Cerebral White Matter Lesions and Depressive Symptoms in Elderly Adults

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Abstract
FOR THE majority of persons with a depression syndrome the age of onset is in the late 20s, but it is also common to have an onset after age 40 years.1,2 Between 1% and 2% of elderly persons suffer from a major depression.3 When a first depressive episode occurs in late life, a different cause is suggested as compared with a younger age of onset.4 It has been suggested that a cerebrovascular component is probably more important to the cause of late-life depression than genetic or psychological factors.5-8 Interest in cerebrovascular disease as a risk factor for depression has grown in the past 5 years, and associations between factors such as hypertension and transient ischemic attacks with depression have been reported.9 Cerebral white matter lesions (WMLs) are thought to result from cerebrovascular brain damage.10 Within the clinical setting, severity of WML has been related with the presence of depression11-13 and with poor outcome of depression.14 Furthermore, when studying persons with a late-life depression, an increased severity of WMLs has been associated with a later age of onset.5,11,15,16 Although these clinical studies provide clues to the relation between WMLs and depression, they have limitations because of the highly selected study population.