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Yuan Y, Qin J, Ma G, Pei J, Wei X, Yang Y, Feng J, Nan J, Yan B, Han L, Ma Y. The prevalence and characteristics of alexithymia in stroke patients: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis 2024; 33:107712. [PMID: 38599473 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107712] [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: 09/27/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Previous studies have indicated the potential occurrence of alexithymia among stroke patients, yet the prevalence of alexithymia in this population remains disparate across different investigations without a synthesized overview. AIM To systematically evaluate the prevalence and characteristics of alexithymia in stroke patients. METHODS A systematic review and meta-analysis was conducted following the PRISMA guidelines. PubMed, Embase, Web of Science, The Cochrane Library, CINAHL, China Knowledge Resource Integrated Database (CNKI), Wanfang Database, Chinese Biomedical Database, and Weipu Database (VIP) were searched from inception to December 31,2022, two independent researchers extracted data and evaluated article quality. RESULTS Seventeen studies were included, reporting on the prevalence of alexithymia or Toronto Alexithymia Scale-20 (TAS-20) scores among stroke patients. The pooled prevalence was found to be 35.0% (95%CI= 23.0-47.0%; I2 =97.5%), and the total scores (TS) of TAS-20 was 59.90 (95% CI=56.34-63.47; I2 =100.0%). Subgroup analysis revealed significant variation in TAS-20 scores across different geographical regions. Specifically, the total TAS-20 score in Chinese stroke patients (62.95, 95%CI=58.75-67.14; I2=100%) was higher compared to non-Chinese stroke patients (52.58, 95%CI=49.12-56.04; I2 = 99.0%). CONCLUSIONS The prevalence of alexithymia is high among stroke patients, with TAS-20 scores surpassing those observed in patients with certain other medical conditions. This underscores the importance of addressing alexithymia in stroke patients promptly through assessment and intervention to mitigate negative emotional consequences and enhance overall quality of life. Future research could explore the influence of demographic factors such as age and sex on alexithymia in stroke patients, enabling a more comprehensive understanding of alexithymia.
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Affiliation(s)
- Yue Yuan
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Jiangxia Qin
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Guifen Ma
- The Health School of Gannan Tibetan Autonomous Prefecture, Gannan Prefecture, Gansu Province, China
| | - Juhong Pei
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China
| | - Xiaoqin Wei
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Yiyi Yang
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Juanjuan Feng
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Jinhan Nan
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China
| | - Boling Yan
- The First Hospital of Lanzhou University, Lanzhou, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China; Department of Nursing, Gansu Provincial Hospital, Lanzhou, Gansu Province, China.
| | - Yuxia Ma
- Evidence-Based Nursing Center, School of Nursing of Lanzhou University, Lanzhou, China; The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China.
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Hao X, Yang Y, Qin Y, Lv M, Zhao X, Wu S, Li K. The Effect of Respiratory Muscle Training on Swallowing Function in Patients With Stroke: A Systematic Review and Meta-Analysis. West J Nurs Res 2024; 46:389-399. [PMID: 38545931 DOI: 10.1177/01939459241242533] [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] [Indexed: 04/13/2024]
Abstract
BACKGROUND The improvement of swallowing function after stroke is a significant challenge faced by patients and health care professionals. However, the current evidence synthesis of the effects of respiratory muscle training (RMT) on swallowing function is limited. OBJECTIVE To assess the effectiveness of RMT on swallowing recovery in patients undergoing stroke. METHODS The CKNI, WanFang Data, PubMed, CINAHL, Web of Science, Embase, MEDLINE, and Cochrane Library databases were searched for studies evaluating RMT interventions' effect on swallowing outcomes. Risks of bias were evaluated using the approach recommended by the Cochrane Collaboration tool and a summary of findings table was generated using the GRADE approach. Outcomes were synthesized using a random-effects meta-analysis model. RESULTS RMT interventions reduced the risk of aspiration (SMD = 1.19; 95% CI, 0.53-1.84), the recovery process of water swallowing function (RR = 1.22; 95% CI, 1.05-1.42), and the activity of the swallowing muscles (SMD = 2.91; 95% CI, 2.22-3.61). However, there was no significant effect of RMT on the functional level of oral intake (SMD = 0.70; 95% CI, -0.03 to 1.42). CONCLUSIONS RMT can be regarded as an innovative, auxiliary means in the near future to better manage and improve swallowing function, given its improving effect on work outcomes in this review.
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Affiliation(s)
- Xiaonan Hao
- School of Nursing, Jilin University, Changchun, China
| | - Yuhang Yang
- School of Nursing, Jilin University, Changchun, China
| | - Yuan Qin
- School of Nursing, Jilin University, Changchun, China
| | - Miaohua Lv
- School of Nursing, Jilin University, Changchun, China
| | - Xuetong Zhao
- School of Nursing, Jilin University, Changchun, China
| | - Shuang Wu
- School of Nursing, Jilin University, Changchun, China
| | - Kun Li
- School of Nursing, Jilin University, Changchun, China
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Ozkan H, Ambler G, Banerjee G, Browning S, Leff AP, Ward NS, Simister RJ, Werring DJ. Prevalence, patterns, and predictors of patient-reported non-motor outcomes at 30 days after acute stroke: Prospective observational hospital cohort study. Int J Stroke 2024; 19:442-451. [PMID: 37950351 DOI: 10.1177/17474930231215660] [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] [Indexed: 11/12/2023]
Abstract
BACKGROUND Adverse non-motor outcomes are common after acute stroke and likely to substantially affect quality of life, yet few studies have comprehensively assessed their prevalence, patterns, and predictors across multiple health domains. AIMS We aimed to identify the prevalence, patterns, and the factors associated with non-motor outcomes 30 days after stroke. METHODS This prospective observational hospital cohort study-Stroke Investigation in North and Central London (SIGNAL)-identified patients with acute ischemic stroke or intracerebral hemorrhage (ICH) admitted to the Hyperacute Stroke Unit (HASU) at University College Hospital (UCH), London, between August 1, 2018 and August 31, 2019. We assessed non-motor outcomes (anxiety, depression, fatigue, sleep, participation in social roles and activities, pain, bowel function, and bladder function) at 30-day follow-up using the Patient-Reported Outcome Measurement Information System-Version 29 (PROMIS-29) scale and Barthel Index scale. RESULTS We obtained follow-up data for 605/719 (84.1%) eligible patients (mean age 72.0 years; 48.3% female; 521 with ischemic stroke, 84 with ICH). Anxiety (57.0%), fatigue (52.7%), bladder dysfunction (50.2%), reduced social participation (49.2%), and pain (47.9%) were the commonest adverse non-motor outcomes. The rates of adverse non-motor outcomes in ⩾ 1, ⩾ 2 and ⩾ 3 domains were 89%, 66.3%, and 45.8%, respectively; in adjusted analyses, stroke due to ICH (compared to ischemic stroke) and admission stroke severity were the strongest and most consistent predictors. There were significant correlations between bowel dysfunction and bladder dysfunction (κ = 0.908); reduced social participation and bladder dysfunction (κ = 0.844); and anxiety and fatigue (κ = 0.613). We did not identify correlations for other pairs of non-motor domains. CONCLUSION Adverse non-motor outcomes were very common at 30 days after stroke, affecting nearly 90% of evaluated patients in at least one health domain, about two-thirds in two or more domains, and almost 50% in three or more domains. Stroke due to ICH and admission stroke severity were the strongest and most consistent predictors. Adverse outcomes occurred in pairs of domains, such as with anxiety and fatigue. Our findings emphasize the importance of a multi-domain approach to effectively identify adverse non-motor outcomes after stroke to inform the development of more holistic patient care pathways after stroke.
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Affiliation(s)
- Hatice Ozkan
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Gargi Banerjee
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
| | - Simone Browning
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex P Leff
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Nick S Ward
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert J Simister
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - David J Werring
- UCL Queen Square Institute of Neurology, London, UK
- Hyper Acute Stroke Unit, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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Erfanian Abdoust M, Knecht S, Husain M, Le Heron C, Jocham G, Studer B. Effort-based decision making and motivational deficits in stroke patients. Brain Cogn 2024; 175:106123. [PMID: 38183905 DOI: 10.1016/j.bandc.2023.106123] [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: 10/05/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 01/08/2024]
Abstract
Motivational deficits in patients recovering from stroke are common and can reduce active participation in rehabilitation and thereby impede functional recovery. We investigated whether stroke patients with clinically reduced drive, initiation, and endurance during functional rehabilitative training (n = 30) display systematic alterations in effort-based decision making compared to age, sex, and severity-matched stroke patients (n = 30) whose drive appeared unaffected. Notably, the two groups did not differ in self-reported ratings of apathy and depression. However, on an effort-based decision-making task, stroke patients with clinically apparent drive impairment showed intact willingness to accept effort for reward, but were more likely to fail to execute the required effort compared to patients without apparent drive impairments. In other words, the decision behavioural assessment revealed that stroke patients that displayed reduced drive, initiation, and endurance during inpatient neurorehabilitation failed to persist in goal-directed effort production, even over very short periods. These findings indicate that reduced drive during rehabilitative therapy in post-stroke patients is not due to a diminished motivation to invest physical effort, but instead is related to a reduced persistence with effortful behaviour.
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Affiliation(s)
- Mani Erfanian Abdoust
- Biological Psychology of Decision Making, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany; Mauritius Hospital Meerbusch, Meerbusch, Germany.
| | - Stefan Knecht
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK; Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK; Division of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Campbell Le Heron
- Department of Medicine, University of Otago (Christchurch), New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand
| | - Gerhard Jocham
- Biological Psychology of Decision Making, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Bettina Studer
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Mauritius Hospital Meerbusch, Meerbusch, Germany
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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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Wang PC, Pai HC. Predictive Factors of Apathy in Stroke Survivors During the Recovery Period. J Neurosci Nurs 2024; 56:25-30. [PMID: 37983366 DOI: 10.1097/jnn.0000000000000737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
ABSTRACT BACKGROUND: Apathy may be an important predictor of depression and significantly negatively affect the quality of life and functional recovery of stroke survivors. However, the evidence reflects the inconsistent findings of studies on the impact of individual-related variables on apathy in patients with stroke. OBJECTIVES: This study examines the relationships among stroke survivors' individual characteristics, background variables, disease-related variables, and apathy; furthermore, we identify predictors of apathy. METHODS: In this cross-sectional correlational study, the participants were recruited from a medical university hospital. Three measurement tools were used: individual and background variables, the modified Rankin Scale, and the Apathy Evaluation Scale. Hierarchical multiple regression analysis was used to identify the predictors of apathy. RESULTS: Participants included 100 stroke survivors with a mean age of 59.9 (12.1) years. The prevalence of apathy among stroke survivors was 27%. Stroke survivors' economic sources (β = 0.430, P = .001), perceived family support (β = -0.163, P = .048), and modified Rankin Scale (β = 0.283, P = .001) accounted for 43.7% of the variance in survivor apathy. CONCLUSION: The results of this study clarified which individual characteristics, background variables, and disease-related variables are key predictors of apathy in patients with stroke.
