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Mu J, Li J. Analysis of radiological features in patients with post-stroke depression and cognitive impairment. Rev Neurosci 2024; 35:565-573. [PMID: 38417835 DOI: 10.1515/revneuro-2023-0120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/04/2024] [Indexed: 03/01/2024]
Abstract
Post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI) are common complications following a stroke, significantly impacting the quality of life and survival time of survivors. Currently, the comorbidity of PSCI and PSD is receiving increasing attention, as they share some common clinical characteristics, mechanisms, risk factors, radiological features, and treatment strategies. They influence each other, with the clinical prevalence of PSD comorbid with PSCI reaching as high as 26.15 %. The prevention, screening, diagnosis, and treatment of PSD and PSCI require collaboration across clinical, radiological, and neuropsychological evaluations. This paper aims to summarize the common radiological features of both conditions from a radiological perspective, which may aid in identifying early screening and predictive imaging biomarkers.
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Affiliation(s)
- Jun Mu
- Department of Neurology, 544251 The First Affiliated Hospital of Chongqing Medical University , Chongqing, 400016, China
| | - Jiayi Li
- Department of Neurology, 544251 The First Affiliated Hospital of Chongqing Medical University , Chongqing, 400016, China
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Xu T, Dong F, Zhang M, Wang K, Xu T, Xia S, Feng C. Post-stroke arrhythmia could be a potential predictor for post-stroke depression. Sci Rep 2024; 14:9093. [PMID: 38643303 PMCID: PMC11032346 DOI: 10.1038/s41598-024-59789-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/15/2024] [Indexed: 04/22/2024] Open
Abstract
Post-stroke depression (PSD) is regarded as the consequence of multiple contributors involving the process of cognition, mood and autonomic system, with the specific mechanism unclear yet. As a common type of stroke-heart syndromes, post-stroke arrhythmia shared some common pathogenesis with PSD. We presumed that post-stroke arrhythmia might be an early distinguishable marker for the presence of PSD and aimed to verity their association in this study. Patients with first-ever ischemic stroke were enrolled. The presence of post-stroke ectopic arrhythmia and the symptoms of arrhythmia were recorded with anti-arrhythmia drugs prescribed when necessary. Patients were followed up 3 months later to identify their presence and severity of PSD using Hamilton Depression Scale (HAMD) and also presence and severity of arrhythmia. Characteristics including the prevalence of various types of arrhythmias were compared between PSD and non-PSD groups. The HAMD scores were compared between patients with and without arrhythmia in PSD group. Logistic regression was used to identify the independent predictor of PSD. Patients with PSD had higher prevalence of post-stroke arrhythmia especially newly-detected arrhythmia, symptomatic arrhythmia and poor-controlled arrhythmia. In PSD group, patients of post-stroke arrhythmia had higher scores of HAMD than those without arrhythmia. Presence of newly-detected, symptomatic and poor-controlled arrhythmias were independent predictor of PSD. post-stroke arrhythmia especially newly-detected arrhythmia and symptomatic arrhythmia could be an early predictor of PSD. Successful control of arrhythmia was associated with reduced prevalence and severity of PSD.
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Affiliation(s)
- Tao Xu
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Fangying Dong
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
- The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Muhua Zhang
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Kewu Wang
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Tian Xu
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Shudong Xia
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China
| | - Chao Feng
- Department of Cardiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Shangcheng Avenue N1#, Yiwu, Zhejiang, China.
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Jaiswal V, Ang SP, Suresh V, Joshi A, Halder A, Rajak K, Nasir YM, Gupta S, Raj N, Chia JE, Deb N, Kainth T. Association between baseline high-sensitive C-reactive protein, homocysteine levels, and post-stroke depression among stroke patients: a systematic review, meta-analysis, and meta-regression. Curr Probl Cardiol 2024; 49:102338. [PMID: 38103817 DOI: 10.1016/j.cpcardiol.2023.102338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Post-stroke depression (PSD) is a prevalent neuropsychiatric sequelae following stroke, often associated with diminished functional recovery and heightened mortality risk. Emerging evidence suggests neuroinflammation, triggered in response to stroke events, may be instrumental in precipitating PSD. AIM This study aims to assess the significance of high-sensitivity C-reactive protein (Hs-CRP) and homocysteine (Hcy) in post-stroke individuals with PSD. METHODS We systematically searched all electronic databases from inception until May 30, 2023. Outcomes were reported as standard mean difference (SMD), and their corresponding 95% confidence interval (95% CI). RESULTS A total of 12 studies with 3,230 patients were included in this study. The mean age of the overall cohort was 65.7 years, and patients with PSD were observed to be older than patients without PSD (68.3 years versus 63.1 years). We observed a higher female prevalence in the PSD group (44.4% versus 40.7%). PSD patients were more likely to be widowed (19.4% versus 8.4%) and more likely to have a family history of psychiatric disorder (11.3% versus 4.9%) compared to non-PSD patients. We also observed that patients with PSD had higher levels of baseline Hs-CRP [SMD 0.16, (95% CI 0.08 to 0.25), p<0.001], and Hcy [SMD 0.14, (95% CI 0.05 to 0.22), p<0.001] than patients without PSD. Meta-regression analysis did not reveal any effect modifier for higher Hs-CRP in the study group, however, history of widowhood was a significant effect modifier when assessing Hcy levels between the two groups (coefficient 1.998, p=0.038). CONCLUSION Baseline levels of Hs-CRP and Hcy were significantly higher in patients with PSD, highlighting the role of recognizing demographic and biochemical markers in understanding the complexities of post-stroke depression.
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Affiliation(s)
- Vikash Jaiswal
- Department of Research, Larkin Community Hospital, South Miami, FL 33143, USA; JCCR Cardiology Research Collaborators, USA
| | - Song Peng Ang
- Department of Internal Medicine, Rutgers Health/Community Medical Center, Toms River, NJ, USA; JCCR Cardiology Research Collaborators, USA
| | - Vinay Suresh
- King George's Medical University, Lucknow, India
| | - Amey Joshi
- Department of Medicine, Michigan State University-Sparrow Hospital, USA; JCCR Cardiology Research Collaborators, USA.
| | - Anupam Halder
- Department of Internal Medicine, UPMC Harrisburg, PA, USA
| | - Kripa Rajak
- Department of Internal Medicine, UPMC Harrisburg, PA, USA; JCCR Cardiology Research Collaborators, USA
| | - Yusra Minahil Nasir
- Department of Internal Medicine, University of Oklahoma Health Science Center, USA; JCCR Cardiology Research Collaborators, USA
| | - Shiva Gupta
- King George's Medical University, Lucknow, India
| | - Nishchita Raj
- Department of Psychiatry, Santosh Medical College and Hospital, Ghaziabad; JCCR Cardiology Research Collaborators, USA
| | - Jia Ee Chia
- Department of Internal Medicine, Texas Tech University Health Science Center El Paso, TX, USA; JCCR Cardiology Research Collaborators, USA
| | - Novonil Deb
- North Bengal Medical College and Hospital, India; JCCR Cardiology Research Collaborators, USA
| | - Tejasvi Kainth
- Department of Psychiatry, Bronxcare Health System, NY 10032, USA; JCCR Cardiology Research Collaborators, USA
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Chan LG, Ng HSM, Loh YJ. Poststroke depression within the first year - phenomenology and clinical correlates from real-world data. J Stroke Cerebrovasc Dis 2024; 33:107509. [PMID: 38103447 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/18/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Studies of poststroke depression (PSD) in Singapore are limited. Specifically, the dynamic epidemiology and phenomenology of PSD in the different stroke types are unknown. OBJECTIVES This study aims to characterize the epidemiology and phenomenology of PSD in both the hospital setting, and in the community setting up to one year after stroke. METHODS Real-world clinical data of 1732 consecutive stroke patients in a tertiary stroke centre was extracted from inception in January 2010 to 30 November 2021. The Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ) were used to identify PSD. Demographic, comorbidities and stroke-related variables, and stroke severity were extracted and analysed by stroke type - ischemic, haemorrhagic, and strategic, at the hospitalisation and community follow-up cross-sections. For each group, the characteristics of those with PSD were compared against those without PSD. Logistic regression was performed to identify PSD predictors. Phenomenology was mapped by the relative frequencies of endorsed items on PHQ and HADS in PSD patients. RESULTS The prevalence of in-hospital PSD was 19.24 % in ischemic stroke, and 24.59 % in both haemorrhagic strokes and strategic basal ganglia/thalamus strokes. Prevalence of PSD in 547 stroke patients who were followed-up ≤ 12 months was 6.42 % in ischemic strokes, 3.52 % in haemorrhagic strokes and 5.23 % among strategic strokes. The association of right sided, bilateral strokes, strategic strokes, and large vessel aetiology with PSD only exists for ischemic strokes. Greater functional impairment and a past psychiatric history are independent predictive factors of PSD in all stroke types. Symptom profile of in-hospital PSD includes anxious distress. CONCLUSION These findings have immediate clinical applicability considering the representativeness of the study sample.
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Affiliation(s)
- Lai Gwen Chan
- Department of Psychiatry, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433.
| | - Hok Shan Matthew Ng
- Rehabilitation Research Institute of Singapore, 11 Mandalay Road #14-03/04, Clinical Sciences Building, Singapore 308232
| | - Yong Joo Loh
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433
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Gainotti G. Mainly Visual Aspects of Emotional Laterality in Cognitively Developed and Highly Social Mammals-A Systematic Review. Brain Sci 2024; 14:52. [PMID: 38248267 PMCID: PMC10813540 DOI: 10.3390/brainsci14010052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/23/2024] Open
Abstract
Several studies have shown that emotions are asymmetrically represented in the human brain and have proposed three main models (the 'right hemisphere hypothesis', the 'approach-withdrawal hypothesis' and the 'valence hypothesis') that give different accounts of this emotional laterality. Furthermore, in recent years, many investigations have suggested that a similar emotional laterality may also exist in different animal taxa. However, results of a previous systematic review of emotional laterality in non-human primates have shown that some of these studies might be criticized from the methodological point of view and support only in part the hypothesis of a continuum in emotional laterality across vertebrates. The aim of the present review therefore consisted in trying to expand this survey to other cognitively developed and highly social mammals, focusing attention on mainly visual aspects of emotional laterality, in studies conducted on the animal categories of horses, elephants, dolphins and whales. The 35 studies included in the review took into account three aspects of mainly visual emotional laterality, namely: (a) visual asymmetries for positive/familiar vs. negative/novel stimuli; (b) lateral position preference in mother-offspring or other affiliative interactions; (c) lateral position preference in antagonistic interactions. In agreement with data obtained from human studies that have evaluated comprehension or expression of emotions at the facial or vocal level, these results suggest that a general but graded right-hemisphere prevalence in the processing of emotions can be found at the visual level in cognitively developed non-primate social mammals. Some methodological problems and some implications of these results for human psychopathology are briefly discussed.
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Affiliation(s)
- Guido Gainotti
- Institute of Neurology, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; ; Tel.: +39-06-30156435
- Fondazione Policlinico A. Gemelli, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico), 00168 Rome, Italy
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Wang Q, Jiang T, Li R, Zheng T, Han Q, Wang M. Whether serum leptin and insulin-like growth factor-1 are predictive biomarkers for post-stroke depression: A meta-analysis and systematic review. J Psychiatr Res 2024; 169:347-354. [PMID: 38091723 DOI: 10.1016/j.jpsychires.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 01/15/2024]
Abstract
Leptin and insulin-like growth factor-1 (IGF-1) may play a role in clinical identification of post-stroke depression (PSD). Here, eight databases (including CNKI, Wanfang, SinoMed, VIP, PubMed, the Cochrane Library, Embase, and the Web of Science) were employed to search for studies on serum leptin and insulin-like growth factor-1 expression levels in patients with PSD. In total, 13 articles were included, of which 6 studies investigated the expression level of serum leptin in patients with PSD, 7 studies explored the serum IGF-1 in PSD patients. Then, the RevMan 5.4 software was used for meta-analysis. The results showed that serum leptin levels were significantly higher in PSD patients than in patients without PSD (SMD = 1.54, 95% CI: 0.84, 2.23; P = 0.006). The result of subgroup analysis showed that the serum leptin levels in PSD patients were significantly higher than those without PSD in acute phase (SMD = 1.38, 95% CI: 0.04, 2.71; P = 0.04), subacute phase (SMD = 2.31, 95% CI: 0.88, 3.73; P = 0.001), and chronic phase (SMD = 1.02, 95% CI: 0.43, 1.60; P = 0.0007); There was no significant difference in serum IGF-1 level between PSD patients and patients without PSD (SMD = 0.49, 95% CI: -0.55, 1.52; P = 0.36). Moreover, the subgroup analysis also showed that there was no statistical difference in acute stage (SMD = 0.36, 95% CI: 0.89, 1.60; P = 0.57). Our study provides evidence to prove that serum leptin level has potential clinical application value as biomarkers for identifying PSD.
