Dement Geriatr Cogn Disord 2007;23:67–73

Depression in Vascular Dementia Is Quantitatively and Qualitatively Different from Depression in Alzheimer’s Disease

Park J.H.a · Lee S.B.a · Lee T.J.a · Lee D.Y.d, e · Jhoo J.H.f · Youn J.C.c · Choo I.H.d · Choi E.A.a · Jeong J.W.a · Choe J.Y.a · Woo J.I.d, e · Kim K.W.a, b, e
aDepartment of Neuropsychiatry and bStroke Center, Seoul National University Bundang Hospital, and cDepartment of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Gyeonggido, dDepartment of Neuropsychiatry, Seoul National University Hospital, and eSeoul National University College of Medicine, Seoul, and fDepartment of Neuropsychiatry, Kangwon University College of Medicine, Kangwondo, Korea
email Corresponding Author

 goto top of outline Key Words

  • Major depressive disorder
  • Minor depressive disorder
  • Vascular dementia
  • Alzheimer’s disease

 goto top of outline Abstract

Background/Aims: To compare the prevalence and characteristics of depression in vascular dementia (VaD) and Alzheimer’s disease (AD) after adjusting for dementia severity and gender. Methods: One hundred and eight pairs of VaD and AD patients matched for dementia severity and gender were assessed. Results: Major depressive disorder (MDD) was more prevalent in the VaD group than in the AD group (20.4% in VaD, 10.2% in AD, p = 0.04, Cochran-Mantel-Haenszel, CMH, test) regardless of the dementia severity and gender. The odds ratio for developing MDD in the VaD group versus the AD group was estimated to be 2.20 (95% confidence interval = 1.02–4.74). Neurovegetative symptoms such as ‘felt tired and weak all the time’ (30.6% in VaD, 13.9% in AD, p = 0.003, CMH test) and ‘changed weight without trying’ (16.7% in VaD, 6.5% in AD, p = 0.02, CMH test) were more prevalent in the VaD group than in the AD group. Conclusion: Depression in VaD was quantitatively and qualitatively different from that in AD regardless of the severity of dementia and gender; depression was more prevalent, severer and more retarded and vegetative in VaD than in AD.

Copyright © 2007 S. Karger AG, Basel

 goto top of outline References
  1. Baldwin RC, Benbow SM, Marriott A, Tomenson B: Depression in old age: a reconsideration of cerebral disease in relation to outcome. Br J Psychiatry 1993;163:82–90.
  2. Drinka TJ, Smith JC, Drinka PJ: Correlates of depression and burden for informal caregivers of patients in a geriatrics referral clinic. J Am Geriatr Soc 1987;35:522–525.
  3. Ballard C, Bannister C, Oyebode F: A review – Depression in dementia sufferers. Int J Geriatr Psychiatry 1996;11:507–515.

    External Resources

  4. Ballard C, Neill D, O’Brien J, McKeith IG, Ince P, Perry R: Anxiety, depression and psychosis in vascular dementia: prevalence and associations. J Affect Disord 2000;59:97–106.
  5. Burns A: Affective symptoms in Alzheimer’s disease. Int J Geriatr Psychiatry 1991;6:371–376.

    External Resources

  6. Ballard C, Bannister C, Solis M, Oyebode F, Wilcock G: The prevalence, associations and symptoms of depression amongst dementia sufferers. J Affect Disord 1996;36:135–144.
  7. Migliorelli R, Teson A, Sabe L, Petracchi M, Leiguarda R, Starkstein SE: Prevalence and correlates of dysthymia and major depression among patients with Alzheimer’s disease. Am J Psychiatry 1995;152:37–44.
  8. Zubenko GS, Moossy J, Kopp U: Neurochemical correlates of major depression in primary dementia. Arch Neurol 1990;47:209–214.
  9. Zweig RM, Ross CA, Hedreen JC, Steele C, Cardillo JE, Whitehouse PJ, Folstein MF, Price DL: The neuropathology of aminergic nuclei in Alzheimer’s disease. Ann Neurol 1988;24:233–242.
  10. Forstl H, Burns A, Luthert P, Cairns N, Lantos P, Levy R: Clinical and neuropathological correlates of depression in Alzheimer’s disease. Psychol Med 1992;22:877–884.
  11. Brun A: Pathology and pathophysiology of cerebrovascular dementia: pure subgroups of obstructive and hypoperfusive etiology. Dementia 1994;5:145–147.
  12. Rockwood K, Bowler J, Erkinjuntti T, Hachinski V, Wallin A: Subtypes of vascular dementia. Alzheimer Dis Assoc Disord 1999;13(suppl 3):S59–S65.

