The association between serum growth differentiation factor-15 and 3-month depression after acute ischemic stroke

Circulating interleukins concentrations and post-stroke depression: A systematic review and meta-analysis

Interleukins may play a role in supporting the diagnosis of post-stroke depression (PSD). Here, eight databases were employed to search for studies on circulating interleukins concentrations in patients with PSD. A total of 45 studies exploring circulating interleukins in PSD and stroke patients without depression (NPSD) were included in the retrieval database, including IL-1(5), IL-1β (10), IL-2(6), IL-6(35), IL-10(7), IL-17(5), IL-18(6). Then, the RevMan 5.4 software was used for meta-analysis. The results of the meta-analysis showed that the PSD patients have higher concentrations of IL-1, IL-4, IL-6, and lower concentrations of IL-10 than NPSD patients. Additionally, the circulating IL-1, IL-6, and IL-18 concentrations in PSD patients were significantly higher than those in NPSD patients in the acute phase; the circulating IL-6 and IL-17 concentrations in PSD patients were significantly higher than those in NPSD patients at discharge; the PSD patients have lower concentrations sin IL-2 but higher concentrations in IL-6 and IL-17 than NPSD patients at the 3rd and 6th month. Our research provides evidence that circulating interleukins may have clinical utility as a biomarker for identifying PSD.

Associations of circulating GDF15 with combined cognitive frailty and depression in older adults of the MARK-AGE study

Growth differentiation factor-15 (GDF15) might be involved in the development of cognitive frailty and depression. Therefore, we evaluated cross-sectional associations of plasma GDF15 with combined cognitive-frailty-and-depression in older (i.e. ≥ 55 years) and younger adults of the MARK-AGE study. In the present work, samples and data of MARK-AGE ("European study to establish bioMARKers of human AGEing") participants (N = 2736) were analyzed. Cognitive frailty was determined by the global cognitive functioning score (GCF) and depression by the Self-Rating Depression Scale (SDS score). Adults were classified into three groups: (I) neither-cognitive-frailty-nor-depression, (II) either-cognitive-frailty-or-depression or (III) both-cognitive-frailty-and-depression. Cross-sectional associations were determined by unadjusted and by age, BMI, sex, comorbidities and hsCRP-adjusted linear and logistic regression analyses. Cognitive frailty, depression, age and GDF15 were significantly related within the whole study sample. High GDF15 levels were significantly associated with both-cognitive-frailty-and-depression (adjusted β = 0.177 [0.044 - 0.310], p = 0.009), and with low GCF scores and high SDS scores. High GDF15 concentrations and quartiles were significantly associated with higher odds to have both-cognitive-frailty-and-depression (adjusted odds ratio = 2.353 [1.267 - 4.372], p = 0.007; and adjusted odds ratio = 1.414 [1.025 - 1.951], p = 0.035, respectively) independent of age, BMI, sex, comorbidities and hsCRP. These associations remained significant when evaluating older adults. We conclude that plasma GDF15 concentrations are significantly associated with combined cognitive-frailty-and-depression status and, with cognitive frailty and depressive symptoms separately in old as well as young community-dwelling adults.

Association of Cardiac Biomarkers in Combination With Cognitive Impairment After Acute Ischemic Stroke

BACKGROUND

Poststroke cognitive impairment is a severe and common clinical complication that constitutes a substantial global health burden. We aimed to evaluate the association of 3 cardiac biomarkers in combination with poststroke cognitive impairment and their prognostic significance.