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Affiliation(s)
- Qi Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Taotao Jiang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Rundong Li
- Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Ting Zheng
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, China
| | - Qian Han
- School of Public Health, Lanzhou University, Lanzhou, 730030, China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, 730030, China.
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Wang T, Liu X, Wu X, Fan Y, Lv Y, Chen B. High-frequency rTMS of the left dorsolateral prefrontal cortex for post-stroke depression: A systematic review and meta-analysis. Clin Neurophysiol 2024; 157:130-141. [PMID: 38103393 DOI: 10.1016/j.clinph.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/03/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This meta-analysis investigated the therapeutic efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) for treatment of post-stroke depression (PSD). METHODS Ten articles with 266 patients in rTMS group and 258 patients in control group were included. The primary outcome was performed to examine the efficacy of rTMS for PSD. Secondary outcomes of response rates and remission rates and subgroup analyses were further explored. RESULTS Our meta-analysis revealed a significant pooled effect size (the standard mean difference (SMD) was -1.45 points (95% CI, -2.04 to -0.86; p < 0.00001)). The odds ratio (OR) of the response rate and remission rate were 8.41 (95% CI, 2.52-28.12, p = 0.0005) and 6.04 (95% CI, 1.5-24.39, p = 0.01). Moreover, rTMS treatment for PSD patients in subacute phase and targeting the left DLPFC at 5-cm anterior to the left motor hotspot or the midpoint of the middle frontal gyrus showed significant antidepressant effect. In addition, the Hamilton Depression Rating Scale (HAMD) was sensitive to detect depressive changes in patients. CONCLUSIONS Our meta-analysis elucidated that the application of high-frequency rTMS over the left DLPFC was an effective treatment alternative for PSD. SIGNIFICANCE Our meta-analysis may help to develop more reasonable treatment strategies in clinical practice for PSD patients.
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Affiliation(s)
- Tiantian Wang
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
| | - Xintian Liu
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
| | - Xiumei Wu
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
| | - Yanzi Fan
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China
| | - Yating Lv
- Center for Cognition and Brain Disorders, the Affiliated Hospital of Hangzhou Normal University, Hangzhou, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China.
| | - Bing Chen
- Jing Hengyi School of Education of Hangzhou Normal University, Hangzhou, China; Zhejiang Philosophy and Social Science Laboratory for Research in Early Development and Childcare, Hangzhou Normal University, Hangzhou, Zhejiang, China.
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Zhan Q, Kong F. Mechanisms associated with post-stroke depression and pharmacologic therapy. Front Neurol 2023; 14:1274709. [PMID: 38020612 PMCID: PMC10651767 DOI: 10.3389/fneur.2023.1274709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Stroke is one of the most common cerebrovascular diseases, which is the cause of long-term mental illness and physical disability, Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke, and its mechanisms are characterized by complexity, plurality, and diversity, which seriously affects the quality of survival and prognosis of patients. Studies have focused on and recognized neurotransmitter-based mechanisms and selective serotonin-reuptake inhibitors (SSRIs) can be used to treat PSD. Neuroinflammation, neuroendocrinology, neurotrophic factors, and the site of the stroke lesion may affect neurotransmitters. Thus the mechanisms of PSD have been increasingly studied. Pharmacological treatment mainly includes SSRIs, noradrenergic and specific serotonergic antidepressant (NaSSA), anti-inflammatory drugs, vitamin D, ect, which have been confirmed to have better efficacy by clinical studies. Currently, there is an increasing number of studies related to the mechanisms of PSD. However, the mechanisms and pharmacologic treatment of PSD is still unclear. In the future, in-depth research on the mechanisms and treatment of PSD is needed to provide a reference for the prevention and treatment of clinical PSD.
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Affiliation(s)
- Qingyang Zhan
- Institute of Chinese Medicine, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Fanyi Kong
- Neurosurgery, Affiliated First Hospital, Harbin Medical University, Harbin, China
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Krick S, Koob JL, Latarnik S, Volz LJ, Fink GR, Grefkes C, Rehme AK. Neuroanatomy of post-stroke depression: the association between symptom clusters and lesion location. Brain Commun 2023; 5:fcad275. [PMID: 37908237 PMCID: PMC10613857 DOI: 10.1093/braincomms/fcad275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 08/07/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
Post-stroke depression affects about 30% of stroke patients and often hampers functional recovery. The diagnosis of depression encompasses heterogeneous symptoms at emotional, motivational, cognitive, behavioural or somatic levels. Evidence indicates that depression is caused by disruption of bio-aminergic fibre tracts between prefrontal and limbic or striatal brain regions comprising different functional networks. Voxel-based lesion-symptom mapping studies reported discrepant findings regarding the association between infarct locations and depression. Inconsistencies may be due to the usage of sum scores, thereby mixing different symptoms of depression. In this cross-sectional study, we used multivariate support vector regression for lesion-symptom mapping to identify regions significantly involved in distinct depressive symptom domains and global depression. MRI lesion data were included from 200 patients with acute first-ever ischaemic stroke (mean 0.9 ± 1.5 days of post-stroke). The Montgomery-Åsberg Depression Rating interview assessed depression severity in five symptom domains encompassing motivational, emotional and cognitive symptoms deficits, anxiety and somatic symptoms and was examined 8.4 days of post-stroke (±4.3). We found that global depression severity, irrespective of individual symptom domains, was primarily linked to right hemispheric lesions in the dorsolateral prefrontal cortex and inferior frontal gyrus. In contrast, when considering distinct symptom domains individually, the analyses yielded much more sensitive results in regions where the correlations with the global depression score yielded no effects. Accordingly, motivational deficits were associated with lesions in orbitofrontal cortex, dorsolateral prefrontal cortex, pre- and post-central gyri and basal ganglia, including putamen and pallidum. Lesions affecting the dorsal thalamus, anterior insula and somatosensory cortex were significantly associated with emotional symptoms such as sadness. Damage to the dorsolateral prefrontal cortex was associated with concentration deficits, cognitive symptoms of guilt and self-reproach. Furthermore, somatic symptoms, including loss of appetite and sleep disturbances, were linked to the insula, parietal operculum and amygdala lesions. Likewise, anxiety was associated with lesions impacting the central operculum, insula and inferior frontal gyrus. Interestingly, symptoms of anxiety were exclusively left hemispheric, whereas the lesion-symptom associations of the other domains were lateralized to the right hemisphere. In conclusion, this large-scale study shows that in acute stroke patients, differential post-stroke depression symptom domains are associated with specific structural correlates. Our findings extend existing concepts on the neural underpinnings of depressive symptoms, indicating that differential lesion patterns lead to distinct depressive symptoms in the first weeks of post-stroke. These findings may facilitate the development of personalized treatments to improve post-stroke rehabilitation.
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Affiliation(s)
- Sebastian Krick
- Department of Neurology, University Hospital Cologne, Cologne 50937, Germany
| | - Janusz L Koob
- Department of Neurology, University Hospital Cologne, Cologne 50937, Germany
| | - Sylvia Latarnik
- Department of Neurology, University Hospital Cologne, Cologne 50937, Germany
| | - Lukas J Volz
- Department of Neurology, University Hospital Cologne, Cologne 50937, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne 50937, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, Jülich 52425, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Cologne, Cologne 50937, Germany
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, Jülich 52425, Germany
- Department of Neurology, Goethe University Hospital Frankfurt, Frankfurt am Main 60528, Germany
| | - Anne K Rehme
- Department of Neurology, University Hospital Cologne, Cologne 50937, Germany
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Xu F, Bai L, Dai Z, Cheng H. Research hotspots and trends in post-stroke dysphagia: a bibliometric analysis. Front Neurosci 2023; 17:1275748. [PMID: 37942140 PMCID: PMC10628302 DOI: 10.3389/fnins.2023.1275748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 10/06/2023] [Indexed: 11/10/2023] Open
Abstract
Background Dysphagia represents one of the common complications following a stroke, and post-stroke dysphagia (PSD) can lead to aspiration, pneumonia, and malnutrition, thus prolonging hospital stay, escalating medical expenditures, and imposing a substantial economic strain on both patients and society. The utilization of bibliometric analysis offers a quantitative approach for investigating the existing literature and recognizes the current status of the research. However, bibliometric analysis on the subject of PSD remains absent. Consequently, we carried out this study to provide researchers with insights, facilitating their further exploration of PSD. Methods Conducting a bibliometric analysis of articles pertaining to PSD retrieved over the past two decades enables us to acquire the research hotspots and trends in this area. The publications concerning PSD were searched from the Core Collection of Web of Science, spanning the period ranging from 2003 to 2023. Articles or reviews published in English were included in this study. Subsequently, we employed CiteSpace and VOSviewer software to visualize the retrieved articles, thereby identifying the cooperative relationships of authors, institutions, and countries, as well as relevant information about journals and references. Results This study comprised 866 papers in total, and the number of articles published each year shows an overall growth trend. As for the analysis of the authors, Dziewas R. was the most prolific author with 21 articles. The most frequently published institutions, countries, and journals were the University of Manchester, China, and Dysphagia, with 28, 254, and 75 publications, respectively. And the co-cited authors and journals with the highest counts were Martino R and Stroke. According to the analysis of keywords and references, dysphagia screening and assessment, prevention of pneumonia, rehabilitation approaches, and nutritional management of PSD are considered research hotpots. Additionally, future research may focus on the topics of systematic review and meta-analysis, noninvasive brain stimulation, and lesion location. Conclusion Through the bibliometrics analysis of PSD, we can capture the research hotspots and frontiers of PSD, thereby providing inspiration and reference for subsequent studies in this field.
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Affiliation(s)
- Fangyuan Xu
- The First Clinical Medical School, Anhui University of Chinese Medicine, Hefei, China
| | - Lin Bai
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Ziliang Dai
- Department of Rehabilitation Medicine, Wuhan Iron and Steel (Group) Second Staff Hospital, Wuhan, China
| | - Hongliang Cheng
- Department of Neurology, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
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Robinson RG, Jorge RE, Starkstein SE. Poststroke Depression: An Update. J Neuropsychiatry Clin Neurosci 2023; 36:22-35. [PMID: 37559511 DOI: 10.1176/appi.neuropsych.21090231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
The presence of neuropsychiatric disorders after stroke has been recognized for more than 100 years, but controlled systematic studies did not begin until the 1970s. The most clinically important advances, however, have been in the treatment and prevention of poststroke depression (PSD). Recent meta-analyses of randomized controlled trials (RCTs) for the treatment of PSD have demonstrated the efficacy of antidepressants. Similarly, RCTs for the prevention of PSD have shown that antidepressants significantly decrease the incidence of PSD compared with placebo. Early treatment of PSD with antidepressants also appears to enhance both physical and cognitive recovery from stroke and may increase survival up to 10 years. Genetic and epigenetic variations, white matter disease, cerebrovascular deregulation, altered neuroplasticity, and changes in glutamate neurotransmission may be relevant etiological factors.
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Affiliation(s)
- Robert G Robinson
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein)
| | - Ricardo E Jorge
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein)
| | - Sergio E Starkstein
- Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson); Mental Health Service Line, Michael E. DeBakey Veterans Affairs Medical Center, and Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Jorge); Department of Psychiatry, University of Western Australia, Perth, Australia (Starkstein)
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12
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Qiu X, Lan Y, Miao J, Pan C, Sun W, Li G, Wang Y, Zhao X, Zhu Z, Zhu S. Depressive symptom dimensions predict the treatment effect of repetitive transcranial magnetic stimulation for post-stroke depression. J Psychosom Res 2023; 171:111382. [PMID: 37285667 DOI: 10.1016/j.jpsychores.2023.111382] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 04/28/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Repetitive transcranial magnetic stimulation (rTMS) has attracted considerable attention because of its non-invasiveness, minimal side effects, and treatment efficacy. Despite an adequate duration of rTMS treatment, some patients with post-stroke depression (PSD) do not achieve full symptom response or remission. METHODS This was a prospective randomized controlled trial. Participants receiving rTMS were randomly assigned to the ventromedial prefrontal cortex (VMPFC), left dorsolateral prefrontal cortex (DLPFC), or contralateral motor area (M1) groups in a ratio of 1:1:1. Enrollment assessments and data collection were performed in weeks 0, 2, 4, and 8. The impact of depressive symptom dimensions on treatment outcomes were tested using a linear mixed-effects model fitted with maximum likelihood. Univariate analysis of variance (ANOVA) and back-testing were used to analyze the differences between the groups. RESULTS In total, 276 patients were included in the analysis. Comparisons across groups showed that 17-item Hamilton Rating Scale for Depression (HAMD-17) scores of the DLPFC group significantly differed from those of the VMPFC and M1 groups at 2, 4, and 8 weeks after treatment (p < 0.05). A higher observed mood score (β = -0.44, 95% confidence interval [CI]: -0.85-0.04, p = 0.030) could predict a greater improvement in depressive symptoms in the DLPFC group. Higher neurovegetative scores (β = 0.60, 95% CI: 0.25-0.96, p = 0.001) could predict less improvement of depressive symptoms in the DLPFC group. CONCLUSION Stimulation of the left DLPFC by high-frequency rTMS (HF-rTMS) could significantly improve depressive symptoms in the subacute period of subcortical ischemic stroke, and the dimension of depressive symptoms at admission might predict the treatment effect.
