ischemic depression (SID), a diagnosis corresponding to the
“vascular depression” hypothesis. Subcortical ischemic depression affects clinical
presentation, long-term outcomes, and response to antidepressant therapy, arguing
that it is a valid diagnostic entity worth further study.
Key Words
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References
- Depression in the elderly.Lancet. 2005; 365: 1961-1970
- ‘Vascular depression’ hypothesis.Arch Gen Psychiatry. 1997; 54: 915-922
- Age-related differences in supervisory attentional system functions.J Gerontol B Pschol Sci Soc Sci. 2000; 55: P373-P380
- Incidental subcortical lesions identified on magnetic resonance imaging in the elderly.Stroke. 1986; 17: 1084-1089
- The prognostic significance of abnormalities seen on magnetic resonance imaging in late life depression: Clinical outcome, mortality, and progression to dementia at three years.Int J Geriatr Psychiatry. 2000; 15: 1097-1104
- Persistence of neuropsychological deficits in the remitted state of late-life depression.Am J Geriatr Psychiatry. 2006; 14: 419-427
- Bradley W. Orgogozo J.M. Van Drimmelen J. Sartorius N. Application of the International Classification of Diseases to Neurology. 2nd ed. World Health Organization, Geneva1997
- Cerebral white matter disease in late-onset paranoid psychosis.Biol Psychiatry. 1990; 28: 266-274
- Psychosocial risk factors for depressive disorders in late life.Biol Psychiatry. 2002; 52: 175-184
- Prevalence and anatomic characteristics of infarct-like lesions on MR images of middle-aged adults: The atherosclerosis risk in communities study.AJNR Am J Neuroradiol. 1999; 20: 1273-1280
- Infarctlike lesion in the brain: Prevalence and anatomic characteristics at MR imaging of the elderly–data from the Cardiovascular Health Study.Radiology. 1997; 202: 17-19
Burton R (1638): The Anatomy of Melancholia. London, England: Hen, Crisps and Lloyd.
- The nature and determinants of neuropsychological functioning in late-life depression.Arch Gen Psychiatry. 2004; 61: 587-595
- Quantitative cerebral anatomy in depression: A controlled magnetic resonance imaging study.Arch Gen Psychiatry. 1993; 50: 7-16
- Evidence-based review of risk factors for geriatric depression and brief preventative interventions.Psychiatr Clin North Am. 2005; 28: 785-803
- Prevalence of cerebral white matter lesions in elderly people: A population based magnetic resonance imaging study.J Neurol Neurosurg Psychiatry. 2001; 70: 9-14
- Hypertension and cerebral white matter lesions in a prospective cohort study.Brain. 2002; 125: 765-772
- Longitudinal study of blood pressure and white matter hyperintensities.Neurology. 2001; 56: 921-926
- Causation and disease: A chronological journey.Am J Epidemiol. 1978; 108: 249-258
- White matter signal abnormalities in normal individuals: Correlation with carotid ultrasonagraphy, cerebral blood flow measurements, and cerebrovascular risk factors.Stroke. 1988; 19: 1285-1288
- Differences between treated and untreated hypertensive subjects in the extent of periventricular hyperintensities observed on brain MRI.Stroke. 1995; 26: 1593-1597
- Neuroanatomic localization of magnetic resonance imaging signal hyperintensities in geriatric depression.Stroke. 1998; 29: 613-617
- MRI signal hyperintensities in geriatric depression.Am J Psychiatry. 1996; 153: 1212-1215
- White matter changes with normal aging.Neurology. 1998; 50: 972-978
- The environment and disease: Association or causation?.Proc R Soc Med. 1965; 58: 295-300
- Brain MRI hyperintensities and one-carbon cycle metabolism in non-geriatric outpatients with major depressive disorder (Part I).Psychiatry Res. 2005; 140: 291-299
