***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Depression is associated with an increased risk of cardiovascular diseases ( CVD ) in vascular patients as well as in the general population . We investigated whether autonomic dysfunction could explain this relationship . Design The Finl and , Italy and The Netherl and s Elderly ( FINE ) Study is a prospect i ve cohort study . Methods Depressive symptoms were measured with the Zung Self-rating Depression Scale  in 870 men , aged 70 - 90 years , free of CVD and diabetes in 1990 .  Resting heart rate was determined from a 15 - 30-s resting electrocardiogram in The Netherl and s and Italy and as pulse rate in Finl and . In addition , in The Netherl and s ,  heart-rate variability ( HRV ) and  QTc interval were determined . Results At baseline , depressive symptoms were associated with an increase in resting heart rate , and nonsignificantly with low HRV and prolonged QTc interval . After 10 years of follow-up , 233 ( 27 % ) men died from CVD . Prospect ively , an increase in resting heart rate with 1 SD was associated with an increased risk of cardiovascular mortality [ hazard ratio ( HR ) , 1.22 ; 95 % confidence interval ( CI ) , 1.08 - 1.38 ] . In addition , low HRV ( HR , 0.78 ; 95 % CI , 0.61 - 1.01 ) and prolonged QTc interval ( HR , 1.28 ; 95 % CI , 1.06 - 1.53 ) per SD were associated with cardiovascular mortality . The increased risk of depressive symptoms for cardiovascular mortality ( HR , 1.38 ; 95 % CI , 1.21 - 1.58 ) did not change after adjustments for several indicators of autonomic dysfunction . Conclusion This study suggests that mild depressive symptoms are associated with autonomic dysfunction in elderly men . The increased risk of cardiovascular mortality with increasing magnitude of depressive symptoms could , however , not be explained by autonomic dysfunction . Eur J Cardiovasc Prev Rehabil 14 : 796 - 802 © 2007 The European Society of PURPOSE To prospect ively evaluate if high- grade ( > or = 80 % luminal narrowing ) internal carotid artery stenosis is associated with depressive symptoms and if carotid artery stent placement ( CAS ) potentially improves depressive symptoms . MATERIAL S AND METHODS The study was approved by the local ethics committee , and informed consent was obtained from all subjects . One hundred forty-three patients ( 91 men , 52 women ; interquartile range , 63 - 76 years ) undergoing CAS because of asymptomatic high- grade ( > or = 80 % luminal narrowing ) carotid artery stenosis and 102 control subjects ( 64 men , 38 women ; interquartile range , 63 - 73 years ) with advanced peripheral artery disease and without carotid artery stenosis undergoing lower-limb percutaneous transluminal angioplasty were included . Substantial depressive symptoms ( defined as a Beck Depression Inventory score of 10 or higher ) were recorded at baseline and at 4 weeks ( follow-up ) after the percutaneous procedures . The chi2 test , Mann-Whitney U test , McNemar test , Wilcoxon rank sum test , and two-group t test were used to check for statistical significance . RESULTS A significantly higher prevalence of depressive symptoms was found in patients with carotid artery stenosis than in control subjects with peripheral artery disease at baseline ( 33.6 % vs 16.7 % , P = .003 ) . At follow-up , a significant reduction of depressive symptoms was found in patients who underwent CAS ( 33.6 % vs 9.8 % , P < .001 ) . The frequency of depressive symptoms remained unaffected in control subjects ( 16.7 % vs 13.0 % , P = .1 ) . CONCLUSION High- grade carotid artery stenosis is associated with depressive symptoms in patients with atherosclerosis .  CAS seems to exert beneficial effects on the course of depressive symptoms in these patients CONTEXT Research on vascular depression has used 2 approaches to subtype late-life depression , based on executive dysfunction or white matter hyperintensity severity . OBJECTIVE To evaluate the relationship of neuropsychological performance and white matter hyperintensity with clinical response in late-life depression . DESIGN Two-site , prospect i ve , nonr and omized controlled trial . SETTING Outpatient clinics at Washington University and Duke University . PARTICIPANTS A total of 217 subjects aged 60 years or older met DSM-IV criteria for major depression , scored 20 or more on the Montgomery-Asberg Depression Rating Scale ( MADRS ) , and received vascular risk factor scores , neuropsychological testing , and magnetic resonance imaging ; they were excluded for cognitive impairment or severe medical disorders . Fazekas rating was conducted to grade white matter hyperintensity lesions . Intervention Twelve weeks of sertraline treatment , titrated by clinical response . Main Outcome Measure Participants ' MADRS scores over time . RESULTS Baseline neuropsychological factor scores correlated negatively with baseline Fazekas scores . A mixed model examined effects of predictor variables on MADRS scores over time . Baseline episodic memory ( P = .002 ) , language ( P = .007 ) , working memory ( P = .01 ) , processing speed ( P < .001 ) , executive function factor scores ( P = .002 ) , and categorical Fazekas ratings ( P = .05 ) predicted MADRS scores , controlling for age , education , age of onset , and race . Controlling for baseline MADRS scores , these factors remained significant predictors of decrease in MADRS scores , except for working memory and Fazekas ratings . Thirty-three percent of subjects achieved remission ( MADRS < or = 7 ) . Remitters differed from nonremitters in baseline cognitive processing speed , executive function , language , episodic memory , and vascular risk factor scores . CONCLUSIONS Comprehensive neuropsychological function and white matter hyperintensity severity predicted MADRS scores prospect ively over a 12-week treatment course with selective serotonin reuptake inhibitors in late-life depression . Baseline neuropsychological function differentiated remitters from nonremitters and predicted time to remission in a proportional hazards model . Predictor variables correlated highly with vascular risk factor severity . These data support the vascular depression hypothesis and highlight the importance of linking subtypes based on neuropsychological function and white matter integrity . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00045773 Beneficial effects of repetitive transcranial magnetic stimulation ( rTMS ) were demonstrated by many controlled studies in major depression . Moreover , this promising and non invasive therapeutic tool seems to be better tolerated than electroconvulsive therapy CONTEXT The term vascular depression ( VD ) has been used to describe late-life depressive disorders in patients with clinical evidence of cerebrovascular disease . Preliminary data on poststroke depression suggest that repetitive transcranial magnetic stimulation ( rTMS ) might also be effective among patients with VD . OBJECTIVE To examine the efficacy and safety of rTMS to treat VD . DESIGN Prospect i ve , r and omized , sham-controlled study . SETTING University hospital . METHODS After discontinuation of antidepressant therapy , 92 patients with clinical ly defined VD were r and omly assigned to receive active or sham rTMS of the left dorsolateral prefrontal cortex . Approximately half of the patients met criteria for magnetic resonance imaging-defined VD . In experiment 1 , we administered a total cumulative dose ( TCD ) of 12 000 pulses ( TCD-12 K ) ; in experiment 2 , 18,000 pulses ( TCD-18 K ) . Sham stimulation was performed using a sham coil . RESULTS In experiment 1 , the sham group showed a 13.6 % decrease in the 17-item Hamilton Depression Rating Scale ( HAMD-17 ) scores compared with a 33.1 % decrease in the TCD-12 K group ( P = .04 ) . Response rates were 6.7 % in the sham group and 33.3 % in the active-stimulation group ( P = .08 ) ; remission rates were 6.7 % and 13.3 % , respectively ( P = .50 ) . In experiment 2 , the sham group showed a 17.5 % decrease in the 17-item Hamilton Depression Rating Scale scores compared with a 42.4 % decrease observed in the TCD-18 K group ( P < .001 ) . Response rates were 6.9 % in the sham group and 39.4 % in the active-stimulation group ( P = .003 ) ; remission rates were 3.5 % and 27.3 % , respectively ( P = .01 ) . Response rates to rTMS  were negatively correlated with age and positively correlated with higher frontal gray matter volumes . CONCLUSIONS To our knowledge , this is the first controlled trial that demonstrates the efficacy of rTMS among geriatric patients with VD . Older age and smaller frontal gray matter volumes were associated with a poorer response to rTMS OBJECTIVES The authors previously reported that repetitive transcranial magnetic stimulation ( rTMS ) produced a response