Brain Study Links Depression, Vascular Disease

Physicians caring for elderly patients with depression now have one more cause to consider before prescribing an appropriate treatment—the constriction of small- and medium-sized blood vessels leading to the brain.

Researchers from the Institute for the Health of the Elderly at the University of Newcastle upon Tyne in the United Kingdom, intrigued by previous studies finding that poststroke depression occurs in 65 percent of the elderly, studied the brains of 40 elderly people postmortem. They reported their findings in the January issue of the Journal of Neurology, Neurosurgery, and Psychiatry.

Half the study subjects met criteria for at least one episode of major depression, and the remaining half, the control subjects, had no history of depression. All 40 subjects had died at the age of 60 years or older.

Lead researcher Alan J. Thomas, M.B.Ch.B., a lecturer in old-age psychiatry based at the Wolfson Research Centre at Newcastle General Hospital in the United Kingdom, assessed the presence of atheroma, or the narrowing and hardening of blood vessels, in the postmortem brains of the study subjects.

He found that compared with the control subjects, approximately half of the depressed subjects had significantly higher rates of atheroma in both the cerebral and aortic vessels.

“These findings suggest that the atherosclerotic disease contributes to depression in a proportion of the elderly,” said Thomas, who suggested a theory behind the increased depression. “The narrowing of the arteries may lead to reduced blood supply in key areas of the brain that regulate mood and behavior.”

Thomas pointed out, however, that the study had notable limitations. “At this early stage of the research, there is not enough information about the number of elderly affected by vascular depression.” Additionally, the study had a small number of subjects, further limiting the significance of findings.

Thomas, who believes that treatments used for vascular diseases might become appropriate for use in some elderly people with late-onset depression, is currently involved in research that looks more closely at the details of vascular changes.

An abstract of the study, “A Neuropathological Study of Vascular Factors in Late-Life Depression,” is posted on the Web at jnnp.bmjjournals.com/cgi/content/abstract/70/1/83. ▪