A cross-sectional study to find out the prevalence, pattern, risk factors, comorbidities and severity of vascular depression in patients attending psychiatric outpatient department in a tertiary care centre

Sandeep Nigam, Madhukar Prasad Shukla, Samhita Bhushan


Background: Depression was declared as the second major cause of disability adjusted life years (DALY) in 2020 and the economic burden experienced by those with depression is next to coronary artery disease. Vascular depression has late age at onset 60 years or older, nonpsychotic subtype, with no family history of mental disorders, presenting with loss of pleasure and functional disability. Depression is accompanied by cerebrovascular lesions as determined by MRI and not accompanied by neurological signs. This has a spiral correlation with various comorbidities leading to diagnostic enigma at one hand and worsened prognosis on the other. This emphasized the early diagnosis and treatment to improve the quality of life.

Methods: Patients with age more than 60 years, of either sex, with a mini GDS score ≥5, having the first episode of depression and who gave consent were included.

Results: Hypertension thus emerged as a significant risk factor and was positively associated with increased severity of depression.

 Conclusions: Subclinical cognitive impairment and mild cognitive impairment (MCI) may precede years before the onset of vascular depression. Prompt detection and management of these entities and associated risk factors could prevent or postpone impending vascular depression.


Depression, Vascular depression, Mini GDS score, Cognitive impairment, MCI

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Christopher JL, Murrey. World Health Organization Geneva, Switzerland. 2002

Caine ED, Lyness JM, King DA, Connors L. Clinical and Etiological Heterogenetiy of Mood Disorders in Elderly Patients. In: Diagnosis and Treatment of Depression in Late Life (Eds. L.S. Schneider, C.F. Reynolds, B.D. Lebowitz, A.J. Friedhoff). American Psychiatric Press, Washington DC.

Alexopoulos GS, Meyers BS, Young RC. Clinically defined vascular depression. Am J Psychiatry. 1997;154:562-5.

Newberg AR, Davydow DS, Lee HB. Cerebrovascular disease basis of depression: post-stroke depression and vascular depression. Int Rev Psychiatry. 2006;18:433-41.

Alexopoulos GS, Meyers BS, Young RC. Vascular depression’ hypothesis. Arch Gen Psychiatry. 1997;54:915-22.

Krishnan KR, Hays JC, Blazer DG. MRI-defined vascular depression. Am J Psychiatry. 1997;154:497-501.

Krishnan KRR, McDonald WM, Doraiswamy PM, Tupler LA, Husain M, Boyko OB et al. Neuroanatomical Substrates of Depression in the Elderly. Eur. Arch. Psychiatry Neurosci. 1993;243:41-6.

Awad. Incidental Subcortical Lesions Identified on MRI in the Elderly. Postmortem Pathological Correlation. Stroke. 1986;17:1090-7.

Saloman A. Subcortical Arteriosclerotic Encephalopathy: Brain Stem Findings with MRI, Radiology. 1987;165:626-9.

Hachinski V, Porter P, Merskey H. Leukoaraiosis. Arch Nurol. 1987;44:21-3.

Fazekas. MR Signal Abnormalities at 1.5 T in Alzheimer's Disease and Normal Ageing. Am. J. Neuroradiol. 1987;8:421-6.

Fisher CM. The Arterial Lesions Underlying Lacunes. Neuropatho. 1969;12:1-15.

McDonald WM. MRI Study of Age Related Changes in Human Putmen Nuclei. Neuro Report. 1991;2:57-60.

Coffey CE, Figiel GS, Djang WT, Weiner RD. Subcortical Hyperintensity on Magnetic Resonance Imaging: A Comparison of Normal and Depressed Elderly Subjects. Am J Psychiatry. 1990;147:187-9.

Steffens DC, Payne ME, Greenberg DL. Hippocampal Volume and Incident Dementia in Geriatric Depression. Am J Geriatr Psychiatry. 2002;10:62-71.

Folstein MF, Folstein SE, McHugh PR. Mini-mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician. J Psychiatr Res. 1975;12:189-98.

