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32 - Cerebrovascular Disease, Aging, and Depression: Clinical Features, Pathophysiology, and Treatment

from Part V - Later Life and Interventions

Published online by Cambridge University Press:  28 May 2020

By
Faith Gunning  and
Abhishek Jaywant
Edited by
Ayanna K. Thomas  and
Angela Gutchess
Ayanna K. Thomas
Affiliation:
Tufts University, Massachusetts
Angela Gutchess
Affiliation:
Brandeis University, Massachusetts
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Summary

This chapter reviews both seminal and recent work on late-life depression (LLD), with an emphasis on the vascular depression subtype of LLD. We first describe the clinical features and symptom presentation of LLD, highlighting executive functioning deficits that are a core feature of the “depression with executive dysfunction” syndrome. We discuss both vascular and nonvascular etiological pathways to depression with executive dysfunction in older adults. We highlight recent findings on the association between vascular disease, altered structural and functional brain network connectivity, and clinical symptoms in LLD. Vascular depression is associated with nonresponse to standard pharmacologic treatment. As such, behavioral interventions offer promising avenues for treatment. Novel behavioral approaches encompass psychotherapy, noninvasive brain stimulation, and cognitive remediation that are targeted toward the specific neural circuitry dysfunctions that underlie both affective and cognitive symptoms in older adults. We review these approaches, as well as psychosocial, exercise, and lifestyle interventions.

Keywords

computerized cognitive remediationdefault mode networkdepression with executive dysfunctiondorsolateral prefrontal cortexexecutive functionexercisefrontostriatalgray matterinflammationlate-life depressionmagnetic resonance imagingpost-stroke depressionproblem-solving therapypsychotherapyrewardtranscranial magnetic stimulationvascular depressionvascular diseasewhite matterwhite matter hyperintensities
Type
Chapter
Information
The Cambridge Handbook of Cognitive Aging
A Life Course Perspective
 , pp. 593 - 611
Publisher: Cambridge University Press
Print publication year: 2020

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