Vascular depression for radiology: A review of the construct, methodology, and diagnosis

Table 1 Vascular depression profiles

ID	Neurorad-iologist comments	Fazekas DWMH rating	Fazekas PV-WMH rating	Depression scores	NP tests	Ethnicity	Age	Other Features
1	Multifocal white matter T2/FLAIR hyperintense lesions, the largest of which are located in the left corona radiata and left centrum semiovale, some of which have T1 hyperintensity, most consistent with a condition of microvascular ischemic disease.	2	3	HAM-D = 17; BDI-II = 12	Trail A = 45” (9%ile); Trail B = 240” (< 1%ile); Stroop = 0.67 (6%ile)	African American	56	CIRS-G = 8; MMSE = 29
2	Moderate periventricular and deep white matter foci of hyperintense FLAIR signal, more confluent in the right greater than left frontal lobe, most likely due to microvascular ischemia in this age group, accounting for concomitant cerebral/cerebellar atrophy and ventricular dilatation.	3	3	HAM-D = 22; BDI-II = 22	Trail A = 50” (63%ile); Trail B = 146” (53%ile); Stroop = 0.52 (19%ile)	Caucasian	81	CIRS-G = 5; MMSE = 29
3	Scattered deep and subcortical punctate foci of hyperintense FLAIR signal in the bilateral frontal, parietal and temporal lobes. Nonspecific patterns likely to represent sequela of migraine headaches, Lyme infection, vasculitis or microvascular ischemia.	2	3	HAM-D = 20; BDI-II = 14	Trail A = 68” (16%ile); Trail B = 148” (34%ile); Stroop = 0.91 (1%ile)	African American	77	CIRS-G = 6; MMSE = 29
4	Diffuse periventricular and deep white matter foci of hyperintense FLAIR signal in the bilateral frontal parietal and temporal lobes, some of which presenting an ovoid shape perpendicular to the long axis of the lateral ventricle. Primary consideration is multiple sclerosis in the appropriate clinical setting. Other possibilities include microvascular ischemia, vasculitis or prior infection.	3	3	HAM-D = 25; BDI-II = 21	Trail A = 92” (< 1%ile); Trail B = 286” (< 1%ile); Stroop = 0.44 (32%ile)	African American	65	CIRS-G = 6; MMSE = 29
5	Mild periventricular and pontine white matter hyperintense FLAIR signal; additional punctate foci of hyperintense FLAIR in the deep and subcortical frontal-parietal white matter. Nonspecific likely due to microvascular ischemia, migraine headaches, or vasculitis.	2	2	HAM-D = 41; BDI-II = 43	Trail A = 30” (55%ile); Trail B = 120” (< 1%ile); Stroop = 0.53 (18%ile)	African American	53	CIRS-G = 5; MMSE = 28

DWMH: Deep white matter hyperintensities; PVH: Periventricular hyperintensities; HAM-D: Hamilton Rating Scale for Depression; BDI-II: Beck Depression Inventory, 2^nd edition; NP: Neuropsychological; %ile: Percentile; CIRS-G: Cumulative Illness Rating Scale – Geriatrics; MMSE: Mini Mental Status Exam.

Table 2 Primary and secondary features of vascular depression

Primary features
Neuroimaging findings consistent with cerebrovascular disease including MRI findings of white matter hyperintensities
Presence of cerebrovascular risk factors
Cognitive impairment, particularly in areas of processing speed and/or executive functioning
Secondary features
Age > 50
Poor antidepressant treatment response
Psychomotor retardation
Marked disability in activities of daily living
Lower rate of family history of mood disorders

Vascular depression is defined as significant depressive symptomatology occurring in the presence of cerebrovascular disease as evidenced above. MRI: Magnetic resonance imaging.