Review
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World J Radiol. May 28, 2020; 12(5): 48-67
Published online May 28, 2020. doi: 10.4329/wjr.v12.i5.48
Vascular depression for radiology: A review of the construct, methodology, and diagnosis
Sara N Rushia, Al Amira Safa Shehab, Jeffrey N Motter, Dakota A Egglefield, Sophie Schiff, Joel R Sneed, Ernst Garcon
Sara N Rushia, Al Amira Safa Shehab, Dakota A Egglefield, Sophie Schiff, Joel R Sneed, Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
Sara N Rushia, Al Amira Safa Shehab, Dakota A Egglefield, Sophie Schiff, Joel R Sneed, Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
Jeffrey N Motter, Joel R Sneed, Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032, United States
Jeffrey N Motter, Joel R Sneed, Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
Ernst Garcon, Department of Radiology, Columbia University Medical Center, New York, NY 10032, United States
Author contributions: Rushia SN, Sneed JR and Garcon E designed the review; Rushia SN, Shehab AAS, Motter JN, Egglefield DA, Schiff S, Sneed JR and Garcon E wrote the paper.
Conflict-of-interest statement: All authors deny any conflicts of interest related to this work.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sara N Rushia, BA, Graduate Student, Department of Psychology, The Graduate Center, City University of New York, 365 5th Avenue, New York, NY 10016, United States. srushia@gradcenter.cuny.edu
Received: February 26, 2020
Peer-review started: February 26, 2020
First decision: April 22, 2020
Revised: May 5, 2020
Accepted: May 12, 2020
Article in press: May 12, 2020
Published online: May 28, 2020
Processing time: 91 Days and 9.6 Hours
Abstract

Vascular depression (VD) as defined by magnetic resonance imaging (MRI) has been proposed as a unique subtype of late-life depression. The VD hypothesis posits that cerebrovascular disease, as characterized by the presence of MRI-defined white matter hyperintensities, contributes to and increases the risk for depression in older adults. VD is also accompanied by cognitive impairment and poor antidepressant treatment response. The VD diagnosis relies on MRI findings and yet this clinical entity is largely unfamiliar to neuroradiologists and is rarely, if ever, discussed in radiology journals. The primary purpose of this review is to introduce the MRI-defined VD construct to the neuroradiology community. Case reports are highlighted in order to illustrate the profile of VD in terms of radiological, clinical, and neuropsychological findings. A secondary purpose is to elucidate and elaborate on the measurement of cerebrovascular disease through visual rating scales and semi- and fully-automated volumetric methods. These methods are crucial for determining whether lesion burden or lesion severity is the dominant pathological contributor to VD. Additionally, these rating methods have implications for the growing field of computer assisted diagnosis. Since VD has been found to have a profile that is distinct from other types of late-life depression, neuroradiologists, in conjunction with psychiatrists and psychologists, should consider VD in diagnosis and treatment planning.

Keywords: Vascular depression; Depression; Magnetic resonance imaging; Cerebrovascular disorders; White matter hyperintensities; Neuroradiology; Case reports

Core tip: This manuscript provides an overview of the vascular depression construct, discusses the methods used to measure cerebrovascular disease on magnetic resonance imaging in older adults, and presents the profile of vascular depression in terms of radiological, neuropsychological, and clinical findings. The goal of this paper is to inform the neuroradiology community of the vascular depression diagnosis and to instill the importance of considering this diagnosis when evaluating magnetic resonance imaging scans of older adults.