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Affiliation(s)
- Pao-Chen Wang
- Pao-Chen Wang, MSN RN, is Nurse, Chung Shan Medical University Hospital, Taichung City, Taiwan, ROC
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Viader F. Basal ganglia matter. Eur J Neurol 2023; 30:3638-3639. [PMID: 37548566 DOI: 10.1111/ene.16029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Affiliation(s)
- Fausto Viader
- Universite de Caen Normandie UFR Sante, Caen, France
- Universite de Caen Normandie UFR Sante, Inserm U1077-NIMH, Caen, France
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Vassilaki M, Syrjanen JA, Krell-Roesch J, Graff-Radford J, Vemuri P, Scharf EL, Machulda MM, Fields JA, Kremers WK, Lowe VJ, Jack CR, Knopman DS, Petersen RC, Geda YE. Association of Cerebrovascular Imaging Biomarkers, Depression, and Anxiety, with Mild Cognitive Impairment. J Alzheimers Dis Rep 2023; 7:1237-1246. [PMID: 38025797 PMCID: PMC10657723 DOI: 10.3233/adr-230073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
The study included 1,738 Mayo Clinic Study of Aging participants (≥50 years old; 1,460 cognitively unimpaired and 278 with mild cognitive impairment (MCI)) and examined the cross-sectional association between cerebrovascular (CVD) imaging biomarkers (e.g., white matter hyperintensities (WMH), infarctions) and Beck Depression Inventory-II (BDI-II) and Beck Anxiety Inventory (BAI) scores, as well as their association with MCI. High (abnormal) WMH burden was significantly associated with having BDI-II>13 and BAI > 7 scores, and both (CVD imaging biomarkers and depression/anxiety) were significantly associated with MCI when included simultaneously in the model, suggesting that both were independently associated with the odds of MCI.
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Affiliation(s)
- Maria Vassilaki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jeremy A. Syrjanen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Janina Krell-Roesch
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | | | | | - Mary M. Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Julie A. Fields
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Walter K. Kremers
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald C. Petersen
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yonas E. Geda
- Department of Neurology, and the Franke Barrow Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix, AZ, USA
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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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Zhang H, Feng Y, Lv H, Tang S, Peng Y. The prevalence of apathy in stroke patients: A systematic review and meta-analysis. J Psychosom Res 2023; 173:111478. [PMID: 37651842 DOI: 10.1016/j.jpsychores.2023.111478] [Citation(s) in RCA: 1] [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: 05/17/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Apathy is a frequent neuropsychiatric disorder in stroke patients. However, its prevalence rates have conflicting results across studies. This meta-analysis aimed to estimate the overall prevalence of apathy in stroke patients from 1990 to 2022. METHODS PubMed, Web of Science, Embase and PsycINFO were systematically searched to identify relevant articles published from January 1, 1990 to October 29, 2022. Literature quality was assessed with the National Institutes of Health Study Quality Assessment Tool. The pooled prevalence, subgroup analyses and meta-regression were calculated by STATA 16.0. RESULTS A total of 39 observational studies involving 5168 stroke patients were eligible for this meta-analysis. The pooled prevalence of apathy in stroke patients was 33.0% (95% CI, 27.6-38.4). Subgroup analyses showed that the pooled prevalence of apathy among stroke patients was higher in Japan (36.6%), China (33.7%) and Turkey (63.5%) compared to that in other countries (30.2%). The pooled prevalence of apathy was higher in ischemic stroke samples (36.1%) than in hemorrhagic stroke samples (14.4%). The pooled prevalence of apathy measured with the Apathy Evaluation Scale (38.3%) was the highest in stroke patients. Meta-regression presented that higher literature quality was significantly associated with lower prevalence, while stroke severity, mean age and female percentage were not significantly associated with the prevalence of apathy in stroke patients. CONCLUSION Our findings revealed that the overall prevalence of apathy in stroke patients was 33.0% based on the current evidence. Furthermore, the prevalence was significantly correlated with countries, stroke subtypes, apathy criteria, and literature quality.
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Affiliation(s)
- Hanrui Zhang
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yaoting Feng
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hequn Lv
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shaowen Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yongjun Peng
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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Blake JJ, Gracey F, Whitmore S, Broomfield NM. Comparing the Symptomatology of Post-stroke Depression with Depression in the General Population: A Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09611-5. [PMID: 37667057 DOI: 10.1007/s11065-023-09611-5] [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: 07/14/2022] [Accepted: 07/12/2023] [Indexed: 09/06/2023]
Abstract
Previous research into the phenomenological differences of post-stroke depression (PSD) has typically focused on comparisons of symptom profiles between stroke and non-stroke population controls. This systematic review aimed to synthesize these findings with results from other methodological approaches that contribute to an understanding of phenomenological differences. Articles were identified via a systematic search of seven databases and additional manual searching. A narrative synthesis approach was adopted because of the high methodological heterogeneity. Twelve articles comparing the symptomatology of depression between stroke and non-stroke controls were included. Three distinct methodological approaches, relevant to the aim, were identified: comparisons of profiles among groups with similar overall depression severity, comparisons of the strengths of correlations between a symptom and depression, and comparisons of latent symptom severity. The symptomatology of depression was generally similar between the groups, including somatic symptoms, despite the hypothesized interference of comorbid physical stroke effects. Despite high heterogeneity, there was a tentative indication that post-stroke depression manifests with comparatively less severe/prevalent anhedonia. Possible mechanisms for the observed similarities and differences are explored, including suggestions for future research.
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Affiliation(s)
- J J Blake
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - F Gracey
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - S Whitmore
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - N M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
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Sobreiro MFM, Terroni L, Guajardo VD, Mattos PF, Leite CDC, Amaro E, Tinone G, Iosifescu DV, Fraguas R. The Impact of Post-Stroke Depressive Symptoms on Cognitive Performance in Women and in Men: A 4 Month Prospective Study. Life (Basel) 2023; 13:1554. [PMID: 37511929 PMCID: PMC10381498 DOI: 10.3390/life13071554] [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: 03/02/2023] [Revised: 06/21/2023] [Accepted: 07/08/2023] [Indexed: 07/30/2023] Open
Abstract
Background: Depressive symptoms have been associated with cognitive impairment after stroke, and women may be specifically affected. Objective: The aim of this study was to investigate gender-specific characteristics in the relationship between changes in depression severity and changes in cognitive performance after stroke. Methods: We prospectively evaluated 73 patients without a previous history of depression in the first and fourth months after a first ischemic stroke. The severity of depressive symptoms was assessed using the 31-item version of the Hamilton Rating Scale for Depression, and executive function, attention, working memory, and verbal fluency were assessed using a neuropsychological battery. Results: We included 46 (63.0%) men and 27 (36.9%) women, with mean ages of 55.2 (SD ± 15.1) and 46.8 (SD ± 14.7) years, respectively. We found significant improvement in the digit span forward and Stroop dots from month 1 to month 4 post stroke for both men and women. Women, but not men, presented a correlation between changes in phonemic verbal fluency and changes in the 31-item version of the Hamilton Rating Scale for Depression scores. Improvement in depression was correlated with improvement in verbal fluency, and worsening in depression was correlated with worsening in verbal fluency. Conclusions: Our results suggest that women might be more vulnerable to the relationship between depressive symptoms and cognitive performance, and improvement of depression may be necessary for women's improvement in phonemic verbal fluency from the first to the fourth month after a stroke. We did not adjust the results for multiple comparisons. Thus, our findings might be considered preliminary, and confirmatory studies, also focusing on specific characteristics of women that could explain these differences, are warranted.
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Affiliation(s)
- Matildes F M Sobreiro
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
| | - Luisa Terroni
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
| | - Valeri Delgado Guajardo
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
| | - Patricia Ferreira Mattos
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
| | - Claudia da Costa Leite
- Departamento de Radiologia do Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Edson Amaro
- Departamento de Radiologia do Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Gisela Tinone
- Departamento de Neurologia, Instituto Central do Hospital das Clinicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Dan V Iosifescu
- New York University School of Medicine and Nathan Kline Institute, New York, NY 10003, USA
| | - Renerio Fraguas
- Grupo de Interconsultas, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
- Laboratório de Investigações Médicas, LIM 21, Departamento e Instituto de Psiquiatria do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, São Paulo CEP 05403-903, Brazil
- Divisão de Psiquiatria e Psicologia, Hospital Universitário, Universidade de São Paulo, São Paulo 05403-903, Brazil
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13
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Liao W, Chen D, Wu J, Liu K, Feng J, Li H, Jiang J. Risk factors for post-stroke depression in patients with mild and moderate strokes. Medicine (Baltimore) 2023; 102:e34157. [PMID: 37390261 PMCID: PMC10313280 DOI: 10.1097/md.0000000000034157] [Citation(s) in RCA: 1] [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: 05/05/2023] [Accepted: 06/09/2023] [Indexed: 07/02/2023] Open
Abstract
To determine the possible risk factors for post-stroke depression in patients with mild and moderate acute strokes. A cross-sectional descriptive study was conducted involving 129 patients with mild and moderate acute strokes. The patients were divided into post-stroke depression and non-depressed stroke groups according to the Hamilton Depression Rating Scale for Depression-17 item and Patient Health Questionnaire-9 item assessments. All participants were evaluated based on clinical characteristics and a battery of scales. Patients with post-stroke depression had an increased stroke frequency, severe stroke symptoms and poor performance in activities of daily living (ADL), cognitive function, sleep quality, interest in pleasurable activities, negative life events, and utilization of social support compared to stroke patients without depression. The Negative Life Event Scale (LES) score was significantly and independently associated with an increased probability of depression in stroke patients. Negative life events were shown to be independently associated with the incidence of depression in patients with mild and moderate acute strokes, likely mediating the influence of other predictors of depression, such as a history of stroke, decreased ADL ability, and utilization of support.