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Affiliation(s)
- Xiuli Qiu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Yan Lan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Jinfeng Miao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Chensheng Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Wenzhe Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Yanyan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Xin Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030.
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, China. 430030.
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13
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Klingbeil J, Brandt ML, Stockert A, Baum P, Hoffmann KT, Saur D, Wawrzyniak M. Associations of lesion location, structural disconnection, and functional diaschisis with depressive symptoms post stroke. Front Neurol 2023; 14:1144228. [PMID: 37265471 PMCID: PMC10231644 DOI: 10.3389/fneur.2023.1144228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/20/2023] [Indexed: 06/03/2023] Open
Abstract
Introduction Post-stroke depressive symptoms (PSDS) are common and relevant for patient outcome, but their complex pathophysiology is ill understood. It likely involves social, psychological and biological factors. Lesion location is a readily available information in stroke patients, but it is unclear if the neurobiological substrates of PSDS are spatially localized. Building on previous analyses, we sought to determine if PSDS are associated with specific lesion locations, structural disconnection and/or localized functional diaschisis. Methods In a prospective observational study, we examined 270 patients with first-ever stroke with the Hospital Anxiety and Depression Scale (HADS) around 6 months post-stroke. Based on individual lesion locations and the depression subscale of the HADS we performed support vector regression lesion-symptom mapping, structural-disconnection-symptom mapping and functional lesion network-symptom-mapping, in a reanalysis of this previously published cohort to infer structure-function relationships. Results We found that depressive symptoms were associated with (i) lesions in the right insula, right putamen, inferior frontal gyrus and right amygdala and (ii) structural disconnection in the right temporal lobe. In contrast, we found no association with localized functional diaschisis. In addition, we were unable to confirm a previously described association between depressive symptom load and a network damage score derived from functional disconnection maps. Discussion Based on our results, and other recent lesion studies, we see growing evidence for a prominent role of right frontostriatal brain circuits in PSDS.
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Affiliation(s)
- Julian Klingbeil
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Max-Lennart Brandt
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Anika Stockert
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Petra Baum
- Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Dorothee Saur
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
| | - Max Wawrzyniak
- Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany
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14
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Tang S, Gao M, Cheng X, Ji L. Scientometric analysis of post-stroke depression research based on CiteSpace. Medicine (Baltimore) 2023; 102:e33633. [PMID: 37145004 PMCID: PMC10158871 DOI: 10.1097/md.0000000000033633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023] Open
Abstract
Post-stroke depression (PSD) has served as a severe and common complication leading to a higher level of mortality. Though various studies have been focused on PSD, limited research endeavor has been dedicated to bibliometric analysis in the past. In view of this, the current analysis serves to elucidate the latest status of global research and pinpoint the emerging area of interest for PSD, in order to support further investigation of the field. Publications related to PSD were retrieved from the Web of Science Core Collection database on September 24, 2022, and included in the bibliometric analysis. VOSviewer and CiteSpace software were used to visually analyze publication outputs, scientific cooperation, highly-cited references, and keywords to identify the current status and future trends in PSD research. A total of 533 publications were retrieved. The annual number of publications showed an increasing trend from 1999 to 2022. In terms of country and academic institution, the USA and Duke University have topped the list of PSD research respectively. Meanwhile, Robinson RG and Alexopoulos GS have been the most representative investigators of the field. In the past, researchers focused on the risk factors of PSD, late-life depression, and Alzheimer disease. In recent years, further research effort has been placed on meta-analysis, ischemic stroke, predictor, inflammation, mechanism, and mortality. In conclusion, in the past 20 years, PSD research has been progressing and gaining more attention. The bibliometric analysis successfully unveiled the field's major contributing countries, institutions, and investigators. Furthermore, current hot spots and future trends in the field of PSD were identified, which included meta-analysis, ischemic stroke, predictor, inflammation, mechanism, and mortality.
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Affiliation(s)
- Saixue Tang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
- The Affiliated Hospital of Shandong University of TCM, Jinan, Shandong Province, China
| | - Mingzhou Gao
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Xunshu Cheng
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Lijin Ji
- Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
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15
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Jiang C, Li Z, Wang J, Liu L, Luo G, Zheng X. Effectiveness of repetitive transcranial magnetic stimulation combined with a brief exposure procedure for post-stroke posttraumatic stress disorder. J Affect Disord 2023; 326:89-95. [PMID: 36717030 DOI: 10.1016/j.jad.2023.01.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 01/21/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
The incidence of posttraumatic stress disorder (PTSD) following stroke ranges from 6.5 % to 25 %. Presently few studies have focused on its treatment. Repetitive transcranial magnetic stimulation (rTMS) is often applied as a rehabilitation method after stroke, and it also represents a novel approach to PTSD. The aim of this study was to explore the effect of rTMS (or combined with a brief stroke re-exposure) on treating post-stroke PTSD. Sixty participants with post-stroke PTSD were randomly assigned into three groups (rTMS + brief exposure group, TMS + BE; rTMS alone group, TMS; sham treatment group, ST) and received 10 sessions of treatment accordingly over two weeks. Changes in PTSD symptoms (Impact of Event Scale-Revised, IES-R) were evaluated at pre-treatment (T1), the end of the first (T2), and the end of the second treatment week (T3). At the three-month follow-up (T4), a PTSD interview and IES-R assessment were given. Results showed that from T1 to T3, IES-R (and its intrusion subscale) scores of TMS + BE group and TMS group were significantly lower than the ST group, and the effect remained at three-month follow-up. The treatment effect was comparable between TMS + BE group and TMS group at T3, however, it was better for TMS + BE group than TMS group at T2, indicating a brief exposure promotes the effect of rTMS. At follow-up, the rates of PTSD were lower in TMS + BE group and TMS group than ST group. In conclusion, rTMS can effectively treat post-stroke PTSD and the effects may be accelerated by combining a brief exposure procedure. TRIAL REGISTRATION: Chinese Clinical Trial Registry, identifier: ChiCTR2100043444.
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Affiliation(s)
- Che Jiang
- Department of Neurosurgery, General Hospital of Southern Theater Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China.
| | - Zhensheng Li
- Department of Neurology, General Hospital of Southern Theatre Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China
| | - Jiajia Wang
- Department of Neurosurgery, General Hospital of Southern Theater Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China
| | - Leiyuan Liu
- Department of Neurosurgery, General Hospital of Southern Theater Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China
| | - Gaoquan Luo
- Department of Neurosurgery, General Hospital of Southern Theater Command, 111 Liuhua Road, Guangzhou 510010, Guangdong, China
| | - Xifu Zheng
- School of Psychology, South China Normal University, Guangzhou 510631, Guangdong, China.
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16
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Pagonabarraga J, Álamo C, Castellanos M, Díaz S, Manzano S. Depression in Major Neurodegenerative Diseases and Strokes: A Critical Review of Similarities and Differences among Neurological Disorders. Brain Sci 2023; 13:brainsci13020318. [PMID: 36831861 PMCID: PMC9954482 DOI: 10.3390/brainsci13020318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/05/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Depression and anxiety are highly prevalent in most neurological disorders and can have a major impact on the patient's disability and quality of life. However, mostly due to the heterogeneity of symptoms and the complexity of the underlying comorbidities, depression can be difficult to diagnose, resulting in limited recognition and in undertreatment. The early detection and treatment of depression simultaneously with the neurological disorder is key to avoiding deterioration and further disability. Although the neurologist should be able to identify and treat depression initially, a neuropsychiatry team should be available for severe cases and those who are unresponsive to treatment. Neurologists should be also aware that in neurodegenerative diseases, such as Alzheimer's or Parkinson's, different depression symptoms could develop at different stages of the disease. The treatment options for depression in neurological diseases include drugs, cognitive-behavioral therapy, and somatic interventions, among others, but often, the evidence-based efficacy is limited and the results are highly variable. Here, we review recent research on the diagnosis and treatment of depression in the context of Alzheimer's disease, Parkinson's disease, and strokes, with the aim of identifying common approaches and solutions for its initial management by the neurologist.
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Affiliation(s)
- Javier Pagonabarraga
- Movement Disorders Unit, Neurology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Centro de Investigación en Red sobre Enfermedades Neurodegenerativas (CIBERNED), 28031 Madrid, Spain
- Correspondence:
| | - Cecilio Álamo
- Department of Biomedical Sciences (Pharmacology), Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, 28801 Madrid, Spain
| | - Mar Castellanos
- Department of Neurology, A Coruña University Hospital and Biomedical Research Institute, 15006 La Coruña, Spain
| | - Samuel Díaz
- Headaches Unit, Department of Neurology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Sagrario Manzano
- Department of Neurology, Infanta Leonor University Hospital, 28031 Madrid, Spain
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17
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Ke X, Deng M, Wu Z, Yu H, Yu D, Li H, Lu Y, Shu K, Pei L. miR-34b-3p Inhibition of eIF4E Causes Post-stroke Depression in Adult Mice. Neurosci Bull 2023; 39:194-212. [PMID: 35802246 PMCID: PMC9905405 DOI: 10.1007/s12264-022-00898-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/14/2022] [Indexed: 11/30/2022] Open
Abstract
Post-stroke depression (PSD) is a serious and common complication of stroke, which seriously affects the rehabilitation of stroke patients. To date, the pathogenesis of PSD is unclear and effective treatments remain unavailable. Here, we established a mouse model of PSD through photothrombosis-induced focal ischemia. By using a combination of brain imaging, transcriptome sequencing, and bioinformatics analysis, we found that the hippocampus of PSD mice had a significantly lower metabolic level than other brain regions. RNA sequencing revealed a significant reduction of miR34b-3p, which was expressed in hippocampal neurons and inhibited the translation of eukaryotic translation initiation factor 4E (eIF4E). Furthermore, silencing eIF4E inactivated microglia, inhibited neuroinflammation, and abolished the depression-like behaviors in PSD mice. Together, our data demonstrated that insufficient miR34b-3p after stroke cannot inhibit eIF4E translation, which causes PSD by the activation of microglia in the hippocampus. Therefore, miR34b-3p and eIF4E may serve as potential therapeutic targets for the treatment of PSD.
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Affiliation(s)
- Xiao Ke
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Manfei Deng
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhuoze Wu
- Department of Pathophysiology, Basic Medical School, North Sichuan Medical College, Nanchong, 637100, China
| | - Hongyan Yu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dian Yu
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hao Li
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Youming Lu
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China
- Department of Physiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Kai Shu
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lei Pei
- Department of Neurobiology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- The Institute for Brain Research, Collaborative Innovation Center for Brain Science, Huazhong University of Science and Technology, Wuhan, 430030, China.
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18
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Álvarez-Fernández S, Andrade-González N, Simal P, Matias-Guiu JA, Gómez-Escalonilla C, Rodriguez-Jimenez R, Stiles BJ, Lahera G. Emotional processing in patients with single brain damage in the right hemisphere. BMC Psychol 2023; 11:8. [PMID: 36635763 PMCID: PMC9837967 DOI: 10.1186/s40359-022-01033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/26/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The interest in the relationship between brain damage and social cognition has increased in recent years. The objectives of the present study were the following: (1) to evaluate and compare emotional facial recognition and subjective emotional experience in patients who have suffered a single ischemic stroke in the right hemisphere (RH) and in healthy people, (2) to analyze the relationship between both variables in both groups of subjects, and (3) to analyze the association between the cerebral location of the stroke and these two variables. METHODS Emotional facial recognition and the subjective emotional experience of 41 patients who had suffered a single ischemic stroke in the RH and 45 volunteers without previous cerebrovascular pathology were evaluated. RESULTS Brain damaged patients performed lower in facial emotional recognition and had a less intense subjective emotional response to social content stimuli compared to healthy subjects. Likewise, among patients with RH ischemic stroke, we observed negative associations between facial recognition of surprise and reactivity to unpleasant images, and positive associations between recognition of disgust and reactivity to pleasant images. Finally, patients with damage in the caudate nucleus of the RH presented a deficit in the recognition of happiness and sadness, and those with damage in the frontal lobe exhibited a deficit in the recognition of surprise, compared to those injured in other brain areas. CONCLUSIONS Emotional facial recognition and subjective emotional experience are affected in patients who have suffered a single ischemic stroke in the RH. Professionals caring for stroke patients should improve their understanding of the general condition of affected persons and their environment, assess for risk of depression, and facilitate their adaptation to work, family, and social environments.