METHODS AND RESULTS

This prospective study included 566 patients with ischemic stroke. Cardiac biomarkers, including sST2 (soluble suppression of tumorigenicity-2 receptor), GDF-15 (growth differentiation factor-15), and NT-proBNP (N-terminal pro-B-type natriuretic peptide), were measured. Cognitive impairment was defined as a Mini-Mental State Examination score of <27 or a Montreal Cognitive Assessment score of <25 at 3 months after ischemic stroke. Odds of cognitive impairment 3 months after ischemic stroke increased with the number of elevated cardiac biomarkers (sST2, GDF-15, and NT-proBNP; Ptrend<0.001). The multivariable adjusted odds ratios (95% CIs) of cognitive impairment defined by the Mini-Mental State Examination and Montreal Cognitive Assessment were 2.45 (1.48-4.07) and 1.86 (1.10-3.14) for the participants with ≥2 elevated cardiac biomarkers, respectively, compared with those without any elevated cardiac biomarker. Additionally, higher cardiac biomarker scores were associated with an increased risk of cognitive impairment (Ptrend<0.05). Simultaneously adding all 3 cardiac biomarkers to the basic model with traditional risk factors significantly improved the risk prediction of Mini-Mental State Examination-defined cognitive impairment (net reclassification improvement=34.99%, P<0.001; integrated discrimination index=2.67%, P<0.001). Similar findings were observed using the Montreal Cognitive Assessment scores.

CONCLUSIONS

An increased number of elevated novel cardiac biomarkers were associated with an increased odds of poststroke cognitive impairment, suggesting that a combination of these cardiac biomarkers may improve the risk prediction of cognitive impairment.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT01840072.

Association between baseline high-sensitive C-reactive protein, homocysteine levels, and post-stroke depression among stroke patients: a systematic review, meta-analysis, and meta-regression

BACKGROUND

Post-stroke depression (PSD) is a prevalent neuropsychiatric sequelae following stroke, often associated with diminished functional recovery and heightened mortality risk. Emerging evidence suggests neuroinflammation, triggered in response to stroke events, may be instrumental in precipitating PSD.

AIM

This study aims to assess the significance of high-sensitivity C-reactive protein (Hs-CRP) and homocysteine (Hcy) in post-stroke individuals with PSD.

METHODS

We systematically searched all electronic databases from inception until May 30, 2023. Outcomes were reported as standard mean difference (SMD), and their corresponding 95% confidence interval (95% CI).

RESULTS

A total of 12 studies with 3,230 patients were included in this study. The mean age of the overall cohort was 65.7 years, and patients with PSD were observed to be older than patients without PSD (68.3 years versus 63.1 years). We observed a higher female prevalence in the PSD group (44.4% versus 40.7%). PSD patients were more likely to be widowed (19.4% versus 8.4%) and more likely to have a family history of psychiatric disorder (11.3% versus 4.9%) compared to non-PSD patients. We also observed that patients with PSD had higher levels of baseline Hs-CRP [SMD 0.16, (95% CI 0.08 to 0.25), p<0.001], and Hcy [SMD 0.14, (95% CI 0.05 to 0.22), p<0.001] than patients without PSD. Meta-regression analysis did not reveal any effect modifier for higher Hs-CRP in the study group, however, history of widowhood was a significant effect modifier when assessing Hcy levels between the two groups (coefficient 1.998, p=0.038).

CONCLUSION

Baseline levels of Hs-CRP and Hcy were significantly higher in patients with PSD, highlighting the role of recognizing demographic and biochemical markers in understanding the complexities of post-stroke depression.

Mechanisms associated with post-stroke depression and pharmacologic therapy

Stroke is one of the most common cerebrovascular diseases, which is the cause of long-term mental illness and physical disability, Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke, and its mechanisms are characterized by complexity, plurality, and diversity, which seriously affects the quality of survival and prognosis of patients. Studies have focused on and recognized neurotransmitter-based mechanisms and selective serotonin-reuptake inhibitors (SSRIs) can be used to treat PSD. Neuroinflammation, neuroendocrinology, neurotrophic factors, and the site of the stroke lesion may affect neurotransmitters. Thus the mechanisms of PSD have been increasingly studied. Pharmacological treatment mainly includes SSRIs, noradrenergic and specific serotonergic antidepressant (NaSSA), anti-inflammatory drugs, vitamin D, ect, which have been confirmed to have better efficacy by clinical studies. Currently, there is an increasing number of studies related to the mechanisms of PSD. However, the mechanisms and pharmacologic treatment of PSD is still unclear. In the future, in-depth research on the mechanisms and treatment of PSD is needed to provide a reference for the prevention and treatment of clinical PSD.

