Cited by 291Dementia and Cognitive Impairment ResearchTreatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

Support for the Vascular Depression Hypothesis in Late-Life Depression: Results of a 2-Site, Prospective, Antidepressant Treatment Trial

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Sheline, Yvette I., Pieper, Carl F., Barch, Deanna M., Welsh-Boehmer, Kathleen, McKinstry, Robert C., MacFall, James R., D’Angelo, Gina, Garcia, Keith S. +6 more·2010·Archives of General Psychiatry

Abstract

CONTEXT: Research on vascular depression has used 2 approaches to subtype late-life depression, based on executive dysfunction or white matter hyperintensity severity. OBJECTIVE: To evaluate the relationship of neuropsychological performance and white matter hyperintensity with clinical response in late-life depression. DESIGN: Two-site, prospective, nonrandomized controlled trial. SETTING: Outpatient clinics at Washington University and Duke University. PARTICIPANTS: A total of 217 subjects aged 60 years or older met DSM-IV criteria for major depression, scored 20 or more on the Montgomery-Asberg Depression Rating Scale (MADRS), and received vascular risk factor scores, neuropsychological testing, and magnetic resonance imaging; they were excluded for cognitive impairment or severe medical disorders. Fazekas rating was conducted to grade white matter hyperintensity lesions. Intervention Twelve weeks of sertraline treatment, titrated by clinical response. Main Outcome Measure Participants' MADRS scores over time. RESULTS: Baseline neuropsychological factor scores correlated negatively with baseline Fazekas scores. A mixed model examined effects of predictor variables on MADRS scores over time. Baseline episodic memory (P = .002), language (P = .007), working memory (P = .01), processing speed (P < .001), executive function factor scores (P = .002), and categorical Fazekas ratings (P = .05) predicted MADRS scores, controlling for age, education, age of onset, and race. Controlling for baseline MADRS scores, these factors remained significant predictors of decrease in MADRS scores, except for working memory and Fazekas ratings. Thirty-three percent of subjects achieved remission (MADRS < or =7). Remitters differed from nonremitters in baseline cognitive processing speed, executive function, language, episodic memory, and vascular risk factor scores. CONCLUSIONS: Comprehensive neuropsychological function and white matter hyperintensity severity predicted MADRS scores prospectively over a 12-week treatment course with selective serotonin reuptake inhibitors in late-life depression. Baseline neuropsychological function differentiated remitters from nonremitters and predicted time to remission in a proportional hazards model. Predictor variables correlated highly with vascular risk factor severity. These data support the vascular depression hypothesis and highlight the importance of linking subtypes based on neuropsychological function and white matter integrity. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00045773.

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  • Baseline impairments in episodic working memory, processing speed, executive function, as well as severity of baseline white matter hyperintensities predict decreased LLD improvement with antidepressant treatment.

    “Other studies have similarly found that baseline impairments in episodic working memory, processing speed, executive function, as well as severity of baseline white matter hyperintensities (WMH) predict decreased LLD improvement with antidepressant treatment130.”
  • Executive dysfunction predicts poor response of LLD to antidepressants and early relapse and recurrence.

    “Executive dysfunction predicts poor response of LLD to antidepressants and early relapse and recurrence32–38.”

    From Mechanisms and treatment of late-life depression (2019) · cites this paper as [37]

  • DED is a syndrome with poor response to antidepressants.

    “Problem solving therapy was more effective that supportive therapy in reducing depression and disability in older adults with DED162,163, a syndrome with poor response to antidepressants32–38,164.”

    From Mechanisms and treatment of late-life depression (2019) · cites this paper as [37]

  • The depression-executive dysfunction (DED) syndrome has a slow or poor response to antidepressants.

    “The depression-executive dysfunction (DED) syndrome has a slow or poor response to antidepressants32–38,164.”

    From Mechanisms and treatment of late-life depression (2019) · cites this paper as [37]

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Authors
Sheline, Y. I., Pieper, C. F., Barch, D. M., Welsh-Boehmer, K., McKinstry, R. C., MacFall, J. R., D’Angelo, G., Garcia, K. S., Gersing, K., Wilkins, C., Taylor, W., Steffens, D. C., Krishnan, R. R., & Doraiswamy, P. M.
Affiliations
  • Washington University in St. Louis (US)
  • Duke University (US)
Venue
Archives of General Psychiatry
Published
2010-03-01
Volume
67
Issue
3
Pages
277
ISSN
0003-990X (ISSN-L)
OpenAlex
W2105366771
Cited by
291
References
64
Citations by year
2026: 8 · 2025: 4 · 2024: 1 · 2023: 7 · 2022: 10 · 2021: 14 · 2020: 46 · 2019: 15 · 2018: 14 · 2017: 14 · 2016: 20 · 2015: 19 · 2014: 22 · 2013: 31 · 2012: 33
FWCI
20.72
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000448)
  • U.S. Public Health Service (K24 65421)
  • National Institute of Mental Health (R01 MH62158, R01-MH60697, R01MH060697, R01MH062158)
  • National Center for Research Resources (RR.00036, M01RR000036)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
vascular depression, geriatric depression, white matter hyperintensities, executive dysfunction, neuropsychological performance, sertraline, selective serotonin reuptake inhibitors, depression remission, processing speed, episodic memory, vascular risk factors
MeSH terms
Aged, Brain, Cerebrovascular Disorders, Cognition Disorders, Major Depressive Disorder, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Neuropsychological Tests, Prospective Studies, Psychiatric Status Rating Scales, Severity of Illness Index, Proportional Hazards Models, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Age of Onset, Sertraline, Executive Function

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