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Affiliation(s)
| | - Nelson Andrade-González
- grid.7159.a0000 0004 1937 0239Psychiatry and Mental Health Research Group, Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain ,grid.464699.00000 0001 2323 8386Faculty of Medicine, Alfonso X el Sabio University, Villanueva de La Cañada, Madrid, Spain
| | - Patricia Simal
- grid.411068.a0000 0001 0671 5785Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Jordi A. Matias-Guiu
- grid.411068.a0000 0001 0671 5785Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Carlos Gómez-Escalonilla
- grid.411068.a0000 0001 0671 5785Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Roberto Rodriguez-Jimenez
- grid.4795.f0000 0001 2157 7667Complutense University of Madrid, Madrid, Spain ,grid.144756.50000 0001 1945 5329Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain ,grid.469673.90000 0004 5901 7501CIBERSAM, Madrid, Spain
| | - Bryan J. Stiles
- grid.10698.360000000122483208Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Guillermo Lahera
- grid.7159.a0000 0004 1937 0239Faculty of Medicine and Health Sciences, University of Alcalá, Alcalá de Henares, Madrid, Spain ,IRyCIS, CIBERSAM, Madrid, Spain ,Príncipe de Asturias University Hospital, Alcalá de Henares, Madrid, Spain
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19
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Stein LK, Mayman N, Jette N, Tuhrim S, Dhamoon MS. Risk, Determinants, and Pharmacologic Treatment of Depression Following Acute Ischemic Stroke. Neurohospitalist 2023; 13:22-30. [PMID: 36531840 PMCID: PMC9755604 DOI: 10.1177/19418744221123199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Background and Purpose: We assessed risk and determinants of new-onset depression in acute ischemic stroke (AIS) patients of all ages and no known history of depression. Additionally, we assessed patterns of post-stroke depression (PSD) treatment with pharmacotherapy. Methods: Retrospective cohort study of de-identified Marketscan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits Datasets for adults age ≥18 years admitted with AIS from July 1, 2016-July 1, 2017. We created Kaplan-Meier curves of cumulative risk of PSD up to 1.5 years following index AIS admission. We performed Cox regression to report hazard ratios for determinants of PSD up to 1.5 years following AIS. We summarized proportions treated with pharmacotherapy and identified the most commonly prescribed medications. Results: Of 8089 AIS patients, 1059 were diagnosed with PSD. At 1 year, cumulative risk of PSD was 13.4% (standard error .4) and 15.3% (standard error .5) at 1.5 years. History of anxiety was most strongly associated with PSD and discharge home least. Among those with PSD, 68.8% were prescribed an antidepressant and 8.4% an antipsychotic. The most commonly prescribed antidepressant was sertraline (28.5%). Conclusions: Among AIS patients of all ages, there is a persistently elevated cumulative risk of new diagnosis of PSD in the 1.5 years following AIS. Of the >2/3 treated with an antidepressant, sertraline was most commonly prescribed. Screening and treatment strategies for PSD require further study.
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Affiliation(s)
- Laura K. Stein
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Naomi Mayman
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathalie Jette
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stanley Tuhrim
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mandip S. Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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20
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Depressive symptoms occurring after stroke by age, sex and socioeconomic status in six population-based studies: Longitudinal analyses and meta-analyses. Asian J Psychiatr 2023; 79:103397. [PMID: 36508782 DOI: 10.1016/j.ajp.2022.103397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/08/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
AIMS Population-based cohort studies that examined the effects of stroke on depressive symptoms in elderly participants with and without stroke in different countries/regions had yielded scant evidence. The objectives of this multi-cohort study were to identify the relationships between stroke and depressive symptoms and to assess the pooled risks of depressive symptoms in total populations and in stratified samples by age, sex, education levels, and total household income in large-scale studies. METHODS The associations in the overall participants in the six cohorts were examined using univariate and multivariable Cox proportional hazards models. The relationships in the population subgroups of the cohorts were determined using multivariable Cox regression models. Crude hazard ratios (HRs) were estimated, and adjusted or time-varying HRs were calculated and then pooled by meta-analyses. RESULTS During a median follow-up time of 3.8 (interquartile range [IQR]: 2.2-4.5) -7.9 (IQR: 4.0-8.0) years, 18267 participants out of 62150 participants developed incident cases of depressive symptoms. In the univariate Cox regression analyses, stroke was consistently linked to depressive symptoms across all studies, with HRs ranging from 1.39 (95% confidence interval [CI]: 1.04-1.85) to 1.84 (95% CI: 1.38-2.46). Adjusted HRs varied between 1.19 (95% CI: 0.89-1.59) and 1.48 (95% CI: 1.00-1.98), and time-varying HRs remained largely unchanged. According to the meta-analysis of overall HRs, stroke survivors were more likely than non-survivors to develop depressive symptoms (pooled HR: 1.35 (95% CI: 1.26-1.44)). CONCLUSIONS In general, stroke significantly increased the risk of depressive symptoms in total and stratified participants in most cohorts. In the future, extensive research will be needed to assess the variations in associations between various population subgroups.
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21
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Sapsford TP, Johnson SR, Headrick JP, Branjerdporn G, Adhikary S, Sarfaraz M, Stapelberg NJC. Forgetful, sad and old: Do vascular cognitive impairment and depression share a common pre-disease network and how is it impacted by ageing? J Psychiatr Res 2022; 156:611-627. [PMID: 36372004 DOI: 10.1016/j.jpsychires.2022.10.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 11/07/2022]
Abstract
Vascular cognitive impairment (VCI) and depression frequently coexist in geriatric populations and reciprocally increase disease risks. We assert that a shared pre-disease state of the psycho-immune-neuroendocrine (PINE) network model mechanistically explains bidirectional associations between VCI and depression. Five pathophysiological sub-networks are identified that are shared by VCI and depression: neuroinflammation, kynurenine pathway imbalance, hypothalamic-pituitary-adrenal (HPA) axis overactivity, impaired neurotrophic support and cerebrovascular dysfunction. These do not act independently, and their complex interactions necessitate a systems biology approach to better define disease pathogenesis. The PINE network is already established in the context of non-communicable diseases (NCDs) such as depression, hypertension, atherosclerosis, coronary heart disease and type 2 diabetes mellitus. We build on previous literature to specifically explore mechanistic links between MDD and VCI in the context of PINE pathways and discuss key mechanistic commonalities linking these comorbid conditions and identify a common pre-disease state which precedes transition to VCI and MDD. We expand the model to incorporate bidirectional interactions with biological ageing. Diathesis factors for both VCI and depression feed into this network and the culmination of shared mechanisms (on an ageing substrate) lead to a critical network transition to one or both disease states. A common pre-disease state underlying VCI and depression can provide clinicians a unique opportunity for early risk assessment and intervention in disease development. Establishing the mechanistic elements and systems biology of this network can reveal early warning or predictive biomarkers together with novel therapeutic targets. Integrative studies are recommended to elucidate the dynamic networked biology of VCI and depression over time.
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Affiliation(s)
- Timothy P Sapsford
- Griffith University School of Medicine, Gold Coast, Queensland, Australia; Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Susannah R Johnson
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - John P Headrick
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | - Grace Branjerdporn
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia.
| | - Sam Adhikary
- Mater Young Adult Health Centre, Mater Hospital, Brisbane, Queensland, Australia
| | - Muhammad Sarfaraz
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Nicolas J C Stapelberg
- Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia; Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
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22
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Stockbridge MD, Vitti E, Faria AV, Hillis AE. Emotional and qualitative outcomes among patients with left and right hemisphere stroke. Front Neurol 2022; 13:969331. [DOI: 10.3389/fneur.2022.969331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/31/2022] [Indexed: 11/18/2022] Open
Abstract
The differences in mental health outcomes of right and left hemisphere strokes are well studied; however, there is a long-standing controversy surrounding whether depression is associated with lateralization of stroke or not. In this investigation, we examined the effect of lesion location on post-stroke depression controlling for lesion size and hemiparesis in a longitudinal sample assessed at acute, subacute, and chronic timepoints. As a secondary aim, we further examined the effect of lesion location on self-reported difficulties across a wide array of domains. A series of 134 patients with left hemisphere strokes and 79 with right hemisphere strokes completed the Patient Health Questionnaire-9 and an inventory of post-stroke abilities at within acute, subacute, and chronic windows following stroke. When controlling for hemiparesis and overall lesion volume, we found no difference in depression between groups at any timepoint. Additional exploratory analyses provided a further look at differing challenges associated with depression in each group.
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23
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Li Y, Jin Y, Wu D, Zhang L. A depression network caused by brain tumours. Brain Struct Funct 2022; 227:2787-2795. [PMID: 36190539 PMCID: PMC9618495 DOI: 10.1007/s00429-022-02573-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022]
Abstract
To systematically analyse and discuss whether suppressive heterogeneous brain tumours (BTs) belong to a common brain network and provide a theoretical basis for identifying BT patients with a high risk of depression and select therapeutic targets for clinical treatment. The PubMed database was systematically searched to obtain relevant case reports, and lesion locations were manually traced to standardised brain templates according to ITK-SNAP descriptive literature. Resting-state functional magnetic resonance imaging data sets were collected from 1,000 healthy adults aged 18-35 years. Each lesion location or functional connectivity area of the lesion network. Connectivity analysis was performed in an MN152 space, and Fisher z-transformation was applied to normalise the distribution of each value in the functional connectivity correlation map, and T maps of each tumour location network were calculated with the T score of individual voxels. This T score indicates the statistical significance of voxelwise connectivity at each tumour location. The lesion networks were thresholded at T = 7, creating binarised maps of brain regions connecting tumour locations, overlaying network maps to identify tumour-sensitive hubs and also assessing specific hubs with other conditional controls. A total of 18 patients describing depression following focal BTs were included. Of these cases, it was reported that depression-related tumours were unevenly distributed in the brain: 89% (16/18) were positively correlated with the left striatum, and the peak of the left striatum lesion network continuously overlapped. The depression-related tumour location was consistent with the tumour suppressor network (89%). These results suggest that sensitive hubs are aligned with specific networks, and specific hubs are aligned with sensitive networks. Brain tumour-related depression differs from acute lesion-related depression and may be related to the mapping of tumours to depression-related brain networks. It can provide an observational basis for the neuroanatomical basis of BT-related depression and a theoretical basis for identifying patients with BTs at high risk of depression and their subsequent clinical diagnosis and treatment.
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Affiliation(s)
- Yanran Li
- Department of Radiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Yong Jin
- Department of Radiology, Changzhi People's Hospital, Changzhi, 046000, Shanxi Province, China
| | - Di Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Lifang Zhang
- Department of Neurology, Changzhi People's Hospital, No. 502 of Changxing Middle Street, Luzhou District, Changzhi, 046000, Shanxi Province, China.
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24
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Schmidt LFS, Rodrigues JDC, Bandeira DR, Salles JFD. Validity evidence for the Cognitive Screening Test in Stroke Patients. PSICO-USF 2022. [DOI: 10.1590/1413-82712022270411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Abstract Cognitive deficits are common among post-stroke patients. Cognitive impairments of this sort are mediated by age and education. In Brazil, the only specific cognitive screening tool designed for post-stroke patients is the Cognitive Screening Test (Triagem Cognitiva - TRIACOG). The goal of this study was to investigate validity evidence related to external variables for the TRIACOG. Our sample included 153 adults and elderly people (M = 60.08, SD = 9.61) from Porto Alegre and metropolitan area, comprising 87 post-stroke patients and 66 healthy individuals. Three-way ANOVAs were used to assess main effects and interactions between the variables group (clinical/control), age and education. An influence of group and age on scores in the TRIACOG was found. We emphasize the relevance of these results to the selection of cut-off points for the tasks and cognitive functions assessed by the instrument, considering education and age, so as to allow more accurate identification of deficits in post-stroke patients.
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25
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Ayasrah S, Ahmad M, Basheti I, Abu-Snieneh HM, Al-Hamdan Z. Post-stroke Anxiety Among Patients in Jordan: A Multihospital Study. J Geriatr Psychiatry Neurol 2022; 35:705-716. [PMID: 34933575 DOI: 10.1177/08919887211060015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to assess the prevalence, correlates, and significant associated factors of anxiety among patients with stroke. A cross-sectional, correlation design was utilized. The Hospital Anxiety and Depression scale was used to detect and assess the severity of anxiety and depression among mentally well patients at general hospital settings. Among the 226 patients with stroke, 45.6% had clinically significant levels of anxiety to be considered as a definite case. Having a short duration since the stroke onset, being a definite case of depression, being unable to perform self-care activities, having an insufficient monthly income, and having visual problems due to stroke were the significantly associated factors. The high prevalence of anxiety among patients with stroke highlights the need for interventions of early detection and management to enhance recovery. Patients who have any of the significant traits predicted post-stroke anxiety required special attention.
