Vascular Heart and Brain Disease and Incident Late-Life Depression

Depression is characterized by depressed mood, loss of interest, rumination, feelings of guilt and shame, suicidal ideation, disturbed sleep and loss of appetite (1). It is associated with limitations in physical and social functioning and places a severe burden on patients and relatives (2). Compared to depression in middle age, late-life depression has some specifi c characteristics. Depressive syndromes that escape the strict criteria of the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM) for major depressive disorder and dysthymia are more common in the elderly (3-5). Many elderly have only some symptoms of depression. Such subthreshold depressive syndromes are considered clinically relevant, because they are related to increased disability and mortality, as are depressive disorders that meet DSM criteria (6-10). Moreover, depression is more common in the old age than in midlife. Th e prevalence ranges from 9 to 18 % in the general elderly population, to more than 30% in long-term care residents (3, 5, 11, 12). Depression in late life often has a chronic course (3, 5, 11, 13) Only 60% of patients recover in one year and 70-80% in two years (7, 9, 14-19). A number of risk factors for depression has been established, which predispose, precipitate, or perpetuate the disease. Female gender, adverse life events, and poverty are the most well known. Late-life depression has some additional specifi c risk factors. Depressive symptoms are very much related to cognitive decline, which occur as part of neurodegenerative brain diseases, such as Alzheimer’s disease, and Parkinson’s disease. Vascular brain damage, such as stroke and white matter lesions, are associated with late-life depression as well. Depression is also common in elderly patients with chronic disabling diseases. Th e focus of this thesis is to further assess the association between cardio- and cerebrovascular diseases and depression in late life.