We agree with Dr Fones that apathy often occurs in patients with vascular depression. However, clinical findings suggest that the syndrome of vascular depression is not limited to apathy but includes symptoms and signs similar to those of nonvascular depression. We have recently reported a study comparing late-onset depression with vascular risk factors to early-onset depression of elderly patients without vascular risk factors.1 The vascular depression group had similar total Hamilton Depression Rating Scale (HDRS) scores to those of the nonvascular depression group (mean [SD], 25.96 [6.76] vs 27 [5.95]). Moreover, no significant differences were noted in any of the individual HDRS symptoms with the exception of agitation, retardation, guilt, and insight. Similar findings have been reported by Krishnan et al2 who observed that patients with white matter hyperintensities had depressive syndromes often characterized by anhedonia.
Alexopoulos GS. Distinguishing Apathy Syndromes From Vascular Depression. Arch Gen Psychiatry. 1998;55(9):844–845. doi: