Cerebrovascular changes in late life depression
The causes of vascular depression in the elderly are poorly understood. It appears as though the mechanism of the development of depression in late life involves more subcortical brain abnormalities and less genetic input than their younger counterparts. We review the literature of the information relating to a conceptual model based on structural changes in the brain and its role in the evolution of depression. Multiple factors including neuroimaging for the assessment of leukoencephalopathy, volumetric analysis, and neuroanatomy of mood circuits are addressed. This includes the individual and integrated pathways of the amygdala, cingulate cortex, the medial prefrontal cortex, the dorsolateral prefrontal cortex and the basal ganglia. Postulates are discussed of the significance of vascular depression in the elderly and the approach of assessing neuroanatomy for its biological origin.
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