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

Published online by Cambridge University Press:  09 May 2014

Celia F. Hybels ,
Carl F. Pieper ,
Lawrence R. Landerman ,
Martha E. Payne  and
David C. Steffens
Celia F. Hybels*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
Carl F. Pieper
Affiliation:
Department of Biostatistics and Bioinformatics, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
Lawrence R. Landerman
Affiliation:
Department of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
Martha E. Payne
Affiliation:
Department of Psychiatry and Behavioral Sciences, Neuropsychiatric Imaging Research Laboratory, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
David C. Steffens
Affiliation:
Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
*
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: [email protected].
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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.

Keywords

depressionfunctional impairmenthyperintensities
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 9 , September 2014 , pp. 1501 - 1509
Copyright
Copyright © International Psychogeriatric Association 2014 

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