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French BR, Boddepalli RS, Govindarajan R. Acute Ischemic Stroke: Current Status and Future Directions. MISSOURI MEDICINE 2016; 113:480-486. [PMID: 30228538 PMCID: PMC6139763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The evolving knowledge on stroke in conjunction with advances in the field of imaging, treatment approaches using recombinant tissue plasminogen activator (rtPA) or thrombectomy devices in recanalization, and efficient emergency stroke workflow processes have opened new frontiers in managing patients with an acute ischemic stroke. These frontiers have been reformed and overcome in overcoming the decades-long watch and wait approach towards patients with ischemic stroke. In this article, we focus on the current strategies for managing ischemic stroke and conclude by providing a brief overview of anticipating developments that can transform future stroke treatments.
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Affiliation(s)
- Brandi R French
- Brandi R. French, MD, Assistant Professor of Clinical Vascular Neurology, Medical Director of Inpatient Neurosciences Unit in the Department of Neurology, University of Missouri - Columbia, Missouri
| | - Raja S Boddepalli
- Raja S. Boddepalli, MD, Research Assistant in the Department of Neurology, University of Missouri - Columbia, Missouri
| | - Raghav Govindarajan
- Raghav Govindarajan MD, FISQua, FACSc, FCCP, MSMA member since 2013 and 2017 Boone County Medical society President, Assistant Professor in the Department of Neurology, University of Missouri - Columbia, Missouri
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102
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Nakase T, Tobisawa M, Sasaki M, Suzuki A. Outstanding Symptoms of Poststroke Depression during the Acute Phase of Stroke. PLoS One 2016; 11:e0163038. [PMID: 27706193 PMCID: PMC5051825 DOI: 10.1371/journal.pone.0163038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 09/01/2016] [Indexed: 11/21/2022] Open
Abstract
Poststroke depression (PSD) is a critical complication which might lead to unfavorable outcomes. However, most cases of PSD in the acute phase, during the 2 or 3 weeks following a stroke, are neglected because of the variable comorbid conditions. In this study, aimed at revealing the outstanding symptoms of PSD during the acute phase, consecutive patients with intracranial hemorrhage (ICH) or brain infarction (BI) were asked to fill out a depression questionnaire (Quick Inventory of Depressive Symptomatology Self-Report: QIDS-SR) at 1 week and 1 month following stroke onset. Patients with disturbed consciousness or aphasia were excluded from this study. Forty-nine ICH patients and 222 BI patients completed the QIDS-SR at 1 week and 27 of ICH and 62 of BI at 1 month. The PSD rate was 67% and 46% at 1 week in ICH and BI, respectively. Although sleep disturbance was the most frequent symptom of PSD, psychomotor agitation and appetite disturbance were the most distinguishing symptoms in ICH at 1 week and fatigue at 1 month. On the other hand, most of the depressive symptoms addressed in QIDS-SR were observed in PSD of BI patients both at 1 week and 1 month. In conclusion, while sleep disturbance was a frequent but non-specific symptom, appetite disturbance and fatigue might be critical symptoms to suggest PSD during the acute phase of stroke.
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Affiliation(s)
- Taizen Nakase
- Department of Stroke Science, Research Institute for Brain and Blood Vessels–Akita, Akita, Japan
- * E-mail:
| | - Maiko Tobisawa
- Department of Stroke Science, Research Institute for Brain and Blood Vessels–Akita, Akita, Japan
| | - Masahiro Sasaki
- Department of Stroke Science, Research Institute for Brain and Blood Vessels–Akita, Akita, Japan
| | - Akifumi Suzuki
- Department of Stroke Science, Research Institute for Brain and Blood Vessels–Akita, Akita, Japan
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Abstract
In this issue of the Biomedical Journal, we examine how far the explosion of epigenetic studies in recent years has translated to benefits for patients in the clinic, and we highlight an original study suggesting that increased vegetable intake protects against osteoporotic fractures. We also hear several opinions on the use, or perhaps misuse, of Impact Factor and what the future should hold for this publication metric.
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Affiliation(s)
- Emma L Walton
- Staff Writer at the Biomedical Journal, 56 Dronningens Gate, 7012 Trondheim, Norway.
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Nguyen VA, Carey LM, Giummarra L, Faou P, Cooke I, Howells DW, Tse T, Macaulay SL, Ma H, Davis SM, Donnan GA, Crewther SG. A Pathway Proteomic Profile of Ischemic Stroke Survivors Reveals Innate Immune Dysfunction in Association with Mild Symptoms of Depression - A Pilot Study. Front Neurol 2016; 7:85. [PMID: 27379006 PMCID: PMC4907034 DOI: 10.3389/fneur.2016.00085] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/23/2016] [Indexed: 12/14/2022] Open
Abstract
Depression after stroke is a common occurrence, raising questions as to whether depression could be a long-term biological and immunological sequela of stroke. Early explanations for post-stroke depression (PSD) focused on the neuropsychological/psychosocial effects of stroke on mobility and quality of life. However, recent investigations have revealed imbalances of inflammatory cytokine levels in association with PSD, though to date, there is only one published proteomic pathway analysis testing this hypothesis. Thus, we examined the serum proteome of stroke patients (n = 44, mean age = 63.62 years) and correlated these with the Montgomery–Åsberg Depression Rating Scale (MADRS) scores at 3 months post-stroke. Overall, the patients presented with mild depression symptoms on the MADRS, M = 6.40 (SD = 7.42). A discovery approach utilizing label-free relative quantification was employed utilizing an LC-ESI–MS/MS coupled to a LTQ-Orbitrap Elite (Thermo-Scientific). Identified peptides were analyzed using the gene set enrichment approach on several different genomic databases that all indicated significant downregulation of the complement and coagulation systems with increasing MADRS scores. Complement and coagulation systems are traditionally thought to play a key role in the innate immune system and are established precursors to the adaptive immune system through pro-inflammatory cytokine signaling. Both systems are known to be globally affected after ischemic or hemorrhagic stroke. Thus, our results suggest that lowered complement expression in the periphery in conjunction with depressive symptoms post-stroke may be a biomarker for incomplete recovery of brain metabolic needs, homeostasis, and inflammation following ischemic stroke damage. Further proteomic investigations are now required to construct the temporal profile, leading from acute lesion damage to manifestation of depressive symptoms. Overall, the findings provide support for the involvement of inflammatory and immune mechanisms in PSD symptoms and further demonstrate the value and feasibility of the proteomic approach in stroke research.
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Affiliation(s)
- Vinh A Nguyen
- Occupational Therapy, College of Science Health and Engineering, School of Allied Health, La Trobe University, Melbourne, VIC, Australia; Neurorehabilitation and Recovery, Stroke, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Leeanne M Carey
- Occupational Therapy, College of Science Health and Engineering, School of Allied Health, La Trobe University, Melbourne, VIC, Australia; Neurorehabilitation and Recovery, Stroke, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - Loretta Giummarra
- School of Psychology and Public Health, La Trobe University , Melbourne, VIC , Australia
| | - Pierre Faou
- School of Molecular Sciences, La Trobe University , Melbourne, VIC , Australia
| | - Ira Cooke
- School of Molecular Sciences, La Trobe University , Melbourne, VIC , Australia
| | - David W Howells
- School of Medicine, University of Tasmania , Hobart, TAS , Australia
| | - Tamara Tse
- Occupational Therapy, College of Science Health and Engineering, School of Allied Health, La Trobe University, Melbourne, VIC, Australia; Neurorehabilitation and Recovery, Stroke, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia
| | - S Lance Macaulay
- Commonwealth Science and Industrial Research Organisation (CSIRO) , Melbourne, VIC , Australia
| | - Henry Ma
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia; Monash University, Clayton, VIC, Australia
| | - Stephen M Davis
- The University of Melbourne, Parkville, VIC, Australia; Department of Medicine, Melbourne Brain Centre, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Geoffrey A Donnan
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia; The University of Melbourne, Parkville, VIC, Australia
| | - Sheila G Crewther
- Neurorehabilitation and Recovery, Stroke, The Florey Institute of Neuroscience and Mental Health, Melbourne, VIC, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1557] [Impact Index Per Article: 194.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Abstract
Stroke is a dramatic event and is associated with potentially severe consequences, including disability, mortality, and social costs. Stroke may occur at any age; however, most strokes occur in individuals aged 65 years and older. Previous research has found that stroke increases suicide risk, especially among women and younger patients. The aim of the current review is to investigate the relationship between suicide and stroke in order to determine which stroke patients are at elevated risk for suicide. Moreover, we review the literature in order to provide pharmacological treatment strategies for stroke patients at high risk of suicide. We performed a careful search to identify articles and book chapters focused on this issue, selecting only English-language articles published from 1990 to 2014 that addressed the issue of suicide after stroke and its pharmacological management. We found 12 clinical trials that explored the relationship between stroke and suicidal ideation and/or suicidal plans and 11 investigating suicide as the cause of death after stroke. We identified stroke as a significant risk factor for both suicide and suicidal ideation, especially among younger adult depressed patients in all articles, providing further support for the association between post-stroke and suicidality. Suicide risk is particularly high in the first 5 years following stroke. Depression, previous mood disorder, prior history of stroke, and cognitive impairment were found to be the most important risk factors for suicide. Selective serotonin reuptake inhibitors (SSRIs) represent the treatment of choice for stroke survivors with suicide risk, and studies in rats have suggested that carbolithium is a promising treatment in these patients. Early identification and treatment of post-stroke depression may significantly reduce suicide risk in stroke patients.
