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Mirolovics Á, Bokor M, Dobi B, Zsuga J, Bereczki D. Socioeconomic Factors Predicting Depression Differ in the Acute Stage and at 1 year After Ischemic Stroke or TIA. J Stroke Cerebrovasc Dis 2020; 29:105241. [PMID: 33066950 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Considerable depressive symptoms follow stroke in about one third of patients. Initial depressive symptoms may wane after the acute phase of stroke, but persisting depressive symptoms adversely affect rehabilitation and quality of life. We set forth to evaluate predictors of depressive symptoms with a focus on socioeconomic factors. METHODS We evaluated clinical features and socioeconomic characteristics in 233 consecutive patients with acute ischemic stroke or TIA. Depressive symptoms could be evaluated in 168 subjects in the acute phase with a repeated testing after a mean of 14.7 months via telephone interview in 116 patients. Survival status, scores on the Center for Epidemiologic Studies-Depression Scale (CES-D), Beck Depression Inventory (BDI) and disability (modified Rankin scale, mRS) were recorded. RESULTS In the acute phase, employment status (p = 0.037) and level of education (p = 0.048) whereas one year later dependency (mRS≥3, p = 0.002) and income (p = 0.012) were the significant predictors of the severity of depressive symptoms. A change from independent (mRS≤2) to dependent living predicted worsening depressive symptoms (p = 0.008), whereas improving to functional independence from an initially dependent condition was associated with diminishing depressive symptoms (p = 0.077 for CES-D and p = 0.044 for BDI) in the first year after an acute ischemic cerebrovascular event. CONCLUSIONS Predictors of the severity of depressive symptoms differed in the acute phase and at follow-up. In addition to disability, education and employment status in the acute phase and income in the late phase predict the severity of depressive symptoms after ischemic stroke or TIA.
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Affiliation(s)
- Ágnes Mirolovics
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary; Departmet of Neurology, National Institute of Psychiatry and Addictions Nyírő Gyula, Budapest, Hungary
| | - Magdolna Bokor
- Departmet of Neurology, National Institute of Psychiatry and Addictions Nyírő Gyula, Budapest, Hungary
| | - Balázs Dobi
- Department of Probability Theory and Statistics, Eötvös Loránd University, Budapest, Hungary
| | - Judit Zsuga
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary; MTA-SE Neuroepidemiological Research Group, Budapest, Hungary.
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Zhu J, Peng Q, Xu Y, Xu H, Wan Y, Li Z, Qiu Y, Xia W, Guo Z, Li H, Jin H, Hu B. Morinda officinalis oligosaccharides ameliorate depressive-like behaviors in poststroke rats through upregulating GLUT3 to improve synaptic activity. FASEB J 2020; 34:13376-13395. [PMID: 32812265 DOI: 10.1096/fj.201902546rr] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 06/24/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022]
Abstract
Poststroke depression (PSD) is one of the most common psychiatric diseases afflicting stroke survivors, yet the underlying mechanism is poorly understood. The pathophysiology of PSD is presumably multifactorial, involving ischemia-induced disturbance in the context of psychosocial distress. The homeostasis of glucose metabolism is crucial to neural activity. In this study, we showed that glucose consumption was decreased in the medial prefrontal cortex (mPFC) of PSD rats. The suppressed glucose metabolism was due to decreased glucose transporter-3 (GLUT3) expression, the most abundant and specific glucose transporter of neurons. We also found Morinda officinalis oligosaccharides (MOOs), approved as an antidepressive Chinese medicine, through upregulating GLUT3 expression in the mPFC, improved glucose metabolism, and enhanced synaptic activity, which ultimately ameliorated depressive-like behavior in PSD rats. We further confirmed the mechanism that MOOs induce GLUT3 expression via the PKA/pCREB pathway in PSD rats. Our work showed that MOOs treatment is capable of restoring GLUT3 level to improve depressive-like behaviors in PSD rats. We also propose GLUT3 as a potential therapeutic target for PSD and emphasize the importance of metabolism disturbance in PSD pathology.
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Affiliation(s)
- Jiayi Zhu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qiwei Peng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Xu
- Beijing Tongrentang Co., Ltd. Institute of Science, Beijing, China
| | - Hexiang Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yan Wan
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhifang Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanmei Qiu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wenguang Xia
- Hubei Provincial Hospital of Integrated Chinese & Western medicine, Wuhan, Hubei, China
| | - Zhenli Guo
- Hubei Provincial Hospital of Integrated Chinese & Western medicine, Wuhan, Hubei, China
| | - Hongkai Li
- Beijing Tongrentang Co., Ltd. Institute of Science, Beijing, China
| | - Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Zhang S, Xu M, Liu ZJ, Feng J, Ma Y. Neuropsychiatric issues after stroke: Clinical significance and therapeutic implications. World J Psychiatry 2020; 10:125-138. [PMID: 32742946 PMCID: PMC7360525 DOI: 10.5498/wjp.v10.i6.125] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 04/13/2020] [Accepted: 04/25/2020] [Indexed: 02/05/2023] Open
Abstract
A spectrum of neuropsychiatric disorders is a common complication from stroke. Neuropsychiatric disorders after stroke have negative effects on functional recovery, increasing the rate of mortality and disability of stroke survivors. Given the vital significance of maintaining physical and mental health in stroke patients, neuropsychiatric issues after stroke have raised concerns by clinicians and researchers. This mini-review focuses on the most common non-cognitive functional neuropsychiatric disorders seen after stroke, including depressive disorders, anxiety disorders, post-traumatic stress disorder, psychosis, and psychotic disorders. For each condition, the clinical performance, epidemiology, identification of the therapeutic implication, and strategies are reviewed and discussed; the main opinions and perspectives presented here are based on the latest controlled studies, meta-analysis, or updated systematic reviews. In the absence of data from controlled studies, consensus recommendations were provided accordingly.
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Affiliation(s)
- Shuo Zhang
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Michael Xu
- Department of Clinical Medicine, International Education School, China Medical University, Shenyang 110004, Liaoning Province, China
| | - Zhi-Jun Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Juan Feng
- Department of Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Yan Ma
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Dajpratham P, Pukrittayakamee P, Atsariyasing W, Wannarit K, Boonhong J, Pongpirul K. The validity and reliability of the PHQ-9 in screening for post-stroke depression. BMC Psychiatry 2020; 20:291. [PMID: 32517743 PMCID: PMC7285729 DOI: 10.1186/s12888-020-02699-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression affects about 30% of stroke survivors within 5 years. Timely diagnosis and management of post-stroke depression facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is recognized as a good screening tool for post-stroke depression. However, no validation studies have been undertaken for the use of the Thai PHQ-9 in screening for depression among Thai stroke patients. METHODS The objectives were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing its results with those of a psychiatric interview as the gold standard. First-ever stroke patients aged ≥45 years with a stroke duration 2 weeks-2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder and adjustment disorder with a depressed mood. The summed-scored-based diagnosis of depression with the PHQ-9 was obtained. Validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed. RESULTS In all, 115 stroke patients with a mean age of 64 years (SD: 10 years) were enrolled. The mean PHQ-9 score was 5.2 (SD: 4.8). Using the DSM-5 criteria, 11 patients (9.6%) were diagnosed with depressive disorder, 12 patients (10.5%) were diagnosed with adjustment disorder with a depressed mood. Both disorders were combined as a group of post-stroke depression. The Thai PHQ-9 had satisfactory internal consistency (Cronbach's alpha: 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored-based diagnosis, an optimal cut-off score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI: 0.78-0.96). CONCLUSIONS The Thai PHQ-9 has acceptable psychometric properties for detecting a mixture of major depression and adjustment disorder in post-stroke patients, with a recommended cut-off score of ≥6 for a Thai population.
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Affiliation(s)
- Piyapat Dajpratham
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 9th floor Srisangwal Building, Siriraj Hospital, Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
| | - Panate Pukrittayakamee
- grid.10223.320000 0004 1937 0490Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanlop Atsariyasing
- grid.10223.320000 0004 1937 0490Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kamonporn Wannarit
- grid.10223.320000 0004 1937 0490Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jariya Boonhong
- grid.7922.e0000 0001 0244 7875Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- grid.7922.e0000 0001 0244 7875Department of Preventive Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Eric C, Melanie G, Yuan H, Jiajia Z, Bankole O. The positive association between employment and self-reported mental health in the USA: a robust application of marginalized zero-inflated negative binomial regression (MZINB). J Public Health (Oxf) 2020; 42:340-352. [PMID: 32219318 DOI: 10.1093/pubmed/fdaa030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Few studies have assessed the impact of employment on mental health among chronically ill patients. This study investigated the association between employment and self-reported mental unhealthy days among US adults. METHODS For this cross-sectional cohort study, we pooled 2011-2017 Behavioral Risk Factor Surveillance System (BRFSS) survey data. We examined the association between employment and mental health in nine self-reported chronic conditions using marginalized zero-inflated negative binomial regression (MZINB). All analyses were conducted using SAS statistical software 9.4. RESULTS Respondents (weighted n = 245 319 917) were mostly white (77.16%), aged 18-64 (78.31%) and employed (57.08%). Approximately 10% of respondents reported one chronic condition. Expected relative risk of mental unhealthy days was highest for employed respondents living with arthritis (RR = 1.70, 95% CI = [1.66, 1.74]), COPD (RR = 1.45, 95% CI = [1.41, 1.49]) and stroke (RR = 1.31, 95% CI = [1.25, 1.36]) compared to unemployed respondents. Employed males had 25% lower risk of self-reported mental unhealthy days compared to females. CONCLUSIONS Results show the interactive effects of employment on self-reported mental health. Employment may significantly impact on self-reported mental health among patients suffering from chronic conditions than those without chronic conditions.
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Affiliation(s)
- Chinaeke Eric
- Department of Clinical Pharmacy and Outcomes Science, University of South Carolina College of Pharmacy, Columbia, South Carolina, 29208, USA
| | - Gwynn Melanie
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, 29208, USA
| | - Hong Yuan
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208, USA
| | - Zhang Jiajia
- Department of Epidemiology & Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina 29208, USA
| | - Olatosi Bankole
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, 29208, USA
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56
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Dong L, Sánchez BN, Skolarus LE, Stulberg E, Morgenstern LB, Lisabeth LD. Sex difference in prevalence of depression after stroke. Neurology 2020; 94:e1973-e1983. [PMID: 32312890 PMCID: PMC7282882 DOI: 10.1212/wnl.0000000000009394] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/16/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE This study investigated the sex difference in prevalence of depression at 90 days after first-ever stroke. METHODS Patients with first-ever stroke (n = 786) were identified from the population-based Brain Attack Surveillance in Corpus Christi project (2011-2016). Poststroke depressive symptoms were assessed by the 8-item Patient Health Questionnaire, and prestroke depression status (history and medication use) was self-reported. Logistic regression was used to examine the association between sex and depression after stroke, and effect modification by prestroke depression status, accounting for missing data. RESULTS Women were more likely to have a history of and be on medication for depression at the time of stroke than men (p < 0.001). Prevalence of depression at 90 days was 28.2% for men (95% confidence interval [CI], 23.7%-32.8%) and 32.7% for women (95% CI, 27.8%-37.5%). The age-adjusted odds ratio (OR) of depression after stroke comparing women and men was 1.34 (95% CI, 0.97-1.85), and fully attenuated after adjustment for sociodemographic, stroke, and prestroke characteristics. Effect modification by prestroke depression status was present (p = 0.038). Among participants on medication for depression at the time of stroke, women were significantly less likely to have depression at 90 days compared with men (OR, 0.39; 95% CI, 0.16-0.96), whereas significant sex differences were not noted among those with and without a depression history. CONCLUSION The sex difference in prevalence of depression at 90 days after first-ever stroke was not significant overall, but varied by prestroke depression status. Interventions to address and prevent poststroke depression are needed, particularly among those with prestroke depression but not undergoing treatment for depression at stroke onset.
