Cerebrovascular diseases and depression: Epidemiology, mechanisms and treatment

摘要

Both cerebrovascular disease (CVD) and depression are common conditions in the elderly, and there is emerging evi-dence of a bi-directional relationship: 1) depression can cause CVD and stroke, transient ischemic attack; and 2) subcorti-cal CVD are associated with increased risk for depression. The frequency of poststroke depression is highest during the first month after the stroke, but remains high even after sev-eral years. Depression is associated with poorer functional prognosis and higher mortality after stroke. There is good evidence that severity of functional impairment, high neurot-icism, low social support as well as genetic factors are associ-ated with an increased risk for post-stroke depression. Deep white matter lesions are the most consistent imaging corre-late of depression. Potential mechanisms mediating the asso-ciation between depression and CVD are neuroinflammation and HPA-axis activation, fronto-subcortical circuit lesions, and serotonergic dysfunction. Antidepressants have dem-onstrated effect on poststroke depression in meta-analyses, and such drugs as well as vitamin B can reduce the incidence of depression in stroke survivors. In addition, serotonergic drugs may strengthen poststroke motor and cognitive re-covery, potentially through restorative mechanisms. Psycho-therapeutic strategies such as problem-solving therapy seem to be effective. There is emerging evidence that treatment of cardiovascular disease and risk-factors can reduce the risk for late-life depression, but more studies are needed to test this hypothesis.