Astrocytes in Post-Stroke Depression: Roles in Inflammation, Neurotransmission, and Neurotrophin Signaling

Post-stroke depression (PSD) is a frequent and disabling complication of stroke that affects up to one-third of stroke survivors. The pathophysiology of PSD involves multiple mechanisms, including neurochemical, neuroinflammatory, neurotrophic, and neuroplastic changes. Astrocytes are a type of glial cell that is plentiful and adaptable in the central nervous system. They play key roles in various mechanisms by modulating neurotransmission, inflammation, neurogenesis, and synaptic plasticity. This review summarizes the latest evidence of astrocyte involvement in PSD from human and animal studies, focusing on the alterations of astrocyte markers and functions in relation to monoamine neurotransmitters, inflammatory cytokines, brain-derived neurotrophic factor, and glutamate excitotoxicity. We also discuss the potential therapeutic implications of targeting astrocytes for PSD prevention and treatment. Astrocytes could be new candidates for antidepressant medications and other interventions that aim to restore astrocyte homeostasis and function in PSD. Astrocytes could be new candidates for antidepressant medications and other interventions that aim to restore astrocyte homeostasis and function in PSD.

An updated review on prediction and preventive treatment of post-stroke depression

INTRODUCTION

Post-stroke depression (PSD), one of the most common complications following stroke, affects approximately one-third of stroke patients and is significantly associated with increased disability and mortality as well as decreased quality of life, which makes it an important public health concern. Treatment of PSD significantly ameliorates depressive symptoms and improves the prognosis of stroke.

AREAS COVERED

The authors discuss the critical aspects of the clinical application of prediction and preventive treatment of PSD. Then, the authors update the biological factors associated with the onset of PSD. Furthermore, they summarize the recent progress in pharmacological preventive treatment in clinical trials and propose potential treatment targets. The authors also discuss the current roadblocks in the preventive treatment of PSD. Finally, the authors put postulate potential directions for future studies so as to discover accurate predictors and provide individualized preventive treatment.

EXPERT OPINION

Sorting out high-risk PSD patients using reliable predictors will greatly assist PSD management. Indeed, some predictors not only predict the incidence of PSD but also predict prognosis, which indicates that they might also aid the development of an individualized treatment scheme. Preventive application of antidepressants may also be considered.

Serum Cystatin C is Associated with Depression After Intracerebral Hemorrhage

Purpose

Cystatins are associated with neuronal degeneration and nervous system healing. Cystatin C (Cys C) has recently been linked to brain injury and immunological inflammation. This study aimed to determine the relationship between serum Cys C levels and depression following intracranial hemorrhage (ICH).

Patients and Methods

Between September 2020 and December 2022, 337 patients with ICH were sequentially recruited and followed up for three months. The post-stroke depression (PSD) and non-PSD groups were separated based on the 17-item Hamilton Depression Rating Scale (HAMD). The PSD diagnosis was established based on the DSM-IV criteria. Cys-C levels were documented within twenty-four hours of admission.

Results

Three months after ICH, 93 (27.6%) of 337 enrolled patients were diagnosed with depression. The Cys C levels were significantly higher in depressed patients than in nondepressed patients after ICH (1.32 vs 1.01; p<0.001). After adjusting for potential confounding variables, depression after ICH was associated with the highest quartile of Cys C levels (odds ratio (OR) = 3.195, 95% CI: 1.562-6.536; p=0.001). The receiver operating characteristic curve (ROC) curve predicted that the ideal cut-off for CysC levels as a predictor of depression after ICH would be 0.730, resulting in 84.5% sensitivity and 88.4% specificity, with an area under curve (AUC) of 0.880 (95% CI: 0.843-0.917; p< 0.0001).

Conclusion

Increased CysC concentrations were independently related to depression three months after ICH, highlighting that CysC levels at admission may be a potential biomarker for predicting the onset of depression following ICH.

Higher levels of peripheral blood glucose in the acute stage of stroke increase the risk of Post-stroke Depression: A Systematic Review and Meta-Analysis

BACKGROUND

Multiple investigations have shown that diabetes mellitus is a predictor of post-stroke depression (PSD). However, whether elevated levels of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are associated with an increased risk of PSD remains controversial.

METHODS

We comprehensively searched databases for eligible studies. Standard mean differences and 95% confidence intervals were used to examine the relationship between peripheral blood glucose levels during the acute phase of stroke and the risk of PSD. Narrative syntheses and meta-analyses were conducted when appropriate unadjusted or adjusted ORs were available.

RESULTS

A total of 21 prospective cohort studies were included in the analysis. PSD patients had significantly higher peripheral blood glucose levels than non-PSD patients (FPG: SMD, 0.28, 95% CI, 0.11-0.45, p＜0.01, HbA1c: SMD, 0.49, 95%CI, 0.20-0.78, p＜0.01, respectively). In the subgroup analyses by classifying the time point of depression assessment, HbA1c was more statistically significant associated with the risk of PSD than FPG. Differences in the prevalence of diabetes were not heterogeneity sources.

CONCLUSION

Higher levels of peripheral blood glucose in the acute phase of stroke increase the risk of PSD. HbA1c might be a better biomarker for the risk of PSD than FPG.

Elevated Red Blood Cell Distribution Width Levels at Admission Predicts Depression After Acute Ischemic Stroke: A 3-Month Follow-Up Study

PURPOSE

Red blood cell distribution width (RDW) is closely related to inflammatory-related disease markers. The present study aimed to investigate the association between the red blood cell distribution width (RDW) and post-stroke depression (PSD).

PATIENTS AND METHODS

A total of 414 patients with acute ischemic stroke (AIS) admitted to our hospital from June 2018 to July 2021 were consecutively enrolled and received 3 months' follow-up. According to the 17-item Hamilton Depression Scale (HAMD) assessment, they were divided into PSD group and non-PSD group. Diagnosis of PSD was made in accordance with DSM-IV. RDW was recorded within 24 hours of admission.

RESULTS

Among the included 414 patients, 95 (22.95%) patients were diagnosed as having PSD at 3 months after stroke. The results showed significantly higher level of RDW in patients with depression (13.69 (IQR13.24-13.88) vs. 13.56 (IQR 12.67-13.77), P<0.001) at admission than patients without depression. After adjustment for potential confounding factors, the odds ratio of PSD was 5.707 (95% CI, 2.717-11.989) for the highest tertile of RDW compared with the lowest tertile. Moreover, based on the receiver operating characteristic (ROC) curve, the optimal cutoff of RDW levels as an indicator for the prediction of PSD was projected as 13.01, which yielded a sensitivity of 83% and a specificity of 41.0%, with an area under the curve (AUC) of 0.643 (95% CI, 0.585-0.701; P = 0.012).

CONCLUSION

Higher RDW levels at admission were found to be correlated with PSD 3 months after stroke.

Homocysteine level at the acute stage of ischemic stroke as a biomarker of poststroke depression: A systematic review and meta-analysis

BACKGROUND

Studies on the association of homocysteine level with poststroke depression (PSD) have yielded conflicting results. This systematic review and meta-analysis aimed to evaluate the elevated homocysteine level at the acute stage of ischemic stroke in predicting PSD.

METHODS

Two authors systematically searched articles indexed in PubMed and Embase databases up to 31 January 2022. Studies evaluating the association of homocysteine level with the development of PSD in patients with acute ischemic stroke were selected.

RESULTS

A total of 10 studies involving 2,907 patients were identified. The pooled adjusted odds ratio (OR) of PSD was 3.72 [95% confidence intervals (CI) 2.03-6.81] for the top vs. bottom homocysteine level. The value of elevated homocysteine level in predicting PSD was stronger in ≥6-month follow-up (OR 4.81; 95% CI 3.12-7.43) than those in ≤ 3-month follow-up subgroup (OR 3.20; 95% CI 1.29-7.91). Moreover, a per unit increase in homocysteine level conferred a 7% higher risk of PSD.

CONCLUSION

Elevated homocysteine level in the acute stage of ischemic stroke may be an independent predictor of PSD.