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Affiliation(s)
- Liming Dong
- From the Departments of Epidemiology (L.D., E.S., L.B.M., L.D.L.) and Biostatistics (B.N.S.), University of Michigan School of Public Health; and Stroke Program (L.E.S., L.B.M., L.D.L.), University of Michigan Medical School, Ann Arbor.
| | - Brisa N Sánchez
- From the Departments of Epidemiology (L.D., E.S., L.B.M., L.D.L.) and Biostatistics (B.N.S.), University of Michigan School of Public Health; and Stroke Program (L.E.S., L.B.M., L.D.L.), University of Michigan Medical School, Ann Arbor
| | - Lesli E Skolarus
- From the Departments of Epidemiology (L.D., E.S., L.B.M., L.D.L.) and Biostatistics (B.N.S.), University of Michigan School of Public Health; and Stroke Program (L.E.S., L.B.M., L.D.L.), University of Michigan Medical School, Ann Arbor
| | - Eric Stulberg
- From the Departments of Epidemiology (L.D., E.S., L.B.M., L.D.L.) and Biostatistics (B.N.S.), University of Michigan School of Public Health; and Stroke Program (L.E.S., L.B.M., L.D.L.), University of Michigan Medical School, Ann Arbor
| | - Lewis B Morgenstern
- From the Departments of Epidemiology (L.D., E.S., L.B.M., L.D.L.) and Biostatistics (B.N.S.), University of Michigan School of Public Health; and Stroke Program (L.E.S., L.B.M., L.D.L.), University of Michigan Medical School, Ann Arbor
| | - Lynda D Lisabeth
- From the Departments of Epidemiology (L.D., E.S., L.B.M., L.D.L.) and Biostatistics (B.N.S.), University of Michigan School of Public Health; and Stroke Program (L.E.S., L.B.M., L.D.L.), University of Michigan Medical School, Ann Arbor
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Ashaie SA, Cherney LR. Eye Tracking as a Tool to Identify Mood in Aphasia: A Feasibility Study. Neurorehabil Neural Repair 2020; 34:463-471. [DOI: 10.1177/1545968320916160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Persons with aphasia often present with low mood/depression, which can negatively affect their quality of life. The validity and reliability of existing depression measures for aphasia have been called into question. Eye tracking in nonstroke populations is reliable in identifying low mood/depression. Depressed persons are biased to negative emotions compared with nondepressed persons and have an absence of bias to positive emotions. However, nondepressed persons may be biased to positive emotions. Objective. To examine the feasibility of using eye tracking to measure mood in persons with aphasia. Methods. We recruited 22 persons with chronic aphasia and 12 healthy controls. Participants completed 2 self-report measures of mood. They also viewed faces that showed happy, sad, and neutral facial expressions during eye tracking. We analyzed 2 eye tracking indices: initial gaze orientation and gaze maintenance to happy, sad, and neutral faces. Results. For initial gaze orientation, participants with aphasia fixated faster on emotional faces compared with healthy controls but directed their gaze less often to happy faces compared with healthy controls. For gaze maintenance components, the duration of first fixation and total fixation duration were shorter on sad faces for participants with aphasia compared with healthy controls. Conclusion. Use of eye tracking with faces representing different mood states is feasible in persons with aphasia. Although there were some similarities, participants with aphasia had different gaze patterns to emotional faces compared with healthy controls. Further research is needed to establish whether this is a valid and reliable method of mood assessment.
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Affiliation(s)
- Sameer A. Ashaie
- Northwestern University, Chicago, IL, USA
- Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago), Chicago, IL, USA
| | - Leora R. Cherney
- Northwestern University, Chicago, IL, USA
- Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago), Chicago, IL, USA
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Conroy SK, Brownlowe KB, McAllister TW. Depression Comorbid With Stroke, Traumatic Brain Injury, Parkinson's Disease, and Multiple Sclerosis: Diagnosis and Treatment. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:150-161. [PMID: 33162852 DOI: 10.1176/appi.focus.20200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Depression is common among patients with neurologic disorders, and it has long been considered more difficult to treat than depression in the general population. In this review, the authors consider challenges in the diagnosis and treatment of depression among patients with stroke, traumatic brain injury, Parkinson's disease, and multiple sclerosis. For each disorder, the authors discuss the epidemiology and time course of depression as well as review the physiologic and psychological etiologies of depression. In addition, for each disorder, they review screening tools and diagnostic considerations, including differential diagnosis; discuss etiological factors, both neurobiological and psychological; and assess evidence for various depression treatments, including pharmacologic, psychosocial, and neuromodulatory therapies. The evidence suggests that depression is common among patients with neurologic disorders and that it is crucial for general psychiatrists to provide treatment for this population.
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Affiliation(s)
- Susan K Conroy
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
| | - Katherine B Brownlowe
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
| | - Thomas W McAllister
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe)
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Chen Y, Pu J, Liu Y, Tian L, Chen X, Gui S, Xu S, Song X, Xie P. Pro-inflammatory cytokines are associated with the development of post-stroke depression in the acute stage of stroke: A meta-analysis. Top Stroke Rehabil 2020; 27:620-629. [PMID: 32316861 DOI: 10.1080/10749357.2020.1755813] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Pro-inflammatory cytokines may be associated with post-stroke depression (PSD); however, results from different studies are inconsistent.Objectives: To investigate whether pro-inflammatory cytokines are associated with the development of PSD in acute stroke.Methods: PubMed, Embase, and Web of science were searched for relevant literature. Meta-analyzes were performed to determine whether the baseline blood concentrations of pro-inflammatory cytokines differed between acute stroke patients with and without depression. Sensitivity analyzes and regression analyzes were conducted to explore sources of heterogeneity.Results: We included 889 acute stroke patients from eight original studies, 312 of whom developed PSD and 577 did not. The serum concentrations of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were higher in the PSD group, compared with the non-PSD group (IL-6: SMD = 1.26, 95% CI = [0.55, 1.97], P < 0.001; TNF-α: SMD = 0.61, 95% CI = [0.13, 1.10], P = 0.010).Conclusions: This study indicates IL-6 and TNF-α as potential biomarkers of PSD in the acute stage of stroke and provides theoretical support for the early prevention and treatment of PSD.
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Affiliation(s)
- Yue Chen
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Juncai Pu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yiyun Liu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Lu Tian
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xiang Chen
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Siwen Gui
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,College of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Shaohua Xu
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemian Song
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Peng Xie
- NHC Key Laboratory of Diagnosis and Treatment on Brain Functional Diseases, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Hong W, Zhao Z, Wang D, Li M, Tang C, Li Z, Xu R, Chan CCH. Altered gray matter volumes in post-stroke depressive patients after subcortical stroke. NEUROIMAGE-CLINICAL 2020; 26:102224. [PMID: 32146322 PMCID: PMC7063237 DOI: 10.1016/j.nicl.2020.102224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/18/2022]
Abstract
Stroke survivors are known to suffer from post-stroke depression (PSD). However, the likelihood of structural changes in the brains of PSD patients has not been explored. This study aims to extract changes in the gray matter of these patients and test how these changes account for the PSD symptoms. High-resolution T1 weighted images were collected from 23 PSD patients diagnosed with subcortical stroke. Voxel-based morphometry and support vector machine analyses were used to analyze the data. The results were compared with those collected from 33 non-PSD patients. PSD group showed decreased gray matter volume (GMV) in the left middle frontal gyrus (MFG) when compared to the non-PSD patients. Together with the clinical and demographic variables, the MFG's GMV predictive model was able to distinguish PSD from the non-PSD patients (0•70 sensitivity and 0•88 specificity). The changes in the left inferior frontal gyrus (61%) and dorsolateral prefrontal cortex (39%) suggest that the somatic/affective symptoms in PSD is likely to be due to patients' problems with understanding and appraising negative emotional stimuli. The impact brought by the reduced prefrontal to limbic system connectivity needs further exploration. These findings indicate possible systemic involvement of the frontolimbic network resulting in PSD after brain lesions which is likely to be independent from the location of the lesion. The results inform specific clinical interventions to be provided for treating depressive symptoms in post-stroke patients.
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Affiliation(s)
- Wenjun Hong
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Zhiyong Zhao
- Key Laboratory for Biomedical Engineering of Ministry of Education, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, China.
| | - Dongmei Wang
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Ming Li
- Department of Radiology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
| | - Chaozheng Tang
- State Key Laboratory of Cognitive Neuroscience and Leaning, Beijing Normal University, Beijing, China.
| | - Zheng Li
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Rong Xu
- Department of Rehabilitation Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China.
| | - Chetwyn C H Chan
- Applied Cognitive Neuroscience Laboratory, Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong; University Research Facility in Behavioral and Systems Neuroscience, The Hong Kong Polytechnic University, Hong Kong, China.
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Assessment of the Progression of Poststroke Depression in Ischemic Stroke Patients Using the Patient Health Questionnaire-9. J Stroke Cerebrovasc Dis 2020; 29:104561. [PMID: 31941579 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/28/2019] [Accepted: 11/21/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Poststroke depression (PSD) affects one-third of stroke patients and is linked with higher stroke morbidity, mortality, and recurrence. Current guidelines do not direct when to screen for PSD, and predictors of PSD are not well understood. We sought to understand progression of PSD symptoms early after ischemic stroke, identify predictors of PSD, and describe the use of antidepressants in PSD. METHODS We collected demographic, clinical, and PSD (Patient Health Questionnaire-9; PHQ-9) data from ischemic stroke patients hospitalized at our Comprehensive Stroke Center and followed up in our clinic. PHQ-9 was obtained during hospitalization and again in clinic within 180 days of discharge. We performed univariate analysis and logistic regression to detect variables associated with PSD. RESULTS Among 201 patients, PSD symptoms (PHQ-9 > 4) were identified in 30% of patients during hospitalization and 46% during follow-up (54% of which had no symptoms during hospitalization). At follow-up, 36% were worse by PHQ-9 category. In univariate analysis, follow-up modified Rankin Scale (mRS) greater than or equal to 2 (P = .03) and antidepressant prescription (P < .001) were associated with worsening PHQ-9 category. In logistic regression analysis, follow-up mRS greater than or equal to 2 (P = .02), posterior circulation stroke (P = .03), and antidepressant prescription (P < .01) were associated with worsening PHQ-9 category. CONCLUSIONS Almost half of ischemic stroke patients develop PSD symptoms and more than one-third worsen between hospitalization and follow-up. Poststroke disability (mRS ≥ 2) and posterior circulation stroke were associated with worsening PSD. Worsening PSD symptoms prompted treatment change in 29% of patients. Screening for PSD during hospitalization should be repeated during early follow-up.