rate of 39.4 % among 62 patients with treatment resistant vascular depression . This study was undertaken to assess the outcome of continuation therapy to prevent relapse among these patients during 9 weeks after completion of rTMS . DESIGN Patients were r and omly assigned to 18,000 pulses of rTMS given over 3 weeks or sham treatment using double blind methods . After rTMS , all patients were given 20 mg/day of citalopram for 9 weeks and reevaluated at 3 , 6 , and 9 weeks . SETTING Outpatient continuation treatment trial . PARTICIPANTS Patients with vascular depression ( N = 62 ) , as determined by magnetic resonance imaging hyperintensities and three or more clinical risk factors for vascular disease without other major medical illness , were recruited . They had onset of major depression after age 50 and failed at least one trial of antidepressants . INTERVENTION After rTMS or sham treatment , all treatment responders were given citalopram for 9 weeks . RESULTS Among the 33 patients who were given rTMS , 13 responded ( i.e. , > 50 % decline in Hamilton Depression Scale score ) . Of these 13 , all completed the 9 weeks of continuation treatment . There were nine patients who continued to be responders and four who had a relapse of depression . CONCLUSION More effective methods are needed to treat elderly patients with treatment resistant vascular depression and to prevent relapse among treatment responders BACKGROUND Vascular depression has been proposed as a unique diagnostic subtype in late life , yet no study has evaluated whether the specified clinical features associated with the illness are jointly indicative of an underlying diagnostic class . METHODS We applied latent class analysis to two independent clinical sample s : the prospect i ve , cohort design , Neurocognitive Outcomes of Depression in the Elderly ( NCODE ) study and the 8-week , multicenter , double blind , placebo-controlled Old-Old study . RESULTS A two-class model consisting of vascular and nonvascular depressed  patients provided an excellent fit to the data in both studies , chi(2)(6 ) = 2.02 , p = .90 in the NCODE study and chi(2)(6 ) = 7.024 , p = .32 in the Old-Old study . Although all of the proposed features of vascular depression were useful in identifying the illness , deep white matter lesion burden emerged with perfect sensitivity ( 1.00 ) and near-perfect specificity ( .95 ) , making it the only indicator necessary to determine class membership . CONCLUSIONS These findings , replicated across two independent clinical sample s , provide the first support for the internal validity of vascular depression as a subtype of late-life depression BACKGROUND ' Vascular depression ' may be caused by cerebrovascular disease . Calcium channel blockers , which are putative treatments for cerebrovascular disease , might be expected to improve depression reduction and to prevent recurrence of depression in this patient population . This clinical trial was design ed to test these hypotheses . DESIGN This was a controlled , double blind , r and omized clinical trial in which 84 patients with vascular depression ( Alexopoulos criteria ) were treated with antidepressants at st and ard doses . Patients were also r and omized to  nimodipine  ( n = 40 ) or an inactive comparator , vitamin C ( n = 44 ) . Treatment outcomes were assessed using the Hamilton depression rating scale ( HDRS ) regularly up to 300 days after treatment initiation . RESULTS As expected , depression reduction was successful in most patients . In addition , those treated with nimodipine plus an antidepressant had greater improvements in depression overall in repeated measures ANCOVA ( F(1,81 ) = 8.64 , p = 0.004 ) . As well a greater proportion of nimodipine-treated participants ( 45 versus 25 % ) exhibited a full remission ( HDRS < or = 10 ) ( chi(2)(df , 1 ) = 3.71 , p = 0.054 ) . Among those experiencing a substantial response in the first 60 days ( 50 % reduction in 
    Output:
    
Efficacy trials suggested that nimodipine , transcranial magnetic stimulation , carotid stent placement , and citalopram were effective for VaD. Exploratory studies suggested that white-matter hyperintensities and global vascular risk are predictors of poor response .
Although the low quality of the studies hinders the findings ' generalization , studies of higher validity support the VaD concept for interventions .