Depression, anxiety and motivation in arterial hypertension

 The vascular depression hypothesis posits that cerebrovascular diseases are a major risk factor for emotional and behavioral disorders (EBD). Arterial hypertension (AH) is one of the main causes of cerebrovascular diseases.

Objective: to assess the relationship between anxiety,  depression and apathy in the patients with AH with case history,  clinical features and neuroimaging.

Patients and methods. 65 hypertensive outpatient were  examined (mean age – 57.17±10.76 years). Cognitive status was  evaluated with MiniMental State Examination, Montreal  Cognitive Assessment (MoCA) and Frontal Assessment Battery.  EBD was assessed with Beck Depression Scale, Spielberger Anxiety Questionnaire, and Robert's Apathy Scale. The Fazekas  scale was used to determine the severity of leukoaraiosis. 

Results and discussion. Significant depression was present in 66.2%, anxiety – in 41.5%, and apathy – in 80% of hypertensive patients. Blood pressure level (p<0.05) and AH duration (p<0,05) were significantly associated with the severity of each  EBD included in the analysis (anxiety, depression, apathy).  Depression, anxiety, and apathy scores were significantly higher  (p<0.01) in patients with hypertension-mediated organ damage or associated clinical conditions. A negative correlation was found between the severity of depression, anxiety and apathy and cognitive scores (p<0.01). Depression, anxiety and apathy were significantly (p<0.05) higher in patients with higher Fazecas score. 

Conclusion. Advanced AH is associated with an increased risk of EBD including depression, anxiety and apathy. These EBD develop together with cognitive impairment and vascular leukoencephalopathy. The study results can emphasize the  pathogenetic impact of AH associated cerebral ischemia in EBD  development. 

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