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Xie J, Han Y, Hong Y, Li WW, Pei Q, Zhou X, Zhang B, Wang Y. Identification of Potential Metabolite Markers for Middle-Aged Patients with Post-Stroke Depression Using Urine Metabolomics. Neuropsychiatr Dis Treat 2020; 16:2017-2024. [PMID: 32922015 PMCID: PMC7457842 DOI: 10.2147/ndt.s271990] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is one of the most common complications in stroke survivors. But, there are still no objective methods to diagnose PSD. This study aims to identify potential biomarkers for diagnosing PSD in middle-aged stroke survivors. METHODS Middle-aged subjects aged 30 to 59 years (92 PSD patients and 89 stroke survivors without depression) were included in this study. Urinary metabolites were detected by gas chromatography-mass spectrometry (GC-MS). Differential urinary metabolites and potential biomarkers were screened by applying statistical analysis. RESULTS The different urinary metabolic phenotypes between PSD patients and stroke survivors without depression were identified. A total of 12 differential urinary metabolites were accurately identified by using orthogonal partial least-squares-discriminant analysis. After analyzing those 12 differential urinary metabolites by step-wise logistic regression analysis, only seven metabolites (palmitic acid, hydroxylamine, myristic acid, glyceric acid, lactic acid, tyrosine and azelaic acid) were finally selected as potential biomarkers for diagnosing PSD in middle-aged stroke survivors. A panel consisting of these potential biomarkers could effectively diagnose middle-aged PSD patients. CONCLUSION Urinary metabolic profiles were different between middle-aged PSD patients and stroke survivors without depression. Our results would be helpful in future for developing an objective method to diagnose PSD in middle-aged stroke survivors.
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Affiliation(s)
- Jing Xie
- Chongqing Emergency Medical Center, Department of Endocrinology and Nephrology, The Fourth People's Hospital of Chongqing, Central Hospital of Chongqing University, Chongqing 400014, People's Republic of China
| | - Yu Han
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Yueling Hong
- Institute of Life Sciences, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Wen-Wen Li
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Qilin Pei
- Institute of Life Sciences, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Xueyi Zhou
- Department of Pathology, Faculty of Basic Medicine, Chongqing Medical University, Chongqing 400016, People's Republic of China
| | - Bingbing Zhang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing 400044, People's Republic of China
| | - Ying Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400000, People's Republic of China
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Brandler ES, Baksh N. Emergency management of stroke in the era of mechanical thrombectomy. Clin Exp Emerg Med 2019; 6:273-287. [PMID: 31910498 PMCID: PMC6952636 DOI: 10.15441/ceem.18.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/24/2018] [Indexed: 01/01/2023] Open
Abstract
Emergency management of stroke has been directed at the delivery of recombinant tissue plasminogen activator (tPA) in a timely fashion. Because of the many limitations attached to the delivery of tPA and the perceived benefits accrued to tPA, its use has been limited. Mechanical thrombectomy, a far superior therapy for the largest and most disabling strokes, large vessel occlusions (LVOs), has changed the way acute strokes are managed. Aside from the rush to deliver tPA, there is now a need to identify LVO and refer those patients with LVO to physicians and facilities capable of delivering urgent thrombectomy. Other parts of emergency department management of stroke are directed at identifying and mitigating risk factors for future strokes and at preventing further damage from occurring. We review here the most recent literature supporting these advances in stroke care and present a framework for understanding the role that emergency physicians play in acute stroke care.
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Affiliation(s)
- Ethan S Brandler
- Department of Emergency Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
| | - Nayeem Baksh
- Department of Emergency Medicine, State University of New York at Stony Brook, Stony Brook, NY, USA
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Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors. Sci Rep 2019; 9:16248. [PMID: 31700058 PMCID: PMC6838079 DOI: 10.1038/s41598-019-52721-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/22/2019] [Indexed: 01/14/2023] Open
Abstract
Few previous studies have focused on affective impairment after transient ischemic attack (TIA) and/or minor stroke. The aim was to establish the prevalence, evolution and predictors of post-stroke depression (PSD) and post-stroke apathy (PSA) over a 12-month follow-up period. We prospectively included TIA and minor stroke patients (NIHSS ≤4) who had undergone magnetic resonance imaging <7 days. PSD was diagnosed according to DSM-5 criteria and PSA was defined based on an Apathy Evaluation Scale (AES-C) score of ≥37. Clinical and neuroimaging variables (presence and patterns of lesion, cerebral bleeds and white matter disease) were analysed in order to find potential predictors for PSD and PSA. Follow-up was performed at 10 days and after 2, 6, 9 and 12 months. 82 patients were included (mean 66.4 [standard deviation11.0] years) of whom 70 completed the follow-up. At 10 days, 36 (43.9%) and 28 (34.1%) patients respectively were diagnosed with PSD and PSA. At 12 months, 25 of 70 (35.7%) patients still had PSA, but only 6 of 70 (8.6%) had PSD. Beck Depression Inventory-II score, mini mental state examination (MMSE) and a previous history of depression or anxiety were predictors for PSD. While MMSE score, The Montgomery Asberg Depression Rating Scale and having previously suffered a stroke were also risk factors for PSA. Acute basal ganglia lesion and periventricular leukoaraiosis were associated with PSA while deep leukorariosis with PSD. Despite the presence of few or only transient symptoms, PSD and PSA frequent appear early after TIA and minor stroke. Unlike PSD, apathy tends to persist during follow-up.
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Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2019; 50:e344-e418. [PMID: 31662037 DOI: 10.1161/str.0000000000000211] [Citation(s) in RCA: 3210] [Impact Index Per Article: 642.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background and Purpose- The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods- Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AIS Guidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting some recommendations, was published online by the AHA. The writing group was asked review the original document and revise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion of important newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers' comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationships with industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the American College of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format. Results- These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. Conclusions- These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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West A, Simonsen SA, Zielinski A, Cyril N, Schønsted M, Jennum P, Sander B, Iversen HK. An exploratory investigation of the effect of naturalistic light on depression, anxiety, and cognitive outcomes in stroke patients during admission for rehabilitation: A randomized controlled trial. NeuroRehabilitation 2019; 44:341-351. [PMID: 31177236 DOI: 10.3233/nre-182565] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients admitted for rehabilitation often lack sufficient natural light to entrain their circadian rhythm. OBJECTIVE Installed diurnal naturalistic light may positively influence the outcome of depressive mood, anxiety, and cognition in such patients. METHODS A quasi-randomized controlled trial. Ninety stroke patients in need of rehabilitation were randomized between May 1, 2014, and June 1, 2015 to either a rehabilitation unit equipped entirely with always on naturalistic lighting (IU), or to a rehabilitation unit with standard indoor lighting (CU).Examinations were performed at inclusion and discharge. The following changes were investigated: depressive mood based on the Hamilton Depression scale (HAM-D6) and Major Depression Inventory scale (MDI), anxiety based on the Hospital Anxiety and Depression Scale (HADS), cognition based on the Montreal Cognitive Assessment (MoCA) and well-being based on the Well-being Index (WHO-5). RESULTS Depressive mood (MDI p = 0.0005, HAM-D6 p = 0.011) and anxiety (HADS anxiety p = 0.045) was reduced, and well-being (WHO-5 p = 0.046) was increased, in the IU at discharge compared to the CU. No difference was found in cognition (MoCA p = 0.969). CONCLUSIONS This study is the first to demonstrate that exposure to naturalistic light during admission may significantly improve mental health in rehabilitation patients. Further studies are needed to confirm these findings.
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Affiliation(s)
- Anders West
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark.,Faculty of Health Sciences, University of Copenhagen, Denmark
| | - Sofie Amalie Simonsen
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Alexander Zielinski
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Niklas Cyril
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Marie Schønsted
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Poul Jennum
- Faculty of Health Sciences, University of Copenhagen, Denmark.,Department of Neurophysiology, Danish Center for Sleep Medicine, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Birgit Sander
- Faculty of Health Sciences, University of Copenhagen, Denmark.,Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Helle K Iversen
- Department of Neurology, Clinical Stroke Research Unit, Rigshospitalet Glostrup, Glostrup, Denmark.,Faculty of Health Sciences, University of Copenhagen, Denmark
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Reliability and Validity of the Patient Health Questionnaire-9 as a Screening Tool for Poststroke Depression. J Neurosci Nurs 2019; 51:147-152. [PMID: 31058767 DOI: 10.1097/jnn.0000000000000442] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Screening for poststroke depression (PSD) using a valid and reliable tool is recommended for all stroke survivors. This literature review identifies the specificity, sensitivity, and appropriateness of the 9-item Patient Health Questionnaire (PHQ-9) to screen stroke patients for PSD. METHODS Relevant databases were searched using the following selection criteria: (1) peer-reviewed primary research, (2) published from 2012 to 2018 (to evaluate the most recent research using this tool), and (3) examined the specificity and sensitivity of the PHQ-9 for screening stroke survivors for PSD. RESULTS Six studies, with an overall level of evidence grade of "B," representing an overall total sample size of 930 participants (851 given a diagnosis of stroke and 49 given a diagnosis of transient ischemic attacks) met criteria for inclusion in the review. Only 2 studies reported data on all of the components necessary to determine the robustness of this tool to screen for depression in stroke survivors. CONCLUSION Evidence regarding the sensitivity and specificity of the PHQ-9 to screen stroke patients for PSD is inconclusive. Additional research is needed to address the appropriateness of the PHQ-9 as a depression screening tool in this population. Clinicians should validate the results of PHQ-9 screening of ischemic stroke patients for PSD with the Structured Clinical Interview for DSM-5, the standard for diagnosing depression, before initiating treatment of PSD.