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Affiliation(s)
| | | | - Iman Basheti
- 59177Applied Science Private University, Amman, Jordan
| | - Hana M Abu-Snieneh
- Faculty of Nursing, 84977Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Zaid Al-Hamdan
- 37251Jordan University of Science and Technology, Irbid, Jordan
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26
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Maurya PK, Qavi A, Deswal S, Singh AK, Kulshreshtha D, Thacker AK. A Comparative Study of Regional Cerebral Blood Flow Asymmetry Index in Stroke Patients with or without Poststroke Depression Using 99m Tc-ECD Single-Photon Emission Computed Tomography. World J Nucl Med 2022; 21:222-230. [PMID: 36060079 PMCID: PMC9436511 DOI: 10.1055/s-0042-1751056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Stroke is a major cause of death and disability around the globe. The development of depression following a stroke further increases the disability and impairs functional recovery. In recent decades, despite the advancement in structural and nuclear medicine imaging, the pathophysiologic basis of poststroke depression (PSD) is not well understood. Etiopathogenesis of PSD is multifactorial and afflictions of the frontal lobe, hippocampus, limbic region, and basal ganglia projections are implicated. Aim The aim of this study was to assess the regional cerebral blood flow (rCBF) using 99m Tc-ethyl cysteinate dimer single-photon emission computed tomography (SPECT) in patients with (PSD + ) or without PSD (PSD-). Materials and Methods To evaluate the hemispheric asymmetry, the percentage of asymmetry index (AI) was calculated for frontal, temporal, parietal, occipital, putamen, caudate, and thalamic regions of brain and compared between PSD+ and PSD-. The correlation between AIs over the different brain regions was also established in patients of PSD+ and PSD-. Our study cohort included 122 patients between 6 weeks and 1 year of stroke. Depression was present in 52 (42.6%) patients, assessed by hospital anxiety and depression scale (HADS) and general health questionnaire-28 items (GHQ-28) scale. The 28 patients with PSD+ and 18 PSD- gave consent for SPECT study. Results Our results are based on 46 patients who underwent SPECT study. In patients with PSD+ and PSD-, the HADS and GHQ-28 scores were 8.93 ± 2.77 vs. 3.94 ± 2.15 ( p = 0.001) and 40.96 ± 9.48 vs. 17.72 ± 5.38 ( p = 0.001), respectively. A significant difference in rCBF AI was found in the temporal lobe ( p = 0.03) between patients of PSD+ and PSD-. On logistic regression analysis, the odds ratio of rCBF AI for temporal lobe was 0.89 (95% confidence interval [CI]: 0.80-0.99; p = 0.04) and caudate nucleus was 0.85 (95% CI: 0.73-0.98; p = 0.03), which were statistically significant. PSD correlated with AI in temporal region ( r = -0.03; p = 0.03) but did not show significant correlation with other regions of brain between PSD+ and PSD-. Conclusion The presence of temporal lobe rCBF AI on SPECT is significantly associated with PSD. This may reflect the dysfunction of the limbic system and contribute to the occurrence of PSD.
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Affiliation(s)
- Pradeep Kumar Maurya
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abdul Qavi
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Satyawati Deswal
- Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajai Kumar Singh
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anup Kumar Thacker
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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27
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Chen J, Liu J, Zeng Y, Li R, Wang Y, Ding W, Guo J, Lin H, Li J. Development and initial validation of a clinical measure to assess symptoms of post-stroke depression in stroke patients at the rehabilitation stage. Front Psychol 2022; 13:928257. [PMID: 35967723 PMCID: PMC9369669 DOI: 10.3389/fpsyg.2022.928257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background The high incidence of post-stroke depression (PSD) during rehabilitation exerts a negative effect on the treatment and functional recovery of patients with stroke and increases the risk of mortality. It is necessary to screen PSD in the rehabilitation stage and thus provide effective intervention strategies. However, existing measurements used to assess PSD in the rehabilitation stage in patients with stroke lack specificity. This study aimed to develop a clinical measure to assess symptoms of PSD in the rehabilitation stage. Methods The research team created the initial items through a literature review and semi-structured interviews of patients with stroke. Then, the symptom-related items were estimated by three panels: healthcare professionals (N = 41), Delphi experts (N = 15), and patients with stroke in the rehabilitation stage (N = 30). Results The literature review and semi-structured interview produced 51 symptom-related items including six domains, and the items were reduced to 47 by the healthcare professionals. The symptom-related items were further reduced to 33 items by a two-round Delphi consultation. The initiative coefficients of the two Delphi rounds were 71.4 and 100%, the expert authority coefficients were both 0.85, Kendall’s W were 0.152 and 0.408 (p < 0.01), and the coefficient of variation (CV) were 0.05–0.32 and 0.00–0.18, respectively. The item-level content validity index (I-CVI) was 0.53–1.00, the scale-level CVI/universal agreement (S-CVI/UA) was 0.26, and the S-CVI/average (S -CVI/Ave) was 0.85 for the first found Delphi consultation; the I-CVI was 0.67–1.00, the S-CVI/UA was 0.61, and the S-CVI/Ave was 0.97 for the second round Delphi consultation. All content validity indicators have been significantly improved compared with the first round. Using mean ≥ 4 and full score ≥ 0.5, combined with CV ≤ 0.16 as the item criteria, a clinical measure of PSD with 33 items and 6 dimensions (cognition, sleep, behavior, emotion, body, and guilt) was finally formed after two rounds. The patients with stroke made no further revisions after evaluation. Conclusion The research team developed a specific tool with good content validity to assess the symptoms of PSD in the rehabilitation stage.
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Affiliation(s)
- Junya Chen
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Jing Liu
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Yawei Zeng
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Ruonan Li
- Division of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yucui Wang
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Weiwei Ding
- School of Nursing, Wenzhou Medical University, Wenzhou, China
| | - Junyi Guo
- Department of Rehabilitation, Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Junyi Guo,
| | - Haiyun Lin
- Department of Rehabilitation, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Haiyun Lin,
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, China
- Jufang Li,
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28
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Jaroonpipatkul C, Onwanna J, Tunvirachaisakul C, Jittapiromsak N, Rakvongthai Y, Chutinet A, Supasitthumrong T, Maes M. Depressive symptoms due to stroke are strongly predicted by the volume and location of the cerebral infarction, white matter hyperintensities, hypertension, and age: A precision nomothetic psychiatry analysis. J Affect Disord 2022; 309:141-150. [PMID: 35430315 DOI: 10.1016/j.jad.2022.04.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/24/2022] [Accepted: 04/09/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To delineate the effects of white matter hyperintensities (WMHs) as measured by Fluid-attenuated inversion recovery (FLAIR) and infarction volume as measured by Diffusion-weighted imaging (DWI) on post-stroke depression symptoms. METHODS Baseline National Institutes of Health Stroke Score (NIHSS) and Modified Rankin Scale (mRS) scores, and FLAIR and DWI MRIs to assess WMHs and acute infarct volumes, respectively, were assessed in 47 patients (≥55 years) with acute ischemic stroke and 17 normal controls. The Montgomery-Åsberg Depression Rating Scale (MDRS) was assessed three months after the stroke. RESULTS The MADRS score was significantly increased in stroke patients as compared with normal controls. The MADRS scale is not unidimensional and cannot be used as an accurate indicator of depression severity in stroke patients. Three months after stroke, key depressive (sadness and inability to feel) and concentration-tension symptoms, and lassitude are significantly predicted by the infarct volume. Right side infarction strongly predicts key depressive symptoms and left side infarction strongly predicts concentration-tension and lassitude scores. Total WMHs significantly predict key depressive and concentration-tension symptoms, and lassitude, with these effects being mediated by right and left DWI stroke volumes and associated disabilities. CONCLUSIONS Interactions between age, hypertension, a chronic atherosclerotic process, and acute stroke account for the onset of key depressive symptoms three months after the acute infarct. Chronic and acute neuro-immune and neuro-oxidative stress pathways associated with the formation of WMHs and acute stroke may explain the incidence of post-stroke key depressive and concentration-tension symptoms, and lassitude.
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Affiliation(s)
| | - Jaruwan Onwanna
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | | | | | - Yothin Rakvongthai
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Aurauma Chutinet
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Research Center, Deakin University, Geelong, Australia
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29
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Liang J, Feng J, He J, Jiang Y, Zhang H, Chen H. Effects of Noninvasive Brain Stimulation Combined With Antidepressants in Patients With Poststroke Depression: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:887115. [PMID: 35662704 PMCID: PMC9160966 DOI: 10.3389/fphar.2022.887115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 11/29/2022] Open
Abstract
Objective: To evaluated the efficacy and safety of noninvasive brain stimulation (NIBS) combined with antidepressants in patients with poststroke depression (PSD). Methods: Seven databases were searched to identify randomized controlled trials of NIBS combined with antidepressants in the treatment of PSD based on the international classification of diseases (ICD-10) criteria and exclusion criteria. The retrieval time was from the database establishment to 31 October 2021. Two researchers independently screened the identified studies through the search strategy, extracted their characteristics, and evaluated the quality of the included literature. Cochrane Collaboration’s tool was used to assess risk of bias. RevMan 5.3 software was applied for meta-analysis. Results: A total of 34 randomized controlled trials were included, involving 2,711 patients with PSD. Meta-analysis showed that the total effective rate was higher in the combined therapy than the antidepressant alone [odds ratio (OR): 4.33; 95% confidence interval (CI): 3.07 to 6.11; p < 0.00001]. The Hamilton depressive scale (HAMD) score was significantly lower in repeated transcranial magnetic stimulation (rTMS) (≤10 Hz) combined with antidepressant than in antidepressant alone [standard mean difference (SMD): −1.44; 95% CI: −1.86 to −1.03; p < 0.00001]. No significant difference was seen in rTMS (>10 Hz) combined with antidepressant versus antidepressant alone (SMD: −4.02; 95% CI: −10.43 to 2.39; p = 0.22). In addition, combination therapy more strongly improved the modified Barthel index (MBI) scale than antidepressants [mean difference (MD): 8.29; 95% CI: 5.23–11.35; p < 0.00001]. Adverse effects were not significantly different between two therapies (OR: 1.33; 95% CI: 0.87 to 2.04; p = 0.18). Conclusion: Low-frequency rTMS (≤10 Hz) combined with antidepressants tends to be more effective than antidepressants alone in patients with PSD, and there are no significant adverse effects. In addition, combined therapy may enhance quality of life after stroke. Combination therapy with high-frequency rTMS (>10 Hz) showed no advantage in treating PSD. The transcranial electrical stimulation (TES) combined with antidepressants might be more effective than antidepressants alone, which are needed to confirm by more clinical trials since the.
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Affiliation(s)
- Jiabin Liang
- Central Laboratory, Guangzhou Panyu Central Hospital, Guangzhou, China.,Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jie Feng
- Radiology Department, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinhua He
- Central Laboratory, Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Yong Jiang
- Central Laboratory, Guangzhou Panyu Central Hospital, Guangzhou, China.,Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Haoyu Zhang
- Central Laboratory, Guangzhou Panyu Central Hospital, Guangzhou, China.,Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hanwei Chen
- Central Laboratory, Guangzhou Panyu Central Hospital, Guangzhou, China
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30
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Yao G, Zhang X, Li J, Liu S, Li X, Liu P, Xu Y. Improving Depressive Symptoms of Post-stroke Depression Using the Shugan Jieyu Capsule: A Resting-State Functional Magnetic Resonance Imaging Study. Front Neurol 2022; 13:860290. [PMID: 35493835 PMCID: PMC9047823 DOI: 10.3389/fneur.2022.860290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuation (fALFF) were used to detect the neuroimaging mechanism of Shugan Jieyu Capsule (SG) in ameliorating depression of post-stroke depression (PSD) patients. Fifteen PSD patients took SG for 8 weeks, completed the 24-item Hamilton Depression Scale (HAMD) assessment at the baseline and 8 weeks later, and underwent functional magnetic resonance imaging (fMRI) scanning. Twenty-one healthy controls (HCs) underwent these assessments at the baseline. We found that SG improved depression of PSD patients, in which ReHo values decreased in the left calcarine sulcus (CAL.L) and increased in the left superior frontal gyrus (SFG.L) of PSD patients at the baseline. The fALFF values of the left inferior parietal cortex (IPL.L) decreased in PSD patients at the baseline. Abnormal functional activities in the brain regions were reversed to normal levels after the administration of SG for 8 weeks. Receiver operating characteristic (ROC) analysis found that the changes in three altered brain regions could be used to differentiate PSD patients at the baseline and HCs. Average signal values of altered regions were related to depression in all subjects at the baseline. Our results suggest that SG may ameliorate depression of PSD patients by affecting brain region activity and local synchronization.
