Depressive Symptoms Are Associated With Subclinical Cerebrovascular Disease Among Healthy Older Women, Not Men

• Published in: The American journal of geriatric psychiatry Vol. 18; no. 10; pp. 940 - 947
• Main Authors: Wendell, Carrington Rice, M.A, Hosey, Megan M., M.A, Lefkowitz, David M., M.D, Katzel, Leslie I., M.D., Ph.D, Siegel, Eliot L., M.D, Rosenberger, William F., Ph.D, Waldstein, Shari R., Ph.D
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-10-2010; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Brain - pathology; Cerebrovascular Disorders - complications; Cerebrovascular Disorders - pathology; Depression; Depression - complications; Depression - pathology; depressive symptoms; Female; Humans; Internal Medicine; Magnetic Resonance Imaging - methods; Male; Middle Aged; MRI; Nerve Fibers, Myelinated - pathology; Sex Characteristics; silent infarcts; subclinical cerebrovascular disease; white matter hyperintensities; Depression; silent infarcts; subclinical cerebrovascular disease; MRI; depressive symptoms; white matter hyperintensities
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1097/JGP.0b013e3181d57a2b

Background Associations among diagnosed unipolar depression, depressive symptoms, and cerebrovascular disease are well known. However, minimal research has investigated whether sex may modify such associations, despite known sex differences in depression and depressive symptoms. This study examined whether depressive symptoms were disproportionately related to subclinical cerebrovascular disease (SCD) in women versus men. Methods One hundred one older adults (58% men; mean age = 67 years), free of major comorbidities, completed the Beck Depression Inventory and underwent magnetic resonance imaging (MRI). MRI scans were neuroradiologist rated for markers of SCD (periventricular and deep white matter hyperintensities, and number of silent infarcts) and brain atrophy (ventricular enlargement and sulcal widening). Two rank-sum outcome variables (SCD and brain atrophy) were then created. Results On average, depressive symptoms were relatively low in magnitude (mean = 3.8, standard deviation = 3.6, range = 0–17). Multiple regression analyses, adjusted for age, sex, education, systolic blood pressure, fasting glucose, maximal oxygen consumption, body mass index, average weekly alcohol consumption, and Mini-Mental State Examination performance revealed sex to be a significant effect modifier of depressive symptoms in the prediction of SCD. Sex-stratified regression analyses indicated depressive symptoms, and SCD was strongly related among women but not men. Depressive symptoms were not related to brain atrophy, regardless of inclusion of sex as an effect modifier. Conclusions Depressive symptoms, even in a subclinical range, are significantly associated with an MRI-derived index of SCD among women, but not men, in the present sample of relatively healthy older adults.