Pathomechanisms of Vascular Depression in Older Adults

Depression in older individuals is a common complex mood disorder with high comorbidity of both psychiatric and physical diseases, associated with high disability, cognitive decline, and increased mortality The factors predicting the risk of late-life depression (LLD) are incompletely understood. The reciprocal relationship of depressive disorder and age- and disease-related processes has generated pathogenic hypotheses and provided various treatment options. The heterogeneity of depression complicates research into the underlying pathogenic cascade, and factors involved in LLD considerably differ from those involved in early life depression. Evidence suggests that a variety of vascular mechanisms, in particular cerebral small vessel disease, generalized microvascular, and endothelial dysfunction, as well as metabolic risk factors, including diabetes, and inflammation that may induce subcortical white and gray matter lesions by compromising fronto–limbic and other important neuronal networks, may contribute to the development of LLD. The “vascular depression” hypothesis postulates that cerebrovascular disease or vascular risk factors can predispose, precipitate, and perpetuate geriatric depression syndromes, based on their comorbidity with cerebrovascular lesions and the frequent development of depression after stroke. Vascular burden is associated with cognitive deficits and a specific form of LLD, vascular depression, which is marked by decreased white matter integrity, executive dysfunction, functional disability, and poorer response to antidepressive therapy than major depressive disorder without vascular risk factors. Other pathogenic factors of LLD, such as neurodegeneration or neuroimmune regulatory dysmechanisms, are briefly discussed. Treatment planning should consider a modest response of LLD to antidepressants, while vascular and metabolic factors may provide promising targets for its successful prevention and treatment. However, their effectiveness needs further investigation, and intervention studies are needed to assess which interventions are appropriate and effective in clinical practice.

Efetividade da terapia com vitamina D em idosos com depressão

Analisar a efetividade da terapia com vitamina D em idosos com depressão, em comparação ao uso de placebos. Revisão sistemática de literatura. Para seu desenvolvimento, efetuou-se pesquisa em bases de dados para a saúde, seguida da aplicação dos critérios de elegibilidade, considerando textos completos em inglês, português e Ensaios Clínicos Randomizados publicados entre 2008-2020. Em sequência, mediante leitura dos títulos e resumos aos pares, seis publicações compuseram a amostragem final. Os achados indicaram, majoritariamente, inexistir diferenças significativas entre os sintomas depressivos em idosos suplementados com a vitamina D em comparação ao uso do placebo. Os achados não mostraram evidências significativas, atestando que a suplementação da vitamina D não refletiu melhores resultados para a depressão em idosos. Contudo, importante mencionar que uma publicação registrou melhorias em pacientes dialíticos com depressão vascular, melhorando o funcionamento cardiovascular desses pacientes após a suplementação.Descritores: Vitamina D, Depressão, Idosos. Effectiveness of vitamin d therapy in elderly people with depressionAbstract: To analyze the effectiveness of vitamin D therapy in elderly people with depression, compared to the use of placebos. Systematic literature review. For the development of the study, a search was performed in the health’s databases, followed by the application of the eligibility criteria, considering the complete texts in English and Portuguese; Randomized Clinical Trials published between the 2008-2020. In sequence, through the reading of the titles and abstracts in pairs, six publications made up the final sample. The selected articles stated that there were no significant differences between depressive symptoms in the elderly related to vitamin D supplementation compared to the use of placebo. The findings showed no significant evidence, attesting that vitamin D supplementation did not reflect better results for depression in the elderly. However, it is important to mention that one publication recorded improvements in dialysis patients with vascular depression, improving the cardiovascular functioning of these patients after supplementation.Descriptors: Vitamin D, Depression, Seniors. Efectividad de la terapia con vitamina d en ancianos con depresiónResumen: Analizar la efectividad de la terapia con vitamina D en ancianos con depresión, en comparación con el uso de placebos. Revisión sistemática de la literatura. Para el desarrollo del estudio se realizó una búsqueda en las bases de datos de salud, seguida de la aplicación de los criterios de elegibilidad, considerando los textos completos en inglés y portugués; ensayos clínicos aleatorizados publicados entre 2008-2020. En secuencia, mediante la lectura de títulos y resúmenes por parejas, seis publicaciones conformaron la muestra final. Los artículos seleccionados indicaron que no hubo diferencias significativas entre los síntomas depresivos en los ancianos relacionados con la suplementación con vitamina D en comparación con el uso de placebo. Los hallazgos no mostraron evidencia significativa, lo que atestigua que la suplementación con vitamina D no reflejaba mejores resultados para la depresión en los ancianos. Sin embargo, es importante mencionar que una publicación registró mejoras en pacientes de diálisis con depresión vascular, mejorando el funcionamiento cardiovascular de estos pacientes después de la suplementación.Descriptores: Vitamina D, Depresión, Mayores.