- Distinguishing between the validity and utility of psychiatric diagnoses.Am J Psychiatry. 2003; 160: 4-12
- The clinical distinction between psychotic and neurotic depressions.Br J Psychiatry. 1970; 117: 257-260
- Coming to terms with the terms of risk.Arch Gen Psychiatry. 1997; 54: 337-343
- Psychiatric disease in the genomic era: Rational approach.Mol Psychiatry. 2005; 10: 978-984
- MRI-defined vascular depression.Am J Psychiatry. 1997; 154: 497-501
- Neuroanatomical substrates of depression in the elderly.Eur Arch Psychiatry Clin Neurosci. 1993; 243: 41-46
- Clinical characteristics of magnetic resonance imaging-defined subcortical ischemic depression.Biol Psychiatry. 2004; 55: 390-397
- Atrophy and high intensity lesions: Complementary neurobiological mechanisms in late-life depression.Neuropsychopharmacology. 2000; 22: 264-274
- Cerebral white matter changes and geriatric syndromes: Is there a link?.J Gerontol A Biol Sci Med Sci. 2004; 59A: 818-826
- Relationship of age, age at onset, and sex to depression in older adults.Am J Geriatr Psychiatry. 1998; 6: 248-256
- MRI lesion severity and mortality in geriatric depression.Am J Geriatr Psychiatry. 2003; 11: 678-682
- The prevalence and severity of white matter lesions, their relationship with age, ethnicity, gender, and cardiovascular disease risk factors: The ARIC Study.Neuroepidemiology. 1997; 16: 149-162
- Presence and severity of cerebral white matter lesions and hypertension, its treatment, and its control: The ARIC study.Stroke. 1996; 27: 2262-2270
- Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people: The cardiovascular health study.Stroke. 1996; 27: 1274-1282
- Medial orbital frontal lesions in late-onset depression.Biol Psychiatry. 2001; 49: 803-806
- Lobar distribution of lesion volumes in late-life depression: The Biomedical Information Research Network (BIRN).Neuropsychopharmacology. 2006; 31: 1500-1507
- Hyperintense lesions on magnetic resonance images in bipolar disorder.Biol Psychiatry. 1999; 45: 965-971
- Severe deep white matter lesions and outcome in elderly patients with major depressive disorder: Follow up study.BMJ. 1998; 317: 982-984
- Vascular cognitive impairment.Lancet Neurol. 2003; 2: 89-98
- Provisional diagnostic criteria for depression of Alzheimer disease.Am J Geriatr Psychiatry. 2002; 10: 129-141
- Provisional diagnostic criteria for depression of Alzheimer’s disease.Am J Geriatr Psychiatry. 2002; 10: 125-128
- Brain MRI white matter hyperintensities and one-carbon cycle metabolism in non-geriatric outpatients with major depressive disorder (Part II).Psychiatry Res. 2005; 140: 301-307
- Silent brain infarction on magnetic resonance imaging and neurological abnormalities in community-dwelling older adults.Stroke. 1997; 28: 1158-1164
- The microvascular frontal-subcortical syndrome of aging.Neurobiol Aging. 2002; 23: 421-431
- Maintenance treatment of major depression in old age.N Engl J Med. 2006; 354: 1130-1138
- Establishment of diagnostic validity in psychiatric illness: Its application to schizophrenia.Am J Psychiatry. 1970; 126: 983-987
- Executive control function: A rational basis for the diagnosis of vascular dementia.Alzheimer Dis Assoc Disord. 1999; 13: S69-S80
- White matter hyperintensities are related to physical disability and poor motor function.J Neurol Neurosurg Psychiatry. 2005; 76: 362-367
- Urinary function in elderly people with and without leukoaraiosis: Relation to cognitive and gait function.J Neurol Neurosurg Psychiatry. 1999; 67: 658-660
- MRI and neuropsychological differences in early- and late-life-onset geriatric depression.Neurology. 1996; 46: 1567-1574
- Cerebrovascular risk factors, executive dysfunction, and depression in older primary care patients.Am J Geriatr Psychiatry. 2006; 14: 145-152
