Baldwin Robert C, O'Brien John
Manchester Royal Infirmary, Manchester, UK.
Br J Psychiatry. 2002 Feb;180:157-60. doi: 10.1192/bjp.180.2.157.
Growing evidence suggests that there may be a subtype of depression arising in later life that is characterised by a distinct clinical presentation and an association with cerebrovascular disease. This has been termed 'vascular depression'.
To review the evidence for associations between cardiovascular disease and depression and between cerebrovascular disease and depression, and to examine implications for clinical practice and research.
The authors reviewed the medical literature covering the past 5 years.
There is strong evidence for an association between cardiovascular disease and depression, but this is not confined to older people. The causal pathway may be bi-directional. There is also a convergence of evidence suggesting a causal link between cerebrovascular disease and depression, especially that occurring later in life. The major focus has been on neuroradiological findings thought to be due to vascular disease, although the pathology may be heterogeneous.
Although there are gaps in the evidence there is strong support for the concept of vascular depression, characterised by reduced depression ideation, subcortical neurological dysfunction, apathy and psychomotor change. This has implications for both treatment and prevention.
越来越多的证据表明，晚年可能出现一种抑郁症亚型，其特征为独特的临床表现以及与脑血管疾病相关。这被称为“血管性抑郁症”。
回顾心血管疾病与抑郁症之间以及脑血管疾病与抑郁症之间关联的证据，并探讨其对临床实践和研究的影响。
作者回顾了过去5年的医学文献。
有强有力的证据表明心血管疾病与抑郁症之间存在关联，但这并不局限于老年人。因果途径可能是双向的。也有越来越多的证据表明脑血管疾病与抑郁症之间存在因果联系，尤其是晚年发生的抑郁症。主要关注点一直是被认为由血管疾病导致的神经放射学发现，尽管其病理可能是异质性的。
尽管证据存在不足，但血管性抑郁症的概念得到了有力支持，其特征为抑郁观念减少、皮质下神经功能障碍、淡漠和精神运动改变。这对治疗和预防都有影响。