Analysis of the Clinical Case of Long-term Monitoring of a Patient with Comorbid Depression: Special Considerations of Psychopharmacotherapy

Depression associated with somatic diseases ranks high among other depressive disorders and has a number of specifi c clinical features as compared to classic depression.The aim of the study was to analyse specifi c features of comorbid depression clinical course, its diagnosis, and methodology for the selection of psychopharmacotherapy—using a clinical case as an example.Results: the authors carried out a detailed retrospective clinical analysis of medical records of long-term (over three years) dynamic monitoring of a patient with comorbid vascular depression. They explored the tactics of selecting pharmacotherapy for anxiety-depressive disorder given the underlying chronic cerebral ischemia, atherosclerosis of brachiocephalic arteries, аrterial hypertension, and atherosclerotic cardiosclerosis. The primary focus was on specifi c aspects of vascular depression pharmacotherapy that were governed by a diverse clinical picture of comorbid personality disorders, dynamic transformation of somatic, neurological, and psychic symptoms and syndromes in a patient. The paper highlights the need for alignment of scientifi c and methodological approaches to assessment of potential risks associated with the use of psychotropic medicines.Conclusions: the choice of rational psychopharmacotherapy for vascular depression should be governed by the data on the drug effi cacy for the prevailing clinical symptoms, by the age and gender characteristics of the patient, by compensation status of organs and systems, as well as by genetic, personal, and social characteristics that aff ect the disease progression. The use of a comprehensive multidisciplinary approach to the diagnosis and treatment of comorbid personality disorders, as well as implementation of personalised medicine methodology in clinical practice in order to assess the patient’s condition as infl uenced by changes in his/her somatic, neurological, psychic status and the results of psychological testing, will increase the effi cacy and safety of treatment.

Oxidative Stress-Related Endothelial Damage in Vascular Depression and Vascular Cognitive Impairment: Beneficial Effects of Aerobic Physical Exercise

Oxidative stress- (OS-) related endothelial damage is involved in the occurrence and progression of several disorders, such as vascular depression and dementia. It has been reported that moderate, aerobic, physical exercise could reduce OS and inflammation, thus limiting the cardiovascular risk factors while improving endothelial homeostasis, mood, and cognition. In this review, we will discuss about the role of OS and OS-related endothelial damage in vascular depression and vascular cognitive impairment. Then, we will comment on the effects of physical exercise on both disorders.

BROODING MODERATES THE RELATIONSHIP BETWEEN CEREBROVASCULAR BURDEN AND VASCULAR DEPRESSION

Objective: The vascular depression hypothesis posits that cerebrovascular burden confers risk for late-life depression. Though neuroanatomical correlates of vascular depression (prefrontal white matter hyperintensities) are well established, little is known about cognitive correlates; the identification of which may suggest therapeutic targets. Aims of this study are to examine the hypothesis that the relationship between cerebrovascular burden and depressive symptoms is moderated by brooding, a type of rumination. Method: A sample of 52 community-dwelling, stroke-free, individuals over the age of 70, without history of severe mental illness or dementia completed the Ruminative Responses Scale, and provided self-report (cardiac disease, hypertension, diabetes, high cholesterol) CVB data. The Geriatric Depression Scale was used to assess depressive symptomatology. Results: Results of a bootstrapped model were that self-reported measures of CVB predicted depressive symptomatology. This relationship was significantly moderated by brooding. Among older adults, those who self-reported high CVB and medium to elevated levels of rumination experienced disproportionately more depressive symptomatology. Conclusions: These findings suggest that brooding rumination may be one correlate of the vascular depression syndrome. Future research should examine neuroanatomical correlates of rumination among older adults, and further explore brooding as a therapeutic target for those with late-life depression.