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Jawaid A, Krajewska J, Pawliczak F, Kandra V, Schulz PE. A Macro Role for Microglia in Poststroke Depression. J Am Geriatr Soc 2016; 64:459-61. [DOI: 10.1111/jgs.13974] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ali Jawaid
- Brain Research Institute; Swiss Federal Institute of Technology; University of Zurich; Zurich Switzerland
| | | | | | | | - Paul E. Schulz
- Department of Neurology; University of Texas Health Science Center at Houston; Houston Texas
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Goldmann E, Roberts ET, Parikh NS, Lord AS, Boden-Albala B. Race/ethnic Differences in Post-stroke Depression (PSD): Findings from the Stroke Warning Information and Faster Treatment (SWIFT) Study. Ethn Dis 2016; 26:1-8. [PMID: 26843790 DOI: 10.18865/ed.26.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Post-stroke depression (PSD) is common and associated with poor stroke outcomes, but few studies have examined race/ethnic disparities in PSD. Given the paucity of work and inconsistent findings in this important area of research, our study aimed to examine race/ethnic differences in depression in a multi-ethnic cohort of stroke patients. DESIGN Longitudinal. SETTING Prospective trial of a post-stroke educational intervention. PARTICIPANTS 1,193 mild/moderate ischemic stroke/transient ischemic attack (TIA) patients. MAIN OUTCOME MEASURES We used the Center for Epidemiologic Studies Depression (CES-D) Scale to assess subthreshold (CES-D score 8-15) and full (CES-D score ≥ 16) depression at one month ("early") and 12 months ("late") following stroke. Multinomial logistic regression analyses examined the association between race/ethnicity and early and late PSD separately. RESULTS The prevalence of subthreshold and full PSD was 22.5% and 32.6% in the early period and 22.0% and 27.4% in the late period, respectively. Hispanics had 60% lower odds of early full PSD compared with non-Hispanic Whites after adjusting for other covariates (OR=.4, 95% CI: .2, .8). Race/ethnicity was not significantly associated with late PSD. CONCLUSIONS Hispanic stroke patients had half the odds of PSD in early period compared with Whites, but no difference was found in the later period. Further studies comparing trajectories of PSD between race/ethnic groups may further our understanding of race/ethnic disparities in PSD and help identify effective interventions.
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Affiliation(s)
- Emily Goldmann
- Division of Social Epidemiology, New York University College of Global Health
| | - Eric T Roberts
- Division of Social Epidemiology, New York University College of Global Health
| | - Nina S Parikh
- Division of Social Epidemiology, New York University College of Global Health
| | - Aaron S Lord
- Department of Neurology, School of Medicine, Langone Medical Center, New York University
| | - Bernadette Boden-Albala
- Division of Social Epidemiology, New York University College of Global Health; Department of Neurology, School of Medicine, Langone Medical Center, New York University; Department of Epidemiology and Health Promotion, College of Dentistry, New York University
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de Mello RF, Santos IDS, Alencar AP, Benseñor IM, Lotufo PA, Goulart AC. Major Depression as a Predictor of Poor Long-Term Survival in a Brazilian Stroke Cohort (Study of Stroke Mortality and Morbidity in Adults) EMMA study. J Stroke Cerebrovasc Dis 2015; 25:618-25. [PMID: 26725125 DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/16/2015] [Accepted: 11/22/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The influence of poststroke depression on long-term survival is poorly investigated. Thus, we aimed to evaluate the influence of major depression disorder (MDD) on long-term survival in the participants from The Study of Stroke Mortality and Morbidity in Adults (EMMA Study) in São Paulo, Brazil. METHODS We prospectively evaluated ischemic and hemorrhagic stroke (HS) cases from the EMMA Study. Baseline and stroke characteristics and cardiovascular risk factors were evaluated according to MDD assessed by the Patient Health Questionnaire, which was applied 30 days after index event and periodically during 1-year follow-up. We performed Kaplan-Meier survival analysis, as well as crude and multiple Cox proportional hazards models. RESULTS In this subset of the EMMA Study, we evaluated 164 (85.9%) patients with ischemic stroke and 27 (14.1%) with HS. Among these, overall incidence of MDD was 25.1% during 1 year of follow-up, regardless stroke subtype. The peak rate of major depression postacute event was beyond 1 month. We observed a lower survival rate among individuals who developed poststroke MDD than among those who did not develop this condition after 1 year of follow-up (85.4% versus 96.5%, log rank P = .006). After multiple analysis, we kept a higher risk of all-cause mortality among those who developed MDD compared to participants without MDD (hazard ratio = 4.60, 95% confidence interval = 1.36-15.55, P = .01). CONCLUSION Our findings suggest that incident MDD is a potential marker of poor prognosis 1 year after stroke.
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Affiliation(s)
- Roberta Ferreira de Mello
- Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil.
| | - Itamar de Souza Santos
- Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil; Medicine School, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Airlane Pereira Alencar
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Isabela Martins Benseñor
- Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil; Medicine School, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Paulo Andrade Lotufo
- Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil; Medicine School, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Alessandra Carvalho Goulart
- Center of Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, São Paulo, São Paulo, Brazil
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Zhou Z, Ding X, Yang Q, Hu J, Shang X, Huang X, Ge L, Zhou T. Association between Single-Nucleotide Polymorphisms of the Tyrosine Kinase Receptor B (TrkB) and Post-Stroke Depression in China. PLoS One 2015; 10:e0144301. [PMID: 26641254 PMCID: PMC4671559 DOI: 10.1371/journal.pone.0144301] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/16/2015] [Indexed: 12/15/2022] Open
Abstract
Background Polymorphisms of the brain-derived neurotrophic factor (BDNF) have been investigated as candidate genes for post-stroke depression (PSD), and its receptor, neurotrophic tyrosine kinase receptor B (TrkB), has been associated with depression. However, no further data have yet reported the association between PSD and polymorphisms in TrkB. This study aims to investigate whether a relationship exists between TrkB polymorphisms and PSD. Methods A total of 312 depression patients (PSD patients) and 472 non-depression patient controls (NPSD patients) were recruited. All patients were evaluated using the Hamilton Rating Scale for Depression (HAMD) to determine depression severity, and PSD patients were diagnosed in accordance with DSM-V criteria. Three single-nucleotide polymorphisms (SNPs), namely, rs1187323, rs1212171, and rs1778929, in the TrkB gene were genotyped by high-resolution melt analysis. Results The SNP rs1778929 was significantly more associated with incident PSD in participants with the TT genotype than in those with CC (OR 0.482, 95% CI: 0.313–0.744). In terms of rs1187323, stroke was significantly more associated with incident depression in participants with the AC genotype than in those with AA (OR 0.500, 95% CI: 0.368–0.680). The minor allele (T) of rs1778929 (P = 0.024, OR = 0.725, 95% CI = 0.590–0.890) and the minor allele (C) of rs1187323 (P = 0.000, OR = 0.598, 95% CI = 0.466–0.767) were found to be significantly associated with PSD. Neither genotype nor allele frequencies of rs1212171 showed statistically significant differences between PSD and NPSD patients. Conclusions The results suggest that rs1778929 and rs1187323 in the TrkB gene are significantly associated with post-stroke depression in the Chinese population. Further studies are necessary to confirm our findings.
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Affiliation(s)
- Zhiming Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, P.R. China
- * E-mail:
| | - Xianhui Ding
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Qian Yang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Jia Hu
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Xianjin Shang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Liang Ge
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Taofeng Zhou
- Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui Province, P.R. China
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Fei K, Benn EKT, Negron R, Arniella G, Tuhrim S, Horowitz CR. Prevalence of Depression Among Stroke Survivors: Racial-Ethnic Differences. Stroke 2015; 47:512-5. [PMID: 26628384 DOI: 10.1161/strokeaha.115.010292] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/02/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Although poststroke depression is common, racial-ethnic disparities in depression among stroke survivors remain underexplored. Thus, we investigated the relationship between race/ethnicity and depression in a multiracial-ethnic stroke cohort. METHODS Baseline survey data of validated scales of depression and functional status, demographics, comorbidities, and socioeconomic status were used from a recurrent stroke prevention study among community-dwelling urban stroke/transient ischemic attack survivors. RESULTS The cohort included 556 participants with a mean age of 64 years. The majorities were black (44%) or latino (42%) and female (60%), had their last stroke/transient ischemic attack nearly 2 years before study enrollment, and lived below the poverty level (58%). Nearly 1 in 2 latinos, 1 in 4 blacks, and 1 in 8 whites were depressed. Multivariate logistic regression showed that survivors who were younger, were female, had ≥3 comorbid conditions, were functionally disabled from stroke, lacked emotional-social support, and who took antidepressants before study entry had higher risk of depression. Time since last stroke/transient ischemic attack did not affect the chance of depression. After adjusting for all above risk factors, latinos had 3× the odds of depression (95% confidence interval: 1.18-6.35) than whites; blacks and whites had similar odds of depression. CONCLUSIONS This study reveals that latino stroke survivors have a significantly higher prevalence of depression compared with their non-latino counterparts.
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Affiliation(s)
- Kezhen Fei
- From the Center for Health Equity and Community Engaged Research (K.F., E.K.T.B., C.R.H.) and Center for Biostatistics (K.F., E.K.T.B.), Icahn School of Medicine, New York, NY; Yale Institute for Network Science, Yale University, New Haven, CT (R.N.); Institute for Family Health, New York, NY (G.A.); Department of Neurology, Icahn School of Medicine, New York, NY (S.T.); and Department of Medicine, Icahn School of Medicine, New York, NY (C.R.H.).
| | - Emma K T Benn
- From the Center for Health Equity and Community Engaged Research (K.F., E.K.T.B., C.R.H.) and Center for Biostatistics (K.F., E.K.T.B.), Icahn School of Medicine, New York, NY; Yale Institute for Network Science, Yale University, New Haven, CT (R.N.); Institute for Family Health, New York, NY (G.A.); Department of Neurology, Icahn School of Medicine, New York, NY (S.T.); and Department of Medicine, Icahn School of Medicine, New York, NY (C.R.H.)
| | - Rennie Negron
- From the Center for Health Equity and Community Engaged Research (K.F., E.K.T.B., C.R.H.) and Center for Biostatistics (K.F., E.K.T.B.), Icahn School of Medicine, New York, NY; Yale Institute for Network Science, Yale University, New Haven, CT (R.N.); Institute for Family Health, New York, NY (G.A.); Department of Neurology, Icahn School of Medicine, New York, NY (S.T.); and Department of Medicine, Icahn School of Medicine, New York, NY (C.R.H.)
| | - Guedy Arniella
- From the Center for Health Equity and Community Engaged Research (K.F., E.K.T.B., C.R.H.) and Center for Biostatistics (K.F., E.K.T.B.), Icahn School of Medicine, New York, NY; Yale Institute for Network Science, Yale University, New Haven, CT (R.N.); Institute for Family Health, New York, NY (G.A.); Department of Neurology, Icahn School of Medicine, New York, NY (S.T.); and Department of Medicine, Icahn School of Medicine, New York, NY (C.R.H.)
| | - Stanley Tuhrim
- From the Center for Health Equity and Community Engaged Research (K.F., E.K.T.B., C.R.H.) and Center for Biostatistics (K.F., E.K.T.B.), Icahn School of Medicine, New York, NY; Yale Institute for Network Science, Yale University, New Haven, CT (R.N.); Institute for Family Health, New York, NY (G.A.); Department of Neurology, Icahn School of Medicine, New York, NY (S.T.); and Department of Medicine, Icahn School of Medicine, New York, NY (C.R.H.)
| | - Carol R Horowitz
- From the Center for Health Equity and Community Engaged Research (K.F., E.K.T.B., C.R.H.) and Center for Biostatistics (K.F., E.K.T.B.), Icahn School of Medicine, New York, NY; Yale Institute for Network Science, Yale University, New Haven, CT (R.N.); Institute for Family Health, New York, NY (G.A.); Department of Neurology, Icahn School of Medicine, New York, NY (S.T.); and Department of Medicine, Icahn School of Medicine, New York, NY (C.R.H.)