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Affiliation(s)
- Wenxiang Liao
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Danlei Chen
- Geriatrics Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Jing Wu
- Neurology Department, Graduate College of Guilin Medical University, Guilin, Guangxi, China
| | - Kaixiang Liu
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Junlin Feng
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Hao Li
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Jingzi Jiang
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
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14
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Zhou P, Li W, Zhao J, Chen S, Chen Y, Shen X, Xu D. Modulated effectiveness of rehabilitation motivation by reward strategies combined with tDCS in stroke: study protocol for a randomized controlled trial. Front Neurol 2023; 14:1200741. [PMID: 37396764 PMCID: PMC10310965 DOI: 10.3389/fneur.2023.1200741] [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: 04/07/2023] [Accepted: 05/26/2023] [Indexed: 07/04/2023] Open
Abstract
Background Stroke survivors often exhibit low motivation for rehabilitation, hindering their ability to effectively complete rehabilitation training task effectively and participate in daily activities actively. Reward strategies have been identified as an effective method for boosting rehabilitation motivation, but their long-term efficacy remains uncertain. Transcranial direct current stimulation (tDCS) has been recognized as a technique that facilitates plastic changes and functional reorganization of cortical areas. Particularly, tDCS can improve the functional connectivity between brain regions associated with goal-directed behavior when applied to the left dorsolateral prefrontal cortex (dlPFC). Combing reward strategies with tDCS (RStDCS) has been shown to motivate healthy individuals to exert more effort in task performance. However, research exploring the combined and sustained effects of these strategies on rehabilitation motivation in stroke survivors is lacking. Methods and design Eighty-seven stroke survivors with low motivation and upper extremity dysfunction will be randomized to receive either conventional treatment, RS treatment, or RStDCS treatment. The RStDCS group will receive reward strategies combined with anodal tDCS stimulation of the left dlPFC. The RS group will receive reward strategies combined with sham stimulation. The conventional group will receive conventional treatment combined with sham stimulation. tDCS stimulation is performed over 3 weeks of hospitalization, 20 min/time, five times a week. Reward strategies refers to personalized active exercise programs for patients during hospitalization and at home. Patients can voluntarily choose tasks for active exercise and self-report to the therapist so as to punch a card for points and exchange gifts. The conventional group will receive home rehabilitation instructions prior to discharge. Rehabilitation motivation, measured using RMS. RMS, FMA, FIM, and ICF activity and social engagement scale will be compared at baseline, 3 weeks, 6 weeks, and 3 months post-enrollment to evaluate patients' multifaceted health condition based on the ICF framework. Discussion This study integrates knowledge from social cognitive science, economic behavioral science, and other relevant fields. We utilize straightforward and feasible reward strategies, combined with neuromodulation technology, to jointly improve patients' rehabilitation motivation. Behavioral observations and various assessment tools will be used to monitor patients' rehabilitation motivation and multifaceted health condition according to the ICF framework. The aim is to provide a preliminary exploration path for professionals to develop comprehensive strategies for improving patient rehabilitation motivation and facilitating a complete "hospital-home-society" rehabilitation process. Clinical trial registration https://www.chictr.org.cn/showproj.aspx?proj=182589, ChiCTR2300069068.
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Affiliation(s)
- Ping Zhou
- Rehabilitation Medicine Research Center, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University School of Medicine, Shanghai, China
- Department of Rehabilitation Medicine, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenxi Li
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingwang Zhao
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Siyun Chen
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yufeng Chen
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xia Shen
- Rehabilitation Medicine Research Center, Shanghai Yangzhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University School of Medicine, Shanghai, China
| | - Dongsheng Xu
- Department of Rehabilitation Medicine, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Rehabilitation Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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15
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Clark ML, Abimanyi-Ochom J, Le H, Long B, Orr C, Khanh-Dao Le L. A systematic review and meta-analysis of depression and apathy frequency in adult-onset Huntington's disease. Neurosci Biobehav Rev 2023; 149:105166. [PMID: 37054804 DOI: 10.1016/j.neubiorev.2023.105166] [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: 11/18/2022] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
Depression and apathy are associated with decreased functional capacity in Huntington's disease (HD) but frequency of depression and apathy in HD is largely unknown. Systematic literature searching was conducted across 21 databases until 30 June 2021. Inclusion criteria was limited to clinician-rated assessments of depression and apathy and adult-onset HD. Inverse-variance heterogeneity meta-analyses were conducted exploring depression and apathy frequency within individuals from families affected by HD, and within individuals with confirmed HD gene-positive status. Screening identified 289 articles for full-text review; nine remained for meta-analysis. Depression frequency in the lifetime in adults affected by or at-risk for HD was 38%, I2 = 99%. Apathy frequency in the lifetime in adults affected by or at-risk for HD was 40%, I2 = 96%. The robustness of the findings improved when limiting the analysis to gene-positive individuals only where apathy was found to be slightly more common than depression, 48% and 43% respectively. Future studies may consider reporting results from juvenile-onset HD and adult-onset HD cohorts separately to further explore phenotypic profiles.
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Affiliation(s)
- Melanie L Clark
- Deakin University, Deakin Health Economics, School of Health and Social Development, Geelong, Victoria, 3220, Australia; Neurosciences Unit, North Metropolitan Health Services Mental Health Public Health Dental Services, Perth, Western Australia; Perron Institute for Neurological and Translational Science, Perth, Western Australia.
| | - Julie Abimanyi-Ochom
- Deakin University, Deakin Health Economics, School of Health and Social Development, Geelong, Victoria, 3220, Australia; Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, 3220, Australia
| | - Ha Le
- Deakin University, Deakin Health Economics, School of Health and Social Development, Geelong, Victoria, 3220, Australia; Deakin University, Institute for Health Transformation, Faculty of Health, Geelong, Victoria, 3220, Australia
| | - Brian Long
- Neurosciences Unit, North Metropolitan Health Services Mental Health Public Health Dental Services, Perth, Western Australia
| | - Carolyn Orr
- Neurosciences Unit, North Metropolitan Health Services Mental Health Public Health Dental Services, Perth, Western Australia; Perron Institute for Neurological and Translational Science, Perth, Western Australia
| | - Long Khanh-Dao Le
- Health Economics Division, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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16
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Elias S, Benevides ML, Pereira Martins AL, Martins GL, Sperb Wanderley Marcos AB, Nunes JC. In-Hospital Symptoms of Depression and Anxiety are Strong Risk Factors for Post-Stroke Depression 90 Days After Ischemic Stroke. Neurohospitalist 2023; 13:121-129. [PMID: 37064927 PMCID: PMC10091427 DOI: 10.1177/19418744221132675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Acute ischemic stroke (AIS) and depression are the major causes of disability and decreased quality of life worldwide. Psychiatric disorders are common after stroke, especially post-stroke depression (PSD), which affects one-third of survivors. Although frequent, little is known about the real complexity of the pathophysiology and the factors associated with PSD. Methods This research aimed to provide data about risk factors and predictors of PSD 90 days after AIS. A cohort study was conducted in a tertiary stroke center located in southern Brazil. We interviewed 148 patients with AIS who were consecutively hospitalized between January 2020 and January 2021. The Hospital Anxiety and Depression Scale (HADS) was applied during hospitalization and at follow-up 90 days after AIS. Furthermore, sociodemographic, clinical, and radiological variables were investigated. Predictive factors were assessed using univariate and multivariate linear regression. The impact of the COVID-19 pandemic on the data was also evaluated. Results The frequency of PSD 90 days after AIS was 33.9%. In-hospital symptoms of depression and anxiety each represented a 2-fold risk for PSD at follow-up. Furthermore, the HADS - anxiety score 90 days after AIS was strongly associated with the HADS - depression value 90 days after stroke (R: .71; B: .56; P < .01). Conclusions The present study highlighted a noteworthy frequency of PSD 90 days after AIS. Psychiatric variables during hospitalization and in the follow-up appeared to be the leading associated factors with PSD. These data might support the determination of which patients require more psychiatric management.
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Affiliation(s)
- Stefany Elias
- University of Southern Santa
Catarina, Santa Catarina, Brazil
| | | | | | - Gladys Lentz Martins
- Department of Neurology, Hospital Governador Celso Ramos
(HGCR), Florianópolis, Brazil
| | - Ana Beatriz Sperb Wanderley Marcos
- Department of Medical Sciences,
Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina
(UFSC), Florianópolis, Brazil
| | - Jean Costa Nunes
- Department of Pathology, Federal University of Santa Catarina
(UFSC), Florianópolis, Brazil
- Neurodiagnostic Brasil – Diagnósticos
em Neuropatologia, Florianópolis, Brazil
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17
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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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18
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Elser H, Caunca M, Rehkopf DH, Andres W, Gottesman RF, Kasner SE, Yaffe K, Schneider ALC. Trends and inequities in the diagnosis and treatment of poststroke depression: a retrospective cohort study of privately insured patients in the USA, 2003-2020. J Neurol Neurosurg Psychiatry 2023; 94:220-226. [PMID: 36400454 PMCID: PMC9931658 DOI: 10.1136/jnnp-2022-330179] [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: 08/19/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression is a common neuropsychiatric consequence of stroke, but there is little empiric evidence regarding clinical diagnosis and management of poststroke depression. METHODS Retrospective cohort study among 831 471 privately insured patients with first stroke in the USA from 2003 to 2020. We identified diagnoses of poststroke depression using codes from the International Classification of Diseases. We identified treatment based on prescriptions for antidepressants. We used Cox proportional hazards regression analysis to examine rates of poststroke depression diagnosis by gender, age and race/ethnicity. Among individuals who received a diagnosis of poststroke depression, we estimated treatment rates by gender, race/ethnicity and age using negative binomial regression analysis. RESULTS Annual diagnosis and treatment rates for poststroke depression increased from 2003 to 2020 (both p for trend<0.001). Diagnosis rates were higher in women than men (HR 1.53, 95% CI 1.51 to 1.55), lower among members of racial/ethnic minorities (vs white patients: Asian HR 0.63, 95% CI 0.60 to 0.66; Black HR 0.76, 95% CI 0.74 to 0.78; Hispanic HR 0.88, 95% CI 0.86 to 0.90) and varied by age. Among individuals diagnosed with poststroke depression, 69.8% were prescribed an antidepressant. Rates of treatment were higher in women vs men (rate ratio, RR=1.19, 95% CI: 1.17 to 1.21), lower among members of racial/ethnic minorities (vs white patients: Asian RR 0.85, 95% CI 0.80 to 0.90; Black RR 0.92, 95% CI 0.89 to 0.94; Hispanic RR 0.96, 95% CI 0.93 to 0.99) and higher among older patients. CONCLUSIONS In this insured population, we identify potential inequities in clinical management of poststroke depression by gender, race/ethnicity and age that may reflect barriers other than access to healthcare.
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Affiliation(s)
- Holly Elser
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Center for Population Health Sciences, Stanford University, Stanford, California, USA
| | - Michelle Caunca
- Department of Neurology, University of California, San Francisco, California, USA
| | - David H Rehkopf
- 4. Epidemiology and Population Health, Stanford University, Stanford, California, USA
| | - Wells Andres
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca F Gottesman
- National Institute of Neurological Disorders and Stroke Intramural Research Program, National Institutes of Health, Bethesda, Maryland, USA
| | - Scott E Kasner
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, California, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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19
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Luo X, Fang W, Ji J, Zhang Y, Garcia-Milian R, Wang Z, Tan Y, Wang S, Wang X, Guo X, Luo X. Association of lesion location with post-stroke depression in China: a systematic review and meta-analysis. EC PSYCHOLOGY AND PSYCHIATRY 2023; 12:34-45. [PMID: 36913221 PMCID: PMC9997510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Background Post-stroke depression (PSD) is a mental health condition that can develop after a stroke, with a higher risk of death and negative outcomes. However, limited research has explored how PSD incidence relates to brain locations in Chinese patients. This study aims to fill this gap by examining the link between PSD occurrence and brain lesion location, as well as the type of stroke experienced by the patient. Methods We conducted a systematic search in databases to gather post-stroke depression literature published between January 1, 2015 and May 31, 2021. Following this, we performed a meta-analysis using RevMan to analyze the incidence of PSD associated with different brain regions and types of stroke separately. Results We analyzed seven studies, with a total of 1604 participants. Our findings indicated that the incidence of PSD was higher when the stroke occurred in the left hemisphere compared to the right hemisphere (RevMan: Z = 8.93, P <0.001, OR = 2.69, 95% CI: 2.16-3.34, fixed model); PSD was more common when the stroke affected the cerebral cortex rather than the subcerebral cortex (RevMan: Z = 3.96, P <0.001, OR = 2.00, 95% CI: 1.42-2.81) and when it affected the anterior cortex compared to the posterior cortex (RevMan: Z = 3.85, P <0.001, OR = 1.89, 95% CI: 1.37-2.62). However, we did not find a significant difference in the occurrence of PSD between ischemic and hemorrhagic strokes (RevMan: Z = 0.62, P = 0.53, OR = 0.02, 95% CI: -0.05-0.09). Conclusions Our findings revealed a higher likelihood of PSD in the left hemisphere, specifically in the cerebral cortex and anterior region.