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68
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Sarfo FS, Agbenorku M, Adamu S, Obese V, Berchie P, Ovbiagele B. The dynamics of Poststroke depression among Ghanaians. J Neurol Sci 2019; 405:116410. [PMID: 31425901 DOI: 10.1016/j.jns.2019.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/17/2019] [Accepted: 07/22/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The very few published data on post-stroke depression (PSD) among indigenous Africans have covered its prevalence and predictors. We sought to evaluate the dynamics of PSD in a cohort of Ghanaian stroke survivors followed for 9 months after an acute stroke. METHODS Stroke survivors in this prospective cohort were adults aged >18 years with CT scan confirmed stroke, recruited into a randomized controlled trial to assess the feasibility of an mHealth technology-enabled, nurse guided intervention for blood pressure control. PSD was assessed a secondary outcome measure using the Hamilton Depression Rating Scale (HDRS) at enrollment, months 3, 6, and 9. Those with a score of >7 points on HDRS were categorized as depressed. A multivariate logistic regression analysis was performed to identify independent predictors of PSF. RESULTS Mean age of study participants was 55.1 ± 12.7 years with 65% being males. Ischemic strokes comprised 76.6% of study population. Prevalence of PSD at baseline was 78.6%, 43.6% at month 3, 41.1% at month 6 and 18.2% at month 9 (p < .0001). Factors significantly associated with PSD at baseline were higher NIH Stoke Scale score (adjusted OR 1.51, 95% CI: 1.03-2.23) and pain (adjusted OR 7.18, 95% CI: 1.52-33.89). NIHSS score (adjusted OR, 1.99, 95% CI: 1.12-3.52) as associated with PSD at month 9. CONCLUSION 80% Ghanaian stroke survivors have early PSD declining to 20% at month 9. Stroke severity is the persistent factor associated with PSD at baseline and follow-up, and good be a target for screening and promptly treating PSD.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Manolo Agbenorku
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sheila Adamu
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Vida Obese
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Patrick Berchie
- Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, USA
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Ashaie SA, Hurwitz R, Cherney LR. Depression and Subthreshold Depression in Stroke-Related Aphasia. Arch Phys Med Rehabil 2019; 100:1294-1299. [DOI: 10.1016/j.apmr.2019.01.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/16/2019] [Accepted: 01/29/2019] [Indexed: 11/25/2022]
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71
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Lanctôt KL, Lindsay MP, Smith EE, Sahlas DJ, Foley N, Gubitz G, Austin M, Ball K, Bhogal S, Blake T, Herrmann N, Hogan D, Khan A, Longman S, King A, Leonard C, Shoniker T, Taylor T, Teed M, de Jong A, Mountain A, Casaubon LK, Dowlatshahi D, Swartz RH. Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue following Stroke, 6th edition update 2019. Int J Stroke 2019; 15:668-688. [PMID: 31221036 DOI: 10.1177/1747493019847334] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The 2019 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Mood, Cognition and Fatigue following Stroke is a comprehensive set of evidence-based guidelines addressing three important issues that can negatively impact the lives of people who have had a stroke. These include post-stroke depression and anxiety, vascular cognitive impairment, and post-stroke fatigue. Following stroke, approximately 20% to 50% of all persons may be affected by at least one of these conditions. There may also be overlap between conditions, particularly fatigue and depression. If not recognized and treated in a timely matter, these conditions can lead to worse long-term outcomes. The theme of this edition of the CSBPR is Partnerships and Collaborations, which stresses the importance of integration and coordination across the healthcare system to ensure timely and seamless care to optimize recovery and outcomes. Accordingly, these recommendations place strong emphasis on the importance of timely screening and assessments, and timely and adequate initiation of treatment across care settings. Ideally, when screening is suggestive of a mood or cognition issue, patients and families should be referred for in-depth assessment by healthcare providers with expertise in these areas. As the complexity of patients treated for stroke increases, continuity of care and strong communication among healthcare professionals, and between members of the healthcare team and the patient and their family is an even bigger imperative, as stressed throughout the recommendations, as they are critical elements to ensure smooth transitions from acute care to active rehabilitation and reintegration into their community.
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Affiliation(s)
- Krista L Lanctôt
- Sunnybrook Research Institute, Toronto, Canada.,University of Toronto Faculty of Medicine, Toronto, Canada
| | | | - Eric E Smith
- Calgary Stroke Program, Calgary, Canada.,Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta
| | - Demetrios J Sahlas
- Division of Neurology, Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | - Gord Gubitz
- Queen Elizabeth II Health Sciences Centre, Halifax, Canada.,Department of Medicine (Neurology), Dalhousie University, Halifax, Canada.,Canadian Stroke Consortium, Ontario, Canada
| | - Melissa Austin
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | - Treena Blake
- GF Strong Rehabilitation Centre, Vancouver, Canada
| | - Nathan Herrmann
- Sunnybrook Research Institute, Toronto, Canada.,University of Toronto Faculty of Medicine, Toronto, Canada
| | - David Hogan
- University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Aisha Khan
- Montreal University Health Center, Montreal, Canada
| | - Stewart Longman
- Calgary Stroke Program, Alberta Health Services, Calgary, Canada
| | - Andrea King
- Nova Scotia Health Authority, Halifax, Canada
| | - Carol Leonard
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ottawa, Canada
| | | | - Trudy Taylor
- Carewest Dr. Vernon Fanning Centre, Calgary, Canada
| | - Moira Teed
- Heart and Stroke Foundation of Canada, Toronto, Canada
| | | | - Anita Mountain
- Dalhousie University Division of Physical Medicine and Rehabilitation, Halifax, Canada.,Nova Scotia Rehabilitation Centre Site, Halifax, Canada
| | - Leanne K Casaubon
- University of Toronto Faculty of Medicine, Toronto, Canada.,Canadian Stroke Consortium, Ontario, Canada.,Toronto Western Hospital, University Health Network, Toronto, Canada
| | | | - Richard H Swartz
- Sunnybrook Research Institute, Toronto, Canada.,University of Toronto Faculty of Medicine, Toronto, Canada
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Arumugam A, Strong A, Tengman E, Röijezon U, Häger CK. Psychometric properties of knee proprioception tests targeting healthy individuals and those with anterior cruciate ligament injury managed with or without reconstruction: a systematic review protocol. BMJ Open 2019; 9:e027241. [PMID: 30948613 PMCID: PMC6500280 DOI: 10.1136/bmjopen-2018-027241] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore, there is a growing need for valid, reliable and responsive knee proprioception tests. No previous study has comprehensively reviewed all the relevant psychometric properties (PMPs) of these tests together. The aim of this review protocol is to narrate the steps involved in synthesising the evidence for the PMPs of specific knee proprioception tests among individuals with an ACL injury and knee-healthy controls. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic reviews and Meta-Analyses will be followed to report the review. A combination of four conceptual groups of terms-(1) construct (knee proprioception), (2) target population (healthy individuals and those with an ACL injury managed conservatively or with a surgical reconstruction), (3) measurement instrument (specific knee proprioception tests) and (4) PMPs (reliability, validity and responsiveness)-will be used for electronic databases search. PubMed, AMED, CINAHL, SPORTDiscus, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials and ProQuest will be searched from their inception to November 2018. Two reviewers will independently screen titles, abstracts and full text articles, extract data and perform risk of bias assessment using the updated COnsensus-based Standards for the selection of health Measurement INstruments risk of bias checklist for the eligible studies. A narrative synthesis of the findings and a meta-analysis will be attempted as appropriate. Each PMP of knee proprioception tests will be classified as 'sufficient', 'indeterminate' or 'insufficient'. The overall level of evidence will be ascertained using an established set of criteria. ETHICS AND DISSEMINATION Ethical approval or patient consent is not required for a systematic review. The review findings will be submitted as a series of manuscripts for peer-review and publication in scientific journals. PROSPERO REGISTRATION NUMBER CRD42018108014.
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Affiliation(s)
- Ashokan Arumugam
- Department of Community Medicine and Rehabilitation – Physiotherapy Section, Umeå University, Umeå, Sweden
| | - Andrew Strong
- Department of Community Medicine and Rehabilitation – Physiotherapy Section, Umeå University, Umeå, Sweden
| | - Eva Tengman
- Department of Community Medicine and Rehabilitation – Physiotherapy Section, Umeå University, Umeå, Sweden
| | - Ulrik Röijezon
- Department of Health Sciences – Physiotherapy Section, Luleå University of Technology, Luleå, Sweden
| | - Charlotte K Häger
- Department of Community Medicine and Rehabilitation – Physiotherapy Section, Umeå University, Umeå, Sweden
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Cai W, Mueller C, Li YJ, Shen WD, Stewart R. Post stroke depression and risk of stroke recurrence and mortality: A systematic review and meta-analysis. Ageing Res Rev 2019; 50:102-109. [PMID: 30711712 DOI: 10.1016/j.arr.2019.01.013] [Citation(s) in RCA: 174] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/14/2019] [Accepted: 01/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post stroke depression is a significant neuropsychiatric manifestation, predicting a range of poor outcomes. There are several studies investigating the association between post stroke depression and stroke recurrence/mortality, but results have been inconsistent. OBJECTIVE A systematic review, meta-analysis and meta regression of observational studies assessing the association between post stroke depression and risk of stroke recurrence and mortality. METHODS A search of Medline (via PubMed), Web of Science databases, EMBASE, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews was conducted until August 2018. We extracted and pooled hazard ratios from observational studies that reported the risk estimates of stroke recurrence and mortality in stroke survivors with/without depression. RESULTS The reviewed sample comprised 15 prospective cohort studies with 250,294 participants, 139,276 cases, and follow-up periods ranging from 1 to 15 years. The meta-analysis concluded a hazard ratio for post stroke depression and all-cause mortality of 1.59 (95% CI, 1.30-1.96), but research to date has been insufficient to determine the association between post stroke depression and stroke recurrence. CONCLUSION AND RELEVANCE Post stroke depression is associated with a significantly increased risk of mortality in stroke survivors. More researches are required on the association with stroke recurrence.
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Pugliese M, Ramsay T, Shamloul R, Mallet K, Zakutney L, Corbett D, Dukelow S, Stotts G, Shamy M, Wilson K, Guerinet J, Dowlatshahi D. RecoverNow: A mobile tablet-based therapy platform for early stroke rehabilitation. PLoS One 2019; 14:e0210725. [PMID: 30682076 PMCID: PMC6347149 DOI: 10.1371/journal.pone.0210725] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/31/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction Stroke survivors frequently experience a range of post-stroke deficits. Specialized stroke rehabilitation improves recovery, especially if it is started early post-stroke. However, resource limitations often preclude early rehabilitation. Mobile technologies may provide a platform for stroke survivors to begin recovery when they might not be able to otherwise. The study objective was to demonstrate the feasibility of RecoverNow, a tablet-based stroke recovery platform aimed at delivering speech and cognitive therapy. Methods We recruited a convenience sample of 30 acute stroke patients to use RecoverNow for up to 3 months. Allied health professionals assigned specific applications based on standard of care assessments. Participants were encouraged to take home the RecoverNow tablets upon discharge from acute care. The study team contacted participants to return for a follow-up interview 3 months after enrollment. The primary outcome of interest was feasibility, defined using 5 facets: recruitment rate, adherence rate, retention rate, the proportion of successful follow-up interventions, and protocol deviations. We tracked barriers to tablet-based care as a secondary outcome. Results We successfully recruited 30 of 62 eligible patients in 15 weeks (48% recruitment rate). Participants were non-adherent to tablet-based therapy inside and outside of acute care, using RecoverNow for a median of 12 minutes a day. Retention was high with 23 of 30 patients participating in follow-up interviews (77% retention rate) and all but 3 of the 23 interviews (87%) were successfully completed. Only 2 major protocol deviations occurred: one enrollment failure and one therapy protocol violation. Barriers to tablet-based care were frequently encountered by study participants with many expressing the assigned applications were either too easy or too difficult. Conclusions Acute stroke patients are interested in attempting tablet-based stroke rehabilitation and are easily recruited early post-stroke. However, tablet-based therapy may be challenging due to patient, device and system-related barriers. Reducing the frequency of common barriers will be essential to keeping patients engaged in tablet-based therapy.
