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Weterings RPC, Kessels RPC, de Leeuw FE, Piai V. Cognitive impairment after a stroke in young adults: A systematic review and meta-analysis. Int J Stroke 2023; 18:888-897. [PMID: 36765436 PMCID: PMC10507997 DOI: 10.1177/17474930231159267] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/29/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND Information about cognitive functioning is vital in the management of stroke, but the literature is mostly based on data from individuals older than 50 years of age who make up the majority of the stroke population. As cognitive functioning is subject to change due to aging, it is unclear whether such cognitive impairment patterns from the general stroke literature apply to the growing population of younger people with a stroke. AIM The aim of the study was to conduct a systematic review and meta-analysis of the proportion and severity of cognitive impairment in young-stroke patients. SUMMARY OF REVIEW MEDLINE, Embase, PsycINFO, and Web of Science were systematically searched up to 11 October 2022. Studies were included if they reported on a population of young-stroke patients, evaluated cognitive functioning as an outcome measure, and reported original data. We estimated the pooled prevalence rates for cognitive impairment and for aphasia. In addition, we calculated the pooled estimates for the severity of impairment per cognitive domain in the chronic phase (defined as >6 months post-stroke). Six hundred thirty-five articles were identified, of which 29 were eligible for inclusion. The pooled prevalence of cognitive impairment was 44% (k = 10; 95% confidence interval (CI): 34-54%) and of aphasia 22% (k = 13; 95% CI: 12-39%). Young-stroke patients in the chronic phase performed worse than stroke-free healthy age-appropriate controls across all cognitive domains examined, with Hedges' g effect sizes ranging from -0.49 to -1.64. CONCLUSION Around half of all young-stroke patients present with cognitive impairment and around a quarter with aphasia. Our data suggest that patterns of impairment in young-stroke patients follow those in the general stroke literature.
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Affiliation(s)
- Rosemarije PC Weterings
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roy PC Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vitória Piai
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center and Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The Netherlands
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Mayer-Suess L, Geiger M, Dejakum B, Boehme C, Domig LM, Komarek S, Toell T, Kiechl S, Knoflach M. Sex-differences in psychosocial sequelae after spontaneous cervical artery dissection. Sci Rep 2022; 12:611. [PMID: 35022509 PMCID: PMC8755839 DOI: 10.1038/s41598-021-04686-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Short- to mid-term functional outcome in spontaneous cervical artery dissection is favorable, but the concomitant psychosocial impact is underreported. We aimed to determine these possible sequelae, with a special focus on sex differences, in our cohort of spontaneous cervical artery dissection subjects. During a standardized prospective in-house follow-up visit we, among other values, evaluated functional outcome (modified Rankin Scale [mRS]), psychosocial measures (return to work-, divorce rate) and health-related quality of life (WHO-QoL-BREF and SF-36-questionnaires). 145 patients participated in the long-term prospective follow-up. Median follow-up time was 6.5 years and excellent functional outcome (mRS ≤ 1) was achieved in 89.0% subjects. 87.6% returned to work and 17.6% married patients had a divorce during follow-up. Even though relevant baseline-/discharge characteristics and functional outcome did not differ between the sexes, women were less likely to return to work compared to men (79.7% vs. 93.8%; P = 0.010) and divorce rate was considerably higher in women (30.2% vs. 9.2%; P = 0.022). Health related quality of life did not differ significantly between the sexes, but women consistently reported lower values. Even though functional outcome is beneficial in most patients, measures to prevent poor psychosocial outcome should be considered in the long-term care of patients with spontaneous cervical artery dissection, especially women.
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Affiliation(s)
- Lukas Mayer-Suess
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Moritz Geiger
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Benjamin Dejakum
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Boehme
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Lena M Domig
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Silvia Komarek
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Thomas Toell
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,VASCage, Research Center on Vascular Ageing and Stroke, Innsbruck, Austria
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Ignacio KHD, Diestro JDB, Medrano JMM, Salabi SKU, Logronio AJ, Factor SJV, Ignacio SD, Pascual V JLR, Pineda-Franks MCC. Depression and Anxiety after Stroke in Young Adult Filipinos. J Stroke Cerebrovasc Dis 2021; 31:106232. [PMID: 34875539 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106232] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Young adult patients may suffer from poststroke depression (PSD) and anxiety. Few studies have evaluated these important psychiatric conditions that may lead to adverse outcomes in young adults. We aimed to determine the prevalence of PSD and anxiety as well as to identify their predictors in a population of young Filipino adults (18-49 years old). METHODS We performed a cross-sectional epidemiologic study in the largest tertiary hospital in the Philippines. The study involved the administration of a structured survey tool and review of medical records. The Hospital Anxiety and Depression Score - Pilipino version (HADS-P) was used to screen for anxiety and depression. Multivariable logistic regression analysis was performed to determine significant socio-economic and clinical risk factors of PSD and anxiety. RESULTS 114 young adult stroke patients were included. The prevalence of depression was 20.2% while that of anxiety was 34.2%. Significant predictors of PSD were the presence of anxiety (OR 1.84; CI 1.05-3.22), lower mRS scores (mRS 3-5 OR 5.52; 95% CI 1.09-8.03) and diabetes (OR 2.09; 95% CI 1.67-6.26). Meanwhile, significant predictors of poststroke anxiety included depression (OR 7.5; 95% CI 5.02-21.94) and dependency (Barthel Index scores 95-100; OR 0.94; 95% CI 0.89-0.99). Relationship status, educational attainment, stroke subtype and location were not found to be significant predictors of PSD and anxiety. CONCLUSION A significant proportion of young adults suffered from depression and anxiety after stroke. Clinicians should be aware of these psychiatric conditions that influence outcomes and quality of life of young adults with stroke.
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Affiliation(s)
- Katrina Hannah D Ignacio
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Jose Danilo B Diestro
- Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, University of Toronto, Canada
| | - Jose Miguel M Medrano
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Sitti Khadija U Salabi
- Department of Family and Community Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Alvin J Logronio
- Department of Medical Imaging and Therapeutic Radiology, National Kidney and Transplant Institute, Quezon City, Philippines
| | - Sedric John V Factor
- Department of Psychiatry and Behavioral Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Sharon D Ignacio
- Department of Rehabilitation Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jose Leonard R Pascual V
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Maria Carissa C Pineda-Franks
- Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Broman J, Aarnio K, But A, Marinkovic I, Rodríguez-Pardo J, Kaste M, Tatlisumak T, Putaala J. Initiation of antidepressants in young adults after ischemic stroke: a registry-based follow-up study. J Neurol 2021; 269:956-965. [PMID: 34165628 PMCID: PMC8782780 DOI: 10.1007/s00415-021-10678-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/16/2021] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Objective Data on post-stroke use of antidepressants in young individuals are scarce. We examined pattern and factors associated with initiating post-stroke antidepressants (PSAD) after ischemic stroke (IS) in young adults. Methods Helsinki Young Stroke Registry includes patients aged 15–49 years with first-ever IS, 1994–2007. Data on prescriptions, hospitalizations and death came from nationwide registers. We defined time of initiating PSAD as time of the first filled prescription for antidepressants within 1 year from IS. We assessed factors associated with initiating PSAD with multivariable Cox regression models, allowing for time-varying effects when appropriate. Results We followed 888 patients, of which 206 (23.2%) initiated PSAD. Higher hazard of starting PSAD within the first 100 days appeared among patients with mild versus no limb paresis 2.53 (95% confidence interval 1.48–4.31) and during later follow-up among those with silent infarcts (2.04; 1.27–3.28), prior use of antidepressants (2.09; 1.26–3.46) and moderate versus mild stroke (2.06; 1.18–3.58). The relative difference in the hazard rate for moderate–severe limb paresis persisted both within the first 100 days (3.84, 2.12–6.97) and during later follow-up (4.54; 2.51–8.23). The hazard rate was higher throughout the follow-up among smokers (1.48; 1.11–1.97) as well as lower (1.78; 1.25–2.54) and upper white-collar workers (2.00; 1.24–3.23) compared to blue-collar workers. Conclusion One-fourth of young adults started PSADs within 1 year from IS. We identified several specific clinical characteristics associated with PSAD initiation, highlighting their utility in assessing the risk of post-stroke depression during follow-up. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10678-4.
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Affiliation(s)
- Jenna Broman
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland.
| | - Karoliina Aarnio
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Anna But
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ivan Marinkovic
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | | | - Markku Kaste
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029, Helsinki, Finland
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5
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Sarecka-Hujar B, Kopyta I. The Impact of Sex on Arterial Ischemic Stroke in Young Patients: From Stroke Occurrence to Poststroke Consequences. CHILDREN-BASEL 2021; 8:children8030238. [PMID: 33803901 PMCID: PMC8003301 DOI: 10.3390/children8030238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 01/12/2023]
Abstract
The male sex has been suggested to predominate in paediatric patients with arterial ischemic stroke (AIS), especially in newborns. The explanation for this phenomenon remains unsatisfactory since it focuses on the analysis of the potential relationship with trauma and arterial dissection. In turn, in some populations of young adults, men suffer from AIS more frequently than women, which may be related to the protective role of oestrogen. On the other hand, certain data indicate that women dominate over men. Some of the disparities in the frequencies of particular symptoms of AIS and poststroke consequences in both children and young adults have been suggested; however, data are scarce. Unfortunately, the low number of studies on the subject does not allow certain conclusions to be drawn. For adults, more data are available for patients aged over 60 years, the results of which are more obvious. The present literature review aimed to discuss available data on the prevalence of AIS, its clinical presentations, and poststroke consequences in regard to the sex of young patients. We considered young patients to be children from birth up to the age of 19 years of life and young adults to be individuals up to the age of 55 years. The role of sex hormones in AIS and possible gender differences in genetic risk factors for AIS were also discussed briefly.