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Lee SH, Niu T, Yang X, Li H, Zhu Q, Niu X. A Quantitative Investigation of Pulse and Tongue Features in Post-Stroke Depressive Patients and Healthy Volunteers: An Observational Pilot Study. Complement Med Res 2015; 22:292-7. [PMID: 26565980 DOI: 10.1159/000440892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression is among the most common neuropsychiatric complications after stroke, having a negative impact on one's quality of life. A number of therapeutic modalities have been used for post-stroke depression (PSD) including traditional Chinese medicine (TCM). However, a lack of objectivity in TCM hampers further improvement in diagnosis and research, since TCM diagnosis is mainly based on subjective judgment of clinicians. In this study, a modern TCM diagnostic device was used to conduct an objective study of pulse and tongue features in PSD patients and healthy individuals. METHODS A total of 67 volunteers participated. Pulse and tongue information of each participant was acquired and analyzed by the TCM Four Diagnosis Auxiliary Apparatus. Quantitative data were gathered and compared between the PSD group and the healthy group. RESULTS Higher rates of weak, slow, slippery, and string pulse were observed in the PSD group (p < 0.01), whereas normal pulse (p < 0.01) was detected in the healthy group. In the tongue analysis, higher rates of purple tongue (p < 0.01) with yellow fur (p < 0.01) and pale-pink tongue (p = 0.023) with white fur (p < 0.01) were observed in the PSD and the healthy groups, respectively. Abnormal tongue features (old, soft, thin, enlarged, thorny, and cracked) were detected (p < 0.05) in the PSD group. CONCLUSIONS Objective and quantitative data of PSD patients and healthy individuals may help providing valuable clinical information for PSD research and establish quantitative TCM diagnostic standards for pulse and tongue diagnosis in clinical practice and research.
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Affiliation(s)
- Samuel Haixiong Lee
- School of Basic Medical Science, Beijing University of Chinese Medicine, Beijing, China
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Bulloch AGM, Fiest KM, Williams JVA, Lavorato DH, Berzins SA, Jetté N, Pringsheim TM, Patten SB. Depression--a common disorder across a broad spectrum of neurological conditions: a cross-sectional nationally representative survey. Gen Hosp Psychiatry 2015; 37:507-12. [PMID: 26153456 DOI: 10.1016/j.genhosppsych.2015.06.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/19/2015] [Accepted: 06/08/2015] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To estimate the prevalence of depression across a range of neurological conditions in a nationally representative sample. METHODS The data source was the Survey of Living with Neurological Conditions in Canada (SLNCC), which accrued its sample by selecting participants from the Canadian Community Health Survey. The point prevalence of depression was estimated by assessment of depressive symptoms with the Patient Health Questionnaire, Brief (Patient Health Questionnaire, 9-item). RESULTS A total of n=4408 participated in the SLNCC. The highest point prevalence of depression (>30%) was seen in those with traumatic brain injury and brain/spinal cord tumors. Depression was also highly prevalent (18-28%) in those with (listed from highest to lowest) Alzheimer's disease/dementia, dystonia, multiple sclerosis, Parkinson's disease, stroke, migraine, epilepsy and spina bifida. The odds ratios for depression, with the referent group being the general population, were significant (from highest to lowest) for migraine, traumatic brain injury, stroke, dystonia and epilepsy. CONCLUSIONS All neurological conditions included in this study are associated with an elevated prevalence of depression in community populations. The conditions with the highest prevalence are traumatic brain injury and brain/spinal cord tumors.
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Affiliation(s)
- Andrew G M Bulloch
- Department of Community Health Sciences, University of Calgary, Canada; Department of Psychiatry, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada.
| | - Kirsten M Fiest
- Department of Community Health Sciences, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada
| | | | - Dina H Lavorato
- Department of Community Health Sciences, University of Calgary, Canada
| | - Sandra A Berzins
- Department of Community Health Sciences, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada
| | - Nathalie Jetté
- Department of Community Health Sciences, University of Calgary, Canada; Department of Clinical Neurosciences, Hotchkiss Brain Institute and Institute for Public Health, University of Calgary, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Hotchkiss Brain Institute and Institute for Public Health, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Canada; Department of Psychiatry, University of Calgary, Canada; Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Canada
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Amaricai E, Poenaru DV. The post-stroke depression and its impact on functioning in young and adult stroke patients of a rehabilitation unit. J Ment Health 2015; 25:137-41. [PMID: 26361062 DOI: 10.3109/09638237.2015.1022251] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Stroke is a leading cause of disability and a major public health problem. AIMS To determine frequency and degree of post-stroke depression (PSD) and its impact on functioning in young and adult stroke patients in a rehabilitation unit. METHOD The study included 72 stroke patients (aged 29-59 years) who were attending rehabilitation. The patients were assessed for depressive symptoms by Beck Depression Inventory (BDI), and their functioning by using the Stroke Impact Scale (SIS) and the Barthel Index of Activities of Daily Living (ADL). RESULTS Forty-eight patients had different degrees of depression: borderline clinical depression (13.8%), moderate depression (34.7%), severe depression (15.2%) or extreme depression (2.9%). There were no significant differences of BDI scores in 30-39, 40-49 and 50-59 years groups. Statistically significant correlations were between BDI score and SIS score, between BDI score and ADL index, and between SIS score and ADL index in men, women and total study patients. CONCLUSIONS More than half of the PSD patients had a moderate degree of depression. Significant correlations were noticed between depressive symptoms and functional status evaluated both by an instrument of assessing stroke impact upon general health and an instrument for assessing the everyday activities.
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Affiliation(s)
- Elena Amaricai
- a Department of Rehabilitation , Physical Medicine and Rheumatology and
| | - Dan V Poenaru
- b 2nd Orthopaedic Surgery and Traumatology Department , "Victor Babeş" University of Medicine and Pharmacy , Timisoara , Romania
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Chuang SF, Shih CC, Yeh CC, Lane HL, Tsai CC, Chen TL, Lin JG, Chen T, Liao CC. Decreased risk of acute myocardial infarction in stroke patients receiving acupuncture treatment: a nationwide matched retrospective cohort study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 15:318. [PMID: 26353964 PMCID: PMC4563856 DOI: 10.1186/s12906-015-0828-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 08/25/2015] [Indexed: 11/11/2022]
Abstract
Background Whether acupuncture protects stroke patients from acute myocardial infarction (AMI) has not been studied previously. The purpose of this study was to investigate the risk of AMI among stroke patients receiving acupuncture treatment. Methods Taiwan’s National Health Insurance Research Database was used to conduct a retrospective cohort study of 23475 stroke patients aged 40–79 years receiving acupuncture treatment and 46950 propensity score-matched stroke patients not receiving acupuncture treatment who served as controls from 2000 to 2004. Both stroke cohorts were followed until the end of 2009 and were adjusted for immortal time to measure the incidence and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) for new-onset AMI in multivariate Cox proportional hazard models. Results Stroke patients who received acupuncture treatment (9.2 per 1000 person-years) exhibited a lower incidence of AMI compared with those who did not receive acupuncture treatment (10.8 per 1000 person-years), with an HR of 0.86 (95 % CI, 0.80–0.93) after adjusting for age, sex, low income, coexisting medical conditions and medications. The relationship between acupuncture treatment and AMI risk was investigated in female stroke patients (HR, 0.85; 95 % CI, 0.76–0.95), male stroke patients (HR, 0.87; 95 % CI, 0.80–0.95), patients from 50 to 59 years of age (HR, 0.75; 95 % CI, 0.63–0.90), patients from 60 to 69 years of age (HR, 0.85; 95 % CI, 0.75–0.95), patients suffering from ischemic stroke (HR, 0.87; 95 % CI, 0.79–0.95), and patients suffering from hemorrhagic stroke (HR, 0.62; 95 % CI, 0.44–0.88). Conclusions We raised the possibility that acupuncture may be effective in lowering the risk of AMI in stroke patients aged 50–69 in this study, which was limited by a lack of information regarding stroke severity and acupuncture points. Our results suggest that prospective randomized trials are needed to establish the efficacy of acupuncture in preventing AMI.
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Lewin-Richter A, Volz M, Jöbges M, Werheid K. Predictivity of Early Depressive Symptoms for Post-Stroke Depression. J Nutr Health Aging 2015; 19:754-8. [PMID: 26193859 DOI: 10.1007/s12603-015-0540-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Depression is a frequent complication after stroke. However, little is known about the predictive value of early self-reported depressive symptoms (DS) for later development of post-stroke depression (PSD) 6 months after discharge. DESIGN Using a prospective longitudinal design, we investigated the prevalence of DS and examined their predictive value for depressive disorders 6 months after stroke while statistically controlling major established PSD risk factors. SETTING AND PARTICIPANTS During inpatient rehabilitation, 96 stroke patients were screened for DS. After 6 months, 71 patients were attainable for a follow-up. MEASUREMENTS DS was assessed using the 15-item Geriatric Depression Scale (GDS-15). At follow-up a telephone interview that included the Structured Clinical Interview for Psychiatric Disorders (SCID), which is based on DSM-IV criteria, and the GDS-15 was conducted. Patients with major depression (MD) at the follow-up were considered to have PSD. RESULTS Regression analyses were conducted to examine the influence of early DS on PSD after 6 months while controlling for age, premorbid depression, and functional and cognitive impairments. The percentage of patients who scored above the GDS-15 cut-off for clinically relevant DS increased significantly, from 37% to 44%, after 6 months. According to the SCID, 27% of stroke patients fulfilled the criteria for MD, and another 16% fulfilled those for minor depression. Logistic regression showed that DS at baseline significantly predicted PSD at follow-up (odds ratio: 1.43; 95% CI: 1.15-1.8). CONCLUSION Self-reported DS during inpatient rehabilitation are predictive for PSD 6 months after discharge. Assessment of early DS contributes to identifying stroke patients at risk for PSD, thereby facilitating prevention and treatment.
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Affiliation(s)
- A Lewin-Richter
- Katja Werheid, Department of Psychology, Humboldt Universität zu Berlin, 10099 Berlin,
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Thorlund K, Druyts E, Wu P, Balijepalli C, Keohane D, Mills E. Comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults: a network meta-analysis. J Am Geriatr Soc 2015; 63:1002-9. [PMID: 25945410 DOI: 10.1111/jgs.13395] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To establish the comparative efficacy and safety of selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors in older adults using the network meta-analysis approach. DESIGN Systematic review and network meta-analysis. PARTICIPANTS Individuals aged 60 and older. MEASUREMENTS Data on partial response (defined as at least 50% reduction in depression score from baseline) and safety (dizziness, vertigo, syncope, falls, loss of consciousness) were extracted. A Bayesian network meta-analysis was performed on the efficacy and safety outcomes, and relative risks (RRs) with 95% credible intervals (CrIs) were produced. RESULTS Fifteen randomized controlled trials were eligible for inclusion in the analysis. Citalopram, escitalopram, paroxetine, duloxetine, venlafaxine, fluoxetine, and sertraline were represented. Reporting on partial response and dizziness was sufficient to conduct a network meta-analysis. Reporting on other outcomes was sparse. For partial response, sertraline (RR=1.28), paroxetine (RR=1.48), and duloxetine (RR=1.62) were significantly better than placebo. The remaining interventions yielded RRs lower than 1.20. For dizziness, duloxetine (RR=3.18) and venlafaxine (RR=2.94) were statistically significantly worse than placebo. Compared with placebo, sertraline had the lowest RR for dizziness (1.14) and fluoxetine the second lowest (1.31). Citalopram, escitalopram, and paroxetine all had RRs between 1.4 and 1.7. CONCLUSION There was clear evidence of the effectiveness of sertraline, paroxetine, and duloxetine. There also appears to be a hierarchy of safety associated with the different antidepressants, although there appears to be a dearth of reporting of safety outcomes.
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Affiliation(s)
- Kristian Thorlund
- Stanford Prevention Research Center, Stanford University, Stanford, California.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Redwood Outcomes, Vancouver, British Columbia, Canada
| | - Eric Druyts
- Redwood Outcomes, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ping Wu
- Redwood Outcomes, Vancouver, British Columbia, Canada
| | | | | | - Edward Mills
- Stanford Prevention Research Center, Stanford University, Stanford, California.,Redwood Outcomes, Vancouver, British Columbia, Canada
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Song J, Kim E, Kim CH, Song HT, Lee JE. The role of orexin in post-stroke inflammation, cognitive decline, and depression. Mol Brain 2015; 8:16. [PMID: 25884812 PMCID: PMC4357085 DOI: 10.1186/s13041-015-0106-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 02/23/2015] [Indexed: 01/02/2023] Open
Abstract
Ischemic stroke results in diverse pathophysiologies, including cerebral inflammation, neuronal loss, cognitive dysfunction, and depression. Studies aimed at identifying therapeutic solutions to alleviate these outcomes are important due to the increase in the number of stroke patients annually. Recently, many studies have reported that orexin, commonly known as a neuropeptide regulator of sleep/wakefulness and appetite, is associated with neuronal cell apoptosis, memory function, and depressive symptoms. Here, we briefly summarize recent studies regarding the role and future perspectives of orexin in post-ischemic stroke. This review advances our understanding of the role of orexin in post-stroke pathologies, focusing on its possible function as a therapeutic regulator in the post-ischemic brain. Ultimately, we suggest the clinical potential of orexin to regulate post-stroke pathologies.
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Affiliation(s)
- Juhyun Song
- Department of Anatomy, Yonsei University College of Medicine, Seoul, 120-752, South Korea.
| | - Eosu Kim
- Department of Pharmacology, Yonsei University College of Medicine, 120-752, Seoul, South Korea.
| | - Chul-Hoon Kim
- Department of Psychiatry, Yonsei University College of Medicine, 120-752, Seoul, South Korea.
| | - Ho-Taek Song
- Department of Diagnostic Radiology, Yonsei University College of Medicine, 120-752, Seoul, South Korea.
| | - Jong Eun Lee
- Department of Anatomy, Yonsei University College of Medicine, Seoul, 120-752, South Korea. .,BK21 Plus Project for Medical Sciences, and Brain Research Institute, Yonsei University, College of Medicine, Seoul, 120-752, South Korea.
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Poststroke depression as a factor adversely affecting the level of oxidative damage to plasma proteins during a brain stroke. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:408745. [PMID: 25838867 PMCID: PMC4370103 DOI: 10.1155/2015/408745] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/20/2015] [Indexed: 11/24/2022]
Abstract
Poststroke depression, the second most serious psychosomatic complication after brain stroke, leads to delay of the rehabilitation process and is associated with an increased disability and cognitive impairment along with increase in term mortality. Research into the biochemical changes in depression is still insufficiently described. The aim of our study was therefore to evaluate the possible association between plasma protein oxidative/nitrative damages and the development of poststroke depression. We evaluated oxidative/nitrative modifications of specific proteins by measurement of 3-nitrotyrosine and carbonyl groups levels using ELISA test. Additionally, we checked differences in proteins thiol groups by spectrophotometric assay based on reaction between DTNB and thiols. We also evaluated catalase activity in erythrocytes measured as ability to decompose H2O2. Correlation analysis was performed using Spearman's rank. We observed significant (P < 0.001) differences in all oxidative/nitrative stress parameters in brain stroke patients compared to healthy group. Our research shows that oxidative damage of proteins is correlated with the degree of poststroke depression, while nitrative changes do not show any relationship. We demonstrate a positive correlation between the concentration of carbonyl groups and the Geriatric Depression Scale and a negative correlation between the degree of depression and the concentration of -SH groups or catalase activity.
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120
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Kang JH, Kao LT, Lin HC, Tsai MC, Chung SD. Statin use increases the risk of depressive disorder in stroke patients: A population-based study. J Neurol Sci 2015; 348:89-93. [DOI: 10.1016/j.jns.2014.11.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 12/11/2022]
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121
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Arauz A, Rodríguez-Agudelo Y, Sosa AL, Chávez M, Paz F, González M, Coral J, Díaz-Olavarrieta C, Román GC. Vascular Cognitive Disorders and Depression After First-Ever Stroke: The Fogarty-Mexico Stroke Cohort. Cerebrovasc Dis 2014; 38:284-9. [DOI: 10.1159/000366471] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/05/2014] [Indexed: 11/19/2022] Open
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122
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Cheng SY, Zhao YD, Li J, Chen XY, Wang RD, Zeng JW. Plasma levels of glutamate during stroke is associated with development of post-stroke depression. Psychoneuroendocrinology 2014; 47:126-35. [PMID: 25001962 DOI: 10.1016/j.psyneuen.2014.05.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression is a frequent mood disorder that affects around 33% of stroke patient. Our aim was to test the possible association between plasma glutamate and the development of post-stroke depression (PSD) in Chinese patients. METHODS The subjects were first-ever acute ischemic stroke (AIS) patients who were hospitalized during the period from November 2011 to September 2013. Clinical information and stroke severity was collected at admission. Neurological and neuropsychological evaluations were conducted at the 3-month follow-up. Plasma glutamate levels were analyzed at baseline using liquid chromatography followed by tandem mass spectrometry. Glutamate oxaloacetate transaminase (GOT), glutamate-pyruvate transaminase (GPT) and blood markers were also tested. Multivariate analyses were performed using logistic regression models. RESULTS During the study period, 209 patients were included in the analysis. Seventy patients (33.5%) were diagnosed as having major depression at 3 month. Patients with major depression showed higher levels of plasma glutamate [299 (235-353) vs. 157 (108-206) μM, P<0.0001] and lower GOT [14 (11-20) vs. 21 (15-32)U/L, P<0.0001] at admission. In multivariate analyses, plasma glutamate and GOT were independent predictors of PSD at 3 months [odds ratio (OR): 1.03 (1.02-1.04), P<0.0001; 0.84 (0.75-0.97), P=0.003]. Plasma levels of glutamate >205 μM were independently associated with PSD (OR, 21.3; 95% CI, 8.28-67.36, P<0.0001), after adjustment for possible variables. CONCLUSION The present study demonstrates a strong relationship between plasma glutamate and GOT levels at admission and the development of PSD within 3 months. Further studies are necessary to confirm this association, which may open the way to the proposal of new therapeutic options.
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Affiliation(s)
- Sai-Yu Cheng
- Department of Neurology, Second Affiliated Hospital and Xin Qiao Hospital, Third Military Medical University, Chongqing 400037, China.
| | - Yan-Dong Zhao
- Department of Neurobiology, College of Basic Medical Sciences, Chongqing Key Laboratory of Neurobiology, Third Military Medical University, Chongqing 400038, China
| | - Jie Li
- Department of Neurology, Second Affiliated Hospital and Xin Qiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Xiao-Yan Chen
- Department of Neurology, Second Affiliated Hospital and Xin Qiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Ruo-Dan Wang
- Department of Neurology, Second Affiliated Hospital and Xin Qiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jun-Wei Zeng
- Department of Physiology, Zunyi Medical College, Zunyi 563000, Guizhou Province, China
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123
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Jeong YJ, Kim WC, Kim YS, Choi KW, Son SY, Jeong YG. The Relationship between Rehabilitation and Changes in Depression in Stroke Patients. J Phys Ther Sci 2014; 26:1263-6. [PMID: 25202192 PMCID: PMC4155231 DOI: 10.1589/jpts.26.1263] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 02/18/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study investigated the primary factors behind changes in depressive symptoms among stroke patients after 8 weeks of rehabilitation (physical, occupational, and cognitive therapy). [Methods] This study was conducted using a literature review, and electronic medical records from January, 2008 to December, 2009. Data were collected for 120 subjects with chronic stroke. [Results] Cardiac disorder, left-brain lesion, early-stage depression, activities of daily living, and cognitive function were significant predictors of the changes in depression in chronic stroke patients. [Conclusion] Post-stroke depression can be controlled by rehabilitation. Also, clinicians should comprehend and share the psychological and physical affliction, develop back-up programs, and make them comprehensively available to support the psychological and physical health of subjects with chronic stroke.