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Affiliation(s)
- Guanqun Yao
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Psychiatry, Tsinghua University Yuquan Hospital, Beijing, China
| | - Xiaoqian Zhang
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Psychiatry, Tsinghua University Yuquan Hospital, Beijing, China
| | - Jing Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinrong Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Pozi Liu
- School of Clinical Medicine, Tsinghua University, Beijing, China
- Department of Psychiatry, Tsinghua University Yuquan Hospital, Beijing, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
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31
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Pan C, Li G, Sun W, Miao J, Qiu X, Lan Y, Wang Y, Wang H, Zhu Z, Zhu S. Neural Substrates of Poststroke Depression: Current Opinions and Methodology Trends. Front Neurosci 2022; 16:812410. [PMID: 35464322 PMCID: PMC9019549 DOI: 10.3389/fnins.2022.812410] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/04/2022] [Indexed: 12/21/2022] Open
Abstract
Poststroke depression (PSD), affecting about one-third of stroke survivors, exerts significant impact on patients’ functional outcome and mortality. Great efforts have been made since the 1970s to unravel the neuroanatomical substrate and the brain-behavior mechanism of PSD. Thanks to advances in neuroimaging and computational neuroscience in the past two decades, new techniques for uncovering the neural basis of symptoms or behavioral deficits caused by focal brain damage have been emerging. From the time of lesion analysis to the era of brain networks, our knowledge and understanding of the neural substrates for PSD are increasing. Pooled evidence from traditional lesion analysis, univariate or multivariate lesion-symptom mapping, regional structural and functional analyses, direct or indirect connectome analysis, and neuromodulation clinical trials for PSD, to some extent, echoes the frontal-limbic theory of depression. The neural substrates of PSD may be used for risk stratification and personalized therapeutic target identification in the future. In this review, we provide an update on the recent advances about the neural basis of PSD with the clinical implications and trends of methodology as the main features of interest.
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32
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Edelkraut L, López-Barroso D, Torres-Prioris MJ, Starkstein SE, Jorge RE, Aloisi J, Berthier ML, Dávila G. Spectrum of neuropsychiatric symptoms in chronic post-stroke aphasia. World J Psychiatry 2022; 12:450-469. [PMID: 35433325 PMCID: PMC8968505 DOI: 10.5498/wjp.v12.i3.450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/13/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) have been insufficiently examined in persons with aphasia (PWA) because most previous studies exclude participants with language and communication disorders.
AIM To report a two-part study consisting of a literature review and an observational study on NPS in post-stroke aphasia.
METHODS Study 1 reviewed articles obtained from PubMed, PsycINFO, Google Scholar and Cochrane databases after cross-referencing key words of post-stroke aphasia to NPS and disorders. Study 2 examined language deficits and activities of daily living in 20 PWA (median age: 58, range: 28-65 years; 13 men) with the Western Aphasia Battery-Revised and the Barthel Index, respectively. Informants of these 20 PWA were proxy-evaluated with the Neuropsychiatric Inventory and domain-specific scales, including the Stroke Aphasia Depression Questionnaire-10 item version and the Starkstein Apathy Scale. In addition, an adapted version of the Hospital Anxiety and Depression Scale was directly administered to the PWA themselves. This observational study is based on the baseline assessment of an intervention clinical trial (EudraCT: 2017-002858-36; ClinicalTrials.gov identifier: NCT04134416).
RESULTS The literature review revealed a broad spectrum of NPS in PWA, including depression, anxiety, apathy, agitation/aggression, eating and sleep disorders, psychosis, and hypomania/mania. These findings alert to the need for improving assessment and treatment approaches of NPS taking into consideration their frequent occurrence in PWA. Study 2 showed that the 20 participants had mild- to-moderate aphasia severity and were functionally independent. A wide range of comorbid NPS was found in the post-stroke aphasic population (median number of NPS: 5, range: 1-8). The majority of PWA (75%) had depressive symptoms, followed by agitation/aggression (70%), irritability (70%), anxiety (65%) and appetite/eating symptoms (65%). Half of them also presented symptoms of apathy, whereas euphoria and psychotic symptoms were rare (5%). Domain-specific scales revealed that 45% of participants had apathy and 30% were diagnosed with depression and anxiety.
CONCLUSION Concurrent NPS are frequent in the chronic period of post-stroke aphasia. Therefore, further research on reliable and valid assessment tools and treatment for this aphasic population is strongly warranted.
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Affiliation(s)
- Lisa Edelkraut
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Diana López-Barroso
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - María José Torres-Prioris
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Sergio E Starkstein
- School of Psychiatry and Neurosciences, The University of Western Australia, Perth 6009, Australia
| | - Ricardo E Jorge
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, United States
| | - Jessica Aloisi
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
| | - Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
| | - Guadalupe Dávila
- Department of Psychobiology and Methodology of Behavioral Science, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga 29071, Spain
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Malaga 29010, Spain
- Instituto de Investigación Biomédica de Málaga, University of Malaga, Malaga 29010, Spain
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Guo J, Wang J, Xia Y, Jiang S, Xu P, Tao C, Sun W, Liu X. Thyroid Function Affects the Risk of Post-stroke Depression in Patients With Acute Lacunar Stroke. Front Neurol 2022; 13:792843. [PMID: 35309559 PMCID: PMC8927643 DOI: 10.3389/fneur.2022.792843] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/21/2022] [Indexed: 12/27/2022] Open
Abstract
Objective This study aimed to investigate whether thyroid function profiles are associated with post-stroke depression (PSD) and evaluate the mediation effect of cerebral small vessel disease (cSVD) on the association of thyroid function profiles and PSD in patients with acute ischemic lacunar stroke. Methods In this study, 372 patients with confirmed acute ischemic lacunar stroke within 3 days of onset were consecutively recruited. Serum levels of thyroid hormones and thyroid antibodies were detected on admission. Lacunar infarcts, white matter lesions, cerebral microbleeds, and enlarged perivascular spaces were rated using validated scales. The severity of depression was scored with the 24-item Hamilton Depression Scale in the hospital after a week of stroke onset. Multivariate regression was utilized to analyze the association of thyroid function profiles and PSD. Mediation analysis was employed to evaluate the effect of cSVD on the association of thyroid function profiles and PSD. Results A total of 87 (23.4%) participants were diagnosed with depression after stroke. Serum thyroid-stimulating hormone (TSH) levels were significantly higher in patients with PSD than in those without PSD, while free triiodothyronine (FT3) and free thyroxine (FT4) were not significantly different between the two groups. After adjusting for potential confounders, serum TSH levels were positively associated with the risk of PSD (OR = 1.228; 95% CI: 1.053–1.431, p = 0.009). A similar association was also found between the total cSVD burden score and PSD (OR = 2.137; 95% CI: 1.634–2.793, p < 0.001). Further mediation analysis indicated that 26.37% of the association between TSH and PSD was mediated by cSVD. Conclusions Serum TSH levels on admission can probably predict depression after acute ischemic lacunar stroke.
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Affiliation(s)
- Jianglong Guo
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Jinjing Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yue Xia
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Shiyi Jiang
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Pengfei Xu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Chunrong Tao
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wen Sun
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Wen Sun
| | - Xinfeng Liu
- Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- *Correspondence: Xinfeng Liu
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Poststroke depression in obstructive cerebrovascular diseases of internal carotid and vertebrobasilar circulation system. COR ET VASA 2022. [DOI: 10.33678/cor.2021.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Revisiting Hemispheric Asymmetry in Mood Regulation: Implications for rTMS for Major Depressive Disorder. Brain Sci 2022; 12:brainsci12010112. [PMID: 35053856 PMCID: PMC8774216 DOI: 10.3390/brainsci12010112] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 02/06/2023] Open
Abstract
Hemispheric differences in emotional processing have been observed for over half a century, leading to multiple theories classifying differing roles for the right and left hemisphere in emotional processing. Conventional acceptance of these theories has had lasting clinical implications for the treatment of mood disorders. The theory that the left hemisphere is broadly associated with positively valenced emotions, while the right hemisphere is broadly associated with negatively valenced emotions, drove the initial application of repetitive transcranial magnetic stimulation (rTMS) for the treatment of major depressive disorder (MDD). Subsequent rTMS research has led to improved response rates while adhering to the same initial paradigm of administering excitatory rTMS to the left prefrontal cortex (PFC) and inhibitory rTMS to the right PFC. However, accumulating evidence points to greater similarities in emotional regulation between the hemispheres than previously theorized, with potential implications for how rTMS for MDD may be delivered and optimized in the near future. This review will catalog the range of measurement modalities that have been used to explore and describe hemispheric differences, and highlight evidence that updates and advances knowledge of TMS targeting and parameter selection. Future directions for research are proposed that may advance precision medicine and improve efficacy of TMS for MDD.
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Bi H, Wang M. Role of social support in poststroke depression: A meta-analysis. Front Psychiatry 2022; 13:924277. [PMID: 36213910 PMCID: PMC9539912 DOI: 10.3389/fpsyt.2022.924277] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Poststroke depression significantly affects health and quality of life of stroke patients. This study evaluates the role of social support in influencing poststroke depression. The literature search was conducted in electronic databases and study selection was based on precise eligibility criteria. The prevalence rates reported by individual studies were pooled. A meta-analysis of standardized mean differences (SMD) in social support between depressed and non-depressed stroke patients was performed. The odds ratios and correlation coefficients showing the relationship between social support and depression were pooled to achieve overall estimates. Twenty-five studies (9431 patients) were included. The prevalence of depression was 36% [95% confidence interval (CI): 28, 45]. Patients with poststroke depression had significantly lower social support in comparison with patients with no or lower levels of depression [SMD in social support scores -0.338 (95% CI: -0.589, -0.087); p = 0.008]. The odds of depression were lower in patients receiving higher levels of social support [OR 0.82 (95% CI: 0.69, 0.95)] but were higher in patients who were receiving weaker social support [OR 5.22 (95% CI: -0.87, 11.31)]. A meta-analysis of correlation coefficients found a significantly inverse correlation between social support and poststroke depression [r -0.336 (95% CI: -0.414, -0.254)]. Poststroke depression has a significant independent inverse association with social support.
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Affiliation(s)
- Haiyang Bi
- Department of Acupuncture, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Mengjia Wang
- Integrated Traditional Chinese and Western Medicine Rehabilitation Medical Center, Heilongjia Provincial Hospital, Harbin, China
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Wen QH, Liu Y, Chen HD, Wu JL, Liang LJ, He WZ, Wang Y, Huang GP. Relationship Between Depression After Hemorrhagic Stroke and Auditory Event-Related Potentials in a Chinese Patient Group. Neuropsychiatr Dis Treat 2022; 18:1917-1925. [PMID: 36065387 PMCID: PMC9440680 DOI: 10.2147/ndt.s362824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Post-stroke depression (PSD) is the most common psychiatric sequelae of stroke. Numerous studies revealed that event-related potentials (ERP) can reflect depression severity to a certain extent, while there is almost no research on depression after hemorrhagic stroke. Therefore, we employed a prospective cross-sectional study to explore the relationship between ERP and depression after hemorrhagic stroke. METHODS A total of 74 patients with intracranial hemorrhage were included in this study. Neurological deficits were evaluated using the National Institutes of Health Stroke Scale (NIHSS) on admission. Depression severity and cognitive impairment were measured using the 17-item Hamilton Depression Scale (HAMD-17) and the Chinese version of the Montreal Cognitive Assessment (MoCA) after two weeks of treatment. All patients were conducted auditory Oddball paradigm for event-related potential mismatch negativity (MMN) and P300. RESULTS In total, 36 patients were diagnosed with PSD at the two weeks of treatment, for a percentage of 48.6%. Depression severity of ICH patients correlated positively with both the latency of MMN (r = 0.376, P = 0.001) and P300 (r = 0.325, P = 0.005), and correlated negatively with both the amplitude of MMN (r=-0.385, P = 0.001) and P300 (r=-0.311, P = 0.007). Depression severity was negatively correlated with cognitive function after hemorrhagic stroke (r=-0.347, P = 0.002). CONCLUSION The latency and amplitude of MMN and P300 can well reflect the degree of depression after hemorrhagic stroke, which may help in the early diagnosis and effective treatment of PSD.