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Affiliation(s)
- Xinqun Luo
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Wenhua Fang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, China
| | - Jiawu Ji
- Department of Psychiatry, Fujian Medical University Affiliated Fuzhou Neuropsychiatric Hospital, Fuzhou, Fujian 350001, China
| | - Yong Zhang
- Department of Bipolar Disorder, Tianjin Anding Hospital, Tianjin 300222, China
| | - Rolando Garcia-Milian
- Bioinformatics Support Program, The Cushing/Whitney Medical Library, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Zhiren Wang
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical School of Medicine, Beijing 100096, China
| | - Yunlong Tan
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical School of Medicine, Beijing 100096, China
| | - Shibin Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Xiaoping Wang
- Department of Neurology, Jiading Branch of Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201800, China
| | - Xiaoyun Guo
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Xingguang Luo
- Beijing Huilongguan Hospital, Peking University Huilongguan Clinical School of Medicine, Beijing 100096, China
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20
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Wouts L, Marijnissen RM, Oude Voshaar RC, Beekman ATF. Strengths and Weaknesses of the Vascular Apathy Hypothesis: A Narrative Review. Am J Geriatr Psychiatry 2023; 31:183-194. [PMID: 36283953 DOI: 10.1016/j.jagp.2022.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 10/07/2022]
Abstract
The vascular apathy hypothesis states that cerebral small vessel disease (CSVD) can cause apathy, even when no other symptoms of CSVD are present. In order to examine this hypothesis, the objectives of this narrative review are to evaluate the evidence for a pathophysiological mechanism linking CSVD to apathy and to examine whether CSVD can be a sole cause of apathy. The nature of the CSVD-apathy relationship was evaluated using the Bradford Hill criteria as a method for research on the distinction between association and causation. Pathological, neuroimaging, and behavioral studies show that CSVD can cause lesions in the reward network, which causes an apathy syndrome. Studies in healthy older individuals, stroke patients and cognitively impaired persons consistently show an association between CSVD markers and apathy, although studies in older persons suffering from depression are inconclusive. A biological gradient is confirmed, as well as a temporal relationship, although the evidence for the latter is still weak. The specificity of this causal relationship is low given there often are other contributing factors in CSVD patients with apathy, particularly depression and cognitive deterioration. Differentiating between vascular apathy and other apathy syndromes on the basis of clinical features is not yet possible, while in-depth knowledge about differences in the prognosis and efficacy of treatment options for apathy caused by CSVD and other apathy syndromes is lacking. Since we cannot differentiate between etiologically different apathy syndromes as yet, it is premature to use the term vascular apathy which would suggest a distinct clinical apathy syndrome.
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Affiliation(s)
- Lonneke Wouts
- Department of Old Age Psychiatry (L.W.), Pro Persona Mental Health Institute, Nijmegen, the Netherlands; Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands.
| | - Radboud M Marijnissen
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Richard C Oude Voshaar
- Department of Psychiatry (L.W., R.M.M., R.C.O.), University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry (A.T.F.B.), Amsterdam UMC, Vrije Universiteit, and GGZinGeest, Amsterdam, the Netherlands
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21
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Aubignat M, Roussel M, Aarabi A, Lamy C, Andriuta D, Tasseel-Ponche S, Makki M, Godefroy O, Roussel M, Barbay M, Canaple S, Lamy C, Leclercq C, Arnoux A, Despretz-Wannepain S, Despretz P, Berrissoul H, Picard C, Diouf M, Loas G, Deramond H, Taillia H, Ardisson AE, Nédélec-Ciceri C, Bonnin C, Thomas-Anterion C, Vincent-Grangette F, Varvat J, Quaglino V, Beaunieux H, Moroni C, Martens-Chazelles A, Batier-Monperrus S, Monteleone C, Costantino V, Theunssens E. Poststroke apathy: Major role of cognitive, depressive and neurological disorders over imaging determinants. Cortex 2023; 160:55-66. [PMID: 36745966 DOI: 10.1016/j.cortex.2022.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/11/2022] [Accepted: 12/01/2022] [Indexed: 01/19/2023]
Abstract
Apathy occurs in approximately one third of people after stroke. Despite its frequency and functional consequences, the determinants of apathy have only been partially defined. The major difficulty lies in disentangling the reduction in activity due to apathy itself from those secondary to comorbidities, such as depression, sensorimotor deficits, and cognitive impairment. Here, we aimed to examine the prevalence of apathy, identify confounding sources of hypoactivity, and define its neuroimaging determinants using multivariate voxel lesion symptom-mapping (mVLSM) analyses. We assessed apathy in a subgroup (n = 325, mean age: 63.8 ± 10.5 years, 91.1% ischemic stroke) of the GRECogVASC cohort using the validated Behavioral Dysexecutive Syndrome Inventory, interpreted using GREFEX criteria, as well as confounding factors (depression, anxiety, severity of the neurological deficit, and gait disorders). mVLSM analysis was used to define neuroimaging determinants and was repeated after controlling for confounding factors. Apathy was present for 120 patients (36.9%, 95% CI: 31.7-42.2). Stepwise linear regression identified three factors associated with apathy: depressive symptoms (R2 = .3, p = .0001), cognitive impairment (R2 = .015, p = .02), and neurological deficit (R2 = .110, p = .0001). Accordingly, only 9 (7.5%) patients had apathy without a confounding factor, i.e., isolated apathy. In conventional VLSM analysis, apathy was associated with a large number of subcortical lesions that were no longer considered after controlling for confounding factors. Strategic site analysis identified five regions associated with isolated apathy: the F3 orbitalis pars, left amygdala, left thalamus, left pallidum, and mesencephalon. mVLSM analysis identified four strategic sites associated with apathy: the right corticospinal tract (R2 = .11; p = .0001), left frontostriatal tract (R2 = .11; p = .0001), left thalamus (R2 = .04; p = .0001), and left amygdala (R2 = .01; p = .013). These regions remained significant after controlling for confounding factors but explained a lower amount of variance. These findings indicate that poststroke apathy is more strongly associated with depression, neurological deficit, and cognitive impairment than with stroke lesions locations, at least using VLSM analysis.
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Affiliation(s)
- Mickael Aubignat
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Martine Roussel
- Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Ardalan Aarabi
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Chantal Lamy
- Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Daniela Andriuta
- Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Sophie Tasseel-Ponche
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France; Departments of Rehabilitation, Amiens University Hospital, Amiens, France
| | - Malek Makki
- Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France.
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22
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Zhang F, Ping Y, Jin X, Hou X, Song J. White matter hyperintensities and post-stroke depression: A systematic review and meta-analysis. J Affect Disord 2023; 320:370-380. [PMID: 36209775 DOI: 10.1016/j.jad.2022.09.166] [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: 09/05/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Post-stroke depression (PSD) is the most common emotional problem following a stroke. White matter hyperintensities (WMHs) are often reported in patients with a stroke, and are often divided into deep WMHs (DWMHs) and periventricular WMHs (PVWMHs). The relationship between WMHs and PSD remains controversial. This review aims to resolve this controversy. METHODS A systematic search of electronic databases was conducted for studies. We extracted the relevant data and evaluated the study quality by using the Newcastle-Ottawa Scale. We pooled odds ratios (OR) for the same type of WMHs that were present in the relevant PSD period. RESULTS 15 studies (n = 4133 patients) met our inclusion criteria. In the acute phase, WMHs, DWMHs, severe WMHs, and severe DWMHs were not significant risk factors for incident depression, but PVWMHs (pooled OR, 1.21; 95 % CI, 1.01-1.44) and severe PVWMHs (pooled OR, 1.72; 95 % CI, 1.12-2.65) had a significant association with PSD. In the subacute phase, DWMHs, DWMHs, and severe WMHs were not significantly associated with PSD, but PVWMHs (pooled OR, 2.44; 95 % CI, 1.25-4.76) showed a significant association with PSD. In the chronic phase, severe PVWMHs had no significant association with PSD, while WMHs (pooled OR, 1.063; 95 % CI, 1.03-1.09), DWMHs (pooled OR, 1.40; 95 % CI, 1.11-1.76), PVWMHs (pooled OR, 1.28; 95 % CI, 1.11-1.48), and severe DWMHs (pooled OR, 1.52; 95 % CI, 1.12-2.05) showed a significant association with PSD. CONCLUSION We found a significant association between WMHs/DWMHs/PVWMHs and PSD in the chronic post-stroke phase. PVWMHs had a stronger correlation with PSD in each period after stroke than WMHs and DWMHs. High-quality prospective studies are still needed to fully resolve this relationship.
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Affiliation(s)
- Feng Zhang
- Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, China; Henan Key Lab of Biological Psychiatry, Henan International Joint Laboratory of Psychiatry and Neuroscience, Xinxiang Medical University, China
| | - Yukun Ping
- Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, China; Henan Key Lab of Biological Psychiatry, Henan International Joint Laboratory of Psychiatry and Neuroscience, Xinxiang Medical University, China
| | - Xuejiao Jin
- Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, China; Henan Key Lab of Biological Psychiatry, Henan International Joint Laboratory of Psychiatry and Neuroscience, Xinxiang Medical University, China
| | - Xiaoli Hou
- General Hospital of Pingmei Shenma Group, Pingdingshan, China
| | - Jinggui Song
- Henan Mental Hospital, The Second Affiliated Hospital of Xinxiang Medical University, China; Henan Key Lab of Biological Psychiatry, Henan International Joint Laboratory of Psychiatry and Neuroscience, Xinxiang Medical University, China.
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23
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Martins-Filho RK, Rodrigues G, da Costa RF, Castro RDS, Zanon Zotin MC, Camilo MR, Pontes-Neto OM. White Matter Hyperintensities and Poststroke Apathy: A Fully Automated MRI Segmentation Study. Cerebrovasc Dis 2022; 52:435-441. [PMID: 36279859 DOI: 10.1159/000526939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 08/15/2022] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Poststroke apathy (PSA) is a common neuropsychiatric disorder that may affect up to 30% of stroke patients. Despite the difficulties of investigating this condition (overlapping with depression, heterogeneity of diagnostic criteria, a small number of studies), some recent diffusion tensor imaging studies have suggested that widespread microstructural white matter (WM) disruption plays a key role in the development of PSA. Therefore, we intended to investigate this hypothesis by evaluating the relationship between WM hyperintensities (WMH) and apathy in patients with cerebrovascular disease. METHODS We studied patients with apathy (n = 7), depression (n = 13), comorbid apathy and depression (n = 13), and controls (n = 20), and we investigated the variables associated with the volume of WMH measured by an automated brain MRI segmentation software. RESULTS The overall prevalence of PSA was 37.7% (pure and comorbid). Patients with apathy presented a higher volume of WMH in comparison to controls. Mini-Mental State Examination (MMSE), NPI-A, and the number of cerebral microbleeds were the only variables associated with WMH. Conversely, NPI-D did not correlate to WMH. DISCUSSION/CONCLUSION This is an exploratory study that supports the view of PSA as a distinct syndrome from PSD mediated mainly by diffuse white matter hyperintensities, which suggests that WM disruption is an important pathway to the development of apathy in stroke patients.
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Affiliation(s)
- Rui Kleber Martins-Filho
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Guilherme Rodrigues
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Raul Ferreira da Costa
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Rodrigo de Souza Castro
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Maria Clara Zanon Zotin
- Department of Neurology, J. Philip Kistler Stroke Research Center, MGH, Boston, Massachusetts, USA
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School, Ribeirão Preto, Brazil
| | - Millene R Camilo
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Octavio M Pontes-Neto
- Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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24
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Li Y, Li HP, Wu MX, Wang QY, Zeng X. Effects of transcranial direct current stimulation for post-stroke depression: A systematic review and meta-analysis. Clin Neurophysiol 2022; 142:1-10. [DOI: 10.1016/j.clinph.2022.07.369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 04/05/2022] [Accepted: 07/09/2022] [Indexed: 12/24/2022]
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25
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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 99mTc-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] [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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26
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Symptomatic plaque enhancement is associated with early-onset post-stroke depression. J Affect Disord 2022; 306:281-287. [PMID: 35337924 DOI: 10.1016/j.jad.2022.03.026] [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: 10/04/2021] [Revised: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The association between imaging features closely associated with symptomatic intracranial atherosclerotic plaques and early-onset post-stroke depression (PSD) is currently unclear. MATERIALS AND METHODS 76 ischemic stroke patients who underwent high-resolution vessel wall magnetic resonance imaging (HR-VWI) were divided into PSD and non-PSD groups according to their DSM-V diagnoses and HAMD-17 scores at 14 days after onset. Clinical data and the imaging features associated with symptomatic plaques (including the enhancement index (EI), remodeling index, and plaque surface irregularity) were compared between groups. Multifactorial logistic regression analysis was used to find independent predictors of early-onset PSD. Spearman rank correlation analysis explores the association between clinical data, symptomatic plaque imaging features, and HAMD-17 in patients. RESULTS The sample comprised 36 patients with early-onset PSD. The symptomatic plaque EI and infarct volume were significantly higher in depressed patients than in patients without depression (P < 0.05). Multivariate logistic regression showed that symptomatic plaque EI could be used as an independent predictor of early-onset PSD after correcting for the confounding factor of infarct volume (OR = 1.034, 95% CI:1.014-1.055, P = 0.001). In the total sample, symptomatic plaque EI, infarct volume, and HAMD-17 had a significant positive correlation with each other (P < 0.05). LIMITATIONS This study focused only on the patients' symptomatic plaques and did not monitor patients' systemic inflammation levels at the time of HR-VWI. CONCLUSIONS The degree of symptomatic plaque enhancement is an independent predictive imaging marker of early-onset PSD and can be used the early diagnosis of early-onset PSD.
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27
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Systemic low-grade inflammation and depressive symptomology at chronic phase of ischemic stroke: The chain mediating role of fibrinogen and neutrophil counts. Brain Behav Immun 2022; 100:332-341. [PMID: 34728390 DOI: 10.1016/j.bbi.2021.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is the most common psychological consequence of stroke. Increased inflammatory markers resulting from ischemic stroke may played an important role in the pathogenesis of depressive symptomology. The present study was conducted to further elucidate the relationship between stroke severity, systemic low-grade inflammation and chronic phase post-stroke depressive symptomology (CP-PSDS). METHODS A total of 897 stroke patients were consecutively recruited in this multicenter prospective cohort study and followed up for 1 year. The analytical sample consisted of 436 patients with ischemic stroke (23.4% female, median age = 57 years) from this cohort. Serum concentrations of inflammatory markers were measured in all 436 patients with ischemic stroke, from fasting morning venous blood samples on admission. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) on admission and post-stroke depressive symptomology (PSDS) was evaluated by 17-item Hamilton Rating Scale for Depression (HRSD). RESULTS In the fully adjusted models, we observed that 1) NIHSS (Model 2: β = 0.200, 95%CI, 0.057 ∼ 0.332), fibrinogen (Model 2: β = 0.828, 95%CI, 0.269 ∼ 1.435), white blood cell counts (WBC, model 2: β = 0.354, 95%CI, 0.122 ∼ 0.577) and neutrophil counts (Model 2: β = 0.401, 95%CI, 0.126 ∼ 0.655) can independently predict the CP-PSDS after ischemic stroke onset; 2) fibrinogen (Indirect effect = 0.027, 95%CI, 0.007 ∼ 0.063, 13.4% mediated), WBC (Indirect effect = 0.024, 95%CI, 0.005 ∼ 0.058, 11.8% mediated) and neutrophil counts (Indirect effect = 0.030, 95%CI, 0.006 ∼ 0.069, 14.8% mediated) could partially mediate the association between stroke severity and CP-PSDS, and 3) stroke severity might cause CP-PSDS partly through the chain-mediating role of both fibrinogen and neutrophil counts (chain mediated effect = 0.003, 95%CI, 0.000 ∼ 0.011, p = 0.025, 1.6% mediated). CONCLUSIONS Findings revealed that fibrinogen, WBC and neutrophil counts may be independent predictors of CP-PSDS and partial mediators of the relationship between stroke severity and CP-PSDS among patients with ischemic stroke. In addition, the chain mediating effect of fibrinogen and neutrophil counts might play an important role in the occurrence of CP-PSDS. However, no inflammatory markers were associated with CP-PSDS in females.
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28
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Thambirajah N, Senanayake S, Gooneratne K, Suraweera C, Ranasinghe L, Kumbukage M. Post-Stroke Depression: Prevalence, Associated Factors, and Relationship to Disability in a Tertiary Care Center in Sri Lanka. J Neurosci Rural Pract 2022; 13:73-79. [PMID: 35110923 PMCID: PMC8803510 DOI: 10.1055/s-0041-1741504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Abstract
Background and Objectives The prevalence of stroke in urban Sri Lanka is estimated at 10.4 per 1000 and is expected to rise. Post-stroke depression (PSD) is an independent predictor of poor long-term outcomes. It leads to suboptimal rehabilitation, decreased quality of life, and increased mortality and is under-recognized. The main objectives of this study were to estimate the prevalence of depression in stroke, assess factors associated with PSD, and assess the relationship of PSD to disability.
Materials and Methods A descriptive cross-sectional study was conducted at the Neurology and Medical Ward, National Hospital of Sri Lanka. Non-probability, consecutive sampling was used to collect data from patients with ischemic stroke admitted from January 2019 to January 2020. Patients with significant pre-existing depression, cognitive impairment, and language deficits were excluded. A structured, pre-tested interviewer-administered questionnaire was used to assess the prevalence and associated factors of PSD. Beck's Depression Inventory (BDI) was administered 3 months following the stroke to screen for depression. Modified Rankin Score (MRS) was used to assess disability on admission, discharge, and at 3 months.
Results Eighty-one stroke patients were screened. The mean age was 66.6 years (±standard deviation [SD]: 12.5). Male:female ratio was 1.2:1. Depression at 3 months of follow-up was observed in 35.8% (95% confidence interval [CI]: 25.4–47.2%) of participants. Following bivariate analysis, large vessel stroke (p < 0.001), cortical stroke (p < 0.001), frontal lobe lesions (p < 0.001), history of past stroke (p = 0.014), and sexual dysfunction (p = 0.026) were associated with increased risk of PSD. The odds of a person with severe disability developing PSD was 7.9 times more than a person with a less severe disability at discharge from hospital and at 3 months of follow-up (odds ratio [OR] =7.9; 95% CI: 2.7–23.3, p = 0.000).
Conclusions PSD occurs in one-third of strokes, keeping with previous studies. The risk of having PSD is higher among patients with severe disabilities. The difference in risk factors identified compared with previous studies can be attributable to differences in methodology. Identifying risk factors for post-stroke depression is essential to mitigate the poor outcome.
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Affiliation(s)
| | - Sunethra Senanayake
- National Hospital Sri Lanka, District General Hospital Hambanthota, Faculty of Medicine, University of Moratuwa, Moratuwa, Sri Lanka
| | - Kishara Gooneratne
- National Hospital Sri Lanka, District General Hospital Hambanthota, Faculty of Medicine, University of Moratuwa, Moratuwa, Sri Lanka
| | - Chaturi Suraweera
- Department of Psychiatry, Faculty of Medicine, National Hospital of Sri Lanka, University of Colombo, Colombo, Sri Lanka
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29
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Gu S, He Z, Xu Q, Dong J, Xiao T, Liang F, Ma X, Wang F, Huang JH. The Relationship Between 5-Hydroxytryptamine and Its Metabolite Changes With Post-stroke Depression. Front Psychiatry 2022; 13:871754. [PMID: 35558423 PMCID: PMC9086784 DOI: 10.3389/fpsyt.2022.871754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 03/02/2022] [Indexed: 12/14/2022] Open
Abstract
Post-stroke depression (PSD) is the most common and serious sequelae of stroke. Approximately 33% of stroke survivors were affected by PSD. However, many issues (e.g., incidence, diagnostic marker, and risk factor) related to PSD remained unclear. The "monoamine hypothesis" is a significant hypothesis for depression, which suggests that three monoamines play a key role in depression. Therefore, most current antidepressants are developed to modulate the monoamines on PSD treatment, and these antidepressants have good effects on patients with PSD. However, the potential mechanisms of three monoamines in PSD are still unclear. Previously, we proposed "three primary emotions," which suggested a new model of basic emotions based on the three monoamines. It may provide a new way for PSD treatment. In addition, recent studies have found that monoamine-related emotional intervention also showed potential effects in the treatment and prevention of PSD. This study discusses these issues and attempts to provide a prospect for future research on PSD.