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Affiliation(s)
- Yeon-Jae Jeong
- Rehabilitation Medicine, Hanyang University Medical Center, Republic of Korea
| | - Won-Cheol Kim
- Rehabilitation Medicine, Hanyang University Medical Center, Republic of Korea
| | - Yoon-Shin Kim
- Environmental and Industrial Medicine, Hanyang University Medical Center, Republic of Korea
| | - Kwan-Woo Choi
- Radiology Department, Asan Medical Center, Republic of Korea
| | - Soon-Yong Son
- Radiology Department, Asan Medical Center, Republic of Korea
| | - Yeon-Gyu Jeong
- Rehabilitation Medicine, Dongguk University Ilsan Medical Center, Republic of Korea
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Wostrack M, Friedrich B, Hammer K, Harmening K, Stankewitz A, Ringel F, Shiban E, Boeckh-Behrens T, Prothmann S, Zimmer C, Meyer B, Förschler A, Ryang YM. Hippocampal damage and affective disorders after treatment of cerebral aneurysms. J Neurol 2014; 261:2128-35. [DOI: 10.1007/s00415-014-7464-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/02/2014] [Accepted: 08/04/2014] [Indexed: 01/02/2023]
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125
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Man SC, Hung BHB, Ng RMK, Yu XC, Cheung H, Fung MPM, Li LSW, Leung KP, Leung KP, Tsang KWY, Ziea E, Wong VT, Zhang ZJ. A pilot controlled trial of a combination of dense cranial electroacupuncture stimulation and body acupuncture for post-stroke depression. Altern Ther Health Med 2014; 14:255. [PMID: 25038733 PMCID: PMC4223407 DOI: 10.1186/1472-6882-14-255] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 07/14/2014] [Indexed: 11/26/2022]
Abstract
Background Our previous studies have demonstrated the treatment benefits of dense cranial electroacupuncture stimulation (DCEAS), a novel brain stimulation therapy in patients with major depression, postpartum depression and obsessive-compulsive disorder. The purpose of the present study was to further evaluate the effectiveness of DCEAS combined with body acupuncture and selective serotonin reuptake inhibitors (SSRIs) in patients with post-stroke depression (PSD). Methods In a single-blind, randomized controlled trial, 43 patients with PSD were randomly assigned to 12 sessions of DCEAS plus SSRI plus body electroacupuncture (n = 23), or sham (non-invasive cranial electroacupuncture, n-CEA) plus SSRI plus body electroacupuncture (n = 20) for 3 sessions per week over 4 weeks. Treatment outcomes were measured using the 17-item Hamilton Depression Rating Scale (HAMD-17), the Clinical Global Impression - Severity scale (CGI-S) and Barthel Index (BI), a measure used to evaluate movement ability associated with daily self-caring activity. Results DCEAS produced a significantly greater reduction of both HAMD-17 and CGI-S as early as week 1 and CGI-S at endpoint compared to n-CEA, but subjects of n-CEA group exhibited a significantly greater improvement on BI at week 4 than DCEAS. Incidence of adverse events was not different in the two groups. Conclusions These results indicate that DCEAS could be effective in reducing stroke patients’ depressive symptoms. Superficial electrical stimulation in n-CEA group may be beneficial in improving movement disability of stroke patients. A combination of DCEAS and body acupuncture can be considered a treatment option for neuropsychiatric sequelae of stroke. Trial registration http://www.clinicaltrials.gov, NCT01174394.
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Obembe A, Mapayi B, Johnson O, Agunbiade T, Emechete A. Reply to “Letter to the Editor: Reintegration to normal living after stroke”. Hong Kong Physiother J 2014. [DOI: 10.1016/j.hkpj.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Peng L, Zhang X, Kang DY, Liu XT, Hong Q. Effectiveness and safety of Wuling capsule for post stroke depression: a systematic review. Complement Ther Med 2014; 22:549-66. [PMID: 24906594 DOI: 10.1016/j.ctim.2014.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 03/17/2014] [Accepted: 04/25/2014] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To review the effectiveness and safety of Wuling capsule for post stroke depression (PSD) systematically. METHODS We searched electronic databases for randomized controlled trials (RCTs) that compared either Wuling capsule with placebo, no treatment or Wuling capsule plus conventional treatment with conventional treatment alone in adults with post stroke depression. Relevant resources were also retrieved. Two reviewers screened the citations, assessed the risk of bias and extracted data independently. RESULTS A total of 16 studies involving 1378 patients were identified for this review. There were 3 trials comparing Wuling capsule with no treatment control and 13 trials comparing Wuling capsule plus conventional treatment (Deanxit, Fluoxetine, Sertraline, Paroxetine or Citalopram) with conventional treatment alone. Meta-analyses indicated Wuling capsule used alone or integrated with conventional treatment was effective for PSD in terms of HAMD (Hamilton depression scale) scores, response rate and with less adverse effects, of which, HAMD scores decreased significantly in favor of Wuling capsule from onset time to 1 week (SMD = 1.27, 95%CI: 0.71-1.83, P < 0.00001), 2 weeks (SMD = 1.45, 95%CI: 0.57-2.33, P = 0.001), 4 weeks (SMD = 2.84, 95%CI: 2.15-3.52, P < 0.00001), 6 weeks (SMD = 2.70, 95%CI: 2.15-3.24, P < 0.00001), and 8 weeks (SMD = 4.53, 95%CI: 3.55-5.50, P < 0.00001) and overall effect (SMD = 2.40, 95%CI: 1.75-3.05, P < 0.00001) (SMD = standardized mean difference). CONCLUSION Wuling capsule appeared to present certain antidepressant effect compared to no treatment control. With a combination of several Western medicines, Wuling capsule could be helpful in strengthening efficacy and reducing the incidence of adverse events as an alternative choice in the treatment of PSD. However, due to the limited number of included trials and relatively moderate methodological quality in the majority of studies, further large scale and rigorously designed trials are warranted to confirm the effectiveness and safety of Wuling capsule for post stroke depression.
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Affiliation(s)
- Le Peng
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xin Zhang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - De-Ying Kang
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, China.
| | - Xue-Ting Liu
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qi Hong
- Department of Evidence-based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu 610041, China
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Zhang WN, Pan YH, Wang XY, Zhao Y. A prospective study of the incidence and correlated factors of post-stroke depression in China. PLoS One 2013; 8:e78981. [PMID: 24260141 PMCID: PMC3832506 DOI: 10.1371/journal.pone.0078981] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 09/25/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is commonly observed among stroke survivors. However, statistical analysis of such data is scarce in developing countries. The purpose of this study is to examine the incidence of PSD and its relationship with stroke characteristics in China. METHODS This was a prospective hospital-based study. Stroke patients were assessed within two weeks after acute ischemic stroke onset and then reevaluated at three months. Hamilton Depression Scale (HAMD) was used for screening depression (PSD). Subjects with HAMD score of ≥7 were further assessed with the World Health Organization Composite International Diagnostic Interview. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS). Stroke outcome was measured by the modified Rankin Scale (mRS). RESULTS One hundred and two stroke patients were recruited, only ninety-one patients completed del period (men = 53, 63.74%), with mean age 60.0±10.4 years (range, 34-82 years). The incidence of PSD was 27.47% two weeks after stroke. The occurrence of PSD was unrelated with age, stroke type, stroke lesion and the history of disease. In univariate analysis gender, PSD was correlated with female gender. In multivariate logistic regression analysis, poor stroke outcome (mRS≥3) (OR 12.113, CI 1.169 to 125.59, P<0.05) was the important predictors of PSD. CONCLUSIONS The study indicated that gender, functional dependence and stroke outcome are determinants of PSD occurrence during the first 2 weeks after stroke in China.
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Affiliation(s)
- Wei-Na Zhang
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
| | - Yong-Hui Pan
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
- * E-mail:
| | - Xiao-Yu Wang
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
| | - Yue Zhao
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
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129
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Chiu SY, Livneh H, Tsao LL, Tsai TY. Acceptance of disability and its predictors among stroke patients in Taiwan. BMC Neurol 2013; 13:175. [PMID: 24224953 PMCID: PMC3833656 DOI: 10.1186/1471-2377-13-175] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2013] [Accepted: 11/07/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Modern medicine has increased the survival rate for stroke patients; however, the patient's psychosocial adaptation after stroke onset may be related to the clinical outcomes. This study aimed to investigate patients' acceptance of disability (AOD) and its predictors in stroke patients. METHODS This cross-sectional study used a purposive sampling method to recruit 175 stroke patients from a hospital in southern Taiwan. A structured questionnaire gathered data on respondent demographics and disease characteristics, and included the Chinese version of the AOD Scale-Revised. Factors associated with AOD were examined by a multiple linear regression analysis. RESULTS The mean AOD score was 71.72, which indicated a lower level of disease acceptance (range, 32-128). Our findings showed that patients who reported no religious beliefs, shorter disease duration, recurrent stroke episodes, and poorer physical functioning also reported lower levels of disability acceptance. These factors accounted for 38.2% of the variance in AOD among participants. CONCLUSIONS The findings are beneficial to healthcare providers by identifying those stroke patients with predisposition of having lower disability acceptance, which could then facilitate the provision of appropriate rehabilitation interventions within six months after the diagnosis of stroke to support their adaptation process.
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Affiliation(s)
- Shan-Yun Chiu
- Department of Nursing, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi 62247, Taiwan
| | - Hanoch Livneh
- Rehabilitation Counseling Program, Portland State University, PO Box 751, Portland, OR 97207-0751, USA
| | - Long-Lung Tsao
- Department of Neurology, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi 62247, Taiwan
| | - Tzung-Yi Tsai
- Department of Medical Research, Dalin Tzuchi Hospital, The Buddhist Tzuchi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi 62247, Taiwan
- Department of Nursing, Tzu Chi College of Technology, No. 880, Chien-Kuo Rd. Sec. 2, Hualien 97005, Taiwan
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Rd., Tainan 70428, Taiwan
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Carey LM, Crewther S, Salvado O, Lindén T, Connelly A, Wilson W, Howells DW, Churilov L, Ma H, Tse T, Rose S, Palmer S, Bougeat P, Campbell BCV, Christensen S, Macaulay SL, Favaloro J, Collins VO, McBride S, Bates S, Cowley E, Dewey H, Wijeratne T, Gerraty R, Phan TG, Yan B, Parsons MW, Bladin C, Barber PA, Read S, Wong A, Lee A, Kleinig T, Hankey GJ, Blacker D, Markus R, Leyden J, Krause M, Grimley R, Mahant N, Jannes J, Sturm J, Davis SM, Donnan GA. STroke imAging pRevention and Treatment (START): A Longitudinal Stroke Cohort Study: Clinical Trials Protocol. Int J Stroke 2013; 10:636-44. [DOI: 10.1111/ijs.12190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 08/05/2013] [Indexed: 02/03/2023]
Abstract
Rationale Stroke and poststroke depression are common and have a profound and ongoing impact on an individual's quality of life. However, reliable biological correlates of poststroke depression and functional outcome have not been well established in humans. Aims Our aim is to identify biological factors, molecular and imaging, associated with poststroke depression and recovery that may be used to guide more targeted interventions. Design In a longitudinal cohort study of 200 stroke survivors, the START – STroke imAging pRevention and Treatment cohort, we will examine the relationship between gene expression, regulator proteins, depression, and functional outcome. Stroke survivors will be investigated at baseline, 24 h, three-days, three-months, and 12 months poststroke for blood-based biological associates and at days 3–7, three-months, and 12 months for depression and functional outcomes. A sub-group ( n = 100), the PrePARE: Prediction and Prevention to Achieve optimal Recovery Endpoints after stroke cohort, will also be investigated for functional and structural changes in putative depression-related brain networks and for additional cognition and activity participation outcomes. Stroke severity, diet, and lifestyle factors that may influence depression will be monitored. The impact of depression on stroke outcomes and participation in previous life activities will be quantified. Study Outcomes Clinical significance lies in the identification of biological factors associated with functional outcome to guide prevention and inform personalized and targeted treatments. Evidence of associations between depression, gene expression and regulator proteins, functional and structural brain changes, lifestyle and functional outcome will provide new insights for mechanism-based models of poststroke depression.
