There is a convergence of evidence that, in many instances, depression and dementia are significantly related. The debate about whether depression is prodrome or risk factor takes a back seat in this discussion to the issue of whether the mechanisms of brain change that produce depression are understood. The most supported biomedical hypothesis to date is the vascular depression hypothesis. This hypothesis expands our conceptualization of VaD in depression and dementia because it allows for the influence of vascular risk factors on brain and behavior change, even in the absence of a stroke. Thus, MRI studies are consistently showing that vascular risk factors are related to white matter changes, which are related to depression in dementia no matter what the etiology. The overlapping of VaD and AD is an idea that has been embraced in other ways as well (Snowden et al., 1997). While the association of vascular risk factors and apparent brain changes to depression are powerful ideas, the exact mechanisms of how these changes take place and exactly how they influence depression is not understood at this time.

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