Cerebrovascular Disease and Late-Life Depression: A Scoping Review

Cerebral small-vessel disease (CSVD) is an umbrella term encompassing chronic, progressive conditions that affect the brain's vasculature. Diverse pathological and neurological factors lead to various clinical and neuroimaging patterns in elderly patients. While depression in the elderly is not uncommon, the connection between CSVD and late-life depression (LLD) remains unclear. CSVD is significant because it is closely linked to chronic hypertension, contributing to microvascular damage and impaired cerebral perfusion. Our objective was to synthesize evidence, evaluate relevant literature to synthesize, and present information relating to the underlying pathophysiology and factors linking CSVD to depression in older adults. Three databases were searched, EMBASE, Ovid MEDLINE, and Web of Science, with the articles selected for inclusion needing to be peer-reviewed, written in English, and published between 1998 and 2022 and have a primary focus on people aged 50 and above who had depression and had a documented history of CSVD. Twenty papers met these criteria and were analyzed, including using statistical correlation. Of the 20 studies, 15 reported a statistically significant correlation between CVSD and LLD, whereas five of the studies found no significant correlation. In the 15 studies that reported a significant relationship between CSVD and LLD, there were a total of 15,158 participants, or an average of approximately 1,011 participants per study. The five studies that did not find a correlation included 2,222 participants, averaging about 444 participants per study. Thus, this review's overall findings are consistent with a significant relationship between CSVD and LLD. White matter hyperintensities (WMHs), one of the findings of CSVD, were found to be a common finding in patients with CSVD and LLD. Increased WMH volume led to an increase in depressive symptoms. However, some studies highlight counterpoints, emphasizing the complexity of the relationship and the influence of non-vascular factors such as neuroinflammation, neurodegeneration, and systemic comorbidities. These findings underscore the importance of early detection of CSVD and interdisciplinary approaches to mitigate the burden of depression and cognitive decline in aging populations. Future research should focus on advanced neuroimaging, genetic profiling, and longitudinal studies to unravel the multifaceted mechanisms linking CSVD and LLD and improve clinical outcomes.