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Affiliation(s)
- Leeanne M. Carey
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- Department of Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Vic., Australia
| | - Sheila Crewther
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- School of Psychological Sciences, La Trobe University, Bundoora, Vic., Australia
| | - Olivier Salvado
- Preventative Health National Research Flagship, The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Qld, Australia
| | - Thomas Lindén
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Alan Connelly
- Brain Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia
| | - William Wilson
- Preventative Health National Research Flagship, Neurodegenerative Diseases, Mental Disorders and Brain Health, CSIRO, North Ryde, NSW, Australia
| | - David W. Howells
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Leonid Churilov
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Henry Ma
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- Stroke Unit, Monash Medical Centre, Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Tamara Tse
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- Department of Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Vic., Australia
| | - Stephen Rose
- Preventative Health National Research Flagship, The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Qld, Australia
| | - Susan Palmer
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Pierrick Bougeat
- Preventative Health National Research Flagship, The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Qld, Australia
| | - Bruce C. V. Campbell
- Department of Medicine, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Soren Christensen
- Department of Medicine, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - S. Lance Macaulay
- Preventative Health National Research Flagship, Neurodegenerative Diseases, Mental Disorders and Brain Health, CSIRO, Parkville, Vic. Australia
| | - Jenny Favaloro
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Victoria O' Collins
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Simon McBride
- Preventative Health National Research Flagship, The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Qld, Australia
| | - Susan Bates
- Neuroscience Trials Australia, Melbourne Brain Centre – Austin Campus, Heidelberg, Vic., Australia
| | - Elise Cowley
- Neuroscience Trials Australia, Melbourne Brain Centre – Austin Campus, Heidelberg, Vic., Australia
| | - Helen Dewey
- Department of Neurology, Austin Health, Heidelberg, Vic., Australia
| | - Tissa Wijeratne
- Department of Neurology, Western Hospital, Western Health, Melbourne, Vic., Australia
| | | | - Thanh G. Phan
- Stroke Unit, Monash Medical Centre, Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Bernard Yan
- Department of Medicine, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Mark W. Parsons
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Chris Bladin
- Department of Neurology, Box Hill Hospital, Eastern Health, Melbourne, Vic., Australia
| | - P. Alan Barber
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Stephen Read
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Andrew Wong
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Andrew Lee
- Flinders Comprehensive Stroke Centre, Flinders Medical Centre and University, Adelaide, SA
| | - Tim Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Graeme J. Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - David Blacker
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Romesh Markus
- Departmentof Neurology, St. Vincent's Hospital, Sydney, NSW, Australia
| | - James Leyden
- Department of Neurology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Martin Krause
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Rohan Grimley
- Department of Neurology, Nambour General Hospital, Nambour, Qld, Australia
| | - Neil Mahant
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Jim Jannes
- Department of Neurology, The Queen Elizabeth Hospital, SA
| | - Jonathan Sturm
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - Stephen M. Davis
- Department of Medicine, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A. Donnan
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
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131
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Kim HJ, Kim W, Kong SY. Antidepressants for neuro-regeneration: from depression to Alzheimer's disease. Arch Pharm Res 2013; 36:1279-90. [PMID: 24129616 DOI: 10.1007/s12272-013-0238-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/17/2013] [Indexed: 02/05/2023]
Abstract
Recently identified new potential functions of antidepressants in the treatment of neurodegenerative will be introduced. Antidepressants are reported to regulate stem cell fate to regenerate neurons in the adult hippocampus and are effective in reducing toxic amyloid peptides and are known to increase neurotrophic factor such as brain-derived neurotrophic factor. Clinical trial data support that antidepressants have potential to treat Alzheimer's disease.
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Affiliation(s)
- Hyun-Jung Kim
- Laboratory of Molecular and Stem Cell Pharmacology, College of Pharmacy, Chung-Ang University, Seoul, 156-756, Republic of Korea,
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132
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Kawamoto H, Kamibayashi K, Nakata Y, Yamawaki K, Ariyasu R, Sankai Y, Sakane M, Eguchi K, Ochiai N. Pilot study of locomotion improvement using hybrid assistive limb in chronic stroke patients. BMC Neurol 2013; 13:141. [PMID: 24099524 PMCID: PMC3851710 DOI: 10.1186/1471-2377-13-141] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/03/2013] [Indexed: 11/10/2022] Open
Abstract
Background Locomotor training using robots is increasingly being used for rehabilitation to reduce manpower and the heavy burden on therapists, and the effectiveness of such techniques has been investigated. The robot suit Hybrid Assistive Limb (HAL) has been developed to rehabilitate or support motor function in people with disabilities. The HAL provides motion support that is tailored to the wearer’s voluntary drive. We performed a pilot clinical trial to investigate the feasibility of locomotor training using the HAL in chronic stroke patients, and to examine differences between two functional ambulation subgroups. Methods Sixteen stroke patients in the chronic stage participated in this study. All patients were trained with the HAL over 16 sessions (20–30 min/day within 2 days/week). Primary outcomes were walking speed, cadence, and number of steps recorded during a 10-meter walk test (10MWT). Berg balance scale (BBS) and timed up and go (TUG) were also measured. All outcome measures were evaluated without wearing HAL assistance before and after the intervention in all patients as well as in the dependent ambulatory and independent ambulatory subgroups. Results All participants completed the intervention with no adverse events. Gait speed, cadence, number of steps during the 10MWT, and BBS increased significantly from 0.41 m/s to 0.45 m/s (P = 0.031), from 68.6 steps/min to 72.0 steps/min (P = 0.020), from 37.5 steps to 33.1 steps (P = 0.017), and from 40.6 to 45.4 (P = 0.004) respectively. The TUG test score improved, although this difference was not statistically significant. The findings in the dependent ambulatory subgroup primarily contributed to the significant differences observed in the group as a whole. Conclusions This pilot study showed that locomotor training using the HAL is feasible for chronic stroke patients. Randomized controlled trials are now required to demonstrate the effectiveness of HAL-based rehabilitation over conventional therapies. Trial registration UMIN000002969
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133
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Laures-Gore JS, DeFife LC. Perceived stress and depression in left and right hemisphere post-stroke patients. Neuropsychol Rehabil 2013; 23:783-97. [PMID: 23799820 PMCID: PMC3830587 DOI: 10.1080/09602011.2013.811087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although it is well accepted that depression and stress are closely related in the general adult population, this link is less understood in post-stroke patients. Due to the high occurrence of depression in post-stroke patients it is important to look closely at this possible association. The current study explores perceived stress and depression in post-stroke patients. Nineteen left hemisphere (LH) stroke patients and 12 right hemisphere (RH) post-stroke patients were assessed for depression, perceived stress, and neurological functioning with the Stroke Aphasia Depression Questionnaire, the Perceived Stress Scale, and the Scandinavian Stroke Scale once per month for three months. Perceived stress and depressive symptoms were significantly correlated for both stroke groups. Neurological functioning was not correlated with either depressive symptoms or perceived stress in either stroke group. The perception of stress may be a more critical variable in developing post-stroke depression than neurological functioning is in stroke patients. Routine screening of perception of stress may need to occur in post-stroke patients to avoid development of depression.
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Affiliation(s)
- Jacqueline S. Laures-Gore
- Communication Sciences & Disorders Program, Georgia State University
- Neuroscience Institute, Georgia State University
| | - Lauren C. DeFife
- Communication Sciences & Disorders Program, Georgia State University
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134
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Tanaka AFD, Scheicher ME. Relação entre depressão e desequilíbrio postural em idosos que sofreram acidente vascular encefálico. FISIOTERAPIA EM MOVIMENTO 2013. [DOI: 10.1590/s0103-51502013000200008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: A incidência de Acidente Vascular Encefálico (AVE) aumenta com o envelhecimento e duplica a cada década de vida a partir dos 55 anos de idade. Entre as complicações decorrentes de um AVE estão o desequilíbrio postural e a depressão. OBJETIVOS: Avaliar e correlacionar equilíbrio postural e depressão em idosos com e sem AVE. MATERIAIS E MÉTODOS: Foram avaliados 38 sujeitos (19 com AVE e 19 sem AVE). O equilíbrio foi avaliado pela Escala de Equilíbrio de Berg e a depressão pela Escala de Depressão de Yesavage. RESULTADOS: Idosos com AVE apresentaram depressão quando comparados com idosos sem a doença (p < 0,0001). O risco de cair em idosos com AVE foi 102 vezes maior do que em idosos sem AVE. Houve correlação entre depressão e equilíbrio (r = -0,55; p = 0,01). CONCLUSÃO: Pacientes idosos com sequelas de AVE apresentam maior desequilíbrio e maior depressão, quando comparados com idosos de mesma faixa etária sem a doença.