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Affiliation(s)
- Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- * E-mail:
| | - Tim Ramsay
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rany Shamloul
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Karen Mallet
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | - Lise Zakutney
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Dale Corbett
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sean Dukelow
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Grant Stotts
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Shamy
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Kumanan Wilson
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Dar Dowlatshahi
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Champlain Regional Stroke Network, Ottawa, Ontario, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
- Brain and Mind Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Trusova NA, Levin OS. Clinical significance and possibilities of therapy of post-stroke depression. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:60-67. [DOI: 10.17116/jnevro201911909260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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76
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Liang ZH, Jia YB, Wang ML, Li ZR, Li M, Yun YL, Zhu RX. Efficacy of ginkgo biloba extract as augmentation of venlafaxine in treating post-stroke depression. Neuropsychiatr Dis Treat 2019; 15:2551-2557. [PMID: 31564880 PMCID: PMC6731991 DOI: 10.2147/ndt.s215191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is one of the most common psychiatric diseases afflicting stroke survivors. This study was conducted to assess the efficacy of ginkgo biloba extract as augmentation of venlafaxine in treating PSD. METHODS The included PSD patients were randomly assigned into the experiment group (receiving ginkgo biloba extract plus venlafaxine) and control group (receiving venlafaxine alone). The treatment was continued for eight weeks. The Hamilton Depression Rating Scale (HDRS) and the Self-rating Depression Scale (SDS) were used to assess the depressive symptoms. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the neurological defect, and the Activities of Daily Living (ADL) was used to assess recovery of abilities of patients after stroke. Meanwhile, the levels of serum 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) were measured before and after treatment. The dose of venlafaxine used and adverse events were also recorded. RESULTS Each group had 40 PSD patients. After treatment, the depressive symptoms, neurological defect and living function were significantly improved in both groups. But the patients receiving ginkgo biloba extract plus venlafaxine had the significantly lower average HDRS score (p=0.0008), SDS score (p<0.00001), NIHSS score (p=0.00001), and higher average ADL score (p=0.0005). Meanwhile, compared to the control group, patients in the experiment group had the significantly higher 5-HT (p<0.00001) level and BDNF level (p<0.00001), needed lower dose of venlafaxine (p=0.007), and experienced fewer adverse events. CONCLUSION These results demonstrated that the ginkgo biloba extract was a good augmentation of venlafaxine in treating PSD and should be further investigated.
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Affiliation(s)
- Zi-Hong Liang
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Yan-Bo Jia
- Department of Orthopaedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia, People's Republic of China
| | - Mei-Ling Wang
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Zi-Ru Li
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Min Li
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Yong-Li Yun
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Run-Xiu Zhu
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
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Rosenfeldt AB, Linder SM, Davidson S, Clark C, Zimmerman NM, Lee JJ, Alberts JL. Combined Aerobic Exercise and Task Practice Improve Health-Related Quality of Life Poststroke: A Preliminary Analysis. Arch Phys Med Rehabil 2018; 100:923-930. [PMID: 30543801 DOI: 10.1016/j.apmr.2018.11.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/21/2018] [Accepted: 11/09/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this project was to determine the effects of lower extremity aerobic exercise coupled with upper extremity repetitive task practice (RTP) on health-related quality of life (HRQOL) and depressive symptomology in individuals with chronic stroke. DESIGN Secondary analysis of data from 2 randomized controlled trials. SETTING Research laboratory. PARTICIPANTS Individuals (N=40) with chronic stroke. INTERVENTIONS Participants received one of the following interventions: forced exercise+RTP (FE+RTP, n=16), voluntary exercise+RTP (VE+RTP, n=16), or stroke education+RTP (EDU+RTP, n=8). All groups completed 24 sessions, each session lasting 90 minutes. MAIN OUTCOME MEASURES The Center for Epidemiological Studies-Depression Scale (CES-D) and Stroke Impact Scale (SIS) were used to assess depressive symptomology and HRQOL. RESULTS There were no significant group-by-time interactions for any of the SIS domains or composite scores. Examining the individual groups following the intervention, those in the FE+RTP and VE+RTP groups demonstrated significant improvements in the following SIS domains: strength, mobility, hand function, activities of daily living, and the physical composite. In addition, the FE+RTP group demonstrated significant improvements in memory, cognitive composite, and percent recovery from stroke. The HRQOL did not change in the EDU+RTP group. Although CES-D scores improved predominantly for those in the FE+RTP group, these improvements were not statistically significant. Overall, results were maintained at the 4-week follow-up. CONCLUSION Aerobic exercise, regardless of mode, preceding motor task practice may improve HRQOL in patients with stroke. The potential of aerobic exercise to improve cardiorespiratory endurance, motor outcomes, and HRQOL poststroke justifies its use to augment traditional task practice.
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Affiliation(s)
- Anson B Rosenfeldt
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Susan M Linder
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; Neurological Institute, Cleveland Clinic, Cleveland, OH.
| | - Sara Davidson
- Neurological Institute, Cleveland Clinic, Cleveland, OH
| | - Cynthia Clark
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | | | - John J Lee
- Department of Physical Medicine and Rehabilitation, Cleveland Clinic, Cleveland, OH
| | - Jay L Alberts
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH; Neurological Institute, Cleveland Clinic, Cleveland, OH; Office of Clinical Transformation, Cleveland Clinic, Cleveland, OH
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Tommasi M, Ferrara G, Saggino A. Application of Bayes' Theorem in Valuating Depression Tests Performance. Front Psychol 2018; 9:1240. [PMID: 30083119 PMCID: PMC6064972 DOI: 10.3389/fpsyg.2018.01240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/28/2018] [Indexed: 11/13/2022] Open
Abstract
The validity of clinical diagnoses is a fundamental topic in clinical psychology, because now there are some political administrations, as the IOM or the U.K. government, which are focusing on best evidence-based practice in clinical psychology. The most problematic issue in clinical psychology is to avoid wrong diagnoses which can have negative consequences on individual life and on the utility of clinical treatments. In the case of diagnoses based on self-report tests, the diagnostic decision about individual health is based on the comparison between its score and the cutoff, according to the frequentist approach to probability. However, the frequentist approach underestimates the possible risks of incorrect diagnoses based on cutoffs only. The Bayesian approach is a valid alternative to make diagnoses on the basis of the scores from psychological tests. The Bayes' theorem estimates the posterior probability of the presence of a pathology on the basis of the knowledge about the diffusion of this pathology (prior probability) and of the knowledge of sensitivity and specificity values of the test. With all this information, it is possible to estimate the diagnostic accuracy of some self-report tests used for assessing depression. We analyzed the diagnostic accuracy of the most used psychological tests of depression (Zung's Self-Rating Depression Scale, Hamilton Rating Scale for Depression, Center for Epidemiological Studies for Depression and the Beck Depression Inventory), together with a new scale (Teate Depression Inventory) developed with the IRT procedure, by analyzing the published works in which data about sensitivity and specificity of these scales are reported. Except the TDI, none of these scales can reach a satisfactory level of diagnostic accuracy, probably for the absence of an optimal procedure to select test items and subjects with clearly defined pathological symptoms which could allow the reduction of false positives in test scoring.
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Affiliation(s)
- Marco Tommasi
- Department of Psychological, Health and Territorial Sciences, Università degli Studi G. d'Annunzio Chieti e Pescara, Chieti, Italy
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Backhouse EV, McHutchison CA, Cvoro V, Shenkin SD, Wardlaw JM. Cognitive ability, education and socioeconomic status in childhood and risk of post-stroke depression in later life: A systematic review and meta-analysis. PLoS One 2018; 13:e0200525. [PMID: 30011299 PMCID: PMC6047794 DOI: 10.1371/journal.pone.0200525] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Depression after stroke is common and is associated with poorer recovery. Risk factors such as gender, age and stroke severity are established, but it is unclear whether factors from earlier in life might also contribute. METHODS We searched MEDLINE, PsycINFO, EMBASE and meta-analysed all available evidence on childhood (premorbid) IQ, socioeconomic status (SES), education and stroke in adulthood. We included all studies reporting data on >50 patients, calculating overall odds ratios (OR), mean difference, correlation, 95% confidence intervals (CI) and 95% predictive intervals (PI) using random effects methods. We quality assessed all studies, performed sensitivity analyses, assessed heterogeneity and publication bias. RESULTS We identified 33 studies including 2,664 participants with post-stroke depression and 5,460 without (314 participants not classified). Low education (< = 8 years) was associated with post-stroke depression in studies which defined depression as score of mild and above on a depression rating scale (OR 1.47 95% CI 1.10-1.97, p<0.01) but not in studies where depression was defined as severe depressive symptoms or a clinical diagnosis of major depression (OR 1.04 95% CI 0.90-1.31, p = 0.60). Low education was not associated with an increased risk for post-stroke depression in studies that adjusted for age and sex (OR 0.86 95% CI 0.50-1.48 p = 0.58). Those with post-stroke depression had fewer years of education than those without post-stroke depression (MD 0.68 95% CI 0.05-1.31 p = 0.04). Few studies adjusted for vascular risk factors or stroke severity. Heterogeneity between studies was moderate and was partly explained by severity of depression. In the one study identified premorbid IQ did not differ between those with post-stroke depression (mean IQ 10.1.8 SD 9.8) vs those without (mean IQ 104 SD 10.1). There were no studies that examined childhood socioeconomic status and risk of post-stroke depression. CONCLUSIONS Having less education is associated with an increased risk of post-stroke depressive symptoms but with large confidence intervals and heterogeneity. Future studies should explore the relationship between early and late life risk factors to improve risk identification and to target prevention and treatment strategies.
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Affiliation(s)
- Ellen V. Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline A. McHutchison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Vera Cvoro
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), Scotland, United Kingdom
| | - Susan D. Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), Scotland, United Kingdom
- Geriatric Medicine, Department of Clinical and Surgical Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), Scotland, United Kingdom
- UK Dementia Research Institute at The University of Edinburgh, Edinburgh Medical School, Edinburgh, United Kingdom
- * E-mail:
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80
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Aujla N, Walker M, Sprigg N, Vedhara K. Do individual versus illness belief schema differ in the prediction of post-stroke recovery? J Health Psychol 2018; 25:2118-2128. [DOI: 10.1177/1359105318785446] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This longitudinal observational study examined how individual versus illness belief schema compare as predictors of post-stroke recovery. A total of 42 stroke survivors (mean age = 66.9 years/range = 29–96 years; 68% male) were involved. The primary outcome, Health-Related Quality of Life was measured using EQ-5D-5L, mood using Patient Health Questionnaire-9 and disability using Nottingham Extended Activities of Daily Living Scale. Stroke Illness Perception Questionnaire-Revised measured illness beliefs. Linear regressions showed that individual illness beliefs significantly explained more of the variance in 3-month post-stroke recovery than schema (7.4%–22.5% versus 1.9%–9.9%). Individual versus illness belief schema predict outcomes differently, but which approach predicts outcomes better remains unclear.