Associations between Sex Hormones and Circulating Growth Differentiation Factor-15 in Male Patients with Major Depressive Disorder

The interaction between the endocrine system and inflammation is crucial pathogenesis of depression. Our study aimed at exploring the possible relationship between sex hormones and growth differentiation factor-15 (GDF-15), a common indicator of inflammation in male patients with major depressive disorder (MDD). Methods: GDF-15 levels of 121 male MDD patients were compared with 105 healthy subjects with the help of a Cobas 8000 automatic chemiluminescence immunoanalyzer. Results: (1) MDD patients showed higher GDF-15 levels, a lower testosterone (T) level and testosterone/estradiol ratio (T/E2 ratio) than healthy subjects (all p < 0.05). (2) Serum T levels and the T/E2 ratio were inversely associated with GDF-15 serum levels (all p < 0.05). (3) HAMD-24 scores were positively correlated with the levels of GDF-15 (p < 0.01), but not with T levels, estradiol (E2) levels, and the T/E2 ratio (all p > 0.05). Conclusion: The high level of GDF-15 was correlated with a low T/E2 ratio and T deficiency in male MDD patients. The above results demonstrate that up-regulation of serum GDF-15 and down-regulation of T and T/E2 ratio may be correlated with the occurrence and severity of depression. So, changing the level of GDF-15 by regulating the proportion of sex hormones may play a key role in the prognosis and treatment of depression.

Higher levels of C-reactive protein in the acute phase of stroke indicate an increased risk for post-stroke depression: A systematic review and meta-analysis

BACKGROUND

Investigations have revealed the association between inflammation and post-stroke depression (PSD). However, whether the C-reactive protein (CRP) level, a biomarker of inflammation, would affect the development of PSD is still controversial.

METHODS

A systematic search of databases was performed for eligible studies. Standardized Mean Difference (SMD) with 95 % Confidence Interval (CI) was used to assess the association between the CRP level in the acute phase of stroke and the risk of PSD.

RESULTS

13 cohort studies that involved 3536 participants were included. Combined results showed that compared with non-PSD patients, the CRP level of PSD patients was significantly higher on admission (SMD = 0.19, 95 % CI: 0.12-0.27). A subgroup analysis by classifying the assessment time of depression showed obvious differences of the CRP levels between the PSD patients who were diagnosed more than 1 month after stroke and the non-PSD (1-3 months: SMD = 0.16, 95 % CI: 0.06-0.25; >3months: SMD = 0.34, 95 % CI: 0.18-0.51).

CONCLUSION

A higher level of CRP in the acute phase of stroke suggests an increased risk for PSD.

Development and Validation of 3-Month Major Post-Stroke Depression Prediction Nomogram After Acute Ischemic Stroke Onset

Purpose

The early detection of major post-stroke depression (PSD) is essential to optimize patient care. A major PSD prediction tool needs to be developed and validated for early screening of major PSD patients.

Patients and Methods

A total of 639 acute ischemic stroke (AIS) patients from three hospitals were consecutively recruited and completed a 3-month follow-up. Sociodemographic, clinical and laboratory test data were collected on admission. With major depression criteria being met in the DSM-V, 17-item Hamilton Rating Scale For Depression (HRSD) score ≥17 at 3 months after stroke onset was regarded as the primary endpoint. Multiple imputation was used to substitute the missing values and multivariable logistic regression model was fitted to determine associated factors with a bootstrap backward selection process. The nomogram was constructed based on the regression coefficients of the associated factors. Performance of the nomogram was assessed by discrimination (C-statistics) and calibration curve.

Results

A total of 7.04% (45/639) of patients were diagnosed with major PSD at 3 months. The final logistic regression model included age, baseline NIHSS and mRS scores, educational level, calcium-phosphorus product, history of hypertension and atrial fibrillation. The model had acceptable discrimination, based on a C-statistic of 0.81 (95% CI, 0.791-0.829), with 71.1% sensitivity and 78.6% specificity. We also transformed the model to a nomogram, an easy-to-use clinical tool which could be used to facilitate the early screening of major PSD patients at 3 months.

Conclusion

We identified several associated factors of major PSD at 3 months and constructed a convenient nomogram to guide follow-up and aid accurate prognostic assessment.

The Association Among Serum Growth Differentiation Factor 15 Level and Suicidal Ideation is Dependent on Testosterone Deficiency in Depressive Patients

Background

Elevated levels of growth differentiation factor (GDF)-15 and reduced levels of testosterone have been linked to depressive disorder, but whether they are also linked to suicidal ideation in patients with depression is unclear.

