Vascular<unk>  is typically diagnosed using either magnetic resonance imaging (MRI) or clinically defined criteria. MRI-defined vascular<unk>  is more commonly referred to as<unk>  (SID) and emphasizes the relationship between MRI identification of lesions in the brain and depressive symptoms. An alternative definition is<unk>  executive dysfunction (DED) syndrome and focuses on the link between clinical symptoms of cardiovascular risk and depressive symptoms. Both of these competing definitions are supported in the literature and provide a strategy to diagnose vascular<unk> . The criteria for MRI-defined vascular<unk>  focus on the presence and severity of either deep white matter lesions, often referred to as white matter hyperintensities, or<unk>  grey matter lesions. The most severe lesion in an individual is scored based on predefined criteria and considered in combination with two measures of depressive symptomology. These white matter lesions are thought to disrupt emotional and cognitive functioning. Alternatively, clinically defined criteria as proposed initially by Alexopoulos and colleagues (1997) includes dimensions of depressive symptoms, disability, and cognitive impairment. Specifically, DED syndrome has been characterized by a loss of interest in activities, psychomotor retardation, paranoia, and cognitive impairment in the domains of language fluency and visual naming. Aizenstein and colleagues (2016) proposed diagnostic criteria for vascular<unk>  that incorporate elements of both clinical and MRI-definitions. These diagnostic criteria are: #Evidence of vascular pathology in elderly subjects with or without cognitive impairment #Absence of previous depressive episodes preceding obvious cerebrovascular disease #Presence of cerebrovascular risk factors #Co-incidence of<unk>  with cerebrovascular risk factors #Clinical symptoms characteristic of vascular<unk>  such as executive dysfunction, decrease in processing speed, and lethargy #Neuroimaging data confirming cerebrovascular disease Studies have not yet been conducted using this set of criteria, so it is unclear whether it provides an advantage over current standards. Some aspects of the criteria are not always necessary to diagnose individuals. For example, one study found that late-onset<unk> , executive dysfunction, and<unk>  gray lesions in individuals were useful for identifying vascular<unk> , but only the presence of deep white matter lesions was necessary to classify individuals as having the disorder. Distinction from Major Depressive Disorder There is inadequate evidence to support vascular<unk>  as a distinct subtype of major depressive disorder due to mixed results. Specifically, it is difficult to differentiate a diagnosis of vascular<unk>  from similar diagnoses, such as post-stroke or late-life<unk> . Some researchers suggest that vascular<unk>  may be too restricted in its definition and proposed etiology. However, there is some evidence of internal validity of vascular<unk>  which provides initial support for its classification as a unique subtype. The most distinctive symptoms of vascular<unk>  compared to non-vascular<unk>  include increased cognitive and executive impairment, proposed to be associated with cerebrovascular risk factors. Additionally, studies have reported that when compared to individuals with non-vascular<unk> , those diagnosed with vascular<unk>  tend to be older, have a lower family history of mental illness, and have a history of hypertension. Individuals with vascular<unk>  also tend to have more deficits in self-initiation and concentration, higher cardiac illness burden and cerebrovascular risk factors, cognitive impairment (as associated with the severity of white matter lesions in the brain), and increased treatment resistance. Those with vascular<unk>  have also reported increased lassitude, which is described as a difficulty getting started in the morning and may be related to fatigue. An additional study found that individuals with vascular<unk>  reported greater executive dysfunction and apathy compared to both nondepressed individuals with vascular disease and healthy control participants. This provides support that these symptoms may be a result of vascular<unk>  specifically and not solely individuals’ vascular disease.
Subcortical ischemic depression
Watershed stroke
Lacunar stroke
Zahn infarct
Early myoclonic encephalopathy
Excited delirium
Emergence delirium
Vascular thalamic amnesia