Late-onset major depression and subthreshold depressive symptoms as early clinical correlates of brain small vessel disease.

Late-onset depression (LOD) and subthreshold depressive symptoms (SDS) have been associated with cerebral small vessel disease (SVD), but the evidence regarding pre-stroke depression remains limited. This study examined the frequency of DSM-5 LOD and SDS prior to the first non-embolic lacunar stroke. Fifty-eight patients (mean age 62.2 ± 8.2 years; 41.4% female) with a first lacunar ischemic stroke underwent Magnetic Resonance Imaging (MRI) (T1, T2, FLAIR sequences) and psychiatric evaluation using the MINI, with data from caregivers and medical records. Patients were classified as having LOD (D), SDS (S), combined (S/D), or none (nD/S). Statistical analyses included Mann-Whitney U and Fisher's Exact tests. Of the total sample, 63.8% (n = 37) exhibited LOD or SDS, with reported onset on average 5-7 years prior to stroke (mean onset age: 55.5 years). Females exhibited higher prevalence of depressive symptoms (87.5% vs 47.1%, P = .001). Hypertension (75.7%) and dyslipidemia (62.2%) were the most common vascular risk factors. No patient had manic or hypomanic episodes. Premorbid depressive symptoms were common and may precede the clinical manifestation of cerebrovascular disease Given the retrospective and observational design, these findings should be regarded as hypothesis-generating rather than causal. Prospective longitudinal studies incorporating quantitative SVD imaging markers are required.