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Affiliation(s)
- Simeng Gu
- Department of Psychology, Jiangsu University Medical School, Zhenjiang, China.,Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Zhengming He
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Qiuyue Xu
- Department of Nurse, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jie Dong
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Tingwei Xiao
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Fei Liang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Xianjun Ma
- Section of Brain Diseases, Department of Neurology, Lianyungang Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Lianyungang, China
| | - Fushun Wang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, TX, United States.,Department of Surgery, Texas A&M University College of Medicine, Temple, TX, United States
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30
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Jaywant A, DelPonte L, Kanellopoulos D, O'Dell MW, Gunning FM. The Structural and Functional Neuroanatomy of Post-Stroke Depression and Executive Dysfunction: A Review of Neuroimaging Findings and Implications for Treatment. J Geriatr Psychiatry Neurol 2022; 35:3-11. [PMID: 33073704 DOI: 10.1177/0891988720968270] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Post-stroke depression and executive dysfunction co-occur and are highly debilitating. Few treatments alleviate both depression and executive dysfunction after stroke. Understanding the brain network changes underlying post-stroke depression with executive dysfunction can inform the development of targeted and efficacious treatment. In this review, we synthesize neuroimaging findings in post-stroke depression and post-stroke executive dysfunction and highlight the network commonalities that may underlie this comorbidity. Structural and functional alterations in the cognitive control network, salience network, and default mode network are associated with depression and executive dysfunction after stroke. Specifically, post-stroke depression and executive dysfunction are both linked to changes in intrinsic functional connectivity within resting state networks, functional over-connectivity between the default mode and salience/cognitive control networks, and reduced cross-hemispheric frontoparietal functional connectivity. Cognitive training and noninvasive brain stimulation targeted at these brain network abnormalities and specific clinical phenotypes may help advance treatment for post-stroke depression with executive dysfunction.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Larissa DelPonte
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY, USA
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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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Altered resting-state functional connectivity of the frontal-striatal circuit in elderly with apathy. PLoS One 2021; 16:e0261334. [PMID: 34898646 PMCID: PMC8668136 DOI: 10.1371/journal.pone.0261334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
Apathy is defined as reduction of goal-directed behaviors and a common nuisance syndrome of neurodegenerative and psychiatric disease. The underlying mechanism of apathy implicates changes of the front-striatal circuit, but its precise alteration is unclear for apathy in healthy aged people. The aim of our study is to investigate how the frontal-striatal circuit is changed in elderly with apathy using resting-state functional MRI. Eighteen subjects with apathy (7 female, 63.7 ± 3.0 years) and eighteen subjects without apathy (10 female, 64.8 ± 3.0 years) who underwent neuropsychological assessment and MRI measurement were recruited. We compared functional connectivity with/within the striatum between the apathy and non-apathy groups. The seed-to-voxel group analysis for functional connectivity between the striatum and other brain regions showed that the connectivity was decreased between the ventral rostral putamen and the right dorsal anterior cingulate cortex/supplementary motor area in the apathy group compared to the non-apathy group while the connectivity was increased between the dorsal caudate and the left sensorimotor area. Moreover, the ROI-to-ROI analysis within the striatum indicated reduction of functional connectivity between the ventral regions and dorsal regions of the striatum in the apathy group. Our findings suggest that the changes in functional connectivity balance among different frontal-striatum circuits contribute to apathy in elderly.
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Chun HYY, Ford A, Kutlubaev MA, Almeida OP, Mead GE. Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence. Stroke 2021; 53:1402-1410. [PMID: 34865508 DOI: 10.1161/strokeaha.121.035499] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression and anxiety each affect around 1 in 3 people during the first year after a stroke. Suicide causes the death of about 3 to 4/1000 stroke survivors during the first 5 years. This narrative review describes the best available evidence for the epidemiology of depression, anxiety, and suicide; their prevention; and the treatment of anxiety and depression. We conclude with directions for future research.
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Affiliation(s)
| | - Andrew Ford
- University of Western Australia, Australia (A.F., O.P.A.)
| | | | | | - Gillian E Mead
- University of Edinburgh, United Kingdom (H.-Y.Y.C., G.E.M.)
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Stuckey SM, Ong LK, Collins-Praino LE, Turner RJ. Neuroinflammation as a Key Driver of Secondary Neurodegeneration Following Stroke? Int J Mol Sci 2021; 22:ijms222313101. [PMID: 34884906 PMCID: PMC8658328 DOI: 10.3390/ijms222313101] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 01/13/2023] Open
Abstract
Ischaemic stroke involves the rapid onset of focal neurological dysfunction, most commonly due to an arterial blockage in a specific region of the brain. Stroke is a leading cause of death and common cause of disability, with over 17 million people worldwide suffering from a stroke each year. It is now well-documented that neuroinflammation and immune mediators play a key role in acute and long-term neuronal tissue damage and healing, not only in the infarct core but also in distal regions. Importantly, in these distal regions, termed sites of secondary neurodegeneration (SND), spikes in neuroinflammation may be seen sometime after the initial stroke onset, but prior to the presence of the neuronal tissue damage within these regions. However, it is key to acknowledge that, despite the mounting information describing neuroinflammation following ischaemic stroke, the exact mechanisms whereby inflammatory cells and their mediators drive stroke-induced neuroinflammation are still not fully understood. As a result, current anti-inflammatory treatments have failed to show efficacy in clinical trials. In this review we discuss the complexities of post-stroke neuroinflammation, specifically how it affects neuronal tissue and post-stroke outcome acutely, chronically, and in sites of SND. We then discuss current and previously assessed anti-inflammatory therapies, with a particular focus on how failed anti-inflammatories may be repurposed to target SND-associated neuroinflammation.
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Affiliation(s)
- Shannon M. Stuckey
- Discipline of Anatomy and Pathology, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide 5005, Australia; (S.M.S.); (L.E.C.-P.)
| | - Lin Kooi Ong
- School of Pharmacy, Monash University Malaysia, Subang Jaya 47500, Malaysia;
- School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan 2308, Australia
| | - Lyndsey E. Collins-Praino
- Discipline of Anatomy and Pathology, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide 5005, Australia; (S.M.S.); (L.E.C.-P.)
| | - Renée J. Turner
- Discipline of Anatomy and Pathology, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide 5005, Australia; (S.M.S.); (L.E.C.-P.)
- Correspondence: ; Tel.: +61-8-8313-3114
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Avadhani R, Thompson RE, Carhuapoma L, Yenokyan G, McBee N, Lane K, Ostapkovich N, Stadnik A, Awad IA, Hanley DF, Ziai WC. Post-Stroke Depression in Patients with Large Spontaneous Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2021; 30:106082. [PMID: 34517296 PMCID: PMC8532502 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106082] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/30/2021] [Accepted: 08/24/2021] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES To determine factors associated with post-stroke depression (PSD) and relationship between PSD and functional outcomes in spontaneous intracerebral hemorrhage (ICH) using prospective data from a large clinical trial. MATERIALS AND METHODS MISTIE III, a randomized, multicenter, placebo-controlled trial, was conducted to determine if minimally invasive surgery with thrombolysis improves outcome compared to standard medical care. Our primary outcome was post-stroke depression at 180 days. Secondary outcomes were change in blinded assessment of modified Rankin Scale (mRS) from 30 to 180 days, and from 180 to 365 days. Logistic regression models were used to assess the relationship between PSD and outcomes. RESULTS Among 379 survivors at day 180, 308 completed Center for Epidemiologic Studies Depression Scale, of which 111 (36%) were depressed. In the multivariable analysis, female sex (Adjusted Odds Ratio [AOR], 95% Confidence Interval [CI]: 1.93 [1.07-3.48]), Hispanic ethnicity (3.05 [1.19-7.85]), intraventricular hemorrhage (1.88 [1.02-3.45]), right-sided lesions (3.00 [1.43-6.29]), impaired mini mental state examination at day 30 (2.50 [1.13-5.54]), and not being at home at day 30 (3.17 [1.05-9.57]) were significantly associated with higher odds of PSD. Patients with PSD were significantly more likely to have unchanged or worsening mRS from day 30 to 180 (42.3% vs. 25.9%; p=0.004), but not from day 180 to 365. CONCLUSIONS We report high burden of PSD in patients with large volume ICH. Impaired cognition and not living at home may be more important than physical limitations in predicting PSD. Increased screening of high-risk post-stroke patients for depression, especially females and Hispanics may be warranted.
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Affiliation(s)
- Radhika Avadhani
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard E Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lourdes Carhuapoma
- Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nichol McBee
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Karen Lane
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Noeleen Ostapkovich
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Agnieszka Stadnik
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Issam A Awad
- Department of Neurosurgery, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Daniel F Hanley
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wendy C Ziai
- Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Neurocritical Care, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Li Z, Xu H, Xu Y, Lu G, Peng Q, Chen J, Bi R, Li J, Chen S, Li H, Jin H, Hu B. Morinda officinalis oligosaccharides alleviate depressive-like behaviors in post-stroke rats via suppressing NLRP3 inflammasome to inhibit hippocampal inflammation. CNS Neurosci Ther 2021; 27:1570-1586. [PMID: 34559953 PMCID: PMC8611777 DOI: 10.1111/cns.13732] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 09/11/2021] [Accepted: 09/11/2021] [Indexed: 01/14/2023] Open
Abstract
Aims Morinda officinalis oligosaccharides (MOOs), a traditional Chinese medicine, have been used to treat mild and moderate depressive episodes. In this study, we investigated whether MOOs can ameliorate depressive‐like behaviors in post‐stroke depression (PSD) rats and further explored its mechanism by suppressing microglial NLRP3 inflammasome activation to inhibit hippocampal inflammation. Methods Behavioral tests were performed to evaluate the effect of MOOs on depressive‐like behaviors in PSD rats. The effects of MOOs on the expression of IL‐18, IL‐1β, and nucleotide‐binding domain leucine‐rich repeat (NLR) family pyrin domain containing 3 (NLRP3) inflammasome were measured in both PSD rats and lipopolysaccharide (LPS) and adenosine triphosphate (ATP) stimulated primary rat microglia by reverse transcription polymerase chain reaction (RT‐PCR), immunofluorescence and Western blot analysis. Adeno‐associated virus (AAV) was injected into the hippocampus to regulate NLRP3 inflammasome expression. The detailed molecular mechanism underlying the effects of MOOs was analyzed by Western blot and immunofluorescence. Results MOOs can alleviate depressive‐like behaviors in PSD rats. PSD rats showed increased expression of IL‐18, IL‐1β, and NLRP3 inflammasome in the ischemic hippocampus, while MOOs reversed the elevation. NLRP3 downregulation ameliorated depressive‐like behaviors and hippocampal inflammation response in PSD rats, while NLRP3 upregulation inhibited the effect of MOOs on depressive‐like behaviors and hippocampal inflammation response in PSD rats. Moreover, we found that NLRP3 was mainly expressed on microglia. In vitro, MOOs effectively inhibited the expression of IL‐18, IL‐1β, and NLRP3 inflammasome in LPS + ATP treated primary rat microglia. We also showed that modulation of NLRP3 inflammasome by MOOs was associated with the IκB/NF‐κB p65 signaling pathway. Conclusion Overall, our study reveals the antidepressive effect of MOOs on PSD rats through modulation of microglial NLRP3 inflammasome. We also provide a novel insight into hippocampal inflammation response in PSD pathology and put forward NLRP3 inflammasome as a potential therapeutic target for PSD.