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81
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Post stroke depression: The sequelae of cerebral stroke. Neurosci Biobehav Rev 2018; 90:104-114. [DOI: 10.1016/j.neubiorev.2018.04.005] [Citation(s) in RCA: 110] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 03/12/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022]
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82
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Reeves M, Lisabeth L, Williams L, Katzan I, Kapral M, Deutsch A, Prvu-Bettger J. Patient-Reported Outcome Measures (PROMs) for Acute Stroke: Rationale, Methods and Future Directions. Stroke 2018; 49:1549-1556. [DOI: 10.1161/strokeaha.117.018912] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Mathew Reeves
- From the Department of Epidemiology, Michigan State University, East Lansing (M.R.)
| | - Lynda Lisabeth
- School of Public Health, University of Michigan, Ann Arbor (L.L.)
| | | | - Irene Katzan
- Neurological Institute, Cleveland Clinic, OH (I.K.)
| | - Moira Kapral
- Division of General Internal Medicine, Department of Medicine, University of Toronto, ON, Canada (M.K.)
| | - Anne Deutsch
- Shirley Ryan AbilityLab, Northwestern University, Chicago, IL (A.D.)
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83
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Wang EY, Meyer C, Graham GD, Whooley MA. Evaluating Screening Tests for Depression in Post-Stroke Older Adults. J Geriatr Psychiatry Neurol 2018; 31:129-135. [PMID: 29793370 DOI: 10.1177/0891988718778791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Uncertainty surrounds which screening test to use in older patients with poststroke depression, in whom symptoms of depression are more complex and often occur in conjunction with other comorbidities. We evaluated screening tests for depression among a cohort of older ambulatory individuals with comorbid ischemic heart disease and prior stroke. METHODS We administered 4 depression screening instruments to 148 participants with ischemic heart disease and self-reported stroke from The Heart and Soul Study. Instruments included the 10-item Center for Epidemiologic Studies Depression Scale (CES-D), 9-item and 2-item versions of the Patient Health Questionnaire (PHQ-9 and PHQ-2), and the Whooley questions, a 2-item yes/no questionnaire. We administered the computerized version of the National Institute of Mental Health Diagnostic Interview Schedule as a gold standard. RESULTS Of the 148 participants, 35 (24%) had major depression. The Whooley questions demonstrated the highest sensitivity for detection (89%), followed by the CES-D (80%), PHQ-2 with cut point ≥2 (79%), PHQ-9 (51%), and PHQ-2 with cut point ≥3 (32%). The Whooley questions had a specificity of 0.66, a positive likelihood ratio of 2.61, and a negative likelihood ratio of 0.82. We observed no significant difference in the area under the receiver operating characteristic curve across the 4 instruments. CONCLUSION In a cohort of ambulatory older adults with coronary heart disease and prior stroke, depression occurred in a fourth of the participants. The simple Whooley questions screening instrument can efficiently detect depression with a high sensitivity in this population, one representative of older patients commonly encountered within a primary care setting.
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Affiliation(s)
- Elizabeth Y Wang
- 1 Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Craig Meyer
- 1 Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA.,2 San Francisco VA Health Care System, San Francisco, CA, USA
| | - Glenn D Graham
- 2 San Francisco VA Health Care System, San Francisco, CA, USA
| | - Mary A Whooley
- 1 Department of Medicine, School of Medicine, University of California, San Francisco, CA, USA.,2 San Francisco VA Health Care System, San Francisco, CA, USA
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84
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Stern-Nezer S, Eyngorn I, Mlynash M, Snider RW, Venkatsubramanian C, Wijman CAC, Buckwalter MS. Depression one year after hemorrhagic stroke is associated with late worsening of outcomes. NeuroRehabilitation 2018; 41:179-187. [PMID: 28505996 DOI: 10.3233/nre-171470] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Poststroke depression is the most common psychiatric sequelae of stroke, and it's independently associated with increased morbidity and mortality. Few studies have examined depression after intracranial hemorrhage (ICH). OBJECTIVE To investigate the relationship between depression, ICH and outcomes. METHODS A substudy of the prospective Diagnostic Accuracy of MRI in Spontaneous Intracerebral Hemorrhage (DASH) study, we included 89 subjects assessed for depression 1 year after hemorrhage. A Hamilton Depression Rating Scale score >10 defined depression. Univariate, multivariable, and trend analyses evaluated relationships between depression, clinical, radiographic, and inflammatory factors and modified Rankin score (mRS) at 90 days and one year. RESULTS Prevalence of depression at one year was 15%. Depression was not associated with hematoma volumes, presence of IVH or admission NIHSS, nor with demographic factors. Despite this, depressed patients had worse 1-year outcomes (p = 0.004) and were less likely to improve between 3 and 12 months, and more likely to worsen (p = 0.042). CONCLUSION This is the first study to investigate depression one year after ICH. Post-ICH depression was common and associated with late worsening of disability unrelated to initial hemorrhage severity. Further research is needed to understand whether depression is caused by worsened disability, or whether the converse is true.
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Affiliation(s)
- Sara Stern-Nezer
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Irina Eyngorn
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Michael Mlynash
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Ryan W Snider
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Chitra Venkatsubramanian
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.,Department of Neurosurgery Stanford, Stanford University, CA, USA
| | - Christine A C Wijman
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Marion S Buckwalter
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.,Department of Neurosurgery Stanford, Stanford University, CA, USA
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Jani BD, Simpson R, Lawrence M, Simpson S, Mercer SW. Acceptability of mindfulness from the perspective of stroke survivors and caregivers: a qualitative study. Pilot Feasibility Stud 2018; 4:57. [PMID: 29497560 PMCID: PMC5827989 DOI: 10.1186/s40814-018-0244-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 02/02/2018] [Indexed: 01/10/2023] Open
Abstract
Background Depression is very common among stroke survivors with estimated prevalence rates of approximately 33% among stroke survivors, but treatment options are limited. Mindfulness-Based Stress Reduction (MBSR) is an effective treatment for depression generally, but benefits in stroke patients are unclear. The aim of this study was to determine the feasibility of delivering MBSR to stroke survivors and their caregivers in the community. We conducted a study to gain views of MBSR as a potential treatment option among stroke survivors and their caregivers in the community. Methods Participants were recruited from an urban community in Scotland (UK) using newspaper adverts, social media and support groups run by health charities. A 2-h MBSR taster session was delivered by two experienced mindfulness instructors, followed by focus group sessions with all participants on their user experience and suggestions for MBSR modifications for stroke survivors. The focus group sessions were audio recorded and transcribed verbatim. Transcript data were analysed thematically using the framework approach. Results The study sample consisted of 28 participants (16 females); there were 21 stroke survivors (11 females) and 7 caregivers (5 females). The median age for participants was 60 years.Most participants described the MBSR taster session as a positive experience. The main challenge reported was trying to maintain focus and concentration throughout the MBSR session. Some participants expressed reservations about the duration of standard mindfulness course sessions, suggesting a preference for shorter sessions. The potential for achieving better control over negative thoughts and emotions was viewed as a potential facilitator for future MBSR participation. Participants suggested having an orientation session prior to starting an 8-week course as a means of developing familiarity with the MBSR instructor and other participants. Conclusion It was feasible to recruit 21 stroke survivors and 7 caregivers for MBSR taster sessions in the community. A shorter MBSR session and an orientation session prior to the full course are suggestions for potential MBSR modifications for stroke survivors, which needs further research and evaluation.
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Affiliation(s)
- Bhautesh Dinesh Jani
- 1General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, Scotland G12 9LX UK
| | - Robert Simpson
- 1General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, Scotland G12 9LX UK
| | - Maggie Lawrence
- 2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, G4 0BA UK
| | - Sharon Simpson
- 1General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, Scotland G12 9LX UK
| | - Stewart W Mercer
- 1General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, Scotland G12 9LX UK
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Quinn TJ, Elliott E, Langhorne P. Cognitive and Mood Assessment Tools for Use in Stroke. Stroke 2018; 49:483-490. [DOI: 10.1161/strokeaha.117.016994] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/20/2017] [Accepted: 11/27/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Terence J. Quinn
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Emma Elliott
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Peter Langhorne
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
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Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018; 49:e46-e110. [PMID: 29367334 DOI: 10.1161/str.0000000000000158] [Citation(s) in RCA: 3453] [Impact Index Per Article: 575.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. METHODS Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight Committee and Stroke Council Leadership Committee. These guidelines use the American College of Cardiology/American Heart Association 2015 Class of Recommendations and Levels of Evidence and the new American Heart Association guidelines format. RESULTS These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. CONCLUSIONS These guidelines are based on the best evidence currently available. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.
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Bartoli F, Di Brita C, Crocamo C, Clerici M, Carrà G. Early Post-stroke Depression and Mortality: Meta-Analysis and Meta-Regression. Front Psychiatry 2018; 9:530. [PMID: 30443225 PMCID: PMC6221899 DOI: 10.3389/fpsyt.2018.00530] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 10/05/2018] [Indexed: 01/01/2023] Open
Abstract
Background: Post-stroke depression (PSD) is a common and serious complication after stroke. In this systematic review and meta-analysis, we evaluated the association between early PSD and mortality, considering depressive symptoms occurring within the first 3 months after the neurological event. Methods: This meta-analysis was conducted following Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines and based on studies indexed till May 2018 in PubMed and Web of Science databases. The relative risk (RR) for mortality in individuals with PSD, as compared with non-depressed ones, was estimated. Findings were pooled according to a random-effects model. Meta-regression and subgroup analyses were carried out. Results: We included seven studies, accounting for 119,075 individuals, of whom 17,609 suffering from an early PSD. We found higher rates of mortality in subjects with PSD as compared with non-depressed ones (RR = 1.50; 95%CI: 1.28 to 1.75; p < 0.001). Heterogeneity across studies was moderate (I 2 = 50.7%). Subgroup analysis showed a slightly higher effect of PSD on short-term mortality (RR = 1.70; p < 0.001), as compared with long-term one (RR = 1.35; p = 0.01). According to relevant meta-regression analyses, the estimate was influenced by sample proportion of men (p = 0.043). Conclusions: Despite some limitations, our study shows the negative impact of early PSD on survival rates. Mechanisms underlying this association still need to be elucidated and several interpretations can be hypothesized. Future research should test if an early management of depression may increase life expectancy after stroke.