    External Resources

  13. Provinciali L, Coccia M: Post-stroke and vascular depression: a critical review. Neurol Sci 2002;22:417–428.
  14. Krishnan KR, Hays JC, Blazer DG: MRI-defined vascular depression. Am J Psychiatry 1997;154:497–501.
  15. Simpson S, Allen H, Tomenson B, Burns A: Neurological correlates of depressive symptoms in Alzheimer’s disease and vascular dementia. J Affect Disord 1999;53:129–136.
  16. Sultzer DL, Levin HS, Mahler ME, High WM, Cummings JL: A comparison of psychiatric symptoms in vascular dementia and Alzheimer’s disease. Am J Psychiatry 1993;150:1806–1812.
  17. Starkstein SE, Jorge R, Mizrahi R, Robinson RG: The construct of minor and major depression in Alzheimer’s disease. Am J Psychiatry 2005;162:2086–2093.
  18. Zubenko GS, Zubenko WN, McPherson S, Spoor E, Marin DB, Farlow MR, Smith GE, Geda YE, Cummings JL, Petersen RC, Sunderland T: A collaborative study of the emergence and clinical features of the major depressive syndrome of Alzheimer’s disease. Am J Psychiatry 2003;160:857–866.
  19. Ballard CG, Cassidy G, Bannister C, Mohan RN: Prevalence, symptom profile, and aetiology of depression in dementia sufferers. J Affect Disord 1993;29:1–6.
  20. Bucht G, Adolfsson R, Winblad B: Dementia of the Alzheimer type and multi-infarct dementia: a clinical description and diagnostic problems. J Am Geriatr Soc 1984;32:491–498.
  21. Reding M, Haycox J, Blass J: Depression in patients referred to a dementia clinic. A three-year prospective study. Arch Neurol 1985;42:894–896.
  22. Fischer P, Simanyi M, Danielczyk W: Depression in dementia of the Alzheimer type and in multi-infarct dementia. Am J Psychiatry 1990;147:1484–1487.
  23. Immerman RS, Mackey WC: The depression gender gap: a view through a biocultural filter. Genet Soc Gen Psychol Monogr 2003;129:5–39.
  24. Kendler KS: Gender differences in the genetic epidemiology of major depression. J Gend Specif Med 1998;1:28–31.
  25. Kuehner C: Gender differences in unipolar depression: an update of epidemiological findings and possible explanations. Acta Psychiatr Scand 2003;108:163–174.
  26. Lee JH, Lee KU, Lee DY, Kim KW, Jhoo JH, Kim JH, Lee KH, Kim SY, Han SH, Woo JI: Development of the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet (CERAD-K): clinical and neuropsychological assessment batteries. J Gerontol B Psychol Sci Soc Sci 2002;57:P47–P53.
  27. Rosen WG, Terry RD, Fuld PA, Katzman R, Peck A: Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 1980;7:486–488.
  28. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 4 (DSM-IV). Washington, American Psychiatric Association, 1994.
  29. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, Amaducci L, Orgogozo JM, Brun A, Hofman A, et al: Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993;43:250–260.
  30. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM: Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984;34:939–944.
  31. Ostbye T, Kristjansson B, Hill G, Newman SC, Brouwer RN, McDowell I: Prevalence and predictors of depression in elderly Canadians: the Canadian Study of Health and Aging. Chronic Dis Can 2005;26:93–99.

