Skip to main content Accessibility help
×
Home

Vascular lesions and functional limitations among older adults: does depression make a difference?

  • Celia F. Hybels (a1), Carl F. Pieper (a2), Lawrence R. Landerman (a3), Martha E. Payne (a4) and David C. Steffens (a5)...

Abstract

Background:

The association between disability and depression is complex, with disability well established as a correlate and consequence of late life depression. Studies in community samples report that greater volumes of cerebral white matter hyperintensities (WMHs) seen on brain imaging are linked with functional impairment. These vascular changes are also associated with late life depression, but it is not known if depression is a modifier in the relationship between cerebrovascular changes and functional impairment.

Methods:

The study sample was 237 older adults diagnosed with major depression and 140 never depressed comparison adults, with both groups assessed at study enrollment. The dependent variable was the number of limitations in basic activities of daily living (ADL), instrumental ADLs, and mobility tasks. The independent variable was the total volume of cerebral white matter lesions or hyperintensities assessed though magnetic resonance imaging.

Results:

In analyses controlling for age, sex, race, high blood pressure, and cognitive status, a greater volume of WMH was positively associated with the total number of functional limitations as well as the number of mobility limitations among those older adults with late life depression but not among those never depressed, suggesting the association between WMH volume and functional status differs in the presence of late life depression.

Conclusions:

These findings suggest older patients with both depression and vascular risk factors may be at an increased risk for functional decline, and may benefit from management of both cerebrovascular risk factors and depression.

Copyright

Corresponding author

Correspondence should be addressed to: Dr. Celia F. Hybels, Associate Professor, Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Box 3003, Durham, 27710 NC. Phone: +(919) 660-7546; Fax: +(919) 668-0453. Email: celia.hybels@duke.edu.

