Elsevier

Biological Psychiatry

Volume 64, Issue 6, 15 September 2008, Pages 491-497
Biological Psychiatry

Archival Report
The Vascular Depression Subtype: Evidence of Internal Validity

https://doi.org/10.1016/j.biopsych.2008.03.032Get rights and content

Background

Vascular depression has been proposed as a unique diagnostic subtype in late life, yet no study has evaluated whether the specified clinical features associated with the illness are jointly indicative of an underlying diagnostic class.

Methods

We applied latent class analysis to two independent clinical samples: the prospective, cohort design, Neurocognitive Outcomes of Depression in the Elderly (NCODE) study and the 8-week, multicenter, double blind, placebo-controlled Old-Old study.

Results

A two-class model consisting of vascular and nonvascular depressed patients provided an excellent fit to the data in both studies, χ2(6) = 2.02, p = .90 in the NCODE study and χ2(6) = 7.024, p = .32 in the Old-Old study. Although all of the proposed features of vascular depression were useful in identifying the illness, deep white matter lesion burden emerged with perfect sensitivity (1.00) and near-perfect specificity (.95), making it the only indicator necessary to determine class membership.

Conclusions

These findings, replicated across two independent clinical samples, provide the first support for the internal validity of vascular depression as a subtype of late-life depression.

Section snippets

Samples

The Neurocognitive Outcomes of Depression in the Elderly (NCODE) study (19) uses a prospective, cohort design to examine neurocognitive outcomes in depressed older adults receiving naturalistic treatment in an outpatient, academic medical setting. All depressed subjects (n = 367) met DSM-IV criteria for single episode or recurrent major depression, were at least 60 years of age at baseline enrollment, and had baseline Mini-Mental Status Exam (MMSE) scores of greater than or equal to 25.

Descriptive Statistics

Descriptive statistics for both the NCODE and Old-Old studies are reported in Table 1 for those who provided both complete and incomplete baseline data on age at onset, a measure of ED, and HI burden. Those with complete baseline data in the NCODE and Old-Old study were comparable in many respects. However, although formal statistical tests across samples were not performed, Old-Old study participants (with complete data) were on average older and had higher depression severity ratings than

Discussion

The results of this study provide the first support for the internal validity of vascular depression as a subtype of late-life depression. A subgroup of patients was identified by the presence of DW, SCG, ED, and LOD. Although all of the proposed core features of vascular depression were used to identify the illness, ultimately, only the presence of DW lesion burden was necessary to determine class membership. Thus, DW lesion burden emerged as the most accurate indicator of the underlying

References (45)

  • A. Miyake et al.

    The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis

    Cognit Psychol

    (2000)
  • G. Alexopoulos et al.

    Executive dysfunction and the course of geriatric depression

    Biol Psychiatry

    (2005)
  • D. Rindskopf

    Using latent class models to test developmental research

    Dev Rev

    (1987)
  • F. Gunning-Dixon et al.

    Neuroanatomical correlates of selected executive functions in middle-aged and older adults: A prospective MRI study

    Neuropsychologia

    (2003)
  • J.R. Sneed et al.

    Response inhibition predicts poor antidepressant treatment response in very old depressed patients

    Am J Geriatr Psychiatry

    (2007)
  • G.S. Alexopoulos

    The vascular depression hypothesis: 10 years later

    Biol Psychiatry

    (2006)
  • M.A. Young

    Evaluating diagnostic criteria: A latent class paradigm

    J Psychiatr Res

    (1983)
  • M.D. Van den Berg et al.

    Depression in later life: Three etiologically different subgroups

    J Affect Disord

    (2001)
  • G.S. Alexopoulos et al.

    'Vascular depression' hypothesis [see comment]

    Arch Gen Psychiatry

    (1997)
  • K.R. Krishnan et al.

    Arteriosclerotic depression

    Med Hypotheses

    (1995)
  • T. Fujikawa et al.

    Incidence of silent cerebral infarction in patients with major depression

    Stroke

    (1993)
  • K.R. Krishnan et al.

    MRI-defined vascular depression

    Am J Psychiatry

    (1997)

    • Cited by (0)

    View full text
    Copyright © 2008 Published by Elsevier Inc.