Among all the patients presenting with depression for the first time in late life, vascular disease appears to be quite common. In the last century the German psychiatrist Gaupp developed a concept called arteriosclerotic depression. This referred to patients in whom the depression was attributed to hardening of the arteries. Vascular Changes MRI is a particularly useful tool for identifying vascular pathology in the brain. Vascular changes are seen as hyperintense signals both in the white matter and gray matter.
Large lesions are quite rare.
The frequency of the changes increases with aging. In most normal subjects the changes are minimal and are thought to represent potential spaces around perforating vessels. Subsequent studies have shown that these changes are present in the white matter and gray matter of patients with depression. The findings were also present in the deep white matter in the frontal part of the brain. Many of the patients had risk factors for vascular disease.