Methods

This retrospective study involved 301 patients ≥22 years old hospitalized for depression between July 2018 and November 2020 at Renmin Hospital of Wuhan University, of whom 120 had suicidal ideation. Serum levels of GDF-15 and testosterone were compared between patients with or without suicidal ideation.

Results

GDF-15 levels were significantly higher among patients with suicidal ideation than among those without, regardless of whether testosterone levels were above or below the median of 314 ng/dL. In multivariate logistic regression involving all patients, serum GDF-15 level was associated with low testosterone level (P=0.001). Among patients with testosterone <314 ng/dL, an increase of 1 standard deviation in serum GDF-15 level translated to a 1.3-fold increase in the risk of suicidal ideation (P=0.007). This relationship was not observed in all population or patients with testosterone levels ≥314 ng/dL.

Conclusion

High serum GDF-15 level may be associated with an increased risk of suicidal ideation in patients with depression, and this association appears to be partly mediated by low testosterone levels.

A sudden and severe depressive episode after a left cingulate gyrus stroke: a case report of post-stroke depression and review of literature

Post-stroke depression is a frequent complication of cerebrovascular lesions and mainly occurs within the first 6 months after stroke. Stroke patients who develop depression have slower recovery, greater disability, and higher mortality rates. The pathophysiology of post-stroke depression is not yet clearly defined, but studies suggest contributions from both psychosocial factors and stroke-related factors, such as lesions affecting the frontal-subcortical circuits. Early treatment has a positive impact on post-stroke rehabilitation outcome and survival. We present the case of an 82-year-old man with no psychiatric history who was brought to the psychiatric emergency department after two suicide attempts in the span of 7 days. He was severely depressed, with feelings of hopelessness, insomnia, and suicidal ideation. He had suffered a stroke the week before, affecting the anterior portion of the left cingulate gyrus, causing right hemiparesis and paresthesia. The psychiatric symptoms developed immediately after the stroke and were not present before the event. He was admitted to the psychiatry ward, treated with sertraline 100 mg/day and quetiapine 50 mg/day and discharged within 28 days, after full remission of symptoms. Our case strengthens the association between lesions located to the frontal-subcortical circuits and post-stroke depression. Physicians should be vigilant regarding the occurrence of depression in stroke patients, especially those who suffer lesions affecting the frontal-subcortical circuits and related regions.

Multiple biomarkers covering several pathways for the prediction of depression after ischemic stroke

BACKGROUND

To assess the potential incremental utility of multiple biomarkers reflecting several pathological pathways for the risk prediction of depression after stroke.

METHODS

We used data from the China Antihypertensive Trial in Acute Ischemic Stroke, and a panel of 13 circulating biomarkers were measured. The study outcome was depression (24-item Hamilton Depression Rating Scale score≥8) at 3 months after ischemic stroke. Logistic regression models were performed to evaluate the risk of depression associated with multiple biomarkers. Discrimination and risk reclassification for depression were analyzed.

RESULTS

Among 631 included ischemic stroke patients, elevated growth differentiation factor-15, anticardiolipin antibodies, antiphosphatidylserine antibodies and matrix metalloproteinase-9 were individually associated with increased risks of depression after stroke. The multiple biomarker analysis showed a clear gradient in the risk of depression with increasing numbers of elevated biomarkers, and multivariate adjusted odds ratio (95% confidence interval) of patients with 4 elevated biomarkers was 6.52 (2.24-18.95) compared with those without elevation in any of 4 biomarkers. The simultaneous inclusion of all 4 biomarkers to the conventional model significantly improved discrimination (C statistic increased from 0.702 to 0.748, P=0.004) and risk reclassification (net reclassification improvement 45.0%; integrated discrimination improvement 6.2%; both P<0.001) for depression after stroke.

LIMITATIONS

We selected biomarkers that had previously been reported to be promising predictors of depression after stroke, while other novel biomarkers not tested might have additional predictive value.

CONCLUSIONS

Simultaneously adding multiple biomarkers from several pathophysiological pathways to traditional risk factors provided substantial incremental utility of the risk stratification for depression after stroke.