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Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Carmen Di Brita
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.,Division of Psychiatry, University College London, London, United Kingdom
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89
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Depression Is Associated with a Higher Risk of Death among Stroke Survivors. J Stroke Cerebrovasc Dis 2017; 26:2870-2879. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/28/2017] [Accepted: 07/10/2017] [Indexed: 11/18/2022] Open
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Evaluation of the Patient Health Questionnaire-2 as a Screening Tool for Depression during the Acute Stroke Admission. J Stroke Cerebrovasc Dis 2017; 26:2519-2526. [PMID: 28756141 DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 03/01/2017] [Accepted: 05/29/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The ideal time to screen for poststroke depression remains uncertain. We evaluated the 2-item Patient Health Questionnaire (PHQ-2) as a screening tool for depression during the acute stroke admission by determining the prevalence of positive depression screen during admission and by calculating the level of agreement between positive screens during admission and follow-up. METHODS This was a retrospective cohort of adult stroke survivors discharged January to December 2013 with principal discharge diagnosis of acute ischemic stroke or intracerebral hemorrhage. Depression screening was systematically performed during the hospital admission using the PHQ-2. The 9-item Patient Health Questionnaire (PHQ-9), which includes the PHQ-2, was completed by patients at outpatient follow-up. RESULTS The study cohort consisted of 337 patients with mean age of 66.3 years. Median time from admission to PHQ-2 was 3 days (interquartile range 1-4 days). The screen was positive for depression in 4.7% (95% confidence interval 2.7%-7.6%) of patients. Of the 150 patients with PHQ-9 data at outpatient follow up, 19.3% screened positive for depression. In both the inpatient setting and at outpatient follow-up, the prevalence of a positive depression screen was similar between patients with and without a history of depression or antidepressant use. CONCLUSIONS Systematic screening for depression using PHQ-2 during hospitalization for acute stroke identified few patients. Most patients with depressive symptoms were identified only at the time of outpatient follow-up. Further study is needed to evaluate the usefulness of other depression screens for stroke patients in the acute hospital setting and the optimal timing for depression screening after stroke.
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91
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Ojagbemi A, Owolabi M, Akinyemi J, Ovbiagele B. Proposing a new stroke-specific screening tool for depression: Examination of construct validity and reliability. eNeurologicalSci 2017; 9:14-18. [PMID: 29202106 PMCID: PMC5709821 DOI: 10.1016/j.ensci.2017.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objectives The optimal tool for identifying depression after stroke is yet to be identified. In the present study, we propose a new context-specific screening tool for PSD and examined its construct validity and reliability within existing data on recent stroke survivors. Methods We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤ one month) stroke survivors. Depression was measured using the Hospital Anxiety and Depression Scale (HADS-D). We also independently administered the 26-items Health Related Quality of Life in Stroke Patients (HRQOLISP-26), a stroke-specific measure developed from a large cross-cultural sample. Using standard protocol, we identified 6 psychoemotional-domain items of the HRQOLISP-26 fitting a single dimensional model with phenomenological and conceptual overlap with the depression framework in the 10th revision of the International Classification of Diseases (ICD-10). We examined construct validity by comparing HRQOLISP-E with the HADS-D, and known group validity by comparing with age, gender, and stroke severity using both the Pearson product moment coefficient and multivariate regression analyses. Internal consistency and split-half reliability were also determined. Results Each HRQOLISP-E item (r = − 0.40 to − 0.53, all p < 0.001), as well as the total HRQOLISP-E score (− 0.53, p < 0.001) showed significant correlation with the HADS-D. The HRQOLISP-E scores also correlated significantly with age and stroke severity. Depression assessed using the HRQOLIPS-E was independently associated with older age and stroke severity. All HRQOLISP-E items scale correlations were > 0.8 (0.81–0.93) compared with 0.56–0.68 for the HADS-D (Cronbach's alpha = 0.939, versus 0.742 for the HADS-D, Split-half reliability = 0.899, versus 0.739 for HADS-D). Conclusion These results provides preliminary support for further development of the HRQOLISP-E as a context-specific screening tool for PSD through an investigation comparing the proposed measure against a referent-standard clinical diagnostic criteria such as the ICD 10 or Diagnostic and Statistical Manual of Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders. The optimal tool for identifying post-stroke depression (PSD) is yet to be identified. We derived HRQOLISPE from a context-specific tool, the Health Related Quality of Life in Stroke Patients. HRQOLISPE demonstrated good construct validity. HRQOLISPE had better reliability compared with Hospital Anxiety and Depression Rating Scale. We propose the HRQOLISPE as a context-specific screening tool for PSD.
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92
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Omura T, Kimura M, Kim K, Mishina M, Mizunari T, Kobayashi S, Morita A. Acute Poststroke Depression Is Associated with Thalamic Lesions and Clinical Outcomes: A Case-Control Study. J Stroke Cerebrovasc Dis 2017; 27:499-505. [PMID: 29079329 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/09/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND We investigated the role of acute-phase stroke lesions and patient characteristics in poststroke depression (PSD) and its effect on the clinical outcome. PATIENTS AND METHODS Five and 30 days after admission, 175 patients self-reported their depressive symptoms on the Patient Health Questionnaire-9. We compared the clinical characteristics and outcomes in patients with (n = 41) and without PSD (n = 134). Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS); the modified Rankin Scale (mRS) was used to determine the functional outcome. RESULTS There was no significant difference between patients with and without PSD in the age, gender ratio, lesion side, and the history of hypertension, diabetes mellitus, alcohol and tobacco use, and previous stroke. Thalamic lesions were significantly associated with PSD (P = .03), although there was no significant difference in both the NIHSS score and the final mRS score of patients with thalamic lesions. Backward stepwise logistic regression analysis showed that a higher NIHSS score and thalamic lesions were independent predictors of PSD. Total hospitalization was significantly longer in patients with PSD. At the time of admission, the NIHSS score was significantly higher in patients who developed moderate to severe PSD than in those with mild PSD or without PSD. CONCLUSIONS PSD in the acute phase was associated with thalamic lesions and severe stroke. Hospitalization was significantly longer in patients with PSD and their functional disability was more severe, suggesting that PSD played a role in the unsatisfactory results of poststroke rehabilitation.
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Affiliation(s)
- Tomoko Omura
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai-city, Chiba, Japan.
| | - Mahito Kimura
- Department of Neuropsychiatry, Nippon Medical School Chiba Hokusoh Hospital, Inzai-city, Chiba, Japan
| | - Kyongsong Kim
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai-city, Chiba, Japan
| | - Masahiro Mishina
- Department of Neuropathophysiological Imaging, Graduate School of Medicine, Nippon, Medical School, Tokyo, Japan
| | - Takayuki Mizunari
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai-city, Chiba, Japan
| | - Shiro Kobayashi
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital, Inzai-city, Chiba, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
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Criterion Validity of the "HRQOLISP-E": A New Context-Specific Screening Tool for Poststroke Depression. Behav Neurol 2017; 2017:6515769. [PMID: 29158623 PMCID: PMC5660745 DOI: 10.1155/2017/6515769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022] Open
Abstract
Objectives The optimal tool for identifying postsroke depression (PSD) is yet to be identified. In the present study, we rely on the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D) as a meaningful criterion to investigate the psychometric properties of the HRQOLISP-E, a new context-specific screening tool for PSD developed from a large cross-cultural sample. Methods We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤one month) stroke survivors. Depression was measured using the HADS-D and the HRQOLISP-E. We determined sensitivity, specificity, likelihood ratios, and posttest probability. The area under a receiver operator curve (AUC) and the most appropriate HRQOLISP-E cut-off were also determined using standard procedures. Results Using data derived from 387 recent stroke survivors, the HRQOLISP-E showed high agreement with the HADS-D, sensitivity = 73.7%, specificity = 79.3%, and posterior test probability = 88% (95% CI = 84%–91%). The AUC was 0.81 (95% CI = 0.76–0.86). The HRQOLISP-E cut-off, corresponding to HADS-D score ≥ 8, was 20/21 (out of a total score of 30). Conclusions Within limitations of using the HADS-D as a referent criterion, the present results provide justification for further development of the HRQOLISP-E as the first stroke-specific screening tool for depression.
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He JR, Zhang Y, Lu WJ, Liang HB, Tu XQ, Ma FY, Yang GY, Zeng LL. Age-Related Frontal Periventricular White Matter Hyperintensities and miR-92a-3p Are Associated with Early-Onset Post-Stroke Depression. Front Aging Neurosci 2017; 9:328. [PMID: 29051732 PMCID: PMC5633610 DOI: 10.3389/fnagi.2017.00328] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 09/22/2017] [Indexed: 01/13/2023] Open
Abstract
Objective: To explore the correlationship among white matter hyperintensities (WMHs), miR-92a-3p and early-onset post-stroke depression (PSD). Methods: We recruited consecutively 238 patients with acute cerebral infarction and MRI examination in the Department of neurology, Ruijin hospital, Shanghai Jiaotong University School of Medicine. The diagnosis of early-onset PSD was made in accordance with DSM-IV criteria for depression in 2 weeks after stroke. Clinical information and assessments of stroke severity were recorded on admission. The analysis of plasma miR-92a-3p was performed using quantitative PCR at the same time. WMHs were evaluated by the Fazekas and Scheltens visual rating scales. The relationship among WMHs, miR-92a-3p and PSD were analyzed by SPSS 22.0 software. Results: Logistic regression demonstrated that periventricular WMHs (PVWMHs) in frontal caps was an independent risk factor with early-onset PSD (OR = 1.579, 95% CI: 1.040-2.397, p = 0.032). The age and numbers of lacunes were related to frontal PVWMHs. Plasma miR-92a-3p in the PSD group was higher compared with the non-depressed group. Receiver operating curve analysis revealed that miR-92a-3p could predict early-onset PSD with 90% sensitivity and 90% specificity. The higher miR-92a-3p trended toward association with greater frontal PVWMHs. Conclusion: Acute ischemic stroke patients with frontal PVWMHs or a high plasma miR-92a-3p at baseline were more likely to develop early-onset PSD. MiR-92a-3p might be involved in the white matter impairment and post-stroke depression.