ICMR Bulletin. Mental Health Ageing. June 2001.

Rao VAA, Virudhagirinathan BS, Malati R. Mental Illness In-Patients Aged 50 and above. Indian Journal of Psychiatry. 1972;14:319.

Nandi DN, Ajnavy S, Ganguly H, Banerjee G, Ghosh A, Sarkar S. Psychiatric Disorders in a Rural Community in West Bengal. An Epidemilogical Study. Ind J Psy. 1975;17:87.

Henderson AS, Jorm AF, Mackinnon A, Christensen H, Scott LR, Korten AE et al. The Prevalence of Depressive Disorder and the Distribution of Depressive Symptoms in Later Life: A Survey Using Draft ICD-10 and DSM-lll-R. Psychol Med. 1993;23:719-29

Kendler KS, Kessler RC, Neale MC, Heath AC, Eaves LJ. The prediction of Major Depression in Women: Toward an Integrated Etiologic Model Am. J. Psychiatry. 1993;150:1139-48.

Lobo A, Saz P, Marcos G, Dia JL, De-la-Camara C. The Prevalence of Dementia and Depression in the Elderly Community in a Southern European Population. Arch. Gen. Psychiatry 1995;52:497-506.

Pahkala K, Kivela SL, Laippala P. Social and Environmental Factors and Major Depression in Old Age. Zeitschrift Fur Gerontologie. 1991;24:17-23.

Regier DA, Farmer ME, Rae DS, Myers JK, Kramer M, Robins LN et al. One month Prevalence of Mental Disorders in the United States and Sociodemographic Characteristics: The Epidemiologic Catchment Area Study. Acta Psychiatr. Scand, 1993;88:35-47.

Livingstone G, Hawkins A, Graham N, Blizard B and Mann A. The Gospel Oak Study: Prevalence Rates of Dementia, Depression and Activity Limitation among Elderly Residents in inner London. Psychol, Med. 1990;20:137-46.

Kennedy GJ, Kelman HR, Thomas C. The Emergence of Depressive Symptoms in Late Life: The Importance of Declining Health and Increasing Disability. J. Comm. Health. 1990;15:93-104.

Burvill PW, Hall WD, Stampfer HG, Emmerson JP. A comparison of early onset and late onset depressive illness in the elderly. Br. J. Psychiatry. 1989;155:673-9.

Hickie I, Scott E, Mitchell P, Wilhelm K, Austin MP, Bennett B. Subcortical Hyperintensities of Magnetic Resonance Imaging: Clinical Correlates and Prognostic Significance in Patients with Severe Depression. Biol Psychiatry. 1995;37:151-60.

Acharya A. Depression in Older People: A Point to Remember in All Series. J Indian Med Assoc. 2004:102(10):559-61.

Brown AS, Gershon S. Dopamine and Depression. J Neural Transm. 1993;91:75-109.

Winokur G. Clinical and Biological Aspect of Depression in the Elderly Psychopatho in the Aged. 1980.

Meyers BS, Kalayam B, Mei-Tal V. Late Onset Delusional Depression: A Distinct Clinical Entity? J Clin Psychiatry. 1984;45:347-9.

Abas MA, Sahakian BJ, Levy R. Neuropsychological Deficit and CT Scan Changes in Elderly Depressives. Psychol Mod. 1990;20:507-20.

Schweitzer I, O'Brien JT, Desmond P, Ames D, Harrigan S, Tres B. Magnetic Resonance Imaging Study of White Matter Lesions in Depression and Alzheimer's Disease. Br. J. Psychiatry 2000;168:477-85.

Jacoby RJ, Levy R: CT in the Elderly, III Affective Disorder. Br J Psychiatry. 1980;136:270-5.

Coffey CE, Wilkinson WE, Weiner RD, Parashos IA, Djang WT, Webb MCFigiel GS et al. Quantitative Cerebral Anatomy in Depression: A Controlled Magnetic Resonance Imaging Study. Arch Gen Psychiatry. 1993;50:7-16.