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Affiliation(s)
- Zhifang Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hexiang Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Xu
- Institute of Science, Beijing Tongrentang Co., Ltd., Beijing, China
| | - Guanfeng Lu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiwei Peng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiefang Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rentang Bi
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianzhuang Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shengcai Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongkai Li
- Institute of Science, Beijing Tongrentang Co., Ltd., Beijing, China
| | - Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Weaver NA, Lim JS, Schilderinck J, Biessels GJ, Kang Y, Kim BJ, Kuijf HJ, Lee BC, Lee KJ, Yu KH, Bae HJ, Biesbroek JM. Strategic Infarct Locations for Poststroke Depressive Symptoms: A Lesion- and Disconnection-Symptom Mapping Study. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 8:387-396. [PMID: 34547548 DOI: 10.1016/j.bpsc.2021.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Depression is the most common neuropsychiatric complication after stroke. Infarct location is associated with poststroke depressive symptoms (PSDS), but it remains debated which brain structures are critically involved. We performed a large-scale lesion-symptom mapping study to identify infarct locations and white matter disconnections associated with PSDS. METHODS We included 553 patients (mean [SD] age = 69 [11] years, 42% female) with acute ischemic stroke. PSDS were measured using the 30-item Geriatric Depression Scale. Multivariable support vector regression (SVR)-based analyses were performed both at the level of individual voxels (voxel-based lesion-symptom mapping) and at predefined regions of interest to relate infarct location to PSDS. We externally validated our findings in an independent stroke cohort (N = 459). Finally, disconnectome-based analyses were performed using SVR voxel-based lesion-symptom mapping, in which white matter fibers disconnected by the infarct were analyzed instead of the infarct itself. RESULTS Infarcts in the right amygdala, right hippocampus, and right pallidum were consistently associated with PSDS (permutation-based p < .05) in SVR voxel-based lesion-symptom mapping and SVR region-of-interest analyses. External validation confirmed the association between infarcts in the right amygdala and pallidum, but not the right hippocampus, and PSDS. Disconnectome-based analyses revealed that disconnections in the right parahippocampal white matter, right thalamus and pallidum, and right anterior thalamic radiation were significantly associated (permutation-based p < .05) with PSDS. CONCLUSIONS Infarcts in the right amygdala and pallidum and disconnections of right limbic and frontal cortico-basal ganglia-thalamic circuits are associated with PSDS. Our findings provide a comprehensive and integrative picture of strategic infarct locations for PSDS and shed new light on pathophysiological mechanisms of depression after stroke.
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Affiliation(s)
- Nick A Weaver
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, Seoul, Republic of Korea
| | - Janniek Schilderinck
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yeonwook Kang
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym Neurological Institute, College of Medicine, Hallym University, Anyang, Republic of Korea; Department of Psychology, Hallym University, Chuncheon, Republic of Korea
| | - Beom Joon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hugo J Kuijf
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym Neurological Institute, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Hallym Neurological Institute, College of Medicine, Hallym University, Anyang, Republic of Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - J Matthijs Biesbroek
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Hartikainen KM. Emotion-Attention Interaction in the Right Hemisphere. Brain Sci 2021; 11:1006. [PMID: 34439624 PMCID: PMC8394055 DOI: 10.3390/brainsci11081006] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 11/16/2022] Open
Abstract
Hemispheric asymmetries in affective and cognitive functions have been extensively studied. While both cerebral hemispheres contribute to most affective and cognitive processes, neuroscientific literature and neuropsychological evidence support an overall right hemispheric dominance for emotion, attention and arousal. Emotional stimuli, especially those with survival value such as threat, tend to be prioritized in attentional resource competition. Arousing unpleasant emotional stimuli have prioritized access, especially to right-lateralized attention networks. Interference of task performance may be observed when limited resources are exhausted by task- and emotion-related processing. Tasks that rely on right hemisphere-dependent processing, like attending to the left visual hemifield or global-level visual features, are especially vulnerable to interference due to attention capture by unpleasant emotional stimuli. The aim of this review is to present literature regarding the special role of the right hemisphere in affective and attentional brain processes and their interaction. Furthermore, clinical and technological implications of this interaction will be presented. Initially, the effects of focal right hemisphere lesion or atrophy on emotional functions will be introduced. Neurological right hemisphere syndromes including aprosodia, anosognosia and neglect, which further point to the predominance of the intact right hemisphere in emotion, attention and arousal will be presented. Then there will be a brief review of electrophysiological evidence, as well as evidence from patients with neglect that support attention capture by emotional stimuli in the right hemisphere. Subsequently, experimental work on the interaction of emotion, attention and cognition in the right hemispheres of healthy subjects will be presented. Finally, clinical implications for better understanding and assessment of alterations in emotion-attention interaction due to brain disorder or treatment, such as neuromodulation, that impact affective brain functions will be discussed. It will be suggested that measuring right hemispheric emotion-attention interactions may provide basis for novel biomarkers of brain health. Such biomarkers allow for improved diagnostics in brain damage and disorders and optimized treatments. To conclude, future technological applications will be outlined regarding brain physiology-based measures that reflect engagement of the right hemisphere in affective and attentional processes.
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Affiliation(s)
- Kaisa M. Hartikainen
- Behavioral Neurology Research Unit, Tampere University Hospital, 33521 Tampere, Finland; or
- Faculty of Medicine and Health Technology, Tampere University, 33520 Tampere, Finland
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Rabat Y, Houeze R, Sagnier S, Olindo S, Poli M, Debruxelles S, Renou P, Rouanet F, Berthoz S, Sibon I. Association between neurological outcome and poststroke comorbid mood and anxiety disorders: A real-life experience. Brain Behav 2021; 11:e02158. [PMID: 33951353 PMCID: PMC8213928 DOI: 10.1002/brb3.2158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Poststroke depression (PSD) and anxiety (PSA) are prevalent and have a strong impact on functional outcome. Beside stroke severity, little is known on their clinical determinants. This study investigated the association between stroke mechanism, neurological poststroke complications and remaining vascular risk factors and the presence of comorbid PSD and PSA, termed poststroke emotional distress (PSED). METHODS This was a retrospective analysis of a prospectively compiled medical records database of consecutive patients evaluated during a follow-up visit 3- to 4-month poststroke. HAD scale was used to define PSED category (PSD+PSA vs. NoPSD+NoPSA). Stroke mechanism and poststroke complications were identified clinically or using appropriate scales. Their association with PSED was tested using a multivariate logistic regression model. RESULTS The sample included 2,300 patients (male: 64.8%); 19% had a PSED and 56.39% were free of any depression or anxiety. The most frequent poststroke complications were fatigue/fatigability (58.4%), sleep problems (26.7%), and pain (20.4%). While no association was observed between PSED and stroke mechanism, higher functional disability (OR:1.572), lower cognitive abilities (OR:0.953), sleep problems (OR:2.334), pain (OR:1.478), fatigue/fatigability (OR:2.331), and abnormal movements (OR:2.380) were all independent risk factors. Persisting tobacco consumption (OR:1.360) was the only vascular significant risk factor. CONCLUSIONS The frequency of comorbid PSED remains high (1/5 patient) despite improved awareness of these conditions. The association between poststroke complications and the presence of PSED emphasizes the need for standardized neurological and psychological evaluations at follow-up. These results foster the need to improve the management of addictive behaviors to reduce the burden of PSED.
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Affiliation(s)
- Yolaine Rabat
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France
| | - Richard Houeze
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France.,Centre Hospitalier de la Police Républicaine, Cotonou, Bénin
| | - Sharmila Sagnier
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France.,CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | - Stephane Olindo
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | - Mathilde Poli
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | | | - Pauline Renou
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | - François Rouanet
- CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
| | - Sylvie Berthoz
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France.,Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
| | - Igor Sibon
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, France.,CHU Bordeaux, Stroke Unit, Department of Neurology, Bordeaux, France
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Wijeratne T, Sales C. Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression. J Clin Med 2021; 10:jcm10081674. [PMID: 33919670 PMCID: PMC8069768 DOI: 10.3390/jcm10081674] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions.
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Affiliation(s)
- Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne 3000, Australia
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapura 50000, Sri Lanka
- Correspondence:
| | - Carmela Sales
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
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Lopatkiewicz AM, Pera J, Slowik A, Dziedzic T. Early apathetic, but not depressive, symptoms are associated with poor outcome after stroke. Eur J Neurol 2021; 28:1949-1957. [PMID: 33619849 DOI: 10.1111/ene.14785] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Depression and apathy are frequent neuropsychiatric disturbances after stroke and may appear together. Despite the overlap in symptoms between poststroke depression and apathy, these two syndromes might be associated with different prognoses and benefit from different treatments. We aimed to disentangle the relationship between early depressive and apathetic symptoms and outcome after stroke. METHODS Of 698 enrolled patients with ischemic stroke, we included 443 participants (median age = 69 years, 51% female) who underwent depressive and apathetic symptom assessment on Day 8 after stroke. We divided patients into four groups: without greater depressive and apathetic symptoms (Group 1), with only apathetic symptoms (Group 2), with only depressive symptoms (Group 3), and with both depressive and apathetic symptoms (Group 4). RESULTS After adjusting for age and stroke severity, Group 2 and Group 4 had an increased risk of poor 3-month outcome (odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.16-3.38, p = 0.01 and OR = 1.58, 95% CI = 1.24-2.01, p < 0.01, respectively). Group 2 and Group 4 also had an increased risk of poor 12-month outcome (OR = 3.85, 95% CI = 2.19-6.78, p < 0.01 and OR = 1.54, 95% CI = 1.22-1.96, p < 0.01, respectively) and mortality (hazard ratio [HR] = 2.76, 95% CI = 1.19-6.41, p = 0.02 and HR = 1.77, 95% CI = 1.32-2.38, p < 0.01, respectively). Compared with Group 1, Group 3 did not have an increased risk of unfavorable outcomes. CONCLUSIONS Early apathetic, but not depressive, symptoms are related to worse outcomes after stroke. Our study underscores the importance of recognizing apathetic symptoms independently from depressive symptoms.
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Affiliation(s)
| | - Joanna Pera
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
| | - Tomasz Dziedzic
- Department of Neurology, Jagiellonian University Medical College, Krakow, Poland
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Abstract
Apathy is a reduction in goal-directed activity in the cognitive, behavioral, emotional, or social domains of a patient’s life and occurs in one out of three patients after stroke. Despite this, apathy is clinically under-recognized and poorly understood. This overview provides a contemporary introduction to apathy in stroke for researchers and practitioners, covering topics including diagnosis, neurobiological mechanisms, associated consequences, and potential treatments for apathy. Apathy is often misdiagnosed as other post-stroke conditions such as depression. Accurate differential diagnosis of apathy, which manifests as reductions in initiative, and depression, which manifests as negative emotionality, is important as it informs prognosis. Research on the neurobiology of apathy suggests that there are few consistent associations between stroke lesion location and the development of apathy. These may be resolved by adopting a network neuroscience approach, which models apathy as a pathology arising from structural or functional damage to brain networks underlying motivated behavior. Importantly, networks can be affected by physiological changes related to stroke, including the acute infarct but also diaschisis and neurodegeneration. Aside from neurobiological changes, apathy is also associated with other negative outcome measures such as functional disability, cognitive impairment, and emotional distress, suggesting that apathy is indicative of a worse prognosis following stroke. Unfortunately, high-quality trials aimed at treating apathy are scarce. Antidepressants may have limited effects on apathy. Acetylcholine and dopamine pharmacotherapy, behavioral interventions, and transcranial magnetic stimulation may be more promising avenues for treatment.