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Affiliation(s)
- Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa Str 3, 41-200 Sosnowiec, Poland
- Correspondence: or ; Tel.: +48-32-269-98-30
| | - Ilona Kopyta
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Medykow Str 16, 40-752 Katowice, Poland;
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6
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Mirolovics Á, Bokor M, Dobi B, Zsuga J, Bereczki D. Socioeconomic Factors Predicting Depression Differ in the Acute Stage and at 1 year After Ischemic Stroke or TIA. J Stroke Cerebrovasc Dis 2020; 29:105241. [PMID: 33066950 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Considerable depressive symptoms follow stroke in about one third of patients. Initial depressive symptoms may wane after the acute phase of stroke, but persisting depressive symptoms adversely affect rehabilitation and quality of life. We set forth to evaluate predictors of depressive symptoms with a focus on socioeconomic factors. METHODS We evaluated clinical features and socioeconomic characteristics in 233 consecutive patients with acute ischemic stroke or TIA. Depressive symptoms could be evaluated in 168 subjects in the acute phase with a repeated testing after a mean of 14.7 months via telephone interview in 116 patients. Survival status, scores on the Center for Epidemiologic Studies-Depression Scale (CES-D), Beck Depression Inventory (BDI) and disability (modified Rankin scale, mRS) were recorded. RESULTS In the acute phase, employment status (p = 0.037) and level of education (p = 0.048) whereas one year later dependency (mRS≥3, p = 0.002) and income (p = 0.012) were the significant predictors of the severity of depressive symptoms. A change from independent (mRS≤2) to dependent living predicted worsening depressive symptoms (p = 0.008), whereas improving to functional independence from an initially dependent condition was associated with diminishing depressive symptoms (p = 0.077 for CES-D and p = 0.044 for BDI) in the first year after an acute ischemic cerebrovascular event. CONCLUSIONS Predictors of the severity of depressive symptoms differed in the acute phase and at follow-up. In addition to disability, education and employment status in the acute phase and income in the late phase predict the severity of depressive symptoms after ischemic stroke or TIA.
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Affiliation(s)
- Ágnes Mirolovics
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary; Departmet of Neurology, National Institute of Psychiatry and Addictions Nyírő Gyula, Budapest, Hungary
| | - Magdolna Bokor
- Departmet of Neurology, National Institute of Psychiatry and Addictions Nyírő Gyula, Budapest, Hungary
| | - Balázs Dobi
- Department of Probability Theory and Statistics, Eötvös Loránd University, Budapest, Hungary
| | - Judit Zsuga
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary; MTA-SE Neuroepidemiological Research Group, Budapest, Hungary.
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Rabi-Žikić T, Živanović Ž, Đajić V, Simić S, Ružička-Kaloci S, Slankamenac S, Žikić M. PREDICTORS OF EARLY-ONSET DEPRESSION AFTER FIRST-EVER STROKE. Acta Clin Croat 2020; 59:81-90. [PMID: 32724278 PMCID: PMC7382869 DOI: 10.20471/acc.2020.59.01.10] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Post-stroke depression (PSD) is a severe and frequent stroke complication and one of the crucial factors for the outcome of rehabilitation and life quality after stroke. However, mood disorders frequently remain unnoticed and therefore untreated. The aim of the study was to examine all the potential risk factors and determine the independent predictors of early-onset depression after first-ever stroke, which would help identify high-risk patients, establish early diagnosis and timely treatment that would improve the course and prognosis of this disorder. This prospective study included 60 patients treated for their first-ever stroke; there were 30 patients diagnosed with depression and 30 patients without depression. The study included collection and analysis of all socio-demographic and clinical risk factors for PSD. Testing was performed two weeks after stroke. Depression was diagnosed according to the Mini International Neuropsychiatry Interview, DSM-IV diagnostic criteria, and depression severity was quantified by the Hamilton Depression Rating Scale. Cognitive impairment was assessed by the Mini Mental State Examination. Neurological deficit was assessed by the US National Institute of Health Stroke Scale. Our results showed that the independent predictors of early-onset depression after stroke were previous depressive episodes, cognitive dysfunction, and more severe neurological deficit.
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Affiliation(s)
| | - Željko Živanović
- 1Department of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Department of Neurology, Novi Sad, Serbia; 3Department of Neurology, Clinical Centre of Republic of Srpska, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 4University of Banjaluka, Faculty of Medicine, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 5Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, Novi Sad, Serbia; 6Global Prevent, Institute for Occupational Health, Novi Sad, Serbia
| | - Vlado Đajić
- 1Department of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Department of Neurology, Novi Sad, Serbia; 3Department of Neurology, Clinical Centre of Republic of Srpska, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 4University of Banjaluka, Faculty of Medicine, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 5Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, Novi Sad, Serbia; 6Global Prevent, Institute for Occupational Health, Novi Sad, Serbia
| | - Svetlana Simić
- 1Department of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Department of Neurology, Novi Sad, Serbia; 3Department of Neurology, Clinical Centre of Republic of Srpska, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 4University of Banjaluka, Faculty of Medicine, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 5Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, Novi Sad, Serbia; 6Global Prevent, Institute for Occupational Health, Novi Sad, Serbia
| | - Svetlana Ružička-Kaloci
- 1Department of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Department of Neurology, Novi Sad, Serbia; 3Department of Neurology, Clinical Centre of Republic of Srpska, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 4University of Banjaluka, Faculty of Medicine, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 5Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, Novi Sad, Serbia; 6Global Prevent, Institute for Occupational Health, Novi Sad, Serbia
| | - Sonja Slankamenac
- 1Department of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Department of Neurology, Novi Sad, Serbia; 3Department of Neurology, Clinical Centre of Republic of Srpska, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 4University of Banjaluka, Faculty of Medicine, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 5Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, Novi Sad, Serbia; 6Global Prevent, Institute for Occupational Health, Novi Sad, Serbia
| | - Milorad Žikić
- 1Department of Neurology, Clinical Centre of Vojvodina, Novi Sad, Serbia; 2University of Novi Sad, Faculty of Medicine, Department of Neurology, Novi Sad, Serbia; 3Department of Neurology, Clinical Centre of Republic of Srpska, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 4University of Banjaluka, Faculty of Medicine, Banjaluka, Republic of Srpska, Bosnia and Herzegovina; 5Department of Endocrinology, Diabetes and Metabolic Diseases, Clinical Centre of Vojvodina, Novi Sad, Serbia; 6Global Prevent, Institute for Occupational Health, Novi Sad, Serbia
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Kapoor A, Scott C, Lanctot KL, Herrmann N, Murray BJ, Thorpe KE, Lien K, Sicard M, Swartz RH. Symptoms of depression and cognitive impairment in young adults after stroke/transient ischemic attack. Psychiatry Res 2019; 279:361-363. [PMID: 31272664 DOI: 10.1016/j.psychres.2019.06.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/15/2019] [Accepted: 06/16/2019] [Indexed: 01/29/2023]
Abstract
Depression and cognitive complaints are common after stroke; these issues have been studied in older populations, but not in the young. Two hundred and seventy four eligible stroke and TIA patients consented to participate and complete the Center for Epidemiologic Studies Depression Scale, and National Institute of Neurological Disorders and Stroke - Canadian Stroke Network 30-min neuropsychological battery; 57 (21%) were ≤ 50 years of age. Younger patients reported greater symptoms of depression and less executive dysfunction than older patients. This study highlights age differences in post-stroke depression symptoms and cognitive impairment, and emphasizes the need for screening across ages.
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Affiliation(s)
- Arunima Kapoor
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Courtney Scott
- Department of Medicine (Neurology), Mackenzie Health, Richmond Hill, Ontario, Canada
| | - Krista L Lanctot
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Brian J Murray
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Kevin E Thorpe
- University of Toronto, Toronto, Ontario, Canada; St. Michael's Hospital, Applied Health Research Centre of the Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Karen Lien
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Michelle Sicard
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Richard H Swartz
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Hurvitz Brain Sciences Research Program, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, Toronto, Ontario, Canada.
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9
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Eriksen S, Bjørkløf GH, Helvik AS, Larsen M, Engedal K. The validity of the hospital anxiety and depression scale and the geriatric depression scale-5 in home-dwelling old adults in Norway ✰. J Affect Disord 2019; 256:380-385. [PMID: 31212233 DOI: 10.1016/j.jad.2019.05.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/20/2019] [Accepted: 05/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about the validity of the Norwegian versions of the Geriatric Depression Scale-5 (GDS-5) and the Hospital Anxiety and Depression Scale-D (HADS-D). The aim of this study was therefor to validate the two assessment tools in a population of home-dwelling persons of 60 years of age and above. METHODS A sample of 194 home-dwelling old adults with and without depressive symptoms were recruited. The participants were examined for depressive symptoms (GDS-5, HADS-D) and cognitive impairment. Sociodemographic information was collected. The participants underwent a blinded diagnostic evaluation for a depressive episode according to the diagnostic criteria of ICD-10. RESULTS In all, 56 (28.9%) participants fulfilled criteria for a depressive episode according to ICD-10. The Receiver Operating Characteristics analyses of HAD-D and GDS-5 using the diagnostic criteria of ICD-10 for depression as gold standard was performed. For GDS-5 the Areal under the Curve was 0.81 and for HAD-D 0.75. The cut-off points of the measures that produced the highest accuracies were ≥2 for GDS-5 with a sensitivity of 73.2% and a specificity of 73.2% and ≥4 for HADS-D with a sensitivity of 70.3% and a specificity of 69.6%. LIMITATIONS A larger sample would have given the opportunity for analyzing home dwelling old adults with and without home health care separately. The participants were talked through the self-filling questionnaires. The procedure could have influenced the participants' answers. CONCLUSION GDS-5 and HADS-D are useful screening tools for old adults, but only fairly good to identify depression according to criteria of ICD-10.
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Affiliation(s)
- S Eriksen
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway.
| | - G H Bjørkløf
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway
| | - A-S Helvik
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway; Department of Public Health and General Practice, Norwegian University of Science and Technology, Postboks 8905, N-7491 Trondheim, Norway
| | - M Larsen
- Department of Geriatric Psychiatry, Diakonhjemmet, Oslo, Postboks 23, Vinderen, N-0319 Oslo, Norway
| | - K Engedal
- Norwegian National Advisory Unit on Ageing and Health, Postboks 2136, N-3103 Tønsberg, Norway
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10
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Backhouse EV, McHutchison CA, Cvoro V, Shenkin SD, Wardlaw JM. Cognitive ability, education and socioeconomic status in childhood and risk of post-stroke depression in later life: A systematic review and meta-analysis. PLoS One 2018; 13:e0200525. [PMID: 30011299 PMCID: PMC6047794 DOI: 10.1371/journal.pone.0200525] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Depression after stroke is common and is associated with poorer recovery. Risk factors such as gender, age and stroke severity are established, but it is unclear whether factors from earlier in life might also contribute. METHODS We searched MEDLINE, PsycINFO, EMBASE and meta-analysed all available evidence on childhood (premorbid) IQ, socioeconomic status (SES), education and stroke in adulthood. We included all studies reporting data on >50 patients, calculating overall odds ratios (OR), mean difference, correlation, 95% confidence intervals (CI) and 95% predictive intervals (PI) using random effects methods. We quality assessed all studies, performed sensitivity analyses, assessed heterogeneity and publication bias. RESULTS We identified 33 studies including 2,664 participants with post-stroke depression and 5,460 without (314 participants not classified). Low education (< = 8 years) was associated with post-stroke depression in studies which defined depression as score of mild and above on a depression rating scale (OR 1.47 95% CI 1.10-1.97, p<0.01) but not in studies where depression was defined as severe depressive symptoms or a clinical diagnosis of major depression (OR 1.04 95% CI 0.90-1.31, p = 0.60). Low education was not associated with an increased risk for post-stroke depression in studies that adjusted for age and sex (OR 0.86 95% CI 0.50-1.48 p = 0.58). Those with post-stroke depression had fewer years of education than those without post-stroke depression (MD 0.68 95% CI 0.05-1.31 p = 0.04). Few studies adjusted for vascular risk factors or stroke severity. Heterogeneity between studies was moderate and was partly explained by severity of depression. In the one study identified premorbid IQ did not differ between those with post-stroke depression (mean IQ 10.1.8 SD 9.8) vs those without (mean IQ 104 SD 10.1). There were no studies that examined childhood socioeconomic status and risk of post-stroke depression. CONCLUSIONS Having less education is associated with an increased risk of post-stroke depressive symptoms but with large confidence intervals and heterogeneity. Future studies should explore the relationship between early and late life risk factors to improve risk identification and to target prevention and treatment strategies.
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Affiliation(s)
- Ellen V. Backhouse
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline A. McHutchison
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
| | - Vera Cvoro
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), Scotland, United Kingdom
| | - Susan D. Shenkin
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), Scotland, United Kingdom
- Geriatric Medicine, Department of Clinical and Surgical Sciences, The University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, United Kingdom
- Scottish Imaging Network, A Platform for Scientific Excellence (SINAPSE), Scotland, United Kingdom
- UK Dementia Research Institute at The University of Edinburgh, Edinburgh Medical School, Edinburgh, United Kingdom
- * E-mail:
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11
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Liu C, Yi X, Li T, Xu L, Hu M, Zhang S, Jiang R. Associations of depression, anxiety and PTSD with neurological disability and cognitive impairment in survivors of moyamoya disease. PSYCHOL HEALTH MED 2018; 24:43-50. [PMID: 29678126 DOI: 10.1080/13548506.2018.1467024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Depression, anxiety and posttraumatic stress disorder (PTSD) are common complications of cerebrovascular diseases. However, they were seldom explored in Moyamoya Disease (MMD) survivors. In this study, we measured the prevalence of depression, anxiety and PTSD in MMD survivors. We evaluated the association of mental disorders with neurological disability and cognitive impairment, and further find out the independent protective and risk factors of neurological disability and cognitive impairment. In MMD survivors, the prevalence of these three mental disorders is high, 46.7% for depression, 50% for anxiety and 47.5% for PTSD. Anxiety and PTSD were significantly associated with more severe neurological disability (p = 0.039 and < 0.001); depression and anxiety were significantly associated with greater cognitive deficiency (p = 0.004 and 0.002). We further found PTSD was the only risk factor associated with neurological disability, and the corresponding odds ratio (OR) and 95% confidence interval (CI) was 81.74 (9.91-674.17); depression and anxiety were risk factors associated with cognitive impairment, and the corresponding OR and 95%CI were 2.73 (1.10-6.81) and 3.37 (1.29-8.78). Therefore, these three mental disorders were associated with more severe neurological disability and greater cognitive deficiency in MMD survivors.
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Affiliation(s)
- Chanchan Liu
- a Department of Neurology , Shenzhen Guangming New District People's Hospital , Shenzhen , China
| | - Xiyan Yi
- b Department of Neurology , Morsani College of Medicine, University of South Florida, 2 Tampa General Circle, USF Health , Tampa , FL , USA
| | - Ting Li
- c Department of Cardiology , Shenzhen Guangming New District People's Hospital , Shenzhen , China
| | - Lei Xu
- d Department of Neurology , Xiangyang Central Hospital, Hubei University of Arts and Science , Xiangyang , China
| | - Mei Hu
- d Department of Neurology , Xiangyang Central Hospital, Hubei University of Arts and Science , Xiangyang , China
| | - Suming Zhang
- e Department of Neurology , Tongji Hospital, Huazhong University of Science and Technology , Wuhan , China
| | - Rifeng Jiang
- f Department of Radiology , Fujian Medical University Union Hospital , Fuzhou , China
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12
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Bodenant M, Leys D. Infarti cerebrali del soggetto giovane. Neurologia 2018. [DOI: 10.1016/s1634-7072(18)41288-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Bjørkløf GH, Engedal K, Selbæk G, Maia DB, Borza T, Benth JŠ, Helvik AS. Can depression in psychogeriatric inpatients at one year follow-up be explained by locus of control and coping strategies? Aging Ment Health 2018; 22:379-388. [PMID: 28051894 DOI: 10.1080/13607863.2016.1262817] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Treatment of depression (in late life) is good. The short-term, but not long-term prognosis after treatment of depression in late life is good. To identify modifiable factors, we wanted to examine whether coping in terms of locus of control and coping strategies in depressed patients were associated with the prognosis of depression at follow-up, adjusted for sociodemographic information and health variables. METHOD In total, 122 patients (mean age 75.4 years; SD = 6.6) were followed up (median 13.7 months, Q1-Q3 386-441) with a diagnostic evaluation(ICD-10) for depression and assessment of depressive symptoms (MADRS). Coping was assessed using Locus of Control of behavior (LoC-scale) and Ways of Coping questionnaire (WoC-scale). RESULTS At follow-up, 37.7% were diagnosed with a depressive episode. A stronger external LoC and lower MMSE-NR score at baseline were in adjusted linear regression analysis significantly more associated to higher depressive symptom scores (MADRS). More use of problem-focused coping, a lower I-ADL functioning, but not emotion-focused coping at baseline were significantly associated with being depressed (ICD-10), at follow-up in adjusted logistic regression analysis. CONCLUSION LoC and coping strategies at baseline were associated with the prognosis of depression at follow-up, and may further be studied as indicators for choice of baseline intervention strategies.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,b Department for Mental Health Research and Development, Division for Mental Health and Addiction , Vestre Viken Hospital Trust , Lier , Norway.,c Institute of Health and Society, Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Knut Engedal
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbæk
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway.,e National School of Public Health, Fundação Oswaldo Cruz , Rio , Brazil
| | - Deborah Bezerra Maia
- f Department of Public Health and General Practice, Faculty of Medicine , Norwegian University of Science and Technology (NTNU)
| | - Tom Borza
- d Centre for Old Age Psychiatric Research Innlandet Hospital Trust , Ottestad , Norway
| | - Jūratė Šaltytė Benth
- g St Olav's University Hospital , Trondheim , Norway.,h Institute of Clinical Medicine, Campus Ahus, University of Oslo , Norway
| | - Anne-Sofie Helvik
- a Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust , Tønsberg , Norway.,i HØKH, Research Centre , Akershus University Hospital , Norway
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14
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Baylor C, Yorkston KM, Jensen MP, Truitt AR, Molton IR. Scoping review of common secondary conditions after stroke and their associations with age and time post stroke. Top Stroke Rehabil 2018; 21:371-82. [PMID: 25341382 DOI: 10.1310/tsr2105-371] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Health care providers need to be alert to secondary conditions that might develop after stroke so that these conditions can be prevented or treated early to reduce further deterioration of health and quality of life. OBJECTIVES To review and describe the prevalence of secondary conditions after stroke and to summarize associations between secondary conditions and age and time post stroke. METHODS A scoping review of studies pertaining to secondary conditions after stroke published between 1986 and 2011 was conducted. RESULTS Seventy-six articles provided information regarding 6 secondary conditions: depression, pain, falls, fatigue, bowel/bladder problems, and sleep difficulties. Prevalence varied widely across studies for each condition. The limited repeated-measures evidence suggests that secondary conditions tend to occur in the first weeks or months post stroke and may remain relatively stable over time. Other evidence from regression analyses suggests either no significant associations between time post stroke or age or mixed results. Secondary conditions appear to be most commonly associated with severity of impairments. CONCLUSIONS Health care providers need to be alert to the development of secondary conditions after stroke in individuals as they age as well as in the poststroke time span. Obtaining a clear understanding of the prevalence of secondary conditions and associations with age and time post stroke is difficult because of variations in research methodologies. Future research is needed to define secondary condition prevalence and risk factors more clearly and to identify interventions that could reduce the prevalence and impact of these conditions on quality of life.
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Affiliation(s)
- Carolyn Baylor
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Kathryn M Yorkston
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Anjali R Truitt
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Ivan R Molton
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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15
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Li MJ, Xiao H, Qiu YX, Huang JH, Man RY, Qin Y, Xiong GH, Peng QH, Jian YQ, Peng CY, Zhang WN, Wang W. Identification of potential diagnostic biomarkers of cerebral infarction using gas chromatography-mass spectrometry and chemometrics. RSC Adv 2018; 8:22866-22875. [PMID: 35540152 PMCID: PMC9081573 DOI: 10.1039/c8ra03132k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/05/2018] [Indexed: 11/21/2022] Open
Abstract
Cerebral infarction (CI) is one of the most common cerebrovascular diseases and remains a major health problem worldwide. In this study, we evaluated the potential diagnostic biomarkers and important relevant metabolic pathways associated with CI. Metabolomics based on gas chromatography-mass spectrometry coupled with the multivariate pattern recognition technique were used to characterize the potential serum metabolic profiles of CI. Forty healthy controls and thirty-three cerebral infarction patients were recruited for the nontargeted global metabolites' study and subsequent targeted fatty acid analysis. Overall, thirty-four endogenous metabolites were found in serum from the untargeted global study, four of which were detected to be significantly different between the CI group and healthy controls, including l-lysine, octadecanoic acid (fatty acid), l-tyrosine and lactic acid. Additionally, fourteen free fatty acids were identified by the subsequent targeted fatty acid analysis, and seven of them were detected to be significantly different between the CI group and healthy controls, which were mainly associated with arachidonic acid metabolism and fatty acid metabolism. Our results suggest several potential diagnostic biomarkers, and serum metabolism research is demonstrated as a powerful tool to explore the pathogenesis of CI. Cerebral infarction (CI) is one of the most common cerebrovascular diseases and remains a major health problem worldwide.![]()
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16
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Wang S, Wang CX, Zhang N, Xiang YT, Yang Y, Shi YZ, Deng YM, Zhu MF, Liu F, Yu P, Ungvari GS, Ng CH. The Association Between Post-stroke Depression, Aphasia, and Physical Independence in Stroke Patients at 3-Month Follow-Up. Front Psychiatry 2018; 9:374. [PMID: 30177891 PMCID: PMC6110154 DOI: 10.3389/fpsyt.2018.00374] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 07/25/2018] [Indexed: 01/28/2023] Open
Abstract
Objective: Few studies have examined the association between post-stroke depression (PSD), aphasia, and physical independence in Chinese patients. This study investigated the above association in stroke patients in China at 3-month follow-up. Methods: Altogether 270 patients within 14 days after ischemic stroke were recruited and followed up at 3 months. PSD, aphasia, and physical functional status were measured using the Stroke Aphasia Depression Questionnaire (SADQ), Western Aphasia Battery (WAB), and modified Rankin Scale (mRS), respectively. Patients with mRS total score >2 were considered as having "physical dependence." Results: Out of 248 patients at 3-month follow up, 119 (48%) were rated as having physical dependence. Multiple logistic regression analyses revealed that female (p = 0.04; OR = 2.2; 95% CI: 1.0-5.1), more severe stroke at admission (p < 0.01; OR = 1.4; 95% CI: 1.3-1.5), and more severe PSD at 3 months (p = 0.01; OR = 1.05; 95% CI: 1.01-1.1) were independently associated with physical dependence at 3 months. Conclusions: Greater PSD and stroke severity were independently associated with physical dependence at 3 months after stroke. Aphasia was also associated with physical dependence but the relationship was not significant. Early and effective depression screening, treatment and stroke rehabilitation appear to be important to improve the physical outcome and reduce the burden of stroke survivors.
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Affiliation(s)
- Shuo Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Chun-Xue Wang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China.,Department of Clinical Psychology, Capital Medical University, Beijing, China
| | - Ning Zhang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Taipa, Macau
| | - Yang Yang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yu-Zhi Shi
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yi-Ming Deng
- China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Department of Interventional Neuroradiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Mei-Fang Zhu
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Fei Liu
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ping Yu
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Marian Centre and Graylands Hospital, Perth, WA, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
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17
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Bjørkløf GH, Engedal K, Selbæk G, Maia DB, Coutinho ESF, Helvik AS. Locus of control and coping strategies in older persons with and without depression. Aging Ment Health 2016; 20:831-9. [PMID: 25955293 DOI: 10.1080/13607863.2015.1040722] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To compare locus of control and coping strategies in older persons with and without depression. METHOD This cross-sectional study included 144 depressed in-patients from seven psychogeriatric hospital units, and 106 community-dwelling older persons without depression. All participants were 60 years and older. Locus of control was assessed by a 17-items self-report questionnaire with six response categories. Coping strategies were assessed by a 26-items self-report questionnaire with five response categories. For analytical purposes, age (<75 years vs. ≥75 years), level of education (<10 years vs. ≥10 years) and general medical health (poor vs. not poor) were categorized. RESULTS In linear regression analysis, controlling for demographics, health, and social variables, the depressed in-patients showed a higher external locus of control orientation and a less frequent use of problem-focused coping strategies compared with the non-depressed group. No differences in use of emotion-focused strategies were found between the two groups. CONCLUSION Compared with the non-depressed old persons, the depressed hospitalized older persons were characterized by perceptions of less personal control, and less use of problem-focused strategies, what also might have brought positive alterations into their situation.
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Affiliation(s)
- Guro Hanevold Bjørkløf
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway.,b Department for Mental Health Research and Development, Division for Mental health and Addiction , Vestre Viken Hospital Trust , Lier , Norway.,c Faculty of Medicine , University of Oslo , Oslo , Norway
| | - Knut Engedal
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway
| | - Geir Selbæk
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway.,d Research Center of Old Age Psychiatry , Innlandet Hospital Trust , Ottestad , Norway.,e Akershus University Hospital , Lørenskog , Norway
| | - Deborah Bezerra Maia
- f National School of Public Health, Fundação Oswaldo Cruz (ENSP-FIOCRUZ) , Rio , Brazil
| | | | - Anne-Sofie Helvik
- a Ageing and Health, Norwegian Centre for Research, Education and Service Development , Vestfold Hospital Trust , Tønsberg , Norway.,g Department of Public Health and General Practice, Faculty of Medicine , Norwegian University of Science and Technology (NTNU) , Trondheim , Norway.,h St Olav's University Hospital , Trondheim , Norway
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18
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Helvik AS, Corazzini K, Selbæk G, Bjørkløf GH, Laks J, Šaltytė Benth J, Østbye T, Engedal K. Health-related quality of life in older depressed psychogeriatric patients: one year follow-up. BMC Geriatr 2016; 16:131. [PMID: 27388445 PMCID: PMC4936227 DOI: 10.1186/s12877-016-0310-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 06/17/2016] [Indexed: 11/16/2022] Open
Abstract
Background Knowledge about long-term change in health related quality of life (HQoL) among older adults after hospitalization for treatment of depression has clinical relevance. The aim was firstly to describe the change of HQoL one year after admission for treatment of depression, secondly to explore if improved HQoL was associated with remission of depression at follow-up and lastly to study how HQoL in patients with remission from depression were compared to a reference group of older persons without depression. Method This study had the one year follow-up information of 108 older patients (≥60 years), all hospitalized for depression at baseline, and a reference sample of 106 community-living older adults (≥60 years) without depression. HQoL was measured using the EuroQol Group’s EQ-5D Index and a visual analog scale (EQ-VAS). Depression and remission were diagnosed according to ICD-10. Socio-demographic variables (age, gender, and education), depressive symptom score (Montgomery-Aasberg Depression Rating Scale), cognitive functioning (Mini Mental State Examination scale), instrumental activities of daily living (the Lawton and Brody’s Instrumental Activities of Daily Living Scale), and poor general physical health (General Medical Health Rating) were included as covariates. Results HQoL had improved at follow-up for the total group of depressed patients, as indicated by better scores on the EQ-5D Index and EQ-VAS. In the multivariate linear regression model, improved EQ-5D Index and EQ-VAS was significantly better in those with remission of depression and those with better baseline physical health. In adjusted analyses, the HQoL in patients with remission from depression at follow-up did not differ from the HQoL in a reference group without depression. Conclusion Older hospital patients with depression who experienced remission one year after admission gained HQoL and their HQoL was comparable with the HQoL in a reference group of older adults without depression when adjusting for differences in socio-demographics and health conditions.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. .,St. Olav's University Hospital, Trondheim, Norway. .,Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway.
| | | | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway.,Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Guro Hanevold Bjørkløf
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
| | - Jerson Laks
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Post Graduation Program in Translational Medicine, Universidade do Grande Rio (Unigranrio), Rio de Janeiro, Brazil
| | - Jūratė Šaltytė Benth
- Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway.,Institute of Clinical Medicine, Ahus Campus, University of Oslo, Oslo, Norway.,Research Centre, HØKH, Akershus University Hospital, Lørenskog, Norway
| | | | - Knut Engedal
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway
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19
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Helvik AS, Bjørkløf GH, Corazzini K, Selbæk G, Laks J, Østbye T, Engedal K. Are coping strategies and locus of control orientation associated with health-related quality of life in older adults with and without depression? Arch Gerontol Geriatr 2016; 64:130-7. [DOI: 10.1016/j.archger.2016.01.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/15/2016] [Accepted: 01/26/2016] [Indexed: 11/26/2022]
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20
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Maaijwee NAMM, Tendolkar I, Rutten-Jacobs LCA, Arntz RM, Schaapsmeerders P, Dorresteijn LD, Schoonderwaldt HC, van Dijk EJ, de Leeuw FE. Long-term depressive symptoms and anxiety after transient ischaemic attack or ischaemic stroke in young adults. Eur J Neurol 2016; 23:1262-8. [PMID: 27094933 DOI: 10.1111/ene.13009] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/02/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Few studies exist on long-term post-stroke depressive symptoms and anxiety in young adults, although these young patients have a particular interest in their long-term prognosis, given their usually long life expectancy and being in the midst of an active social, working and family life. The aims of this study were to investigate the prevalence of depressive symptoms and anxiety and their association with clinical and demographic variables and with functional outcome after stroke in young adults. METHODS AND RESULTS Long-term prevalence of depressive symptoms and anxiety was calculated in 511 patients with a transient ischaemic attack or ischaemic stroke, aged 18-50 years, using the Hospital Anxiety and Depression scale, compared with 147 controls. Functional outcome was assessed with the modified Rankin Score (mRS) and the Instrumental Activities of Daily Living scale (IADL). 16.8% of patients had depressive symptoms and 23.0% had anxiety, versus 6.1% (P = 0.001) and 12.2% (P < 0.001) in controls. In ischaemic stroke patients, depressive symptoms and anxiety were associated with poor functional outcome (mRS > 2 or IADL < 8). CONCLUSION Even a decade after stroke at young age, depressive symptoms and anxiety were prevalent and associated with poor functional outcome. Therefore, even in the long term, treating physicians should be aware of the long-term presence of these symptoms as their recognition may be the first step in improving long-term functional independence.
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Affiliation(s)
- N A M M Maaijwee
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - I Tendolkar
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L C A Rutten-Jacobs
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - R M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - P Schaapsmeerders
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - L D Dorresteijn
- Department of Neurology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - H C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - F-E de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Calvet D. Infarctus cérébral du sujet jeune. Rev Med Interne 2016; 37:19-24. [DOI: 10.1016/j.revmed.2015.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 11/16/2022]
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Wei C, Gao J, Chen L, Zhang F, Ma X, Zhang N, Zhang W, Xue R, Luo L, Hao J. Factors associated with post-stroke depression and emotional incontinence: lesion location and coping styles. Int J Neurosci 2015; 126:623-9. [PMID: 26005045 DOI: 10.3109/00207454.2015.1051045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Post-stroke depression (PSD) and post-stroke emotional incontinence (PSEI) have attracted worldwide interest in recent years. These emotional disturbances have a negative impact on the rehabilitation process and the associated worse outcome. Consequently, defining the risk factors for development of PSD and PSEI is important. In this study, we evaluated 368 consecutive patients with acute ischemic stroke at admission and at three months later. PSD was evaluated by using the Beck Depression Inventory, and PSEI was evaluated using Kim's criteria. The Social Support Rating Scale and Medical Coping Modes Questionnaire were also used as measurement tools. Multivariate analyses showed that anterior cortex infarction was associated with PSEI three months after stroke occurrence. The appearance of PSD was not related to lesion location. Both motor and sensory dysfunctions was independently associated with PSD at admission, whereas low degree of social utilization was the independent factor associated with PSD 3 months after stroke. Acceptance-resignation is related to PSD and PSEI both at admission and 3 months after stroke. Avoidance was the independent factor related to PSD at 3 months after stroke onset.
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Affiliation(s)
- Changjuan Wei
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
| | - Juan Gao
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
| | - Li Chen
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
| | - Fang Zhang
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
| | - Xiaofeng Ma
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
| | - Nan Zhang
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
| | - Wei Zhang
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
| | - Rong Xue
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
| | - Lanlan Luo
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
| | - Junwei Hao
- a Department of Neurology and Tianjin Neurological Institute , Tianjin Medical University General Hospital , Tianjin , China
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Brito-Brito PR, Fernandez-Gutierrez DA, M Smith H. Case Study: Community Nursing Care Plan for a Man With Functional and Psychosocial Problems Following a Stroke. Int J Nurs Knowl 2015; 27:170-4. [PMID: 25774001 DOI: 10.1111/2047-3095.12084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aims to use the standardized nursing process to assist a middle-aged man with functional and psychosocial problems following a stroke. DATA SOURCES Data were obtained from interviews with the patient during primary care nurse consultations, electronic health record reviews, and reports from other professionals. To build the care plan, we used available scientific evidence, and we also considered a nurse-patient agreement. DATA SYNTHESIS We used clinical reasoning with NANDA-I classification, the Nursing Outcomes Classification, and the Nursing Interventions Classification to select nursing diagnoses, patient outcomes, and nursing interventions. CONCLUSIONS Psychosocial problems complicate the management of a patient with functional consequences after a stroke. This fact has high impact on people who are going through this process.
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Affiliation(s)
- Pedro Ruyman Brito-Brito
- Nursing School, University Hospital Nuestra Sra. Candelaria, Tenerife, Santa Cruz de Tenerife, Canary Islands
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De Ryck A, Fransen E, Brouns R, Geurden M, Peij D, Mariën P, De Deyn PP, Engelborghs S. Poststroke depression and its multifactorial nature: results from a prospective longitudinal study. J Neurol Sci 2014; 347:159-66. [PMID: 25451004 DOI: 10.1016/j.jns.2014.09.038] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/01/2014] [Accepted: 09/22/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Poststroke depression (PSD) is commonly observed in stroke patients and has a negative impact on functional outcome and quality of life. Therefore, a prospective, longitudinal epidemiological study was conducted aiming to determine prevalence and risk factors for PSD at 1, 3, 6, 12 and 18 months poststroke. METHODS A total of 222 patients were included in the study and 201 patients entered data analysis. Demographic data, vascular risk factors, stroke characteristics, functional and neurocognitive outcome measures and psychosocial factors were considered as potential risk factors for PSD. Clinically significant signs and symptoms of PSD were quantified by means of the Cornell Scale for Depression (CSD) and the Montgomery and Åsberg Depression Rating Scale (MADRS). RESULTS PSD was present at 1, 3, 6, 12 and 18 months poststroke in 24.5%, 27.1%, 28.3%, 19.8% and 26.3% of the patients respectively. Univariate regression analyses revealed that PSD was significantly associated with stroke severity, physical disability, cognitive impairment and stroke outcome during the 18 months time frame of the study. Reduced social activities and the presence of apraxia were consistently associated with PSD whereas aphasia was only significantly associated in the first 6 months after stroke. Patients with relational problems had a 3 times greater risk of becoming depressed at 18 months poststroke than patients without relational problems (OR=3.09; 95% CI=1.31-7.26). CONCLUSIONS Risk factors for PSD seem variable indicating the need for clinicians to consider the dynamic and multifactorial nature of PSD emphasizing the importance of a rigorous and long-term monitoring and support of stroke patients and their caregivers.
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Affiliation(s)
- A De Ryck
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium.
| | - E Fransen
- StatUa Center for Statistics, University of Antwerp, Belgium
| | - R Brouns
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - M Geurden
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium; Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium
| | - D Peij
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - P Mariën
- Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium; Department of Neurolinguistics, Vrije Universiteit Brussel, Belgium
| | - P P De Deyn
- Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium; Department of Health Care Sciences, Artesis University College of Antwerp, Antwerp, Belgium; University of Groningen, University Medical Center Groningen, Department of Neurology and Alzheimer Research Center, Netherlands; Reference Centre for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - S Engelborghs
- Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Belgium; Reference Centre for Biological Markers of Dementia (BIODEM), Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
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De Ryck A, Brouns R, Geurden M, Elseviers M, De Deyn PP, Engelborghs S. Risk factors for poststroke depression: identification of inconsistencies based on a systematic review. J Geriatr Psychiatry Neurol 2014; 27:147-58. [PMID: 24713406 DOI: 10.1177/0891988714527514] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Depression after stroke or poststroke depression (PSD) has a negative impact on the rehabilitation process and the associated rehabilitation outcome. Consequently, defining risk factors for development of PSD is important. The relationship between stroke and depression is described extensively in the available literature, but the results are inconsistent. The aim of this systematic review is to outline conflicting evidence on risk factors for PSD. METHODS PubMed, Medline, and Web of Knowledge were searched using the keywords "stroke," "depression," and "risk factor" for articles published between January 01, 1995, and September 30, 2012. Additional articles were identified and obtained from a hand search in related articles and reference lists. RESULTS A total of 66 article abstracts were identified by the search strategy and 24 articles were eligible for inclusion based on predefined quality criteria. The methodology varies greatly between the various studies, which is probably responsible for major differences in risk factors for PSD reported in the literature. The most frequently cited risk factors for PSD in the literature are sex (female), history of depression, stroke severity, functional impairments or level of handicap, level of independence, and family and social support. CONCLUSIONS Many risk factors are investigated over the last 2 decades and large controversy exists concerning risk factors for development of PSD. These contradictions may largely be reduced to major differences in clinical data, study population, and methodology, which underline the need for more synchronized studies.
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Affiliation(s)
- Annemieke De Ryck
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Raf Brouns
- Department of Neurology, Universitair Ziekenhuis Brussel, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Marleen Geurden
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
| | - Monique Elseviers
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium Heymans Institute of Clinical Pharmacology, Ghent University, Ghent, Belgium
| | - Peter P De Deyn
- Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium Department of Neurology and Alzheimer Research Center, University of Groningen and University Medical Center Groningen, Groningen, the Netherlands Laboratory of Neurochemistry and Behaviour, Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Department of Neurology and Memory Clinic, ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium Laboratory of Neurochemistry and Behaviour, Department of Biomedical Sciences, Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
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Maaijwee NAMM, Rutten-Jacobs LCA, Schaapsmeerders P, van Dijk EJ, de Leeuw FE. Ischaemic stroke in young adults: risk factors and long-term consequences. Nat Rev Neurol 2014; 10:315-25. [PMID: 24776923 DOI: 10.1038/nrneurol.2014.72] [Citation(s) in RCA: 219] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Contrary to trends in most other diseases, the average age of ischaemic stroke onset is decreasing, owing to a rise in the incidence of stroke among 'young' individuals (under 50 years of age). This Review provides a critical overview of the risk factors and aetiology of young ischaemic stroke and addresses its long-term prognosis, including cardiovascular risk, functional outcome and psychosocial consequences. We highlight the diminishing role of 'rare' risk factors in the pathophysiology of young stroke in light of the rising prevalence of 'traditional' vascular risk factors in younger age groups. Long-term prognosis is of particular interest to young patients, because of their long life expectancy and major responsibilities during a demanding phase of life. The prognosis of young stroke is not as favourable as previously thought, with respect either to mortality or cardiovascular disease or to psychosocial consequences. Therefore, secondary stroke prevention is probably a life-long endeavour in most young stroke survivors. Due to under-representation of young patients in past trials, new randomized trials focusing on this age group are needed to confirm the benefits of long-term secondary preventive medication. The high prevalence of poor functional outcome and psychosocial problems warrants further study to optimize treatment and rehabilitation for these young patients.
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Affiliation(s)
- Noortje A M M Maaijwee
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Loes C A Rutten-Jacobs
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Pauline Schaapsmeerders
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
| | - Frank-Erik de Leeuw
- Department of Neurology, Radboud University Nijmegen Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, PO Box 9101, 6500 HB, Nijmegen, Netherlands
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De Ryck A, Fransen E, Brouns R, Geurden M, Peij D, Mariën P, De Deyn PP, Engelborghs S. Psychosocial problems associated with depression at 18 months poststroke. Int J Geriatr Psychiatry 2014; 29:144-52. [PMID: 23625635 DOI: 10.1002/gps.3974] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/26/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE With a prevalence that varies between 20% and 65%, poststroke depression (PSD) is a frequent sequel of stroke. The aim of this study was to determine incidence and risk factors for PSD 18 months after stroke. METHODS As part of the Middelheim Interdisciplinary Stroke Study, patients were followed up for 18 months in this prospective and longitudinal epidemiological study. Clinically significant signs and symptoms of PSD were quantified by means of the Cornell Scale for Depression (CSD) and the Montgomery and Åsberg Depression Rating Scale. Activities, including social activities, were measured with the Stroke Impact Scale (SIS). Relational problems since stroke onset were defined by a questionnaire. RESULTS Data analysis was performed on 125 patients who completed follow-up assessments. Depression (CSD score ≥8) was diagnosed in 28% of the patients. Patients with PSD were more dependent for activities of daily living and displayed more physical and cognitive impairment than patients without PSD. The risk to become depressed decreased with 5% when the patient's activities increased with one unit on the SIS (odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.93-0.97). Patients with persistent relational problems since stroke onset had approximately four and a half times greater risk of becoming depressed than patients without (OR = 4.48; 95%CI = 1.17-16.87). CONCLUSIONS Multiple regression models indicated that the most determining features for developing PSD at 18 months poststroke include reduced activity and relationship problems due to stroke. Further studies on risk factors for PSD are essential, including psychosocial aspects, given its negative impact on rehabilitation and quality of life.
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Affiliation(s)
- A De Ryck
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Department of Neurology, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
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Zhang WN, Pan YH, Wang XY, Zhao Y. A prospective study of the incidence and correlated factors of post-stroke depression in China. PLoS One 2013; 8:e78981. [PMID: 24260141 PMCID: PMC3832506 DOI: 10.1371/journal.pone.0078981] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 09/25/2013] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is commonly observed among stroke survivors. However, statistical analysis of such data is scarce in developing countries. The purpose of this study is to examine the incidence of PSD and its relationship with stroke characteristics in China. METHODS This was a prospective hospital-based study. Stroke patients were assessed within two weeks after acute ischemic stroke onset and then reevaluated at three months. Hamilton Depression Scale (HAMD) was used for screening depression (PSD). Subjects with HAMD score of ≥7 were further assessed with the World Health Organization Composite International Diagnostic Interview. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS). Stroke outcome was measured by the modified Rankin Scale (mRS). RESULTS One hundred and two stroke patients were recruited, only ninety-one patients completed del period (men = 53, 63.74%), with mean age 60.0±10.4 years (range, 34-82 years). The incidence of PSD was 27.47% two weeks after stroke. The occurrence of PSD was unrelated with age, stroke type, stroke lesion and the history of disease. In univariate analysis gender, PSD was correlated with female gender. In multivariate logistic regression analysis, poor stroke outcome (mRS≥3) (OR 12.113, CI 1.169 to 125.59, P<0.05) was the important predictors of PSD. CONCLUSIONS The study indicated that gender, functional dependence and stroke outcome are determinants of PSD occurrence during the first 2 weeks after stroke in China.
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Affiliation(s)
- Wei-Na Zhang
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
| | - Yong-Hui Pan
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
- * E-mail:
| | - Xiao-Yu Wang
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
| | - Yue Zhao
- Department of Neurology, the First Clinical Medical College of Harbin Medical University, Harbin, PR China
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Paul N, Das S, Hazra A, Ghosal MK, Ray BK, Banerjee TK, Chaudhuri A, Sanyal D, Basu A, Das SK. Depression among stroke survivors: a community-based, prospective study from Kolkata, India. Am J Geriatr Psychiatry 2013; 21:821-31. [PMID: 23871116 DOI: 10.1016/j.jagp.2013.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 03/02/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Post-stroke depression (PSD) is a disabling entity among stroke survivors (SS). Longitudinal studies on PSD, essential to determine its prognosis, are lacking from developing countries. This prospective study was undertaken to assess the prevalence, natural history, and correlates of depression among SS in an Indian community. METHODS From a community based stroke registry, SS were assessed annually for cognition, disability, and depression using Bengali validated scales. PSD was diagnosed if score on geriatric depression scale was greater than or equal to 21. Complex sample strategy was considered when calculating prevalence of post stroke depression. An age- and sex-matched case-control study was undertaken to determine the odds of depression in SS. RESULTS Prevalence of PSD was 36.98% (95% confidence interval [CI]: 31.89%-42.06%) among 241 patients assessed at baseline. About 17% developed depression annually and a similar proportion had spontaneous improvement. Peak rate of PSD was beyond 3 months and continued up to 18 months after stroke. Compared to the non-depressed group, PSD subjects were significantly older, had higher age at first stroke, less education, lower socioeconomic status, and greater cognitive impairment and disability. Education had a protective role. Mortality in PSD was nearly twice that in non-depressed patients, though not significant statistically (hazard ratio: 1.84; 95% CI: 0.90-3.77). Compared with controls, odds ratio of PSD was 19.95 (95% CI: 10.09-39.47). CONCLUSIONS Approximately one-third of SS develop PSD, similar to developed countries. Prevalence remains stable annually. Delayed peak of PSD suggested later realization of underlying disability. Predictors of PSD have been described and higher literacy was protective in this study.
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Affiliation(s)
- Neelanjana Paul
- Department of Psychiatry, Institute of Psychiatry, Institute of Postgraduate Medical Education & Research (IPGME&R), Kolkata, India
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De Ryck A, Brouns R, Fransen E, Geurden M, Van Gestel G, Wilssens I, De Ceulaer L, Mariën P, De Deyn PP, Engelborghs S. A prospective study on the prevalence and risk factors of poststroke depression. Cerebrovasc Dis Extra 2013; 3:1-13. [PMID: 23626594 PMCID: PMC3567876 DOI: 10.1159/000345557] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and Purpose Poststroke depression (PSD) is common. Early detection of depressive symptoms and identification of patients at risk for PSD are important as PSD negatively affects stroke outcome and costs of medical care. Therefore, the aim of this study was to determine incidence and risk factors for PSD at 3 months after stroke. Methods We conducted a prospective, longitudinal epidemiological study aiming to determine incidence and risk factors for PSD at 1, 3, 6, 12 and 18 months poststroke. The present data analysis covers the convalescent phase of 3 months poststroke. Participants in this study were inpatients, admitted to a stroke unit with first or recurrent stroke. Demographic data and vascular risk factors were collected and patients were evaluated at baseline and 3 months poststroke for functional and cognitive deficits, stroke characteristics, stroke severity and stroke outcome. Signs and symptoms of depression were quantified by means of the Cornell Scale for Depression (CSD) and Montgomery and Åsberg Depression Rating Scale (MADRS). Significantly associated variables from univariate analysis were analyzed by using multiple linear and logistic regression methods. Results Data analysis was performed in 135 patients who completed follow-up assessments at 3 months poststroke. Depression (CSD score ≥8) was diagnosed in 28.1% of the patients. Patients with PSD were significantly more dependent with regard to activities of daily living (ADL) and displayed more severe physical and cognitive impairment than patients without PSD. A higher prevalence of speech and language dysfunction and apraxia were observed in patients with PSD (36.8 and 34.3%, respectively) compared to non-depressed stroke patients (19.6 and 12.4%; p = 0.036 and p = 0.004, respectively). Applying multiple linear regressions, cognitive impairment and reduced mobility as part of the Stroke Impact Scale were independently associated with PSD, as scored using CSD and MADRS (r2 = 0.269 and r2 = 0.474, respectively). Conclusions The risk of developing PSD is increased in patients with more functional and cognitive impairment, greater dependency with regard to ADL functions and with occurrence of speech and language dysfunctions and apraxia. Multiple regression models indicated that the most determining features for depression risk in the convalescent phase after stroke include reduced mobility and cognitive impairment. Further studies on risk factors for PSD are essential, given its negative impact on rehabilitation and quality of life. Identification of risk factors for PSD may allow more efficacious preventive measures and early implementation of adequate antidepressive treatment.
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Affiliation(s)
- A De Ryck
- Department of Nursing and Midwifery Sciences, Faculty of Medicine and Health Sciences, and University of Antwerp, Antwerp, Belgium ; Department of Neurology, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim and Hoge Beuken, Antwerp, Belgium
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Cognitive outcome of survivors of space-occupying hemispheric infarction. J Neurol 2013; 260:1396-403. [DOI: 10.1007/s00415-012-6810-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/13/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
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Naess H, Lunde L, Brogger J. The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: the Bergen Stroke Study. Vasc Health Risk Manag 2012; 8:407-13. [PMID: 22910531 PMCID: PMC3402053 DOI: 10.2147/vhrm.s32780] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Many patients with cerebral infarction suffer from symptoms such as pain, fatigue, and depression. The aim of this study was to evaluate these symptoms in relation to health-related quality of life (HRQoL) on long-term follow-up. Materials and methods All surviving stroke patients admitted to the Stroke Unit, Haukeland University Hospital, Norway between February 2006 and November 2008 were sent a questionnaire, including a visual analog pain scale, Fatigue Severity Scale, Depression Subscale of Hospital Anxiety and Depression Scale, Barthel Index, and three measures of HRQoL – 15D, EuroQol, and EuroQol Visual Analogue Scale – at least 6 months after stroke onset. Cox regression survival analysis, including EQ-5D, was performed by November 2009. Results The questionnaire was returned by 328 patients. All three symptoms were reported by 10.1% of the patients, and 26% reported two symptoms. There was a significant association between worse HRQoL scores and an increasing number of cooccurring symptoms for all three HRQoL scores. Fatigue, depression, pain, functional state, and sleeping disorder on follow-up accounted for 58%–83% of the variability in HRQoL, depending on which HRQoL scale was used. Cox regression analysis showed that mortality was associated with a low EuroQol score (P = 0.016). Conclusion Pain, fatigue, and depression were common symptoms among these stroke patients and, to a large extent, they determined the patients’ HRQoL. Low HRQoL was associated with increased mortality.
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Affiliation(s)
- Halvor Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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Li ZW, Xie MJ, Tian DS, Li JJ, Zhang JP, Jiao L, Tang ZP, Tang RH. Characteristics of depressive symptoms in essential tremor. J Clin Neurosci 2011; 18:52-6. [PMID: 20888237 DOI: 10.1016/j.jocn.2010.05.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 05/02/2010] [Accepted: 05/30/2010] [Indexed: 01/25/2023]
Abstract
Depressive symptoms are common in essential tremor (ET) and may be a primary feature of the underlying disease. However, it is still unclear whether depression in ET and depression in primary affective disorders share common clinical manifestations. Sixty-one depressed ET patients and 112 depressed patients without ET were assessed using the Montgomery-Asberg Depression Rating Scale (MADRS). We compared the individual depressive symptoms of the two groups by comparing MADRS subitem scores. Although there was no significant difference between the level of cognitive function and the severity of depression, patients with ET had a lower score on items "reported sadness", "inability to feel" and "pessimistic thoughts", and a higher score on items "concentration difficulties" and "lassitude" than those of patients without ET. These results show that depressive symptoms in patients with ET possess distinct characteristics compared to those in depressed patients without ET.
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Affiliation(s)
- Zai-Wang Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Boulevard, Wuhan, Hubei 430030, China
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Naess H, Lunde L, Brogger J, Waje-Andreassen U. Depression predicts unfavourable functional outcome and higher mortality in stroke patients: the Bergen Stroke Study. Acta Neurol Scand 2011:34-8. [PMID: 20586733 DOI: 10.1111/j.1600-0404.2010.01373.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To assess the influence of depression prior to stroke (PD) on stroke severity on admittance, functional outcome (short- and long-term), mortality, and long-term depression (PSD). METHODS Consecutive acute stroke patients were screened for PD. The National Institute of Health Stroke Scale score was obtained on admission. Short-term functional state was registered by the modified Rankin scale and on long-term functional outcome by the Barthel Index. PSD was defined as depression subscale of the hospital anxiety and depression scale (HADSD) >or=11. HADSD and Barthel Index were obtained by postal questionnaire. Survival analyses were performed. RESULTS Among 771 patients 21.7% had PD. Among 376 patients returning the questionnaire, 8.8% were depressed. On logistic regression analyses severity of stroke on admission, short-term, and long-term functional outcome were independently associated with PD. Logistic regression showed PSD to be independently associated with PD and being unmarried. Cox regression analyses showed that both PD and PSD were associated with high long-term mortality. CONCLUSIONS This study has identified several factors associated with PSD. PD predicts more severe stroke on admittance and less functional improvement both in the short- and the long-term. Both PD and PSD predict higher long-term mortality.
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Affiliation(s)
- H Naess
- Department of Neurology, Haukeland University Hospital, Bergen, Norway.
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Chausson N, Olindo S, Cabre P, Saint-Vil M, Smadja D. Five-Year Outcome of a Stroke Cohort in Martinique, French West Indies. Stroke 2010; 41:594-9. [PMID: 20167913 DOI: 10.1161/strokeaha.109.573402] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicolas Chausson
- From the Department of Neurology, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Stéphane Olindo
- From the Department of Neurology, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Philippe Cabre
- From the Department of Neurology, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Martine Saint-Vil
- From the Department of Neurology, University Hospital of Fort-de-France, Martinique, French West Indies
| | - Didier Smadja
- From the Department of Neurology, University Hospital of Fort-de-France, Martinique, French West Indies
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Helvik AS, Skancke RH, Selbaek G. Screening for depression in elderly medical inpatients from rural area of Norway: prevalence and associated factors. Int J Geriatr Psychiatry 2010; 25:150-9. [PMID: 19551706 DOI: 10.1002/gps.2312] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM The present investigation screened for depression in order to assess the prevalence of depression and to study the associated factors with depression in elderly medically hospitalised patients from a rural area in Norway. METHODS A cross-sectional study evaluated 484 (243 women) elderly medical inpatients with age range 65-101 (mean 80.7) years between September 2006 and August 2008 and used the Hospital Anxiety and Depression scale (HAD), Montgomery and Asberg Depression Rating Scale, the Mini-Mental State Examination, Lawton and Brody's scale for self-maintaining and instrumental activities of daily living. RESULTS The prevalence of current depression, depression score > or =8 at HAD, was for the total sample 10% of whom 78% was previously not diagnosed as having depression. The odds for depression were decreased for women aged 80 years or more while for men at the same age strata it was increased threefold. Age adjusted logistic regression analyses demonstrated an increased odds for depression for those who were in need of nursing assistance before hospitalisation, had lower level of physical functioning, had clinical anxiety symptoms and had higher number of medicaments at inclusion time. CONCLUSION The prevalence of depression in medical hospitalised elderly from rural areas was lower than in most other hospital studies. However, most patients with depression were not previously recognised as being depressed.
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Affiliation(s)
- Anne-Sofie Helvik
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
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Poynter B, Shuman Hon M, Diaz-Granados N, Kapral M, Grace SL, Stewart DE. Sex Differences in the Prevalence of Post-Stroke Depression: A Systematic Review. PSYCHOSOMATICS 2009. [DOI: 10.1016/s0033-3182(09)70857-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Jiménez I, Sobrino T, Rodríguez-Yáñez M, Pouso M, Cristobo I, Sabucedo M, Blanco M, Castellanos M, Leira R, Castillo J. High serum levels of leptin are associated with post-stroke depression. Psychol Med 2009; 39:1201-1209. [PMID: 19356259 DOI: 10.1017/s0033291709005637] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depression is a frequent mood disorder that affects around 33% of stroke patients and has been associated with both poorer outcome and increased mortality. Our aim was to test the possible association between inflammatory and neurotrophic molecular markers and the development of post-stroke depression. METHOD We studied 134 patients with a first episode of ischemic stroke without previous history of depression or speech disorders. We screened for the existence of major depression symptoms in accordance with DSM-IV criteria and a Yesavage Geriatric Depression Scale (GDS) score >11 at discharge and 1 month after stroke. At these times, serum levels of molecular markers of inflammation [interleukin (IL)-1beta, IL-6, intracellular adhesion molecule 1 (ICAM-1), tumor necrosis factor (TNF)-alpha, leptin and high-sensitivity C-reactive protein (hs-CRP)] and neurotrophic factors [brain-derived neurotrophic factor (BDNF)] were measured by enzyme-linked immunosorbent assay (ELISA). RESULTS Twenty-five patients (18.7%) were diagnosed as having major depression at discharge. Out of 104 patients who completed the follow-up period, 23 were depressed at 1 month (22.1%). Patients with major depression showed higher serum leptin levels at discharge [43.4 (23.4-60.2) v. 6.4 (3.7-16.8) ng/ml, p<0.001] and at 1 month after stroke [46.2 (34.0-117.7) v. 6.4 (3.4-12.2) ng/ml, p<0.001). Serum levels of leptin >20.7 ng/ml were independently associated with post-stroke depression [odds ratio (OR) 16.4, 95% confidence interval (CI) 5.2-51.5, p<0.0001]. Leptin levels were even higher in the eight patients who developed depression after discharge [114.6 (87.6-120.2) v. 7.2 (3.6-13.6) ng/ml, p<0.0001]. CONCLUSIONS Serum leptin levels at discharge are found to be associated with post-stroke depression and may predict its development during the next month.
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Affiliation(s)
- I Jiménez
- Department of Neurology, Neuropsychology Laboratory, Clinical Neuroscience Research Laboratory, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain
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Surgical decompression for space-occupying cerebral infarction (the Hemicraniectomy After Middle Cerebral Artery infarction with Life-threatening Edema Trial [HAMLET]): a multicentre, open, randomised trial. Lancet Neurol 2009; 8:326-33. [DOI: 10.1016/s1474-4422(09)70047-x] [Citation(s) in RCA: 649] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Carota A, Bogousslavsky J. Stroke-related psychiatric disorders. HANDBOOK OF CLINICAL NEUROLOGY 2009; 93:623-651. [PMID: 18804672 DOI: 10.1016/s0072-9752(08)93031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Antonio Carota
- Centre Hospitalier Universitaire Vaudois-CHUV, Lausanne, Switzerland.
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Townend E, Brady M, McLaughlan K. Exclusion and inclusion criteria for people with aphasia in studies of depression after stroke: a systematic review and future recommendations. Neuroepidemiology 2007; 29:1-17. [PMID: 17898519 DOI: 10.1159/000108913] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND/AIMS A third of individuals are depressed following stroke. A similar proportion have aphasia. The extent of their inclusion in depression following stroke studies affects the generalizability of findings. METHODS We systematically reviewed published studies (to December 2005) that diagnosed depression following stroke. We identified aphasia screening methods, aphasia exclusion and inclusion criteria and respective numbers of individuals with aphasia. RESULTS Of 129 studies (n = 19,183), aphasia screening methods were only reported by 57 (31 described a published aphasia-specific tool). No mention of aphasia was made in 13 studies. Most studies (92, 71%) reported some exclusion of people with aphasia (49 reported how many: n = 3,082, range = 2-554). Almost half of the studies (60, 47%) actually reported participants with aphasia (37 specified numbers: n = 829, range = 5-60). Aphasia exclusion or inclusion was not associated with sample source (community, acute hospital, other) or study purpose (observation, intervention, screening). Studies that reported screening for aphasia were more likely to describe aphasia exclusion and inclusion criteria and include participants with aphasia. CONCLUSION Aphasia screening, exclusion and inclusion criteria reporting across studies of depression following stroke has been highly inconsistent. This impairs the interpretation of generalizability. Improved aphasia screening and reporting of exclusion and inclusion criteria are urgently recommended.
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Affiliation(s)
- Ellen Townend
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK.
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Baune BT, Adrian I, Arolt V, Berger K. Associations between major depression, bipolar disorders, dysthymia and cardiovascular diseases in the general adult population. PSYCHOTHERAPY AND PSYCHOSOMATICS 2006; 75:319-26. [PMID: 16899969 DOI: 10.1159/000093955] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) and affective disorders are both very prevalent in the general population. However, it is unclear on a population level if the prevalence of different subtypes of affective disorders like unipolar major depression or dysthymia is different in individuals with specific CVDs. METHODS In 4,181 participants of the general population, lifetime prevalences for affective disorders were assessed through the Composite International Diagnostic Interview and cardiovascular diseases by self-report and subsequent physician-verified diagnosis. Multivariable logistic regression was used in the analysis. RESULTS Prevalences of unipolar depression, bipolar disorder and dysthymia were significantly higher in participants with coronary heart disease or stroke compared to those without these CVDs. Dysthymia had a stronger (OR = 2.03; 95% CI = 1.21-3.39) association with coronary heart disease than unipolar depression (OR = 1.58; 95% CI = 1.09-2.30) or any depression (OR = 1.92; 95% CI = 1.37-2.70). In contrast, unipolar depression (OR = 2.27; 95% CI = 1.29-3.99) showed a significant OR for the relation with stroke compared to dysthymia that reached no statistical significance. The commonly used category 'any depression' revealed higher odds (OR = 2.50; 95% CI = 1.46-4.28) for the relationship with stroke than unipolar depression or dysthymia, but lower odds than bipolar I disorder (OR = 5.71, 95% CI = 1.23-26.66). CONCLUSIONS Classification into diagnostic subgroups of affective disorders is important for an improved clinical and pathophysiological understanding of their relationship with CVDs. Dysthymia, in particular, plays an important role regarding the relation of affective disorders and CVDs. Future research on biological models may elucidate the pathophysiological link between subtypes of affective disorders and CVDs.
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Affiliation(s)
- Bernhard T Baune
- Mental Health Epidemiology, Department of Psychiatry, University of Muenster, Muenster, Germany
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Nys GMS, van Zandvoort MJE, van der Worp HB, de Haan EHF, de Kort PLM, Jansen BPW, Kappelle LJ. Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke. J Neurol Sci 2006; 247:149-56. [PMID: 16716359 DOI: 10.1016/j.jns.2006.04.005] [Citation(s) in RCA: 175] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2005] [Revised: 02/09/2006] [Accepted: 04/10/2006] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The aim of the present study was to examine the predictive value of cognitive impairment in the acute phase after stroke as a risk factor for long-term (six to ten months after stroke) depressive symptoms (DS) and a reduced quality of life (QOL), independent of demographic and neurological predictors. METHODS We evaluated 143 patients within the first 3 weeks post-stroke. Predictor variables included domain-specific cognitive function, demographic data, vascular risk factors, lesion characteristics, and clinical factors. Predictor variables associated with long-term DS (Montgomery Asberg Depression Rating Scale >or=7) and QOL (Stroke-Specific Quality of Life Scale) were identified with multiple logistic and linear regression. RESULTS Long-term DS were independently predicted by cognitive impairment at baseline, DS at baseline, female sex, diabetes mellitus, and previous TIA(s). Cognitive impairment, increasing age, and functional dependence predicted a reduced QOL, whereas hypercholesterolaemia predicted a better QOL. Among all cognitive disorders, unilateral neglect was the greatest risk factor for DS after 6 months, whereas a disorder in visual perception and construction affected QOL the most. CONCLUSIONS Cognitive impairment and vascular risk factors are important predictors of long-term DS and QOL after stroke. The prognostic value of cognition suggests a reactive component in the development or continuation of long-term DS.
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Affiliation(s)
- G M S Nys
- Psychological Laboratory, Helmholtz Institute, Utrecht University, The Netherlands.
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