Post-stroke depression: Chaos to exposition

Cerebral ischemia contributes to significant disabilities worldwide, impairing cognitive function and motor coordination in affected individuals. Stroke has severe neuropsychological outcomes, the major one being a stroke. Stroke survivors begin to show symptoms of depression within a few months of the incidence that overtime progresses to become a long-term ailment. As the pathophysiology for the progression of the disease is multifactorial and complex, it limits the understanding of the disease mechanism completely. Meta-analyses and randomized clinical trials have shown that intervening early with tricyclic antidepressants and selective serotonin receptor inhibitors can be effective. However, these pharmacotherapies possess several limitations that have given rise to newer approaches such as brain stimulation, psychotherapy and rehabilitation therapy, which in today's time are gaining attention for their beneficial results in post-stroke depression (PSD). The present review highlights numerous factors like lesion location, inflammatory mediators and genetic abnormalities that play a crucial role in the development of depression in stroke patients. Further, we have also discussed various mechanisms involved in post-stroke depression (PSD) and strategies for early detection and diagnosis using biomarkers that may revolutionize treatment for the affected population. Towards the end, along with the preclinical scenario, we have also discussed the various treatment approaches like pharmacotherapy, traditional medicines, psychotherapy, electrical stimulation and microRNAs being utilized for effectively managing PSD.

Post-stroke depression: A 2020 updated review

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.

Association of serum biomarker neurofilament light concentration with post-stroke depression: A preliminary study

OBJECTIVE

To investigate serum neurofilament light (sNfL) levels in acute ischemic stroke and to assess whether sNfL are related to the severity of disease and a potential prognostic marker of post-stroke depression (PSD) during a 3-month follow-up period.

METHODS

This was a single-center prospective cohort study. The sNfL concentration was measured in baseline samples using the Simoa platform- Single Molecule Array technology. A psychiatrist administered the Structural Clinical Interview for Diagnostic and Statistical Manual IV to all patients and made a diagnosis of PSD 3 months after stroke. The logistic regression was used to examine the association between sNfL and PSD.

RESULTS

In total, 236 ischemic stroke cases were included and finished the follow-up. In the follow-up, 55 patients were defined as PSD, thus the incidence rate was 23.3% (95% confidence intervals [CI]: 17.9%-28.7%). Significant differences were observed between the sNfL levels in patients with PSD (124.8 pg/ml [interquartile range {IQR}: 59.6-159.2]) and in patients without PSD (35.9 pg/ml [IQR: 18.2-60.4]) levels (P < 0.001). After adjusting for age, family history of depression, marital status, National Institutes of Health and Stroke Scale score, C-reactive protein and homocysteine levels, sNfL levels independently predicted the development of post-stroke depression. The crude and adjusted odds ratios [OR] (and 95%CI) of PSD associated with an IQR increase for sNfL were 3.38(2.29, 4.98) and 2.65(1.59, 4.04), respectively. According to receiver operating characteristic curves (ROC) curves, the cut-off value of sNfL to predict PSD was 111.4 pg/ml with an area under the curve (AUC) of 0.84(95% CI, 0.78-0.90) and with the highest sensitivity (61.8%) and specificity (95.4%).

CONCLUSIONS

In this study, elevated level of sNfL is associated with higher risk of 3-month depression in patients with ischemic stroke and makes early diagnoses of depression. The study needs replication to ensure the validity of our preliminary results.

Gender and functional outcomes in prestroke depressive patients treated with thrombolytic therapy

Aim: This study investigated the clinical factors associated with functional ambulatory outcomes and gender differences in prestroke depressive patients. Materials & methods: Clinical risk factors associated with improved functional outcomes with recombinant tissue plasminogen activator-treated cohorts were determined using binary logistic regression. Results: In the adjusted analysis, improvement in ambulation was associated with male patients that had higher National Institute of Health stroke scale score (p = 0.04), a stroke history (p = 0.026), lower serum creatinine levels (p = 0.049) and were taking cholesterol reducing medication (p = 0.014). Improvement in females was associated with taking antidepressants (p = 0.027) and having lower National Institute of Health stroke scale score (p = 0.002). Conclusion: Our findings indicate gender disparities between male and female prestroke depressive patients.