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135
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da Rocha e Silva CE, Alves Brasil MA, Matos do Nascimento E, de Bragança Pereira B, André C. Is poststroke depression a major depression? Cerebrovasc Dis 2013; 35:385-91. [PMID: 23635428 DOI: 10.1159/000348852] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 02/06/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poststroke depression (PSD) is the most common neuropsychiatric consequence of stroke. A large number of studies have focused on the pathogenesis of PSD, but only a few aimed to characterize its psychopathology; these studies yielded results that are difficult to compare because of the different methods utilized. The current study aimed to characterize the symptom profile of PSD in an attempt to better understand the disease and allow a more accurate diagnosis. METHODS The study sample comprised 64 patients divided into three groups: stroke patients without diagnosis of depression (n = 33), stroke patients diagnosed with PSD (PSD group, n = 14) and patients diagnosed with major depression (MD) but with no clinical comorbidity (MD group, n = 17). All patients were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The initial diagnostic interview was complemented by the Mini Mental State Examination (MMSE), the Rankin Scale, and four scales for the assessment of the intensity of symptoms of anxiety and depression: the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression General Scale (HADS), the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). The Star Plot, a graphical method of data visualization, was used to analyze the results. The t test was used for independent samples (two-tailed analysis). RESULTS As measured by the BDI, HAM-D and HAM-A scales and HADS depression subscale, the average total scores of symptoms for the sample of patients diagnosed with MD without clinical comorbidity was significantly higher than that of the PSD patients (p < 0.05). Similar results were obtained by plotting the BDI data on Star Plot. The PSD patients showed mild typical depressive symptoms such as less depressed mood, anhedonia, disinterest, guilt, negative thoughts, depreciation, suicidal ideation and anxiety, when evaluated by the HAM-A scale. Moreover, the somatic symptoms of depression did not lead to increased diagnosis of major depression in stroke patients. CONCLUSIONS The results indicate that the PSD clinical picture comprised, in general, symptoms of mild/moderate intensity, especially those considered as pillars for the diagnosis of depression: depressed mood, loss of pleasure and lack of interest. Given the imprecision of boundaries that separate the clinical forms of depression from subclinical and nonpathological forms, or even from the concepts of demoralization and adjustment disorders, we situate PSD in a complex biopsychosocial context in which a better understanding of its psychopathological profile could provide diagnostic and therapeutic alternatives best suited to the difficult reality experienced by stroke patients.
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Affiliation(s)
- Carlos E da Rocha e Silva
- Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
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136
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Cocchini G, Crosta E, Allen R, Zaro F, Beschin N. Relationship between anosognosia and depression in aphasic patients. J Clin Exp Neuropsychol 2013; 35:337-47. [DOI: 10.1080/13803395.2013.776008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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137
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Depression after stroke and risk of mortality: a systematic review and meta-analysis. Stroke Res Treat 2013; 2013:862978. [PMID: 23533964 PMCID: PMC3606772 DOI: 10.1155/2013/862978] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/21/2012] [Accepted: 01/25/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Depression after stroke may have great burden on the likelihood of functional recovery and long-term outcomes. Objective. To estimate the association between depression after stroke and subsequent mortality. Methods. A systematic search of articles using PubMed and Web of Science databases was performed. Odds ratios (ORs) and hazard ratios (HRs) were used as association measures for pooled analyses, based on random-effects models. Results. Thirteen studies, involving 59,598 subjects suffering from stroke (6,052 with and 53,546 without depression), had data suitable for meta-analysis. The pooled OR for mortality at followup in people suffering from depression after stroke was 1.22 (1.02–1.47). Subgroups analyses highlighted that only studies with medium-term followup (2–5 years) showed a statistically significant association between depression and risk of death. Four studies had data suitable for further analysis of pooled HR. The meta-analysis revealed a HR for mortality of 1.52 (1.02–2.26) among people with depression after stroke. Conclusions. Despite some limitations, this paper confirms the potential role of depression on post stroke mortality. The relationship between depression and mortality after stroke seems to be related to the followup duration. Further research is needed to clarify the nature of the association between depression after stroke and mortality.
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Salzman B, Collins L, Hajjar ER. Chronic disease management: the changing landscape of primary care. Prim Care 2012; 39:xv-xxi. [PMID: 22608877 DOI: 10.1016/j.pop.2012.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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139
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Ellis C, Grubaugh AL, Egede LE. The association between major depression, health behaviors, and quality of life in adults with stroke. Int J Stroke 2011; 7:536-43. [PMID: 22151696 DOI: 10.1111/j.1747-4949.2011.00708.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM The study aims to examine the association between major depression, healthcare behaviors, and quality of life indices among adults with stroke. METHODS Data from 5869 participants with stroke in the 2006 Behavioral Risk Factor Surveillance Survey were examined. Multiple logistic regression was used to assess the independent association between depression status, self-care and preventive health behaviors, and quality of life indices, after accounting for relevant covariates. RESULTS In multivariate models, individuals with major depression were less likely to engage in physical activity (odds ratio 0·41; 95% confidence interval 0·29, 0·56) than those without major depression. Women with major depression were also less likely to have received a mammogram in the past two-years (odds ratio 0·61; 95% confidence interval 0·40, 0·96 for women ≥ age 40 and odds ratio 0·58; 95% confidence interval 0·36, 0·72 for women ≥ age 50) and a pap smear in the past three-years (odds ratio 0·40; 95% CI 0·22, 0·72). In comparisons of quality of life, individuals with major depression were less likely to perceive their health as excellent/very good/good (odds ratio 0·36; 95% confidence interval 0·25, 0·53), to report being satisfied with life (odds ratio 0·13; 95% confidence interval 0·08, 0·20), and to report receiving needed social support (odds ratio 0·42; 95% confidence interval 0·28, 0·63). Individuals who were depressed were also more likely to report one or more poor physical and poor mental health days in the past 30 days (odds ratio 4·56; 95% confidence interval 3·08, 6·76 and odds ratio 10·97; 95% confidence interval 7·75, 15·52, respectively). CONCLUSIONS In adults with stroke, major depression is associated with decreased engagement in stroke-specific and gender-specific self-care and preventive health behaviors, as well as a broad range of quality of life indices.
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Affiliation(s)
- Charles Ellis
- Department of Health Sciences & Research, Medical University of South Carolina, Charleston, SC 29425, USA.
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Suttipong C, Sindhu S. Predicting factors of pressure ulcers in older Thai stroke patients living in urban communities. J Clin Nurs 2011; 21:372-9. [PMID: 22082321 DOI: 10.1111/j.1365-2702.2011.03889.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM AND OBJECTIVE To describe the contributing factors for pressure ulcer development in older Thai stroke patients in an urban community. BACKGROUND Pressure ulcers are a common problem signifying a source of morbidity and mortality in older stroke patients. In the past, most studies have focused on the physiological factors affecting pressure ulcer development. However, studies related to effect of stroke severity and psychosocial factors in community-based setting have not found. DESIGN Cross-sectional survey design. METHODS One hundred and sixty-eight older stroke patients from urban communities in three districts in metropolitan Thailand were recruited for this cross sectional study. Data were collected from the Skin Assessment Tool, the Braden scale, the Canadian Neurological Scale, the Social Support Questionnaire and the Thai Geriatric Depression Scale for each patient. The results were analysed using multiple logistic regression and the chi-square test. RESULTS Eighty older stroke patients who developed pressure ulcers (47·6%). The participants were aged between 60-93 years. Multiple logistic regression analysis was applied to calculate the odds ratio. The significant predicting factors for pressure ulcers were activity, moisture, nutrition, friction and shearing and depression. Sensory perception, mobility, severity of stroke and social support were not found to be significant predictors. CONCLUSIONS Physiological factors and depression were found to be significant predicting factors for pressure ulcer development in older stroke patients living in an urban community. RELEVANCE TO CLINICAL PRACTICE To help prevent pressure ulcers in older stroke patients, the findings suggest that healthcare providers assess activity, moisture, nutrition, friction and shearing, as well as psychological assessment for depression. The results indicate that models for pressure ulcer prevention merit further investigation.
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Affiliation(s)
- Chophaka Suttipong
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand.
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Cahana-Amitay D, Albert ML, Pyun SB, Westwood A, Jenkins T, Wolford S, Finley M. Language as a Stressor in Aphasia. APHASIOLOGY 2011; 25:593-614. [PMID: 22701271 PMCID: PMC3372975 DOI: 10.1080/02687038.2010.541469] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND: Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians and researchers would agree that language may be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce. AIM: The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a program for future study. In doing so, we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation. MAIN CONTRIBUTION: Post stroke emotional dysregulation in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term "linguistic anxiety." Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to "linguistic anxiety." CONCLUSION: Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer's disease or persons with post traumatic stress disorder, or even with healthy aging persons, in whom "linguistic anxiety" might be at work when they have trouble finding words.
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Affiliation(s)
- Dalia Cahana-Amitay
- Boston University, Department of Neurology, Harold Goodglass Aphasia Research Center, VA Healthcare System, 150 South Huntington Avenue Boston, MA 02130
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142
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Zhang T, Wang C, Liu L, Zhao X, Xue J, Zhou Y, Wang Y, Wang Y. A prospective cohort study of the incidence and determinants of post-stroke depression among the mainland Chinese patients. Neurol Res 2010; 32:347-52. [PMID: 20482999 DOI: 10.1179/016164110x12656393665125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Post-stroke depression is a common consequence of stroke and can negatively affect the rehabilitation process in patients. This work was undertaken to examine the incidence, demographic factors and clinical determinants of post-stroke depression in 3 months after ischemic stroke in mainland Chinese patients. METHODS One hundred and sixty-five patients with acute ischemic stroke were included in the present work. The Diagnostic and Statistical Manual of Mental Disorders (fourth edition) diagnosis of post-stroke depression was evaluated by the World Health Organization Composite International Diagnostic Interview during the follow-up exam at 3 months after the stroke. The demographic factors and clinical variables at the time of stroke onset and 14 days after stroke were also examined. RESULTS The 3 month cumulative incidence of post-stroke depression was 27.3% in this patient population. The univariate analysis suggests that the female gender, past history of depression, marital status and level of handicap at 14 days after stroke were factors associated with the development of post-stroke depression. In the multivariate model, female gender [p=0.0040; odds ratio (OR)=3.550; 95% confidence interval (CI): 1.499-8.408], past history of depression (p=0.0010; OR=5.225; 95% CI: 1.959-13.940) and level of handicap at 14 days after stroke (p=0.0066; OR=1.607; 95% CI: 1.141-2.262) were further confirmed as demographic and clinical factors that correlate with the development of post-stroke depression. CONCLUSION The present work suggests that female gender, history of depression and level of handicap at 14 days after stroke are three independent determinants of post-stroke depression occurrence during the first 3 months after ischemic stroke in mainland Chinese patients.
