Depression in the Elderly Linked to Damaged Areas of the Brain

From the WebMD Archives

Sept. 30, 1999 (Atlanta) -- Researchers at Duke and Wake Forest universities have detected a link between depression in the elderly and small strokes that otherwise produce no symptoms.

According to research published in the October issue of Stroke: Journal of the American Heart Association, brain lesions were present in elderly people who were diagnosed with what scientists term vascular depression, a type of depression caused by changes in the blood flow in the brain. Previous studies with fewer patients have shown similar results.

"The type of depression these lesions are associated with is very different than depression in people in their 20s and 30s," researcher David Steffens, MD, of Duke University Medical Center, tells WebMD. "The experience is much more of a losing of interest, apathy, and social withdrawal. The public and some physicians don't appreciate a criterion of slowing down compared to outward sadness or crying. A lot of these older people tell me they wish they could summon up the energy to cry."

Stroke occurs when blood vessels leading to the brain become blocked or begin to leak, interrupting flow and killing brain tissue. Steffens believes that in this group of elderly patients, damage is done to parts of the brain that affect appetite, sleep, and energy.

"The same processes that puts people at risk for classic strokes are also at work here," says Steffens. "The difference is these vascular changes hit different parts of the brain but don't produce classic stroke symptoms [such as weakness] on one side of the body and slurred speech. Instead it produces these symptoms of depression."

Steffens says the same cardiovascular risk factors for classic or larger strokes, such as high blood pressure or cholesterol counts and diabetes, for example, also were present in subjects with these brain lesions and symptoms of depression.

In the study, 3,660 men and women over 65 were given physical examinations and interviewed in detail about their medical histories and current health. Then an MRI was conducted, a technique that allows a doctor to see a very detailed image of the brain.

"More than two lesions carry some degree of risk," he says. "A few may do enough damage to contribute to depression symptoms."

The study's results could lead to enhanced diagnosis and treatment of depression through the detection of lesions, and could help physicians gauge the risk of massive strokes in people with health risks who may have already suffered this smaller type of stroke.

"The study demonstrates that stroke, as a disease process, is even a larger problem than previously considered," says Arthur Pancioli, MD, who reviewed the study for WebMD.

"If depression is documented in an older person without a previous history of depression, physicians might consider looking for vascular disease," says Pancioli, who is an assistant professor of emergency medicine at the University of Cincinnati Medical Center and a member of the Greater Cincinnati-Greater Kentucky Stroke Team. "If people have had subtle strokes they are likely at risk for larger, more disabling strokes. The number-one thing we can do for stroke is prevent it."

Steffens says that further research is necessary before effective treatment combinations may come about. "Future studies might examine the role of antidepressants and [blood thinning] therapy, but we're not there yet."

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