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2 results

  • 32 - Cerebrovascular Disease, Aging, and Depression: Clinical Features, Pathophysiology, and Treatment

  • from Part V - Later Life and Interventions
  • Edited by Ayanna K. Thomas, Tufts University, Massachusetts, Angela Gutchess, Brandeis University, Massachusetts
  • Book:
    The Cambridge Handbook of Cognitive Aging
    Published online:
    28 May 2020
    Print publication:
    28 May 2020, pp 593-611

  • Summary

    This chapter reviews both seminal and recent work on late-life depression (LLD), with an emphasis on the vascular depression subtype of LLD. We first describe the clinical features and symptom presentation of LLD, highlighting executive functioning deficits that are a core feature of the “depression with executive dysfunction” syndrome. We discuss both vascular and nonvascular etiological pathways to depression with executive dysfunction in older adults. We highlight recent findings on the association between vascular disease, altered structural and functional brain network connectivity, and clinical symptoms in LLD. Vascular depression is associated with nonresponse to standard pharmacologic treatment. As such, behavioral interventions offer promising avenues for treatment. Novel behavioral approaches encompass psychotherapy, noninvasive brain stimulation, and cognitive remediation that are targeted toward the specific neural circuitry dysfunctions that underlie both affective and cognitive symptoms in older adults. We review these approaches, as well as psychosocial, exercise, and lifestyle interventions.