References

Hide All
Alexopoulos, G. S. et al. (1996). Disability in geriatric depression. American Journal of Psychiatry, 153, 877885.
Alexopoulos, G., Meyers, B., Young, R., Campbell, S., Silbersweig, D. and Charlson, M. (1997). ‘Vascular depression’ hypothesis. Archives of General Psychiatry, 54, 915922.
Baezner, H. et al. (2008). Association of gait and balance disorders with age-related white matter changes: the LADIS Study. Neurology, 70, 935942.
Blahak, C. et al. (2009). Deep frontal and periventricular age related white matter changes but not basal ganglia and infratentorial hyperintensities are associated with falls: cross-sectional results from the LADIS study. Journal of Neurology, Neurosurgery, and Psychiatry, 80, 608613.
Blazer, D. and Hughes, D. (1991). Subjective social support and depressive symptoms in major depression: separate phenomena or epiphenomena. Journal of Psychiatric Research, 25, 191203.
Bruce, M. L. (2001). Depression and disability in late life: Directions for future research. American Journal of Geriatric Psychiatry, 9, 102112.
Efron, B. and Tibshirani, R. (1994). An Introduction to the Bootstrap: CRC Monographs on Statistics and Applied Probability 57. Boca Raton: Chapman and Hall.
Fillenbaum, G. G. (1988). Multidimensional Functional Assessment of Older Adults: The Duke Older Americans Resources and Services Procedures. Hillsdale, NJ: Erlbaum.
Folstein, M. F., Folstein, S. E. and McHugh, P. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for clinicians. Journal of Psychiatric Research, 12, 189198.
Hannestad, J. et al. (2006). White matter lesion volumes and caudate volumes in late-life depression. International Journal of Geriatric Psychiatry, 21, 11931198.
Inzatari, D. et al. (2007). Risk of rapid global functional decline in elderly patients with severe cerebral age-related white matter changes. Archives of Internal Medicine, 167, 8188.
Katz, I. R. (2004). Depression and frailty: the need for multidisciplinary research. American Journal of Geriatric Psychiatry, 12, 15.
Katz, S., Downs, T. D., Cash, H. R. and Grotz, R. C. (1970). Progress in development of the index of ADL. The Gerontologist, 10, 2030.
Krishnan, K. R. R., Hays, J. C. and Blazer, D. G. (1997). MRI-defined vascular depression. American Journal of Psychiatry, 154, 497501.
Masdeu, J. C. and Wolfson, L. (2009). White matter lesions predispose to falls in older people. Stroke, 40, e546.
Pantoni, L. et al. (2006). Leukoaraiosis predicts hidden global functioning impairment in nondisabled older people: the LADIS (Leukoaraiosis and Disability in the Elderly) Study. Journal of the American Geriatrics Society, 2006, 10951101.
Payne, M., Fetzer, D., MacFall, J., Provenzale, J., Byrum, C. and Krishnan, K. (2002). Development of a semi-automatic method for quantification of MRI gray and white matter lesions in geriatric subjects. Psychiatry Research Neuroimaging, 115, 6377.
Radloff, L. S. (1977). The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385401.
Robins, L. N., Helzer, J. E., Croughan, J. and Ratcliff, K. (1981). National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Archives of General Psychiatry, 38, 381389.
Rosano, C., Kuller, L. H., Chung, H., Arnold, A. M., Longstreth, W. T. and Newman, A. B. (2005). Subclinical brain magnetic resonance imaging abnormalities predict physical functional decline in high-functioning older adults. Journal of the American Geriatrics Society, 53, 649654.
Rosow, I. and Breslau, N. (1966). A Guttman health scale for the aged. Journal of Gerontology, 21, 556559.
Rothman, K., Greenland, S. and Lash, T. (2008). Modern Epidemiology. Philadephia: Wolters Kluwer Health/Lippincott Williams and Wilkins.
Srikanth, V. et al. (2009). Cerebral white matter lesions, gait, and the risk of incident falls. Stroke, 40, 175180.
Steffens, D. C. and Krishnan, K. R. R. (1998). Structural neuroimaging and mood disorders: recent findings, implications for classification, and future directions. Social and Biological Psychiatry, 43, 705712.
Steffens, D. C., Hays, J. C. and Krishnan, K. R. R. (1999). Disability in geriatric depression. American Journal of Geriatric Psychiatry, 7, 3440.
Steffens, D., Bosworth, H., Provenzale, J. and MacFall, J. (2002). Subcortical white matter lesions and functional impairment in geriatric depression. Depression and Anxiety, 15, 2328.
Steffens, D. C. et al. (2007). Longitudinal magnetic resonance imaging vascular changes, apolipoprotein E genotype, and development of dementia in the Neurocognitive Outcomes of Depression in the Elderly Study. American Journal of Geriatric Psychiatry, 15, 839849.
Taylor, W. D. et al. (2003). White matter hyperintensity progression and late-life depression outcomes. Archives of General Psychiatry, 60, 10901096.
Taylor, W. et al. (2005). Greater MRI lesion volumes in elderly depressed subjects than in control subjects. Psychiatry Research Neuroimaging, 139, 17.
Thomas, A. et al. (2002). Ischemic basis for deep white matter hyperintensities in major depression. Archives of General Psychiatry, 59, 785792.
Tupler, L., Krishnan, K., McDonald, W., Dombeck, C., D'Souza, S. and Steffens, D. (2002). Anatomic location and laterality of MRI signal hyperintensities in late-life depression. Journal of Psychosomatic Research, 53, 665676.
VanderWeele, T. and Robins, J. (2007). Four types of effect modification: a classification based on directed acyclic graphs. Epidemiology, 18, 561568.
Wakefield, D. B. et al. (2010). White matter hyperintensities predict functional decline in voiding, mobility, amd cognition in older adults. Journal of the American Geriatrics Society, 58, 275281.
Zheng, J. et al. (2012a). White matter hyperintensities are an independent predictor of physical decline in community-dwelling older people. Gerontology, 58, 398406.
Zheng, J. et al. (2012b). Brain white matter hyperintensities, executive dysfunction, instability, and falls in older people: a prospective cohort study. Journal of Gerontology: Medical Sciences, 67, 10851091.

Keywords

Vascular lesions and functional limitations among older adults: does depression make a difference?

  • Celia F. Hybels (a1), Carl F. Pieper (a2), Lawrence R. Landerman (a3), Martha E. Payne (a4) and David C. Steffens (a5)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed