The Influence of Depressive Symptoms on Quality of Life after Stroke: A Prospective Study

High-frequency rTMS of the left dorsolateral prefrontal cortex for post-stroke depression: A systematic review and meta-analysis

OBJECTIVE

This meta-analysis investigated the therapeutic efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) for treatment of post-stroke depression (PSD).

METHODS

Ten articles with 266 patients in rTMS group and 258 patients in control group were included. The primary outcome was performed to examine the efficacy of rTMS for PSD. Secondary outcomes of response rates and remission rates and subgroup analyses were further explored.

RESULTS

Our meta-analysis revealed a significant pooled effect size (the standard mean difference (SMD) was -1.45 points (95% CI, -2.04 to -0.86; p < 0.00001)). The odds ratio (OR) of the response rate and remission rate were 8.41 (95% CI, 2.52-28.12, p = 0.0005) and 6.04 (95% CI, 1.5-24.39, p = 0.01). Moreover, rTMS treatment for PSD patients in subacute phase and targeting the left DLPFC at 5-cm anterior to the left motor hotspot or the midpoint of the middle frontal gyrus showed significant antidepressant effect. In addition, the Hamilton Depression Rating Scale (HAMD) was sensitive to detect depressive changes in patients.

CONCLUSIONS

Our meta-analysis elucidated that the application of high-frequency rTMS over the left DLPFC was an effective treatment alternative for PSD.

SIGNIFICANCE

Our meta-analysis may help to develop more reasonable treatment strategies in clinical practice for PSD patients.

Impact of depression on stroke outcomes among stroke survivors: Systematic review and meta-analysis

BACKGROUND

Depression may negatively affect stroke outcomes and the progress of recovery. However, there is a lack of updated comprehensive evidence to inform clinical practice and directions of future studies. In this review, we report the multidimensional impact of depression on stroke outcomes.

METHODS

Data sources. PubMed, PsycINFO, EMBASE, and Global Index Medicus were searched from the date of inception. Eligibility criteria. Prospective studies which investigated the impact of depression on stroke outcomes (cognition, returning to work, quality of life, functioning, and survival) were included. Data extraction. Two authors extracted data independently and solved the difference with a third reviewer using an extraction tool developed prior. The extraction tool included sample size, measurement, duration of follow-up, stroke outcomes, statistical analysis, and predictors outcomes. Risk of bias. We used Effective Public Health Practice Project (EPHPP) to assess the quality of the included studies.

RESULTS

Eighty prospective studies were included in the review. These studies investigated the impact of depression on the ability to return to work (n = 4), quality of life (n = 12), cognitive impairment (n = 5), functioning (n = 43), and mortality (n = 24) where a study may report on more than one outcome. Though there were inconsistencies, the evidence reported that depression had negative consequences on returning to work, functioning, quality of life, and mortality rate. However, the impact on cognition was not conclusive. In the meta-analysis, depression was associated with premature mortality (HR: 1.61 (95% CI; 1.33, 1.96)), and worse functioning (OR: 1.64 (95% CI; 1.36, 1.99)).

CONCLUSION

Depression affects many aspects of stroke outcomes including survival The evidence is not conclusive on cognition and there was a lack of evidence in low-income settings. The results showed the need for early diagnosis and intervention of depression after stroke. The protocol was pre-registered on the International Prospective Register of Systematic Review (PROSPERO) (CRD42021230579).

Depressive Symptoms and Anger Expression Among Survivors After Stroke

INTRODUCTION

Stroke is a frequent cause of death and one of the most common causes of disability and depression in the countries of the Western world. Depression is associated with limited functionality, reduced self-care, and increased mortality in patients with stroke. Anger often occurs in these patients and may disrupt the course of their recovery.

AIM

The investigation of the presence of depressive symptomatology, the expression of anger, and the degree of functioning/independence of patients after stroke.

METHOD

One hundred and ten patients after stroke completed the Center for Epidemiological Studies-Depression (CES-D) scale, the State-Trait Anger Expression Inventory, and the Barthel Index.

RESULTS

Patients who lived alone had a higher depressive symptomatology score than patients who did not live alone (p = 0.009). An increase in the total depressive symptomatology score was related to an increase in the anger expression score (p = 0.011), increase in anger-in score (p < 0.001), increase in anger-out score (p < 0.001), and decrease in anger control score (p = 0.001). Females had lower anger-in scores compared to men (p = 0.029). Individuals with a history of previous stroke had higher anger-out scores compared to people without a history of previous stroke (p = 0.025). An increase in the patient's functional/independence score was associated with an increase in anger control score (p = 0.015).

CONCLUSIONS

Early detection and management of depression and anger will facilitate patient's compliance to the rehabilitation program in order to achieve optimal therapeutic results and ensure a better quality of life.

The mediating effect of post-stroke depression between social support and quality of life among stroke survivors: A meta-analytic structural equation modeling

OBJECTIVES

The aim was to confirm the relationship between social support (SS), post-stroke depression (PSD), and quality of life (QOL) and determine the mediating effect of PSD in stroke survivors. Additionally, we tested the impact of economic development level (in developed or developing countries) on the relationship between SS, PSD, and QOL.

METHODS

This study utilized meta-analytic structural equation modeling on systematically searched articles from PubMed, MEDLINE, Cochrane Library, Scopus, PsycINFO, Web of Science, China National Knowledge Infrastructure, and WanFang data published from inception to February 2022. Collect the sample size (n) of each study and the associations of observed variables, and conduct meta-analysis path analysis using AMOS 23.0 to assess the relationships. Concurrently, the effects of the national economic development level were extracted for moderator analysis.

RESULTS

A total of 28 studies (N = 3967) were included for analysis. SS and PSD were significant predictors of QOL (both p < 0.01). PSD mediated the relationship between SS and QOL (β = 0.31; 95% confidence interval 0.273-0.345; p < 0.01). Furthermore, in developed countries, SS was not statistically correlated with PSD (p = 0.811) compared to developing countries.

CONCLUSIONS

Improving SS may help improve the QOL of stroke patients. PSD should be addressed using a comprehensive approach that includes interventions to enhance the QOL. Additionally, people have different psychological reactions to SS at different stages of economic development; thus, further research is needed to develop different measurement standards for patients according to the country's level of economic development.

Prevalence of depression and its associated factors among stroke survivors in Saudi Arabia

AIM

The purpose of this study was to investigate the prevalence of poststroke depression (PSD) in Saudi Arabia and its association with socio-demographic and clinical factors.

DESIGN

A predictive correlational cross-sectional study.

METHODS

The study adopted a non-probability convenience sampling method to recruit 211 stroke survivors between April and October 2021 from the neurology outpatient departments of two main governmental hospitals in Saudi Arabia. PSD was measured using a self-assessment reliable and valid scale (The Hospital Anxiety and Depression Scale [HADS]).

RESULTS

More than two-thirds (70.6%) of the study sample (Mean age = 53 years, SD = 8.5, 51.2% were males) experienced some degree of depression (Score ≥8); of these, approximately half (48.8%) were in severe depression. The final prediction model was statistically significant (χ₂ [15] = 31.39, p ˂ .01). PSD is a statistically significant health issue and requires immediate attention by healthcare providers to improve the health outcomes of stroke survivors.

Predictors of Post-Stroke Depression: A Retrospective Cohort Study

Despite reports of a high incidence and various predictors of post-stroke depression (PSD), the underdiagnosis and undertreatment rates of PSD are still high. This study aimed to examine the incidence of depression in stroke patients and identify factors associated with PSD. This was a retrospective cohort study on ischemic stroke patients from the Geisinger Neuroscience Ischemic Stroke (GNSIS) registry. The following statistical analyses were performed to predict PSD in the studied population: a Kaplan−Meier estimator and a Cox proportional hazards model. A total of 5882 patients were included in the study. The median age at the time of an ischemic stroke was 72 years and 56% were males. A total of 294 patients were diagnosed with PSD within one year of a stroke. The cumulative incidence of depression was found to be 6.4% (95% CI 5.7−7.1%) at one year for the entire cohort. Women were found to have a higher risk of PSD than men (HR for women = 1.47, 95% CI 1.18−1.85, p = 0.001). A history of prior stroke (HR = 1.58, 95% CI 1.18−2.11, p = 0.002) and myocardial infarction (HR = 1.47, 95% CI 1.05−2.06, p = 0.025) were associated with PSD. Medicaid patients had a higher risk for PSD (HR = 2.16, 95% CI 1.5−3.12, p < 0.001) than those with commercial insurance or health maintenance organization plans. Our findings showed that women, patients with a history of prior stroke or myocardial infarction, and with Medicaid insurance were more likely to develop PSD. Through an observational study on the EHR data, we confirmed that chronic stress, including financial and health-related stress, irrespective of age, significantly increased the risk for PSD.

General and comparative self-rated health in chronic stroke: an important outcome measure for health professionals

BACKGROUND

After a stroke, several aspects of health and function may influence how individuals perceive their own health. However, self-rated health (SRH), as well as its relationship with functioning, has been little explored in individuals with stroke. The aims of this study were to determine how individuals with chronic post-stroke disabilities evaluate their health, considering general, time- and age-comparative SRH questions and to investigate whether SRH measures would be influenced by the following health and functioning domains: mental/physical functions and personal factors.

METHODS

Sixty-nine individuals with chronic post-stroke disabilities answered the three types of SRH questions and were assessed regarding depressive symptoms (emotional function domain), physical activity levels (physical function domain), and engagement in physical activity practice (personal factor domain). Subjects were divided into the following groups: good/poor for the general SRH question; better, similar, and "worse" for both time- and age-comparative questions. Between-group differences in the three domains for each SRH question were investigated (α = 5%).

RESULTS

General SRH was rated as good by 73% of the participants. Time- and age-comparative SRH was rated as better by 36% and 47% and as similar by 31% and 28% of the subjects, respectively. Significant between-group differences in emotional function were found for both the general and age-comparative questions. For the time-comparative question, significant differences were only observed for physical function.

CONCLUSION

SRH evaluation differed in individuals with chronic post-stroke disabilities according to the types of questions and health/functioning domains.

Indirect effects of social support and hope on quality of life via emotional distress among stroke survivors: A three-wave structural equation model

OBJECTIVES

Stroke survivors are prone to functional impairments and reduced quality of life (QoL). This study examined the mediating role of social support and hope in the relationships between functional impairment, emotional distress, and QoL.

METHODS

A total of 188 stroke survivors in Hong Kong completed assessments on functional impairment, social support, and hope at baseline, with follow-up measurements of emotional distress at 2 months and QoL at 8 months. Structural equation modeling with bootstrapping was used to analyze the direct and indirect effects of functional impairment on emotional distress and QoL via the mediating factors of social support and hope.

RESULTS

The partial cascading model provided an adequate fit to the data. Functional impairment had significant negative direct effects on hope and physical QoL and social support had significant positive direct effects on hope and physical QoL. Social support had a significant positive indirect effect on physical QoL via hope and perceived stress and on psychosocial QoL via hope and depression. Functional impairment and hope had a significant negative interaction effect on perceived stress.

CONCLUSION

The findings support a mediating role for hope in the relationship between social support and QoL in stroke survivors. The protective effect of hope on perceived stress was stronger among patients with greater functional impairment.

Occurence of Post-Traumatic Stress Symptoms, Anxiety and Depression in the Acute Phase of Transient Ischemic Attack and Stroke

Rates of post-traumatic stress symptoms, anxiety and depression are increased in patients having experienced a transient ischemic attack (TIA) or stroke several months ago. However, data of psychiatric symptoms in the acute phase within the first days after ictus are lacking. In 20 patients with stroke and 33 patients with TIA we assessed disease severity by means of the NIHSS, levels of depression and anxiety by HADS, PTSD-like symptoms by PC-PTSD, quality of life (HrQoL) by SF-12, and coping style by brief COPE Inventory within the first 5 days after ictus. NIHSS on admission was lower in patients with TIA (0 ± 1) than in patients with stroke (3 ± 2, p < 0.001). HADS depression score was significantly higher in patients with stroke (7.0 ± 4.5) than in patients with TIA (4.9 ± 4.0). HADS anxiety score, HrQoL and coping styles were similar between TIA and stroke patients (p > 0.05). 5 and 3 of 33 TIA patients as well as 4 and 3 of 20 stroke patients had at least 11 points in the HADS anxiety and depression score respectively (p = 0.001). 2 of 33 TIA patients and 2 of 20 stroke patients had more than 2 points in the PC-PTSD (p = 0.646). We did not find consistent correlations between the NIHSS and the psychometric parameters. Within the first five days after patients having experienced a TIA or stroke PTSD-like, anxious and depressive symptoms are more common than in the general population. As the acute psychological status after ictus is predictive for psychiatric comorbidity years later physicians should pay attention and adequately treat psychiatric symptoms already in the acute phase of stroke.Trial Registration: German Clinical Trials Register, DRKS00021730, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021730 , registered 05/19/2020- Retrospectively registered.

Elevated neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios predict post-stroke depression with acute ischemic stroke

Post-stroke depression (PSD) is the most prevalent psychiatric complication of acute ischemic stroke. The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are indicators of inflammation and are associated with stroke and depression. Therefore, the purpose of the present study was to examine the relationship between NLR/PLR and PSD. Retrospective analysis was carried out in 376 patients with first-ever acute ischemic stroke in the First Affiliated Yijishan Hospital of Wannan Medical College between March 2015 and September 2017. Patients were divided into PSD (n=104; 27.7%) and non-PSD (n=272; 72.3%) groups according to the Diagnostic and Statistical Manual of Mental Disorders-IV criteria at 6 months after stroke. Clinical data were collected retrospectively. NLR and PLR were acquired retrospectively from the routine blood tests performed at admission. A total of 120 healthy volunteers from the physical examination center in the First Affiliated Yijishan Hospital of Wannan Medical College were recruited as controls. Using logistic regression analysis, NLR (≥4.02) and PLR (≥203.74) were independently associated with PSD. NLR, odds ratio (OR) 3.926, 95% confidence intervals (CI, 2.365-7.947), P<0.001; PLR, OR 3.853, 95% CI (2.214-6.632), P=0.002. The ability of the combined index [area under the receiver operating characteristic curve, 0.701; 95% CI (0.622-0.780); P<0.001] to diagnose PSD was greater than that of either ratio alone. Higher NLRs and PLRs (≥4^th quartile) were associated with PSD with a 5.79-fold (P<0.001) increase compared with lower levels of both. Higher NLRs and PLRs were found to be associated with depression 6 months after stroke, and the combined index was more meaningful than either alone in the early clinical detection of PSD.

Admission Heart Rate Variability Is Associated With Poststroke Depression in Patients With Acute Mild-Moderate Ischemic Stroke

BACKGROUND

Stroke has been shown to cause cardiac autonomic dysfunction. Depression is common complication after acute ischemic stroke (AIS). The purpose of this study was to investigate whether decreased heart rate variability (HRV) was related to poststroke depression (PSD) in patients with mild-moderate AIS.

METHODS

In this study, we assessed autonomic function of ischemic stroke patients within 72 h from symptom onset by fractal dimension (FD). 503 patients (mean age 65.93 ± 10.19) with mild-moderate AIS underwent FD test after admission. Depressive symptoms were assessed using 17-item Hamilton Depression Rating Scale (HDRS) at baseline (within 7 days) and 3 months. Depression were defined if HDRS >6 points. According to the data of FD, we investigated association with early-onset PSD status and 3-month PSD.

RESULTS

59.24% (293/503) of patients had early-onset PSD status at baseline, and 38.66% (184/476) of patients had PSD at 3 months. ROC curve analysis shown that the optimal cut point of FD for early-onset PSD status and 3-month PSD were FD ≤ 1.27 and FD ≤ 1.19, respectively. In fully adjusted models, higher NIHSS [adjusted odd ratios (OR), 1.15; 95% confidence interval (CI), 1.05-1.27; P=0.005], younger age (adjusted OR, 1.18; 95% CI, 1.01-1.13; P=0.046), and FD ≤ 1.27 (adjusted OR, 3.31; 95% CI, 2.23-4.92; P<0.001) were associated with increased risk of early-onset PSD status. Higher NIHSS (adjusted OR, 1.21; 95% CI, 1.09-1.43; P<0.001) and FD ≤ 1.19 (adjusted OR, 2.68; 95% CI, 1.79-4.03; P=0.000) were associated with increased risk of 3-month PSD.

CONCLUSIONS

PSD is common after mild-moderate AIS and is highly correlated with decreased HRV, FD could serve as an objective tool to help in prediction of PSD.

Health-related quality of life associated with different symptoms in women and in men who suffer from schizophrenia

Health-related quality of life (HRQoL) in patients with schizophrenia is related to the severity of psychiatric symptoms. The objective of this study is to analyze whether the symptoms that influence HRQoL are similar in women and men. Data were part of the Pattern study, an international observational investigation which collected data from 1379 outpatients with schizophrenia. Patients were evaluated with the Mini International Neuropsychiatric Inventory, the Clinical Global Impression-Schizophrenia, and the Positive and Negative Syndrome Scale (PANSS), and reported their quality of life using the Schizophrenia Quality of Life Scale (SQLS), the Short Form-36 (SF-36), and the EuroQol-5 Dimension (EQ-5D). Men reported higher HRQoL on all scales. PANSS total score was 80.6 (SD 23.6) for women and 77.9 (SD 22.1) for men. In women, a higher PANSS negative score and a higher PANSS affective score were associated with a lower SQLS score. In men, a higher PANSS positive score and a higher PANSS affective score were associated with a lower SQLS score. The same pattern appeared with EQ-VAS and EQ-5D tariff. In women, greater age and higher PANSS affective score were associated with a lower SF-36 mental component score. In men, higher PANSS affective, positive, and cognitive scores were associated with a lower SF-36 mental component score. This study shows that HRQoL is influenced by different psychiatric symptoms in women and men. This may have significant implications when deciding the main treatment target in patients with schizophrenia.ClinicalTrials.gov Identifier: https://clinicaltrials.gov/ct2/show/NCT01634542.

[The prognosis for post-stroke aphasia]

AIM

To determine risk factors and factors of favorable prognosis for regression of post-stroke aphasia in the early recovery period of ischemic stroke (IS).

MATERIAL AND METHODS

A cohort study was undertaken with 40 patients with different clinical forms of aphasia. The duration of study was 3-4 months of the disease. The regression of speech and non-speech cognitive impairment was assessed by the Method of a 10-point evaluation of higher mental functions. The method involves a comprehensive assessment of all mental functions with more than 90 subtests at the beginning and at the end of rehabilitation course and the calculation of the difference in the scoring of each mental function as a measure of treatment efficacy. Using logistic regression and odds ratio estimation, significance of the influence and the prognostic relationship of symptoms related to IS, and a number of biological and social factors (sex, age, and education) were studied.

RESULTS

An independent prognostic value for the aphasia regression on the third month of disease has the severity of neurologic symptomatology (NIHSS score) for the first day of stroke (OR 3,27 95% CI 1,02-9,77) and the third month of the disease (p=0,005, OR 4,6, 95% CI [1,39-15,11]) and the decrease in daily activity assessed by the total score of the Barthel index (p=0,004, OR 3,92, 95% CI [1,01-15,21]). A number of MRI signs (localization of post-stroke changes in the left angular gyrus, frontal-temporal region and focal volume) had a significant effect on the dynamics of non-verbal cognitive impairment. Neuropsychological examination revealed a significant improvement of speech in patients with initially severe forms of aphasias, in particular, sensory and sensorimotor. A direct relationship between age and certain clinical forms of aphasia as well as a significant positive effect of duration (β=1,91, p≤0,01) and level of education (β=1,68, p≤0,007) on aphasia regression were determined.

CONCLUSION

The severity of neurologic symptoms, in particular motor and sensory deficits, both in the acute and in the recovery period of the disease is one of the pathogenetic factors worsening the processes of functional reorganization of neuronal speech networks. The positive dynamics of the recovery of speech function is associated with the initial severity and clinical form of aphasia. The level and duration of education are related to factors positively affecting post-stroke neuroplasticity.

Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up

Objectives: This study aimed to examine the rate of remission in individuals experiencing early-onset poststroke depression (PSD) in China and to identify predictors of remission during a 3-month follow-up. This study also explored the interaction between cognitive impairment and depression. Methods: A total of 820 patients with PSD from a massive multicenter prospective cohort project in China (PRIOD) were included in the present study. Depressive symptoms were measured with the Hamilton Depression Rating Scale (17 Items, HDRS-17) at 2 weeks and the endpoint of the 3-month follow-up. The cut-off score of HDRS-17 (< 8) was used to define remission of depression at the endpoint. The Mini-Mental State Exam (MMSE) was used to evaluate the cognitive impairment of the patients (at the 2-week follow-up and 3-month endpoint). The National Institutes of Health Stroke Scale (NIHSS) was used to measure the severity of stroke. Results: (1) Six hundred and forty-two patients completed the 3-month follow-up, and 332 (51.7%) patients remitted by the end of the study. Univariate analyses indicated that there was a higher proportion of patients who had hypertension, frontal lobe lesion, basal ganglia lesion, poor outcome at 2 weeks, high scores on the NIHSS at 2 weeks, major life events within 3 months, and major medical diseases within 3 months in the nonremission group. In stepwise multiple logistic regression analyses, remission was significantly predicted by lower NIHSS scores at 2 weeks (p = 0.001, OR = 1.086, 95% CI 1.035-1.139), fewer major life events (p = 0.036, OR = 5.195, 95% CI 1.111-27.283), fewer major medical comorbidities (p = 0.015, OR = 2.434, 95% CI 1.190-4.979), and fewer frontal lobe lesions (p = 0.042, OR = 1.717, 95% CI 1.019-2.891). (2) After controlling for confounding variables, repeated measures analysis of variance revealed a significant interaction between time (2 weeks vs. 3 months) and group (remitters vs. nonremitters) on MMSE scores [F (1, 532) = 20.2, p < 0.001]. Conclusions: Early-onset PSD patients with milder neurological impairment, fewer major life events, fewer major medical comorbidities and no frontal lobe lesion at baseline were more likely to achieve remission 3 months after stroke. Only remitters of PSD improved significantly in cognitive impairment after stroke. The PRIOD trial is registered at http://www.isrctn.com/, number ISRCTN62169508.

Experimental models of focal and multifocal cerebral ischemia: a review

Rodent and rabbit stroke models have been instrumental in our current understanding of stroke pathophysiology; however, translational failure is a significant problem in preclinical ischemic stroke research today. There are a number of different focal cerebral ischemia models that vary in their utility, pathophysiology of causing disease, and their response to treatments. Unfortunately, despite active preclinical research using these models, treatment options for ischemic stroke have not significantly advanced since the food and drug administration approval of tissue plasminogen activator in 1996. This review aims to summarize current stroke therapies, the preclinical experimental models used to help develop stroke therapies, as well as their advantages and limitations. In addition, this review discusses the potential for naturally occurring canine ischemic stroke models to compliment current preclinical models and to help bridge the translational gap between small mammal models and human clinical trials.

The association between mean platelet volume levels and poststroke depression

OBJECTIVE

High levels of mean platelet volume (MPV) had been found in depression subjects. We sought to examine the relationship between MPV and poststroke depression (PSD).

METHODS

One hundred and eighty-five patients with acute ischemic stroke were enrolled in our study. Peripheral venous blood samples were drawn at admission and MPV levels were measured by the automated hematology analyzer. Patients with a HAMD-17 score >7 were diagnosed as having PSD.

RESULTS

We found that 60 patients (32.4%) developed PSD, the MPV levels in PSD patients were significantly higher (9.3 ± 1.8 fl) compared to non-PSD patients (8.5 ± 1.6 fl). High MPV levels (≥9.1 fl) were independently correlated with PSD (OR 2.762, 95% CI 1.138-6.702, p = 0.025).

CONCLUSIONS

Patients with higher levels of MPV at admission were correlated with the development of PSD at 1 month after stroke and might be a predictor of its presence.

Prevalence, patterns and predictors of depression treatment among community-dwelling older adults with stroke in the United States: a cross sectional study

BACKGROUND

Depression is one of the most common psychiatric conditions among stroke survivors and is associated with several negative health outcomes. However, little is known about the depression treatment patterns among stroke survivors. The objective of this study was to examine national-level prevalence, patterns and predictors of depression treatment among community-dwelling stroke survivors.

METHODS

This study adopted a retrospective, cross-sectional study design using multiple years of Medical Expenditure Panel Survey (MEPS) (2002-2012) data. The study population consisted of older adults (age ≥ 50 years) who (i) were stroke survivors (ICD-9-CM codes of 430-438), (ii) did not die during the calendar year, and (iii) had co-occurring depression (ICD-9-CM code of 296.xx, or 311.xx). Depression treatment, identified by antidepressant medication and/or psychotherapy use, was the dependent variable of this study. Multinomial logistic regression analysis was conducted to examine the association of individual level factors with depression treatment among stroke survivors with co-occurring depression.

RESULTS

The final study sample consisted 370 (unweighted) community-dwelling older adults with self-reported stroke and depression. The prevalence of co-occurring depression among stroke survivors was 22.03% [95% Confidence Interval (CI) 19.7-24.4%]. An overwhelming majority (87.6%) of stroke survivors with co-occurring depression reported some form of depression treatment. Antidepressants only and combination therapy was reported by 74.8% (95% CI, 71.6-78.0%] and 12.8% (95% CI, 10.5-15.1%) by stroke survivors with co-occurring depression respectively. Approximately, 61% of stroke survivors with co-occurring depression reported using SSRIs, followed by SNRIs (15.2%), miscellaneous antidepressants (12.1%), TCAs (9.8%), phenylpiperazine antidepressants (5.2%), and tetracyclic antidepressants (4%). Sertraline (15.8, 95% CI, 12.7-19.0%) had the highest reported use among individual antidepressants.

CONCLUSIONS

Vast majority (nearly 90%) of the study sample received some form of depression treatment and several individual level factors (such as age, education) were associated with the report of depression treatment use. Future longitudinal studies are warranted to assess the comparative treatment benefits of antidepressants, psychotherapy and their combination. Healthcare providers should carefully assess the risks and benefits of antidepressant (such as SSRIs or TCAs) use in this vulnerable population prior to their use.

Health-related quality of life in outpatients with schizophrenia: factors that determine changes over time

PURPOSE

The objective of this study was to analyze the clinical factors associated with changes in HRQoL in outpatients with schizophrenia using both generic and condition-specific HRQoL scales.

METHODS

Adult outpatients with schizophrenia at least 18 years of age who did not have an acute psychotic exacerbation in the 3 months prior to baseline were recruited. PANSS dimensions were calculated based on Lindenmayer et al.'s five factors. HRQoL data were assessed by patients using the Schizophrenia Quality of Life Scale (SQLS), the Short Form-36 (SF-36), and the EuroQol-5 Dimension (EQ-5D) questionnaires.

RESULTS

Out of the 1345 patients included at baseline, 1196 (89%) were evaluated at 12 months. Regression models showed that the factor most consistently associated with HRQoL at endpoint was change in the PANSS negative symptoms score. A decrease in the PANSS negative symptoms score from baseline to 1 year was associated with a decrease in HRQoL during the same period. There were also significant associations of the change in PANSS excitatory factor with all the HRQoL scales except the SF-36 PCS. Female gender was associated with a decrease in all HRQoL ratings. There was also a relationship between years since onset and HRQoL. The longer the time since illness onset, the larger the decrease in HRQoL.

CONCLUSIONS

This study has found that, in outpatients with schizophrenia, changes in negative and excitement symptoms may have a greater an association with HRQoL than changes in positive, cognitive and depressive symptoms.

Relation of depressive symptoms to outcome of CI movement therapy after stroke

OBJECTIVE

Depressive symptoms after stroke have been associated with negative outcomes, including poorer functional ability, less efficient use of rehabilitation services, decreased quality of life, and increased mortality. It has been anecdotally noted that depressive symptoms do not limit motor recovery in patients who undergo Constraint-Induced Movement Therapy (CIMT), an efficacious intervention for chronic poststroke hemiparesis. Here we analyze depressive symptom and motor scores from 40 participants who received CIMT in 2 previously published studies.

METHOD

Adults more than 1-year after stroke with mild to moderate upper-extremity hemiparesis completed the Zung Self-Rating Depression Scale and Motor Activity Log (MAL) before and after CIMT. We used regression analysis to test whether Zung scores predicted response to CIMT and paired t tests to test whether depressive symptoms changed from pre- to posttreatment.

RESULTS

Pretreatment Zung score did not predict outcome on the MAL Arm Use scale, ΔR2 (1, 30) = 0.004, p = .19, after controlling for pretreatment MAL scores. Additionally, participants had a small but statistically significant decrease in Zung score, t(39) = 3.0, p = .005, mean change = -3.6.

CONCLUSION

These results suggest that depressive symptoms do not significantly limit motor recovery in patients treated with CIMT for chronic poststroke hemiparesis. Additionally, treatment with CIMT may improve depressive symptoms. (PsycINFO Database Record

Factors associated with health-related quality of life in Koreans aged over 50 Years: the fourth and fifth Korea National Health and Nutrition Examination Survey

BACKGROUND

To evaluate and analyse the factors associated with health-related quality of life (HR-QoL) in the Korean population aged 50 years and older.

METHODS

We used data obtained from the fourth and fifth Korea National Health and Nutrition Examination Survey (KNHANES IV-V) 2007-2012, a national, cross-sectional health examination and survey, for which representative data on the health, nutritional status, and physical activities of the Korean general population are collected by the Korea Centres for Disease Control and Prevention (KCDC). The sampling protocol for the KNHANES was designed to involve a complex, stratified, multistage probability cluster survey of a representative sample of the noninstitutionalized civilian population in South Korea using a cross-sectional design. The association between HR-QoL and socio-economic factors and medical comorbidities in adults aged 50 years and older was investigated using data from the KNHANES IV-V from 2007 to 2012 (n = 17,937). The EuroQol 5-Dimension Questionnaire (EQ-5D) was used to evaluate HR-QoL, and the factors associated with HR-QoL were analysed after adjusting for socio-economic and demographic factors, anthropometric measurements and clinical comorbidities.

RESULTS

Health status declined with ageing, and low socio-economic status had negative associations with health status. Gender had no association with health status. Among chronic medical conditions, arthritis and depression had significant associations with health status in older people when stratified by age and gender (P < 0.05).

CONCLUSIONS

These findings suggest that older people may value the ability to perform daily activities, which may mean that it is necessary to pay more attention to the factors associated with musculoskeletal pain and emotional distress, as well as socio-economic status or chronic diseases.

TRIAL REGISTRATION

The Korea National Health and Nutrition Examination Survey (KNHNES) is not a clinical trial registry, but the national health survey conducted by the Government of the Republic of Korea, to gather information on health and nutritional status of Korean population, to plan public health services and health education programs, and to do statistical studies of the efficiency of public health services required for setting up welfare and healthcare policies.

The Factors Associated With Health-Related Quality of Life in Stroke Survivors Age 40 and Older

Objective

To evaluate the association between clinical and socio-demographic status and health-related quality of life (HR-QoL) in stroke survivors age 40 and older in the Korean population.

Methods

The relationship between stroke and HR-QoL was investigated using data from the Korea National Health and Nutrition Examination Survey (KNHANES), conducted from 2007-2012. The total number of respondents was 24,050 and 757 stroke survivors were included. Specifically, we investigated factors associated with the lowering of HR-QoL in a group of Korean adult stroke patients age 40 and older after adjusting for socio-demographic factors, anthropometric measurements, and clinical comorbidities. Adjusted effects of covariates on EuroQol-visual analog scales (EQ-VAS) scores were estimated with a complex-samples general linear model and multivariate-adjusted odds ratios of the lowest quintile versus highest quintile of the EQ-VAS scores in the stroke group were estimated with a complex-samples logistic regression model.

