Part 1 | Vascular risk factors for depression and apathy 55 3 Second, biological markers of physical diseases have not been measured extensively. Previous articles on LASA, however, have confirmed good validity and high accuracy of our interview and algorithms used to classify the presence or absence of disease states 17 26. Nonetheless, many patients have asymptomatic atrial fibrillation in later life, which may have underestimated our prevalence of cardiac arrhythmias 37. Third, the number of participants with a stroke within subgroups was rather low, especially in the subgroup of nondepressed, noncardiac patients. Therefore, confirmation in other samples seems relevant in order to rule out chance findings. Nonetheless, our findings within subgroups categorized by depression (yes/no) and neuroticism (high/low) status were confirmed by analyses using depressive symptoms and neuroticism dimensionally. Neuroticism and vascular disease are 2 major vulnerability factors in late-life depression 1 22 32. Patients with depression with high levels of neuroticism are more likely to benefit from classical antidepressant treatment strategies, compared to patients with depression with higher level of vascular disease 38 39. These latter patients are also at increased risk of future health events like stroke 4 and might benefit from optimizing vascular disease management, including lifestyle intervention like walking or running. Therefore, replication studies as well as randomized controlled studies on the surplus of vascular screening in nonneurotic older patients with depression without known vascular disease are warranted. The results of our study suggest that in older persons with depression without a history of clinically overt vascular disease, persons with a low level of neuroticism have a higher risk of developing stroke, compared to those with a high level of neuroticism. These results support the idea that neurotic depression is a different type of depression than depression associated with vascular disease. Moreover, late-life depression in the context of low neuroticism might be a marker of vascular depression. This can be explained by subclinical vascular disease, in line with previous findings of an association between measures of generalized atherosclerosis and depressive symptoms in the population 11. Glossary CES-D: Center for Epidemiologic Studies-Depression scale CI: confidence interval DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th edition GP: general practitioner HR: hazard ratio ICD: International Classification of Diseases LASA: Longitudinal Aging Study Amsterdam MMSE: Mini-Mental State Examination
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