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Book Forum: Neural Mechanisms of Illness   |    
Vascular Disease and Affective Disorders
ROBERT HOWARD, M.D., M.R.C.Psych.
Am J Psychiatry 2004;161:587-587. doi:10.1176/appi.ajp.161.3.587
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Edited by Edmond Chiu, A.M., M.B.B.S., D.P.M., F.R.A.N.Z.C.P., David Ames, B.A., M.D., F.R.C.Psych., F.R.A.N.Z.C.P., and Cornelius Katona, M.D., F.R.C.Psych. London, Martin Dunitz, 2002, 276 pp., $44.95 (paper).

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Cardiovascular and cerebrovascular disease both go with depression, and a plethora of magnetic resonance imaging studies have associated white matter hyperintensities with depressive disorder. Although not explicit in the book’s title, the fact that the editors are all well-known old-age psychiatrists should alert the reader that the material covered relates largely to affective disorder in older adults. Like the proverbial game of football (known to U.S. readers as soccer), this is a book of two halves of more or less equal length with some postmatch pundits’ analysis contained in a concluding chapter written by the editors.

The first half kicks off with five chapters reviewing the evidence for associations between affective and anxiety disorders and systemic vascular disease. In the second half, a more attacking game is played with specific focus on the relationship between cerebrovascular disease and affective disorders. Some excellent, authoritative, and thought-provoking chapters on the role of the basal ganglia and the often forgotten area of mania in older adults certainly hit the back of the net.

Some surprising areas remained unplayed, more or less left on the substitutes’ bench. I would have expected to see more coverage of the emerging characterization of neuropsychological impairment in late-life depression, specifically, details of executive dysfunction and motivational disturbance. Since these impairments appear to offer an important link between focal vascular brain damage and the symptom profile of patients with late-life depression, I was disappointed that this area merited only a single page in a chapter on vascular depression.

There is much that is good about this book, however, and the editors should be congratulated for spotting an up-and-coming and promising area of psychiatry and producing a volume that is accessible and attractively presented. For a single reference volume on the area, there is no better source. So, after the final whistle has blown, is depression in older people a cerebrovascular disease? The vascular depression hypothesis is appealingly simple and should be easily testable. To my surprise, even after following the editors’ postmatch punditry, I didn’t really reach a definite conclusion. This is not the book’s fault. Lines of evidence from widely disparate areas of medicine and neuroscience are sometimes hard to piece together, particularly when the data are still awaiting confirmatory replication. But there’s always next season, and I am sure that there will be a demand for further editions of this book. As the field matures and consolidates, Vascular Disease and Affective Disorders should deliver some more great goals and some decisive results.

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