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Affiliation(s)
- Qian-Hui Wen
- Department of Neurosurgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, People's Republic of China.,Faculty of Psychiatry and Mental Health, North Sichuan Medical College, Nanchong, People's Republic of China
| | - Yang Liu
- Department of Neurosurgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, People's Republic of China
| | - Hu-Dan Chen
- Department of Psychiatry, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, People's Republic of China
| | - Jun-Lin Wu
- Department of Psychiatry, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, People's Republic of China
| | - Li-Jun Liang
- Faculty of Psychiatry and Mental Health, North Sichuan Medical College, Nanchong, People's Republic of China
| | - Wen-Zhi He
- Faculty of Psychiatry and Mental Health, North Sichuan Medical College, Nanchong, People's Republic of China
| | - Yao Wang
- Faculty of Psychiatry and Mental Health, North Sichuan Medical College, Nanchong, People's Republic of China
| | - Guo-Ping Huang
- Department of Neurosurgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, People's Republic of China.,Faculty of Psychiatry and Mental Health, North Sichuan Medical College, Nanchong, People's Republic of China
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Wang KW, Xu YM, Lou CB, Huang J, Feng C. The etiologies of post-stroke depression: Different between lacunar stroke and non-lacunar stroke. Clinics (Sao Paulo) 2022; 77:100095. [PMID: 36027756 PMCID: PMC9424932 DOI: 10.1016/j.clinsp.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 06/10/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Depression is common after both lacunar stroke and non-lacunar stroke and might be associated with lesion locations as proven by some studies. This study aimed to identify whether lesion location was critical for depression after both lacunar and non-lacunar strokes. METHODS A cohort of ischemic stroke patients was assigned to either a lacunar stroke group or a non-lacunar stroke group after a brain MRI scan. Neurological deficits and treatment response was evaluated during hospitalization. The occurrence of depression was evaluated 3 months later. Logistic regressions were used to identify the independent risk factors for depression after lacunar and non-lacunar stroke respectively. RESULTS 83 of 246 patients with lacunar stroke and 71 of 185 patients with non-lacunar stroke developed depression. Infarctions in the frontal cortex, severe neurological deficits, and a high degree of handicap were identified as the independent risk factors for depression after non-lacunar stroke, while lesion location was not associated with depression after lacunar stroke. CONCLUSION The main determinants for depression after lacunar and non-lacunar stroke were different. Lesion location was critical only for depression after non-lacunar stroke.
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Affiliation(s)
- Ke-Wu Wang
- The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Yang-Miao Xu
- The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Chao-Bin Lou
- The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China
| | - Jing Huang
- Shanghai Xuhui Central Hospital, Shanghai, China
| | - Chao Feng
- The Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu, China.
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Lee CH, Jeon SH, Kim MJ, Ra GD, Lee YH, Hong SH, Shin BS, Kang HG. Factors Affecting Post-Stroke Depression in Acute Ischemic Stroke Patients after 3 Months. J Pers Med 2021; 11:jpm11111178. [PMID: 34834530 PMCID: PMC8618912 DOI: 10.3390/jpm11111178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/09/2021] [Accepted: 11/09/2021] [Indexed: 12/29/2022] Open
Abstract
Post-stroke depression (PSD) affects approximately one-third of stroke patients. PSD not only impairs recovery and lowers quality of life, but has also serious neurological consequences, high mortality, and stroke recurrence risks. Studies on PSD-related prognostic factors are still lacking, especially environmental factors. Moreover, relieving factors after PSD in stroke patients has not been reported. This study aimed to investigate (study design 1) risk factors for PSD diagnosis after three months, and (study design 2) related factors for the relieving of early PSD after three months. This retrospective study included 227 patients hospitalized for acute ischemic stroke within three days at Jeonbuk National University Hospital from January to December 2019. The depressive status was assessed using the Hamilton Depression Rating Scale (HDRS) at admission and after three months. Clinical and laboratory data were analyzed for relevant prognostic factors. (Study design 1) HDRS score at admission (adjusted odds ratio (aOR) 1.22, 95% confidence interval (CI) 1.14–1.31; p < 0.001) and hospitalization period (aOR 1.11, 95% CI 1.02–1.20; p = 0.013) were confirmed as prognostic factors of PSD after three months. (Study design 2) The National Institute of Health Stroke Scale (NIHSS) score at discharge (aOR 0.80, 95% CI 0.68–0.94; p = 0.006) and HDRS score at admission (aOR 0.80, 95% CI 0.71–0.89; p < 0.001) were confirmed as prognostic factors of depression improvement after three months. In conclusion, environmental factors such as hospitalization period could be important in managing PSD. Factors related to PSD improvement are expected to be helpful in establishing a strategy for PSD recovery.
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Affiliation(s)
- Chan-Hyuk Lee
- Department of Neurology, Jeonbuk National University Medical School, Jeonju 54907, Korea; (C.-H.L.); (B.-S.S.)
- Department of Neurology and Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Korea
| | - Su Hong Jeon
- Jeonbuk National University Medical School, Jeonju 54907, Korea; (S.H.J.); (M.J.K.); (G.D.R.); (Y.-H.L.); (S.H.H.)
| | - Min Ju Kim
- Jeonbuk National University Medical School, Jeonju 54907, Korea; (S.H.J.); (M.J.K.); (G.D.R.); (Y.-H.L.); (S.H.H.)
| | - Gyu Dam Ra
- Jeonbuk National University Medical School, Jeonju 54907, Korea; (S.H.J.); (M.J.K.); (G.D.R.); (Y.-H.L.); (S.H.H.)
| | - Yong-Hyun Lee
- Jeonbuk National University Medical School, Jeonju 54907, Korea; (S.H.J.); (M.J.K.); (G.D.R.); (Y.-H.L.); (S.H.H.)
| | - Seung Hyeon Hong
- Jeonbuk National University Medical School, Jeonju 54907, Korea; (S.H.J.); (M.J.K.); (G.D.R.); (Y.-H.L.); (S.H.H.)
| | - Byoung-Soo Shin
- Department of Neurology, Jeonbuk National University Medical School, Jeonju 54907, Korea; (C.-H.L.); (B.-S.S.)
- Department of Neurology and Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Korea
| | - Hyun Goo Kang
- Department of Neurology, Jeonbuk National University Medical School, Jeonju 54907, Korea; (C.-H.L.); (B.-S.S.)
- Department of Neurology and Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Korea
- Correspondence: ; Tel.: +82-63-250-1590; Fax: +82-63-251-9364
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Zemed A, Sany K, Gahaw M. Burden of depression and predictors among Ethiopian stroke survivors: Cross-sectional study. Ann Med Surg (Lond) 2021; 71:102926. [PMID: 34712476 PMCID: PMC8531554 DOI: 10.1016/j.amsu.2021.102926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND stroke is a common cause of mortality and morbidity in low- and middle-income countries. It is a very sudden episode in the patients' lives and can lead to multiple psychosocial, social, and economic consequences, and psychiatric problems. poststroke depression is the most common and major neuropsychiatric consequence of stroke that affects one-third of stroke survivors. The aim of this study to assess the burden of depression and its predictors among stroke survivors with local version validated Patient Health Questionnaire. METHODS An institutional-based cross-sectional study was conducted among stroke patients at selected tertiary level hospitals. Data were collected by interview method using structured questionnaires, and patient medical record reviews and data were recruited by using consecutive sampling method. Bivariate and multivariable binary logistic regression model analysis was used with SPSS version 23 to identify factors associated with depression. RESULTS A total of one hundred eighty stroke patients participated in the study with a response rate of 88.2%. The overall prevalence of depression is 49.6% (95% CI: 42.8, 56.7). Occupation, marital status, level of education of stroke patients was significantly associated with post stroke depression with P < 0.05. CONCLUSION The study findings presented that nearly half of the stroke patients suffered from post stroke depression. Post-stroke depression was strongly associated with patient occupation, marital status, and level of education There is urgent need for integration of screening for and management of post-stroke depression among stroke survivors.
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Affiliation(s)
- Ashenafi Zemed
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Kedir Sany
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Moges Gahaw
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia
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Risk Factors for Depressive Symptoms in Korean Adult Stroke Survivors: The Korea National Health and Nutrition Examination Survey IV-VII (2007-2018). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158178. [PMID: 34360469 PMCID: PMC8346056 DOI: 10.3390/ijerph18158178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022]
Abstract
Depressive symptoms are common in stroke survivors, and they are associated with poor outcomes. Therefore, this study aimed to investigate the depressive symptoms in stroke survivors and the risk factors for depressive symptoms in stroke survivors. We included 33,991 participants who were 19 years or older and had completed a questionnaire about the history of stroke from the Korea National Health and Nutrition Examination Survey (KNHANES) IV–VII (from 2007 to 2018). The mean Patient Health Questionnaire-9 score and the prevalence of major depression, depressive symptoms, antidepressant treatment, suicidal ideation, and suicide attempts were significantly higher in stroke survivors than in non-stroke participants (4.4 vs. 2.6, 16.2% vs. 5.3%, 24.7% vs. 9.3%, 3.8% vs. 1.4%, 21.7% vs. 4.8%, and 2.5% vs. 0.6%, respectively, all p < 0.001). Complex sample multivariate logistic regression analysis revealed that the female sex, unemployment, a low education level, a low family income, and activity limitations were independent risk factors for depressive symptoms in stroke survivors. Activity limitations showed the highest odds ratio among the independent factors, and its causes were further analyzed. The most common causes of activity limitations were stroke sequelae and musculoskeletal problems. To reduce depressive symptoms in stroke survivors, attention needs to be paid to minimizing stroke sequelae and musculoskeletal problems along with regular screening for depressive symptoms.
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Wei L, Guo J, Yu X, Chen H, Du Y, Ji Z, Xie Y, Qiu Y. Role and characteristics of hippocampal region microglial activation in poststroke depression. J Affect Disord 2021; 291:270-278. [PMID: 34058609 DOI: 10.1016/j.jad.2021.05.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 05/09/2021] [Accepted: 05/14/2021] [Indexed: 01/08/2023]
Abstract
AIMS To study the role and characteristics of activated microglia in poststroke depression (PSD) . METHODS Twenty-four male Wistar rats were randomly divided into three groups: the poststroke (PS) group, PSD group, and Sham group. Neurobehavioral testing was performed 24 h postoperation. The body weights of the rats were regularly recorded, and behavioral testing was regularly performed at 1, 2 and 3 weeks postmodeling. Immunofluorescent staining was used to detect the microglial marker OX42. Real-time PCR was used to analyze the relative gene expression of microglial activation markers (TNF-a, IL-10, IL-1, TGF-β, CD86, iNOS, CD206, IL-1β, and Arg1) . RESULTS The relative gene expression of proinflammatory markers (IL-1, TNF-a, iNOS, and IL1β) and anti-inflammatory markers (CD206 and Arg1) significantly increased in the hippocampal region compared with that in the right cerebral and left cerebral hemispheres in the PSD group. The relative gene expression of proinflammatory markers (TNF-a, IL-1, iNOS, and CD86) in the hippocampal region was significantly increased in the PSD group compared with that in the Sham and PS groups. The anti-inflammatory markers (TGF-β and CD206) in the hippocampal region were significantly increased in the PSD group compared with that in the Sham group, and the M2 marker Arg1 was significantly increased in the PSD group compared with that in the PS group. Correlation analysis showed that IL-1 was strongly negatively correlated with PSD . CONCLUSIONS Most microglia in the hippocampal region of PSD had a proinflammatory status and an anti-inflammatory status. IL-1 showed a strong negative correlation with PSD.
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Affiliation(s)
- Li Wei
- State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Jing Guo
- State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaopeng Yu
- State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hui Chen
- NHC Key Laboratory of Combined Multiorgan Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yupeng Du
- Department of Rehabilitation, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhongkang Ji
- State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yirui Xie
- State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yunqing Qiu
- State Key Laboratory of Diagnostic and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
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Facucho-Oliveira J, Esteves-Sousa D, Espada-Santos P, Moura N, Albuquerque M, Fraga AM, Sousa S, Cintra P, Mendonça L, Pita F. Depression after stroke. Pract Neurol 2021; 21:384-391. [PMID: 33990426 DOI: 10.1136/practneurol-2020-002622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 01/01/2023]
Abstract
Stroke treatment has dramatically improved in recent decades. However, although new treatments have reduced its mortality and the severity of its physical and cognitive sequelae, many people still have incapacitating disabilities following a stroke. Depression is the most common psychiatric disorder following stroke; it is important to recognise and treat as it limits motor and cognitive rehabilitation. Antidepressant medication is an effective treatment and can improve adherence to clinically recommended physical and cognitive tasks, thereby enhancing functional remodelling of neuronal pathways and improving rehabilitation outcomes.