Results

Socio-demographic, anthropometric factors, and clinical comorbidities significantly differed between the stroke and non-stroke groups, except regarding gender and residential area. The EQ-VAS was significantly lower in the stroke than non-stroke group. Anxiety/depression problems significantly lowered EQ-VAS, as did low education level, smoking, mobility and usual activities problems. Also, aging in 1-year increments and cardiovascular disease had a significant effect on lower EQ-VAS in stroke survivors.

Conclusion

People with a stroke have significantly lower HR-QoL than healthy subjects. Therefore, managing depression, smoking, or cardiovascular disease and maintenance of physical function may be priority goals in improving HR-QoL after a stroke.

Fractional amplitude of low-frequency fluctuations (fALFF) in post-stroke depression

Depression is a common outcome following stroke, associated with reduced quality of life and poorer recovery. Despite attempts to associate depression symptoms with specific lesion sites, the neural basis of post-stroke depression remains poorly understood. Resting state fMRI has provided new insights into the neural underpinnings of post-stroke depression, but has been limited to connectivity analyses exploring interregional correlations in the time-course of activity. Other aspects of resting state BOLD signal remain unexamined. Measuring the amplitude of low frequency fluctuations allows the detection of spontaneous neural activity across the whole brain. It provides complementary information about frequency-specific local neural activity. We calculated the fractional amplitude of low frequency fluctuations (fALFF) in a group of 64 participants scanned 3 months post-stroke. Twenty showed depression symptoms when assessed with the Patient Health Questionnaire (PHQ-9). We performed analyses in both the typical 0.01-0.08 Hz range, as well as separately in the slow-5 (0.01-0.027 Hz) and slow-4 (0.027-0.073 Hz) ranges. We found significantly higher fALFF in the depressed compared to non-depressed participants in the left dorsolateral prefrontal cortex (DLPFC) and the right precentral gyrus, and a significant association between higher depression scores and higher fALFF in the left insula. The group differences were detected in the slow-5 fluctuations, while the association with depression severity was observed in the slow-4 range. We conclude that post-stroke depression can be characterised by aberrant spontaneous local neural activity, which in small samples could be a more sensitive measure than lesion volume and location.

[The correlation analysis of parameters of neurological deficit and quality-of-life in the patients after atherotrombotic stroke]

AIM

To establish correlations between parameters of the neurological status of patients in the acute period and quality-of-life in the late recovery period of atherotrombotic stroke in carotid and vertebrobasilar areas.

MATERIAL AND METHODS

One hundred and sixty-two patients, including 124 with carotid stroke and 28 with vertebrobasilar stroke, were examined. Quantitative parameters of the neurologic status were estimated during the hospitalization of patients. Quality-of-life assessed with the «SF-36 Health Status Survey» with the calculation of two parameters (mental (MH) and physical (PH) wellbeing) was evaluated 10-14 months after stroke.

RESULTS AND CONCLUSION

Parameters of the neurologic status had an effect only on the PH domain of quality-of-life while MH was independent of the indicators studied. The initial NIHSS index and Rivermead Mobility Index had the greatest impact on PH in patients with carotid stroke. In patients with vertebrobasilar stroke, the strong correlation of PH with the age of patients and an index of independence, measured with the Rankin scale on the 14th day of hospitalization, was found.

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality of life and is consistent with the patients’ values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient- and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient’s family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payer-provider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.

Predictors of functional level and quality of life at 6 months after a first-ever stroke: the KOSCO study

Predicting functional outcome and quality of life (QOL) is critical to the treatment of patients with stroke. The purpose of this study was to analyze the factors influencing functional status and QOL of stroke patients 6 months after a first-ever stroke. This study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation Study, designed to include 10 years of follow-up for first-ever stroke patients. This study analyzed data from 2857 patients who completed face-to-face assessments with the functional independence measurement (FIM) and Euro Quality of Life-5D (EQ-5D) at 6 months after stroke onset. A multivariate regression analysis was used to analyze factors that potentially influenced FIM and EQ-5D results at 6 months after stroke. Of the patients in this study, 80.1 % suffered from ischemic stroke and 19.9 % experienced hemorrhagic stroke. The independent predictors of functional independency measured by FIM at 6 months after stroke were age, initial stroke severity, duration of hospitalization, and functional level at discharge in terms of motor, ambulation, and language. For QOL measured by EQ-5D at 6 months after stroke, age, duration of hospitalization, and motor function at discharge were significant predictors. In conclusion, proper treatment to achieve maximal functional gain at discharge may be an important factor in improving functional independency and QOL in chronic stage stroke survivors. These results provide useful information for establishing comprehensive and systematic care for stroke patients.