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Affiliation(s)
- Tong Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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143
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Determinants of depression and anxiety in family practice patients with comorbidities. Wien Klin Wochenschr 2010; 122 Suppl 2:35-9. [PMID: 20517669 DOI: 10.1007/s00508-010-1337-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM To identify the prevalence of anxiety and depression in patients with chronic conditions in Slovenian family practices and to identify predictors for anxiety and depression. METHODS Self-administered questionnaires (Zung's self-rating depression scale and Zung's self-rating anxiety scale) in a sample of 800 consecutive family-practice patients. The main outcome measures were depression and anxiety scores in patients with various comorbidities. RESULTS A binary logistic regression model for the presence of depression showed that widowed/divorced status, elementary/vocational education, cardiac diseases, migraine and higher levels of chronic pain were independent predictors for the presence of depression. A binary logistic regression model for the presence of anxiety showed that female gender, lower income, cardiac diseases, osteoarthritis and rheumatologic diseases, and higher levels of chronic pain were independent predictors for with the presence of anxiety. CONCLUSIONS Family physicians should actively and routinely look for the presence of depression and anxiety among their patients, especially among women, patients with lower levels of education, widowed and divorced patients, patients with chronic pain, patients with cardiac and rheumatologic diseases, and patients with migraine. Family doctors should provide better analgesic treatment for patients with chronic pain in order to prevent the development of depression and anxiety.
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144
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Abstract
Poststroke depression (PSD) in elderly patients has been considered the most common neuropsychiatric consequence of stroke up to 6-24 months after stroke onset. When depression appears within days after stroke onset, it is likely to remit, whereas depression at 3 months is likely to be sustained for 1 year. One of the major problems posed by elderly stroke patients is how to identify and optimally manage PSD. This review provides insight to identification and management of depression in elderly stroke patients. Depression following stroke is less likely to include dysphoria and more likely characterized by vegetative signs and symptoms compared with other forms of late-life depression, and clinicians should rely more on nonsomatic symptoms rather than somatic symptoms. Evaluation and diagnosis of depression among elderly stroke patients are more complex due to vague symptoms of depression, overlapping signs and symptoms of stroke and depression, lack of properly trained health care personnel, and insufficient assessment tools for proper diagnosis. Major goals of treatment are to reduce depressive symptoms, improve mood and quality of life, and reduce the risk of medical complications including relapse. Antidepressants (ADs) are generally not indicated in mild forms because the balance of benefit and risk is not satisfactory in elderly stroke patients. Selective serotonin reuptake inhibitors are the first choice of PSD treatment in elderly patients due to their lower potential for drug interaction and side effects, which are more common with tricyclic ADs. Recently, stimulant medications have emerged as promising new therapeutic interventions for PSD and are now the subject of rigorous clinical trials. Cognitive behavioral therapy can also be useful, and electroconvulsive therapy is available for patients with severe refractory PSD.
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Affiliation(s)
- Johan Lökk
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
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145
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Zalihić A, Markotić V, Zalihić D, Mabić M. Gender and quality of life after cerebral stroke. Bosn J Basic Med Sci 2010; 10:94-9. [PMID: 20507287 DOI: 10.17305/bjbms.2010.2701] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this work is to investigate the influence of gender on recovery after cerebral stroke.It is believed that functional outcome of cerebral stroke (CS) depends on gender. Female gender is mildly negative prognostic factor in after stroke results. Two hundred and two patients who had first ischemic cerebral stroke were questioned with help of, HADS and WHOQOL-Bref questionnaires, looking for differences in recovery depending on gender. Average patients' age was 72+/-13 (ME+/-IR) years. The youngest patient had 40 years, and the oldest 92 years, and medium range was 52 years. There were 112 males and 90 females. Quality of life was equally graded by both male and female after CS (p=0.208). Male patients had significantly better results in physical (p=0.035) and psychological (p=0.020) domain of life quality. After CS, male patients had better results only in memory dimension (p=0.003). Anxiety was statistically more frequent among female patients (p=0.009). Gender did not influence frequency of metabolic syndrome in patients with CS. Quality of life after CS was better in male patients, and statistically significant difference has been shown in physical, psychological domain and memory dimension. Female patients were more anxious then male after CS.
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Affiliation(s)
- Amra Zalihić
- Department of Family Medicine, Health Care Center Mostar, Hrvatskih branitelja bb, Mostar, Bosnia and Herzegovina
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146
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The effectiveness and safety of acupuncture therapy in depressive disorders: systematic review and meta-analysis. J Affect Disord 2010; 124:9-21. [PMID: 19632725 DOI: 10.1016/j.jad.2009.07.005] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Revised: 07/02/2009] [Accepted: 07/02/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND Although acupuncture has been used as an alternative treatment for depressive disorders, its effectiveness and safety are not well defined. The purpose of this systematic review with meta-analysis was to evaluate the effectiveness of acupuncture as monotherapy and as an additional therapy in treating various depressive conditions, particularly major depressive disorder (MDD) and post-stroke depression (PSD). METHODS Following systematic review, meta-analysis was conducted on high-quality randomized controlled trials (RCTs). RESULTS Of 207 clinical studies of acupuncture for various depression retrieved, 113 (54.6%) were on MDD and 76 (36.7%) on PSD. Twenty RCTs of MDD (n=1998) and 15 of PSD (n=1680) identified for high-quality protocol (Jadad score >or=3) were included for meta-analysis. The efficacy of acupuncture as monotherapy was comparable to antidepressants alone in improving clinical response and alleviating symptom severity of MDD, but not different from sham acupuncture. No sufficient evidence favored the expectation that acupuncture combined with antidepressants could yield better outcomes than antidepressants alone in treating MDD. Acupuncture was superior to antidepressants and waitlist controls in improving both response and symptom severity of PSD. The incidence of adverse events in acupuncture intervention was significantly lower than antidepressants. CONCLUSIONS Acupuncture therapy is safe and effective in treating MDD and PSD, and could be considered an alternative option for the two disorders. The efficacy in other forms of depression remains to be further determined.
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147
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Abstract
Depression is common after stroke. Post-stroke depression (PSD) is an independent predictor of poor long-term functional outcome following stroke. PSD has been associated with poor social and rehabilitation outcomes, cognitive impairment and increased mortality. Prevalence varies widely between studies because of differences in patient selection, time, evaluation methods and diagnostic criteria. Approximately a third of stroke survivors may suffer from PSD. Potential confounders include anosognosia, apathy and emotional lability. The identification of risk factors is important to prevent and detect PSD early, and provide appropriate interventions. PSD may be associated with restriction in social activities and dependence in activities of daily living in the chronic phase of stroke. Pharmacologic and rehabilitation strategies are needed to treat PSD. More evidence is required before recommendations can be made about the routine use of antidepressants to prevent PSD.
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148
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Brunoni AR, Teng CT, Correa C, Imamura M, Brasil-Neto JP, Boechat R, Rosa M, Caramelli P, Cohen R, Porto JAD, Boggio PS, Fregni F. Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting. ARQUIVOS DE NEURO-PSIQUIATRIA 2010; 68:433-51. [PMID: 20602051 DOI: 10.1590/s0004-282x2010000300021] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Accepted: 09/29/2009] [Indexed: 12/28/2022]
Abstract
The use of neuromodulation as a treatment for major depressive disorder (MDD) has recently attracted renewed interest due to development of other non-pharmacological therapies besides electroconvulsive therapy (ECT) such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). METHOD: We convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD. RESULTS: The state-of-art of neuromodulation techniques was reviewed and discussed in four sections: [1] epidemiology and pathophysiology of MDD; [2] a comprehensive overview of the neuromodulation techniques; [3] using neuromodulation techniques in MDD associated with non-psychiatric conditions; [4] the main challenges of neuromodulation research and alternatives to overcome them. DISCUSSION: ECT is the first-line treatment for severe depression. TMS and tDCS are strategies with a relative benign profile of side effects; however, while TMS effects are comparable to antidepressant drugs for treating MDD; further research is needed to establish the role of tDCS. DBS and VNS are invasive strategies with a possible role in treatment-resistant depression. In summary, MDD is a chronic and incapacitating condition with a high prevalence; therefore clinicians should consider all the treatment options including invasive and non-invasive neuromodulation approaches.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Roni Cohen
- Centro Brasileiro de Estimulação Magnética, Brazil
| | | | | | - Felipe Fregni
- Spaulding Rehabilitation Hospital; Harvard Medical School; Berenson-Allen Center for Noninvasive Brain Stimulation; Harvard Medical School, USA
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149
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Aggarwal A, Gaur V, Kumar A. Nitric oxide mechanism in the protective effect of naringin against post-stroke depression (PSD) in mice. Life Sci 2010; 86:928-35. [DOI: 10.1016/j.lfs.2010.04.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 02/18/2010] [Accepted: 04/18/2010] [Indexed: 10/19/2022]
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150
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Srivastava A, Taly AB, Gupta A, Murali T. Post-stroke depression: prevalence and relationship with disability in chronic stroke survivors. Ann Indian Acad Neurol 2010; 13:123-7. [PMID: 20814496 PMCID: PMC2924510 DOI: 10.4103/0972-2327.64643] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 08/02/2009] [Accepted: 10/01/2009] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate (1) the prevalence of operationally defined depressive disorder (ICD-10) in chronic stroke subjects and (2) the relationship of post-stroke depression (PSD) with disability. DESIGN Cross-sectional, descriptive study. SETTING Neurological rehabilitation unit of a tertiary care university research center. MATERIALS AND METHODS Participants were those with first episode of supratentorial stroke of more than 3 months' duration with impaired balance and gait who had been referred for rehabilitation. Data were collected on demographic data, stroke data (side and type of lesion and post-stroke duration), cognition (mini mental state examination), depressive ideation (Hamilton Depression Rating Scale - HRDS), impairment (Scandinavian Stroke Scale), balance (Berg Balance Scale), ambulatory status (Functional Ambulation Category), walking ability (speed), and independence in activities of daily living (Barthel Index). Statistical analysis was done using SPSS 13.0. We carried out the chi-square test for ordinal variables and the independent t test for continuous variables. RESULTS Fifty-one patients (M:F: 41:10) of mean age 46.06 +/- 11.19 years and mean post-stroke duration of 467.33 +/- 436.39 days) were included in the study. Eighteen of the 51 participants (35.29%) met the criteria for depression. Demographic variables like male gender, being married, living in a nuclear family, urban background, and higher HRDS score were significantly correlated with PSD (P < 0.05). Depression was related to functional disability after stroke but to a statistically insignificant level (P > 0.05) and was unrelated to lesion-related parameters. CONCLUSION Depression occurs in one-third of chronic stroke survivors and is prevalent in subjects referred for rehabilitation. PSD is related primarily to demographic variables and only to a lesser extent to functional disability following stroke.
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Affiliation(s)
- Abhishek Srivastava
- Center for Physical Medicine & Rehabilitation, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Bangalore-560029, India.
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