- Genetic aspects of microangiopathy-related cerebral damage.J Neural Transm Suppl. 2000; 59: 15-21
- MRI white matter hyperintensities: Three-year follow-up of the Austrian Stroke Prevention Study.Neurology. 1999; 53: 132-139
- Is subcortical disease associated with a poor response to antidepressants?.Psychol Med. 1998; 28: 1015-1026
- Subcortical white matter lesions and functional impairment in geriatric depression.Depress Anxiety. 2002; 15: 23-28
- Cerebrovascular disease and depression symptoms in the cardiovascular health study.Stroke. 1999; 30: 2159-2166
- Structural neuroimaging and mood disorders: Recent findings, implications for classification, and future directions.Biol Psychiatry. 1998; 43: 705-712
- Cerebrovascular disease and evolution of depressive symptoms in the cardiovascular health study.Stroke. 2002; 33: 1636-1644
- Grey-matter lesions and dementia.Lancet. 2000; 356: 1686-1687
- Methodology and preliminary results from the neurocognitive outcomes of depression in the elderly study.J Geriatr Psychiatry Neurol. 2004; 17: 202-211
- A double blind, randomized clinical trial assessing the efficacy and safety of augmenting standard antidepressant therapy with nimodipine in the treatment of ’vascular depression’.Int J Geriatr Psychiatry. 2001; 16: 254-260
- A double-blind, randomized clinical trial to assess the augmentation with nimodipine of antidepressant therapy in the treatment of “vascular depression.”.Int Psychogeriatr. 2005; 17: 487-498
- Clinical features of leuko-araiosis.J Neurol Neurosurg Psychiatry. 1996; 60: 431-436
- Greater MRI lesion volumes in elderly depressed subjects than in control subjects.Psychiatry Res. 2005; 139: 1-7
- Serial MR imaging of hyperintense white matter lesion volumes in elderly subjects: Correlation with vascular risk factors.AJR Am J Roentgenol. 2003; 181: 571-576
- Localization of age-associated white matter hyperintensities in late-life depression.Prog Neuropsychopharmacol Biol Psychiatry. 2003; 27: 539-544
- White matter hyperintensity progression and late-life depression outcomes.Arch Gen Psychiatry. 2003; 60: 1090-1096
- Frontal-subcortical neuronal circuits and clinical neuropsychiatry: An update.J Psychosom Res. 2002; 53: 647-654
- Ischemic basis for deep white matter hyperintensities in major depression.Arch Gen Psychiatry. 2002; 59: 785-792
- Late-onset paranoid psychosis as a distinct clinicopathologic entity: Magnetic resonance imaging data in elderly patients with paranoid psychosis of late onset and schizophrenia of early onset.Neuropsychiatry Neuropsychol Behav Neurol. 1999; 12: 230-235
- Progression of cerebral white matter hyperintensities on MRI is related to diastolic blood pressure.Neurology. 1998; 51: 319-320
- CADASIL: Hereditary arteriopathy leading to multiple brain infarcts and dementia.Ann N Y Acad Sci. 2000; 903: 273-284
- An application of prefrontal cortex function theory to cognitive aging.Psychol Bull. 1996; 120: 272-292
- A prospective study of cerebral white matter abnormalities in older people with gait dysfunction.Neurology. 2001; 57: 990-994
- Total homocysteine is associated with white matter hyperintensity volume: The Northern Manhattan Study.Stroke. 2005; 36: 1207-1211
- White matter hyperintensities on MRI in the neurologically nondiseased elderly: Analysis of cohorts of consecutive subjects aged 55 to 85 years living at home.Stroke. 1995; 26: 1171-1177
Article info
Publication history
Published online: October 04, 2006
Accepted:
May 12,
2006
Received in revised form:
May 10,
2006
Received:
January 18,
2006
Identification
Copyright
© 2006 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