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Affiliation(s)
- Jonathan Tay
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Robin G Morris
- Department of Psychology, King's College London, London, UK
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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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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López-Espuela F, Roncero-Martín R, Canal-Macías MDLL, Moran JM, Vera V, Gomez-Luque A, Lendinez-Mesa A, Pedrera-Zamorano JD, Casado-Naranjo I, Lavado-García J. Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249542. [PMID: 33419273 PMCID: PMC7766010 DOI: 10.3390/ijerph17249542] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We aimed to know the prevalence of post-stroke depression (PSD) in our context, identify the variables that could predict post-stroke depression, by using the Hamilton Depression Rating Scale, occurring within six months after stroke, and identify patients at high risk for PSD. Methods: descriptive, cross-sectional and observational study. We included 173 patients with stroke (transient ischemic attack (TIA) included) and collected sociodemographic and clinical variables. We used the Hamilton Depression Scale (HDS) for depression assessment and Barthel Index and modified Rankin Scale (mRS) for functional assessment. The neurological severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Results: 35.5% were women, aged 71.16 (±12.3). Depression was present in 42.2% patients (n = 73) at six months after stroke. The following variables were significantly associated with PSD: diagnosis of previous depression (p = 0.005), the modified Rankin Scale at discharge (p = 0.032) and length of hospital stay (p = 0.012). Conclusion: PSD is highly prevalent after stroke and is associated with the severity, left location of the stroke, and the degree of disability at discharge. Its impact justifies the evaluation and early treatment that still continues to be a challenge today.
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Affiliation(s)
- Fidel López-Espuela
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Raúl Roncero-Martín
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Maria de la Luz Canal-Macías
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
- Correspondence: ; Tel.: +34-927257450
| | - Jose M. Moran
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Vicente Vera
- Department of Stomatology II, School of Dentistry, Complutense University, 28040 Madrid, Spain;
| | - Adela Gomez-Luque
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Alejandro Lendinez-Mesa
- Nursing Department, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - Juan Diego Pedrera-Zamorano
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | | | - Jesus Lavado-García
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
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Nakamori M, Imamura E, Tachiyama K, Kamimura T, Hayashi Y, Matsushima H, Okamoto H, Mizoue T, Wakabayashi S. Patient Health Questionnaire-9 predicts the functional outcome of stroke patients in convalescent rehabilitation ward. Brain Behav 2020; 10:e01856. [PMID: 32951302 PMCID: PMC7749590 DOI: 10.1002/brb3.1856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Poststroke depression (PSD) negatively affects the functional outcome of stroke patients. Patient Health Questionnaire-9 (PHQ-9) is a validated screening tool for detecting PSD. This study investigated the relationship between PHQ-9 score and functional outcomes in stroke patients in a convalescent rehabilitation ward by evaluating functional independence measure (FIM) gain scores and the proportion of patients discharged. METHODS In this retrospective study conducted from January 2017 to September 2019, consecutive stroke patients who were admitted to the convalescent rehabilitation ward and could answer PHQ-9 were assessed. The association between PHQ-9 scores at the time of admission to the convalescent rehabilitation ward and outcomes (FIM gain score and the proportion of patients discharged) was statistically analyzed. RESULTS Among the 215 patients enrolled in the study, 62 (28.8%) were assessed as having depression, in whom PHQ-9 scores were 5 or above. Multivariate analysis revealed that the PHQ-9 score on admission to the convalescent rehabilitation ward was a significant independent factor influencing the FIM gain score (p = .009). In addition, a multivariate analysis revealed that the PHQ-9 score at the time of admission to the convalescent rehabilitation ward was a significant independent factor influencing the inability to discharge a patient (odds ratio 1.24, 95% confidence interval 1.12-1.39, p < .001). CONCLUSIONS The PHQ-9 score is a useful tool for predicting patient functional outcome, admission to the facility, and screening for poststroke depression.
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Affiliation(s)
- Masahiro Nakamori
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.,Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Keisuke Tachiyama
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.,Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Teppei Kamimura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.,Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuki Hayashi
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan.,Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hayato Matsushima
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Hiroyuki Okamoto
- Department of Rehabilitation, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
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Medeiros GC, Prueitt WL, Minhajuddin A, Patel SS, Czysz AH, Furman JL, Mason BL, Rush AJ, Jha MK, Trivedi MH. Childhood maltreatment and impact on clinical features of major depression in adults. Psychiatry Res 2020; 293:113412. [PMID: 32950785 DOI: 10.1016/j.psychres.2020.113412] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study examined: 1) the prevalence of childhood maltreatment (CMT) in individuals with chronic and/or recurrent depression, 2) the association between CMT and depressive symptoms, 3) the link between CMT and worse clinical presentation of depression, 4) the effects of accumulation of different types of CMT, and 5) the relationship between the age at CMT and depression. METHODS We analyzed the baseline data of 663 individuals from the CO-MED study. CMT was determined by a brief self-reported questionnaire assessing sexual abuse, emotional abuse, physical abuse, and neglect. Correlational analyses were conducted. RESULTS Half of the sample (n = 331) reported CMT. Those with CMT had higher rates of panic/phobic, cognitive and anhedonic symptoms than those without CMT. All individual types of maltreatment were associated with a poorer clinical presentation including: 1) earlier MDD onset; 2) more severe MDD, 3) more suiccidality, 4) worse quality of life, and functioning, and 5) more psychiatric comorbidities. Clinical presentation was worse in participants who reported multiple types of CMT. CONCLUSIONS In chronic and/or recurrent depression, CMT is common, usually of multiple types and is associated with a worse clinical presentation in MDD. The combination of multiple types of CMT is associated with more impairment.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - William L Prueitt
- Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Abu Minhajuddin
- Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Shirali S Patel
- Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Andrew H Czysz
- Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Jennifer L Furman
- Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - Brittany L Mason
- Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA
| | - A John Rush
- Duke-National University of Singapore, Singapore; Department of Psychiatry, Duke University Medical School, Durham, NC, USA; Department of Psychiatry, Texas Tech Health Science Center, Permian Basin, TX, USA
| | - Manish K Jha
- Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Madhukar H Trivedi
- Department of Psychiatry, Peter O'Donnell Jr. Brain Institute, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9070, USA.
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Lobar microbleeds are associated with cognitive impairment in patients with lacunar infarction. Sci Rep 2020; 10:16410. [PMID: 33009480 PMCID: PMC7532194 DOI: 10.1038/s41598-020-73404-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 09/04/2020] [Indexed: 11/28/2022] Open
Abstract
Associations between cognitive decline and cerebral microbleeds (CMBs) have received increasing attention. An association between CMB distribution (deep or lobar) and cognitive decline has been reported, but these findings are controversial. We investigated the association between magnetic resonance imaging (MRI) findings, including CMBs, and cognitive function in patients with first-ever lacunar infarction. We retrospectively included consecutive patients admitted with first-ever lacunar infarction identified by MRI from July 1, 2011, to December 31, 2018. We excluded patients diagnosed with dementia, including strategic single-infarct dementia, before or after the onset of stroke. The Mini-Mental State Examination (MMSE) was performed within 3 days of admission. We searched the records of 273 patients (age 72.0 ± 11.2 years, 95 females). The median MMSE score was 27 (interquartile range 25.5–29). In a univariate analysis, the MMSE score was associated with age, body mass index (BMI), education, dyslipidemia, chronic kidney disease (CKD), periventricular hyperintensity, medial temporal atrophy, lobar CMBs, and mixed CMBs (p < 0.20). The lacunar infarction location was not associated with the MMSE score. In a multivariate analysis of these factors, lobar CMBs (p < 0.001) and mixed CMBs (p = 0.008) were independently associated with the MMSE score. Lobar CMBs were associated with cognitive impairment.
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49
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Medeiros GC, Roy D, Kontos N, Beach SR. Post-stroke depression: A 2020 updated review. Gen Hosp Psychiatry 2020; 66:70-80. [PMID: 32717644 DOI: 10.1016/j.genhosppsych.2020.06.011] [Citation(s) in RCA: 204] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Post-stroke depression (PSD) is common and associated with higher mortality, poorer recovery, more pronounced cognitive deficits, and lower quality of life than is stroke without depression. This manuscript will conduct an updated, comprehensive and clinically-useful review of the risk factors, pathophysiology, assessment, prevention, and treatment of PSD. METHODS This narrative review summarizes articles obtained on PubMed, Medline, EMBase, Google Scholar and the Cochrane Database. This review prioritized articles with a more robust level of evidence, such as original articles with longitudinal data and/or larger samples, randomized controlled trials, systematic reviews, and metaanalyses. RESULTS One hundred twenty-four articles were reviewed, of which 44 (35%) were published before 2016 and 80 (65%) that were published since 2016. DISCUSSION Rates of PSD range from 18 to 33%, yet it is vastly underdiagnosed and undertreated. Risk factors for PSD include female sex, history of psychiatric illness, large or multiple strokes, injuries in frontal/anterior areas or in the basal ganglia, stroke occurrence within the past year, poor social support, and pronounced disability. The pathophysiology of PSD is multifactorial and likely involves decreased levels of monoamines, abnormal neurotrophic response, increased inflammation with dysregulation of hypothalamic-pituitary-adrenal axis, and glutamate-mediated excitotoxicity. The evidence for preventive interventions for PSD is somewhat inconsistent and modest. The best treatment for PSD consists of the combination of pharmacological, psychosocial and stroke-focused interventions. CONCLUSION PSD is a common, treatable condition that is associated with several negative outcomes. Early detection and proper management are critical to obtain better outcomes in individuals with PSD.
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Affiliation(s)
- Gustavo C Medeiros
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA; Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Durga Roy
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas Kontos
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
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50
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Lin C, Babiker A, Srdanovic N, Kocherginsky M, Harvey RL. Depressive symptoms after stroke are associated with worse recovery. Int J Psychiatry Med 2020; 55:227-238. [PMID: 32050815 DOI: 10.1177/0091217420905459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE More studies are needed on how depressive symptoms in stroke patients can impact outcomes. We evaluated the relationship between depression symptom severity and motor outcomes in a cohort of patients with motor impairment from ischemic stroke. METHOD We enrolled consecutive ischemic stroke patients without a clinical diagnosis of depression who presented to a single-center urban academic referral hospital. The Patient Health Questionnaire-9 (PHQ-9) scale was used to measure depression symptom severity at three months. Three assessments of motor function were collected at stroke onset and three months: Fugl-Meyer upper extremity (FM-UE), Motricity Index, and Action Research Arm Test (ARAT). We assessed the association between three-month severity on PHQ-9 scores with the outcome measures using univariable and multivariable linear regression models. RESULTS Fifty-seven patients (mean age 67.8 ± 17.0 years; 50.9% male; 59.6% Caucasian) were included in the final analysis. Mean (standard deviation) outcome scores at three months were PHQ-9: 6.39 (5), Motricity Index: 86.93 (30.04), FM-UE: 52.67 (17.83), and ARAT: 43.77 (20.03). After adjusting for age, initial National Institute of Health Stroke Scale, and if patient discharged after hospitalization on a selective serotonin reuptake inhibitor, sex, and baseline motor outcome, we found that for every point increase in PHQ-9, the Motricity Index decreased by 0.82 points (p = 0.02) and the FM-UE decreased by 0.77 points (p = 0.049). CONCLUSION Depressive symptoms are common in the stroke population. Depressive symptoms after stroke are associated with multiple types of motor impairments. We need better understanding of the biologic and psychologic aspects of depression involved in stroke recovery.
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Affiliation(s)
- Chen Lin
- University of Alabama at Birmingham, Birmingham, AL, USA
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