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Affiliation(s)
| | - Daniel Esteves-Sousa
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Pedro Espada-Santos
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Nuno Moura
- Department of Mental Health and Psychiatry, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | | | - Ana Margarida Fraga
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Sandra Sousa
- Department of Neurology, Lusiadas Health Group, Lisboa, Portugal
| | - Pedro Cintra
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Luis Mendonça
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Fernando Pita
- Department of Neurology, Lusiadas Health Group, Lisboa, Portugal
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Ribeiro NF, Madruga L. A sudden and severe depressive episode after a left cingulate gyrus stroke: a case report of post-stroke depression and review of literature. J Neural Transm (Vienna) 2021; 128:711-716. [PMID: 33825944 DOI: 10.1007/s00702-021-02334-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Abstract
Post-stroke depression is a frequent complication of cerebrovascular lesions and mainly occurs within the first 6 months after stroke. Stroke patients who develop depression have slower recovery, greater disability, and higher mortality rates. The pathophysiology of post-stroke depression is not yet clearly defined, but studies suggest contributions from both psychosocial factors and stroke-related factors, such as lesions affecting the frontal-subcortical circuits. Early treatment has a positive impact on post-stroke rehabilitation outcome and survival. We present the case of an 82-year-old man with no psychiatric history who was brought to the psychiatric emergency department after two suicide attempts in the span of 7 days. He was severely depressed, with feelings of hopelessness, insomnia, and suicidal ideation. He had suffered a stroke the week before, affecting the anterior portion of the left cingulate gyrus, causing right hemiparesis and paresthesia. The psychiatric symptoms developed immediately after the stroke and were not present before the event. He was admitted to the psychiatry ward, treated with sertraline 100 mg/day and quetiapine 50 mg/day and discharged within 28 days, after full remission of symptoms. Our case strengthens the association between lesions located to the frontal-subcortical circuits and post-stroke depression. Physicians should be vigilant regarding the occurrence of depression in stroke patients, especially those who suffer lesions affecting the frontal-subcortical circuits and related regions.
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Affiliation(s)
- Nuno Filipe Ribeiro
- Department of Psychiatry and Mental Health, Setúbal Hospital Center, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal.
| | - Luís Madruga
- Department of Psychiatry and Mental Health, Setúbal Hospital Center, Rua Camilo Castelo Branco, 2910-446, Setúbal, Portugal
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Mayman N, Stein LK, Erdman J, Kornspun A, Tuhrim S, Jette N, Dhamoon MS. Risk and Predictors of Depression Following Acute Ischemic Stroke in the Elderly. Neurology 2021; 96:e2184-e2191. [PMID: 33722998 DOI: 10.1212/wnl.0000000000011828] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/29/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We sought to comprehensively evaluate predictors of poststroke depression (PSD) in the United States and to compare PSD to post-myocardial infarction (MI) depression to determine whether ischemic stroke uniquely elevates risk of depression. METHODS This is a retrospective cohort study of 100% deidentified inpatient, outpatient, and subacute nursing Medicare data from 2016 to 2017 for US patients ≥65 years of age from July 1, 2016, to December 31, 2017. We calculated Kaplan-Meier unadjusted cumulative risk of depression up to 1.5 years after the index admission. We performed Cox regression to report the hazard ratio for diagnosis of depression up to 1.5 years after stroke vs MI and independent predictors of PSD, and we controlled for patient demographics, comorbid conditions, length of stay, and acute stroke interventions. RESULTS In fully adjusted models, patients with stroke (n = 174,901) were ≈50% more likely than patients with MI (n = 193,418) to develop depression during the 1.5-year follow-up period (Kaplan-Meier cumulative risk 0.1596 ± 0.001 in patients with stroke vs 0.0973 ± 0.000778 in patients with MI, log-rank p < 0.0001). History of anxiety was the strongest predictor of PSD, while discharge home was most protective. Female patients, White patients, and patients <75 years of age were more likely to be diagnosed with depression after stroke. CONCLUSIONS Despite the similarities between MI and stroke, patients with stroke were significantly more likely to develop depression. There were several predictors of PSD, most significantly history of anxiety. Our findings lend credibility to a stroke-specific process causing depression and highlight the need for consistent depression screening in all patients with stroke.
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Affiliation(s)
- Naomi Mayman
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Laura Katherine Stein
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - John Erdman
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Alana Kornspun
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Stanley Tuhrim
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Nathalie Jette
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia
| | - Mandip S Dhamoon
- From the Icahn School of Medicine at Mount Sinai (N.M., J.E.); Department of Neurology (L.K.S., S.T., N.J., M.D.), Icahn School of Medicine at Mount Sinai, New York, NY; and University of Pennsylvania Health System (A.K.), Philadelphia.
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Gong P, Ma X, Gao L, Bi J. Simple acupuncture combined with fluoxetine in the treatment of poststroke depression: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e24968. [PMID: 33725863 PMCID: PMC7969235 DOI: 10.1097/md.0000000000024968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Poststroke depression is a common secondary mental disorder after stroke, which increases the recurrence rate and mortality rate after stroke and hinders the recovery of function. As a combination therapy, simple acupuncture combined with fluoxetine has achieved good clinical effect, but there is a lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of acupuncture combined with fluoxetine in the treatment of poststroke depression by meta-analysis. METHODS Search Chinese and English databases: China national knowledge infrastructure, VP information Chinese Journal Service Platform, Wanfang, the China Biomedical Database, PubMed, Embase, the Cochrane Library, and web of science. A randomized controlled trial of simple acupuncture combined with fluoxetine in the treatment of poststroke depression will be selected. The retrieval time is of the establishment of the database in January 2021. Selected literature is extracted and deleted by 2 researchers, and the quality of the included literature is evaluated. The included literature is analyzed by Meta with RevMan5.3 software. RESULTS In this study, the efficacy and safety of acupuncture combined with fluoxetine in the treatment of post-stroke depression are evaluated by Hamilton Depression scale (HAMD) and its reduction rate, Treatment Emergency Symptom Scale, Self-rating Depression Scale, and Activities of Daily living scale. CONCLUSION This study will provide reliable evidence-based evidence for the clinical application of acupuncture combined with fluoxetine in the treatment of post-stroke depression. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/5J896.
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Polding LC, Tate WJ, Mlynash M, Marks MP, Heit JJ, Christensen S, Kemp S, Albers GW, Lansberg MG. Quality of Life in Physical, Social, and Cognitive Domains Improves With Endovascular Therapy in the DEFUSE 3 Trial. Stroke 2021; 52:1185-1191. [PMID: 33596675 DOI: 10.1161/strokeaha.120.031490] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The DEFUSE 3 (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3) randomized clinical trial demonstrated the efficacy of endovascular therapy in treating ischemic stroke 6 to 16 hours after onset, resulting in better functional outcomes than standard medical therapy alone. The objective of this secondary analysis is to analyze the effect of late-window endovascular treatment of ischemic stroke on quality of life (QoL) outcomes. METHODS Patients (n=182) who presented between 6 and 16 hours after they were last known to be well with acute anterior circulation ischemic stroke were randomized to endovascular thrombectomy plus standard medical therapy or standard medical therapy alone and followed-up through 90 days poststroke. QoL at day 90 was assessed with the QoL in Neurological Disorders measurement tool. RESULTS Of the 146 subjects alive at day 90, 136 (95%) filled out QoL in Neurological Disorders short forms. Patients treated with endovascular therapy had better QoL scores in each domain: mobility, social participation, cognitive function, and depression (P<0.01 for all). Variables other than endovascular therapy that were independently associated with better QoL included lower baseline National Institutes of Health Stroke Scale, younger age, and male sex. The degree to which the modified Rankin Scale captures differences in QoL between patients varied by domain; the modified Rankin Scale score accounted for a high proportion of the variability in mobility (Rs2=0.82), a moderate proportion in social participation (Rs2=0.62), and a low proportion in cognition (Rs2=0.31) and depression (Rs2=0.19). CONCLUSIONS Patients treated with endovascular therapy 6 to 16 hours after stroke have better QoL than patients treated with medical therapy alone, including better mobility, more social participation, superior cognition, and less depression. The modified Rankin Scale fails to capture patients' outcomes in cognition and depression, which should therefore be assessed with dedicated QoL tools. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02586415.
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Affiliation(s)
| | - William J Tate
- Stanford University School of Medicine, CA (L.C.P., W.J.T.)
| | - Michael Mlynash
- Stanford Stroke Center, Palo Alto, CA (M.M., S.C., S.K., G.W.A., M.G.L.)
| | - Michael P Marks
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA (M.P.M., J.J.H.)
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Palo Alto, CA (M.P.M., J.J.H.)
| | - Soren Christensen
- Stanford Stroke Center, Palo Alto, CA (M.M., S.C., S.K., G.W.A., M.G.L.)
| | | | - Gregory W Albers
- Stanford Stroke Center, Palo Alto, CA (M.M., S.C., S.K., G.W.A., M.G.L.)
| | - Maarten G Lansberg
- Stanford Stroke Center, Palo Alto, CA (M.M., S.C., S.K., G.W.A., M.G.L.)
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Abstract
Neuropsychiatric disturbances represent a common and uniquely challenging consequence of stroke. These disorders arise at the intersection of lesion-related brain dysfunction and psychological distress related to the event and its aftermath, making it difficult to identify what symptom is a direct physiological consequence of the stroke. Depression, anxiety, fatigue, apathy, emotionalism, and anger are the most common of these syndromes, and posttraumatic stress disorder related to the stroke event has become increasingly recognized as a relevant entity. Mania, obsessive-compulsive disorder, and psychosis are less commonly encountered but potentially highly debilitating conditions that may be underrecognized. Early identification and treatment may mitigate functional impairment and improve quality of life. Evidence-based guidelines from the general population are often relied upon to guide treatment. Further research is needed to understand and tailor treatment of these disorders in the poststroke population.
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Affiliation(s)
- Katlyn Nemani
- Departments of Neurology and Psychiatry, NYU Langone Health, New York, New York
| | - Lindsey Gurin
- Departments of Neurology, Psychiatry, and Rehabilitation Medicine, NYU Langone Health, New York, New York
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Klingbeil J, Brandt ML, Wawrzyniak M, Stockert A, Schneider HR, Baum P, Hoffmann KT, Saur D. Association of Lesion Location and Depressive Symptoms Poststroke. Stroke 2021; 52:830-837. [PMID: 33504189 DOI: 10.1161/strokeaha.120.031889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Poststroke depression is a common stroke sequel, yet its neurobiological substrates are still unclear. We sought to determine whether specific lesion locations are associated with depressive symptoms after stroke. METHODS In a prospective study, 270 patients with first ever stroke were repeatedly tested with the depression subscale of the Hospital Anxiety and Depression Scale within the first 4 weeks and 6 months after stroke. Voxel-based lesion behavior mapping based on clinical imaging was performed to test for associations between symptoms of depression and lesion locations. RESULTS Frequency of poststroke depression (Hospital Anxiety and Depression Scale-D score >7) after 6 months was 19.6%. Higher Hospital Anxiety and Depression Scale-D scores for depression within the first 4 weeks were the only independent predictor for poststroke depression after 6 months in a multiple logistic regression also including age, sex, lesion volume, stroke severity, Barthel-Index, and the anxiety subscale of the Hospital Anxiety and Depression Scale. Nonparametric permutation-test based voxel-based lesion behavior mapping identified a cluster of voxels mostly within the left ventrolateral prefrontal cortex where lesions were significantly associated with more depressive symptoms after 6 months. No such association was observed within the right hemisphere despite better lesion coverage. CONCLUSIONS Lesions in the left ventrolateral prefrontal cortex increase the risk of depressive symptoms 6 months poststroke. Lesions within the right hemisphere are unrelated to depressive symptoms. Recognition of left frontal lesions as a risk factor should help in the early diagnosis of poststroke depression through better risk stratification. The results are in line with evidence from functional imaging and noninvasive brain stimulation in patients without focal brain damage indicating that dysfunction in the left lateral prefrontal cortex contributes to depressive disorders.
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Affiliation(s)
- Julian Klingbeil
- Department of Neurology, University of Leipzig Medical Center, Germany
| | | | - Max Wawrzyniak
- Department of Neurology, University of Leipzig Medical Center, Germany
| | - Anika Stockert
- Department of Neurology, University of Leipzig Medical Center, Germany
| | | | - Petra Baum
- Department of Neurology, University of Leipzig Medical Center, Germany
| | | | - Dorothee Saur
- Department of Neurology, University of Leipzig Medical Center, Germany
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50
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Abstract
Stroke causes many forms of disability, including emotional and mood disorders. Depression is the most common of these, affecting approximately one-third of stroke patients. Other disorders like mania, bipolar disorder, anxiety disorder, or apathy may also develop following stroke, although they are less common. The development of mood and emotional disorders is dependent on the severity of brain injury, the side of injury, and hemispheric location. Whereas a left hemispheric stroke often results in depression or a catastrophic reaction with anxiety, injury to the right hemisphere has predominantly been associated with the development of emotional indifference (anosodiaphoria) or euphoria. In this chapter, we discuss the mood disorders associated with hemispheric strokes and the neuropsychological mechanisms that might account for the clinical manifestations of these affective disorders.
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Affiliation(s)
- Michał Harciarek
- Department of Social Sciences, Institute of Psychology, University of Gdansk, Gdansk, Poland.
| | - Aleksandra Mańkowska
- Department of Social Sciences, Institute of Psychology, University of Gdansk, Gdansk, Poland
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