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Affiliation(s)
- Ji-Rong He
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Neurology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu Zhang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen-Jing Lu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huai-Bin Liang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuan-Qiang Tu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei-Yue Ma
- Department of Neurology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Yuan Yang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Li Zeng
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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95
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Thakore NJ, Pioro EP. Laughter, crying and sadness in ALS. J Neurol Neurosurg Psychiatry 2017; 88:825-831. [PMID: 28572273 PMCID: PMC5629932 DOI: 10.1136/jnnp-2017-315622] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 03/16/2017] [Accepted: 04/12/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Pseudobulbar affect (PBA) is prevalent in amyotrophic lateral sclerosis (ALS), but there is limited information on its associations and course. OBJECTIVES Explore prevalence, associations, course and manifestations of PBA in outpatient cohort of patients with ALS and examine its relationship to depression. METHODS Self-reported measures of PBA and depression (Center for Neurologic Study-Lability Scale (CNS-LS) and Patient Health Questionnaire (PHQ-9), respectively) were obtained from consecutive patients with ALS using tablet devices in waiting rooms (Knowledge Program). RESULTS PBA (CNS-LS ≥13) was seen in 209/735 patients (28.4%). PBA was associated with bulbar onset and dysfunction, upper motor neuron dysfunction, cognitive impairment, depression and lower quality of life. A multivariable model that included lower bulbar and gross motor subscores, female gender, younger age and shorter duration of disease predicted PBA with 74% accuracy. CNS-LS scores increased only slowly with time. Women with PBA reported more crying than men. Crying (but not laughter) correlated with depression, and crying was associated with poorer quality of life. Exploratory factor analysis of pooled questions of CNS-LS and PHQ-9 identified three underlying factors (laughter, crying and depression) loaded on appropriate questions of the respective instruments. CONCLUSION This study identifies associations of PBA and additionally finds PBA (especially crying-predominant PBA) more prevalent in women with ALS. Although the two self-report instruments (CNS-LS and PHQ-9) discriminate well between PBA and depression, there is significant overlap between depression and crying in PBA. Studies of PBA should stratify for gender, examine crying and laughter as separate outcomes and adjust for depression.
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Affiliation(s)
- Nimish J Thakore
- Department of Neurology, Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Erik P Pioro
- Department of Neurology, Neuromuscular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Neurosciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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96
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Facai L, Dehong H, Nana H, Yihuang G, Yunchuan W. Effect of music therapy derived from the five elements in Traditional Chinese Medicine on post-stroke depression. J TRADIT CHIN MED 2017. [DOI: 10.1016/s0254-6272(17)30322-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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97
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Sun Y, Liang Y, Jiao Y, Lin J, Qu H, Xu J, Zhao C. Comparative efficacy and acceptability of antidepressant treatment in poststroke depression: a multiple-treatments meta-analysis. BMJ Open 2017; 7:e016499. [PMID: 28775189 PMCID: PMC5629745 DOI: 10.1136/bmjopen-2017-016499] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE The aim of this study is to create a rank order of the comparative efficacy and acceptability (risk of all-cause discontinuation) of antidepressant treatment in poststroke depression (PSD) by integrating direct and indirect evidence. DESIGN Multiple-treatments meta-analysis of randomised controlled trials. PARTICIPANTS Patients with depression following stroke. INTERVENTIONS 10 antidepressants and placebo in the acute treatment of PSD. OUTCOME MEASURES The primary outcomes were the overall efficacy, defined as the mean change of the total depression score. The secondary outcome was the acceptability, defined as risk of all-cause discontinuation. These estimates as standardised mean differences or ORs with 95% CIs. RESULTS We identified 12 suitable trials, with data from 707 participants. All drugs were significantly more effective than placebo apart from sertraline, nefiracetam and fluoxetine. Most of the comparisons for acceptability revealed no significant differences except that paroxetine had significantly lower all-cause discontinuation than doxepin, citalopram and fluoxetine. Standardised mean differences compared with placebo for efficacy varied from -6.54 for the best drug (reboxetine) to 0.51 for the worst drug (nefiracetam). ORs compared with placebo for acceptability ranged from 0.09 for the best drug (paroxetine) to 3.42 for the worst drug (citalopram). For the efficacy rank, reboxetine, paroxetine, doxepin and duloxetine were among the most efficacious treatments, the cumulative probabilities of which were 100%, 85.7%, 83.2%, 62.4%, respectively. With respect to the acceptability rank, paroxetine, placebo, sertraline and nortriptyline were among the most acceptable treatments, the cumulative probabilities of which were 92.4%, 63.5%, 57.3%, 56.3%. CONCLUSION After weighing the efficacy and acceptability, we conclude that paroxetine might be the best choice when starting acute treatment for PSD, and fluoxetine might be the worst choice. TRIAL REGISTRATION NUMBER This systematic review has been registered in the Prospective Register of Systematic Review Protocols (PROSPERO) public database (CRD42017054741; http://www.crd.york.ac.uk/PROSPERO).
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Affiliation(s)
- Yefei Sun
- Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Yifan Liang
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Jiao
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Jueying Lin
- Department of Emergency, Zhongshan Hospital Xiamen University, Xiamen, China
| | - Huiling Qu
- Department of Neurology, The People's Hospital of Liaoning Province, Shenyang, China
| | - Junjie Xu
- Department of Laboratory Medicine, The First Hospital of China Medical University, Shenyang, China
| | - Chuansheng Zhao
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
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98
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McCall J, Brusoski M, Rosen D. Research with Older Adult Methadone Clients: The Importance of Monitoring Suicide Ideation. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2017; 60:458-470. [PMID: 28489495 PMCID: PMC6117196 DOI: 10.1080/01634372.2017.1328479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study reports on the importance of monitoring suicide ideation among older adult research participants. A recently completed randomized controlled trial of older adults who are current clients in methadone maintenance treatment (MMT) served as a case study to elucidate a suicide protocol that was designed to account for the potential instances of suicide ideation within the research project structure. As the numbers of older adult heroin users increases, this study's findings seek to influence research protocols that involve older adults with addictions who may be particularly vulnerable to suicide risk due to comorbid psychiatric conditions and psychosocial adversities.
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Affiliation(s)
- Janice McCall
- Veterans Affairs Healthcare System, Center for Health Equity Promotion and Research, University Drive (151C), ROB, Pittsburgh, PA 15240-1001
| | - Melissa Brusoski
- University of Pittsburgh, School of Social Work, 2117 Cathedral of Learning, Pittsburgh, PA 15260
| | - Daniel Rosen
- University of Pittsburgh, School of Social Work, 2117 Cathedral of Learning, Pittsburgh, PA 15260
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99
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Vansimaeys C, Zuber M, Pitrat B, Join-Lambert C, Tamazyan R, Farhat W, Bungener C. Combining Standard Conventional Measures and Ecological Momentary Assessment of Depression, Anxiety and Coping Using Smartphone Application in Minor Stroke Population: A Longitudinal Study Protocol. Front Psychol 2017; 8:1172. [PMID: 28747895 PMCID: PMC5506189 DOI: 10.3389/fpsyg.2017.01172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 06/27/2017] [Indexed: 12/19/2022] Open
Abstract
Context: Stroke has several consequences on survivors’ daily life even for those who experience short-lasting neurological symptoms with no functional disability. Depression and anxiety are common psychological disorders occurring after a stroke. They affect long-term outcomes and quality of life but they are difficult to diagnose because of the neurobiological consequences of brain lesions. Current research priority is given to the improvement of the detection and prevention of those post-stroke psychological disorders. Although previous studies have brought promising perspectives, their designs based on retrospective tools involve some limits regarding their ecological validity. Ecological Momentary Assessment (EMA) is an alternative to conventional instruments that could be a key in research for understanding processes that underlined post-stroke depression and anxiety onset. We aim to evaluate the feasibility and validity of anxiety, depression and coping EMA for minor stroke patients. Methods: Patients hospitalized in an Intensive Neuro-vascular Care Unit between April 2016 and January 2017 for a minor stroke is involved in a study based on an EMA methodology. We use a smartphone application in order to assess anxiety and depression symptoms and coping strategies four times a day during 1 week at three different times after stroke (hospital discharge, 2 and 4 months). Participants’ self-reports and clinician-rates of anxiety, depression and coping are collected simultaneously using conventional and standard instruments. Feasibility of the EMA method will be assessed considering the participation and compliance rate. Validity will be the assessed by comparing EMA and conventional self-report and clinician-rated measures. Discussion: We expect this study to contribute to the development of EMA using smartphone in minor stroke population. EMA method offers promising research perspective in the assessment and understanding of post-stroke psychological disorders. The development of EMA in stroke population could lead to clinical implications such as remotely psychological follow-ups during early supported discharge. Trial registration: European Clinical Trials Database Number 2014-A01937-40
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Affiliation(s)
- Camille Vansimaeys
- Laboratory of Psychopathology and Health Processes, Psychology Institute, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Mathieu Zuber
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Benjamin Pitrat
- Child and Adolescent Psychiatry Department, Robert Debré Hospital, Assistance Publique-Hôpitaux de ParisParis, France
| | - Claire Join-Lambert
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Ruben Tamazyan
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Wassim Farhat
- Neurology and Neurovascular Department, Saint Joseph Hospital Group, Université Paris Descartes-Sorbonne Paris CitéParis, France
| | - Catherine Bungener
- Laboratory of Psychopathology and Health Processes, Psychology Institute, Université Paris Descartes-Sorbonne Paris CitéParis, France
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Salinas J, Beiser A, Himali JJ, Satizabal CL, Aparicio HJ, Weinstein G, Mateen FJ, Berkman LF, Rosand J, Seshadri S. Associations between social relationship measures, serum brain-derived neurotrophic factor, and risk of stroke and dementia. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2017; 3:229-237. [PMID: 29067329 PMCID: PMC5651441 DOI: 10.1016/j.trci.2017.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Mechanisms underlying social determinants of stroke and dementia are unclear and brain-derived neurotrophic factor (BDNF) may contribute as a molecular link. METHODS Using the Framingham Study, we examined social relationship measures as predictors of higher serum BDNF level and cumulative incidence of stroke and dementia. RESULTS Among 3294 participants, controlling for age and sex, isolation trended with lower BDNF (odds ratio = 0.69 [0.47-1.00]). Participants with more companionship had reduced risk for stroke (hazard ratio [HR] = 0.59 [0.41-0.83]) and dementia (HR = 0.67 [0.49-0.92]). Greater emotional support was associated with higher BDNF (odds ratio = 1.27 [1.04-1.54]), reduced dementia risk (HR = 0.69 [0.51-0.94], and among smokers, reduced stroke risk (HR = 0.23 [0.10-0.57]). Associations persisted after additional adjustments. BDNF partly mediated the total effect between emotional support and dementia risk. CONCLUSIONS Availability of social support appears to be associated with increased BDNF levels and, in certain subsets, reduce risk of subsequent dementia and stroke, thus warranting study of these pathways to understand their role in neuroprotection.
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Affiliation(s)
- Joel Salinas
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- The Framingham Heart Study, Boston, MA, USA
- Department of Epidemiology, Harvard Center for Population and Development Studies, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard Center for Population and Development Studies, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Alexa Beiser
- The Framingham Heart Study, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jayandra J. Himali
- The Framingham Heart Study, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Claudia L. Satizabal
- The Framingham Heart Study, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Hugo J. Aparicio
- The Framingham Heart Study, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Galit Weinstein
- The Framingham Heart Study, Boston, MA, USA
- School of Public Health, University of Haifa, Haifa, Israel
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lisa F. Berkman
- Department of Epidemiology, Harvard Center for Population and Development Studies, Harvard TH Chan School of Public Health, Boston, MA, USA
- Department of Social and Behavioral Sciences, Harvard Center for Population and Development Studies, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Human Genetics Research, Massachusetts General Hospital, Boston, MA, USA
| | - Sudha Seshadri
- The Framingham Heart Study, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
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