    External Resources

  32. Suh GH, Kim JK, Yeon BK, Park SK, Yoo KY, Yang BK, Kim YI, Cho MJ: Prevalence and risk factors of dementia and depression in the elderly. J Korean Neuropsychiatr Assoc 2000;39:809–824.
  33. Beekman AT, Copeland JR, Prince MJ: Review of community prevalence of depression in later life. Br J Psychiatry 1999;174:307–311.
  34. Greenwald BS, Kramer-Ginsberg E, Marin DB, Laitman LB, Hermann CK, Mohs RC, Davis KL: Dementia with coexistent major depression. Am J Psychiatry 1989;146:1472–1478.
  35. Newman SC: The prevalence of depression in Alzheimer’s disease and vascular dementia in a population sample. J Affect Disord 1999;52:169–176.
  36. Reichman WE, Coyne AC: Depressive symptoms in Alzheimer’s disease and multi-infarct dementia. J Geriatr Psychiatry Neurol 1995;8:96–99.
  37. Cooper JK, Mungas D: Risk factor and behavioral differences between vascular and Alzheimer’s dementias: the pathway to end-stage disease. J Geriatr Psychiatry Neurol 1993;6:29–33.
  38. Mayeux R: Diagnostic problems in nursing home patients with dementia: why we should and how we can improve accuracy. Alzheimer Dis Assoc Disord 1994;8(suppl 1):S184–S187.
  39. Boller F, Verny M, Hugonot-Diener L, Saxton J: Clinical features and assessment of severe dementia: a review. Eur J Neurol 2002;9:125–136.
  40. Rocca WA, Kokmen E: Frequency and distribution of vascular dementia. Alzheimer Dis Assoc Disord 1999;13(suppl 3):S9–S14.
  41. Andersen K, Launer LJ, Dewey ME, Letenneur L, Ott A, Copeland JR, Dartigues JF, Kragh-Sorensen P, Baldereschi M, Brayne C, Lobo A, Martinez-Lage JM, Stijnen T, Hofman A: Gender differences in the incidence of AD and vascular dementia: the EURODEM studies. EURODEM Incidence Research Group. Neurology 1999;53:1992–1997.
  42. Fratiglioni L, Viitanen M, von Strauss E, Tontodonati V, Herlitz A, Winblad B: Very old women at highest risk of dementia and Alzheimer’s disease: incidence data from the Kungsholmen Project, Stockholm. Neurology 1997;48:132–138.
  43. van Gorp WG, Marcotte TD, Sultzer D, Hinkin C, Mahler M, Cummings JL: Screening for dementia: comparison of three commonly used instruments. J Clin Exp Neuropsychol 1999;21:29–38.
  44. Forsell Y, Jorm AF, Fratiglioni L, Grut M, Winblad B: Application of DSM-III-R criteria for major depressive episode to elderly subjects with and without dementia. Am J Psychiatry 1993;150:1199–1202.
  45. Lopez OL, Becker JT, Sweet RA, Klunk W, Kaufer DI, Saxton J, Habeych M, De Kosky ST: Psychiatric symptoms vary with the severity of dementia in probable Alzheimer’s disease. J Neuropsychiatry Clin Neurosci 2003;15:346–353.
  46. Zubenko GS, Rosen J, Sweet RA, Mulsant BH, Rifai AH: Impact of psychiatric hospitalization on behavioral complications of Alzheimer’s disease. Am J Psychiatry 1992;149:1484–1491.
  47. Cummings JL, Miller B, Hill MA, Neshkes R: Neuropsychiatric aspects of multi-infarct dementia and dementia of the Alzheimer type. Arch Neurol 1987;44:389–393.
  48. Naarding P, de Koning I, van Kooten F, Dippel DW, Janzing JG, van der Mast RC, Koudstaal PJ: Depression in vascular dementia. Int J Geriatr Psychiatry 2003;18:325–330.

 goto top of outline Author Contacts

Ki Woong Kim, MD, PhD
Department of Neuropsychiatry, Seoul National University College of Medicine and
Seoul National University Bundang Hospital
300 Gumidong, Bundanggu, Seongnamsi, Gyeonggido 463-707 (Korea)
Tel. +82 31 787 7432, Fax +82 31 787 4058, E-Mail

 goto top of outline Article Information

Accepted: September 20, 2006
Published online: November 15, 2006
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 3, Number of References : 48

 goto top of outline Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 23, No. 2, Year 2007 (Cover Date: January 2007)

Journal Editor: Chan-Palay, V. (New York, N.Y.)
ISSN: 1420–8008 (print), 1421–9824 (Online)

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