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Liu H, Zhang Y, Hou X, Zhu C, Yang Q, Li K, Fan L, Zhang X, Jiang X, Jin X, Lei H, Chen T, Zhang F, Zhang Z, Song J. CRHR1 antagonist alleviated depression-like behavior by downregulating p62 in a rat model of post-stroke depression. Exp Neurol 2024; 378:114822. [PMID: 38823676 DOI: 10.1016/j.expneurol.2024.114822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/08/2024] [Accepted: 05/19/2024] [Indexed: 06/03/2024]
Abstract
Post-stroke depression (PSD) is a complication of cerebrovascular disease, which can increase mortality after stroke. CRH is one of the main signaling peptides released after activation of the hypothalamic-pituitary-adrenal (HPA) axis in response to stress. It affects synaptic plasticity by regulating inflammation, oxidative stress and autophagy in the central nervous system. And the loss of spines exacerbates depression-like behavior. Therefore, synaptic deficits induced by CRH may be related to post-stroke depression. However, the underlying mechanism remains unclear. The Keap1-Nrf2 complex is one of the core components of the antioxidant response. As an autophagy associated protein, p62 participates in the Keap1-NrF2 pathway through its Keap1 interaction domain. Oxidative stress is involved in the feedback regulation between Keap1-Nrf2 pathway and p62.However, whether the relationship between CRH and the Keap1-Nrf2-p62 pathway is involved in PSD remains unknown. This study found that serum levels of CRH in 22 patients with PSD were higher than those in healthy subjects. We used MCAO combined with CUMS single-cage SD rats to establish an animal model of PSD. Animal experiments showed that CRHR1 antagonist prevented synaptic loss in the hippocampus of PSD rats and alleviated depression-like behavior. CRH induced p62 accumulation in the prefrontal cortex of PSD rats through CRHR1. CRHR1 antagonist inhibited Keap1-Nrf2-p62 pathway by attenuating oxidative stress. In addition, we found that abnormal accumulation of p62 induces PSD. It alleviates depression-like behavior by inhibiting the expression of p62 and promoting the clearance of p62 in PSD rats. These findings can help explore the pathogenesis of PSD and design targeted treatments for PSD.
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Affiliation(s)
- Huanhuan Liu
- Henan Key Laboratory of Biological Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University
| | - Yunfei Zhang
- Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University; The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Xiaoli Hou
- General Hospital of Pingmei Shenma Group, Pingdingshan, Henan, China
| | - Chuanzhou Zhu
- Henan Key Laboratory of Biological Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University
| | - Qianling Yang
- Henan Key Laboratory of Biological Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University
| | - Kun Li
- Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University; The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Lifei Fan
- Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University; The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Xinyue Zhang
- Henan Key Laboratory of Biological Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University
| | - Xinhui Jiang
- The Third People's Hospital of Luoyang, Luoyang, Henan, China
| | - Xuejiao Jin
- Henan Key Laboratory of Biological Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University
| | - Hao Lei
- Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University; The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China
| | - Tengfei Chen
- Henan Key Laboratory of Biological Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University
| | - Fuping Zhang
- Henan Key Laboratory of Biological Psychiatry, the Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University.
| | - Zhaohui Zhang
- Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University; The First Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China.
| | - Jinggui Song
- Henan Engineering Research Center of Physical Diagnostics and Treatment Technology for the Mental and Neurological Diseases, The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China; Henan Collaborative Innovation Center of Prevention and treatment of mental disorder, the Second Affiliated Hospital of Xinxiang Medical University.
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Qian L, Huang S, Liu X, Jiang Y, Jiang Y, Hu Y, Yang Z. Morroniside improves the symptoms of post-stroke depression in mice through the BDNF signaling pathway mediated by MiR-409-3p. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 123:155224. [PMID: 38006805 DOI: 10.1016/j.phymed.2023.155224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/22/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Post-stroke depression (PSD) is a common psychiatric symptom after a stroke. Morroniside, an iridoid glycoside found in Cornus officinalis, has garnered significant attention for its potential to alleviate symptoms associated with depression. PURPOSE This study aims to highlight the potential use of morroniside in the treatment of PSD and elucidate the underlying molecular mechanisms. METHODS To establish a reliable PSD model, male C57BL/6 mice were subjected to brief MCAO in conjunction with CUMS. Post-morroniside administration, neuronal viability, and hippocampal cell apoptosis were evaluated by Nissl staining and TUNEL detection, respectively. Depression-like behaviors were evaluated using SPT, TST, and FST. The Longa score and cylinder test were used to evaluate the effect of morroniside on motor function. Furthermore, to investigate the underlying molecular mechanisms, bioinformatic analysis and the dual luciferase assay were performed to investigate the MiR-409-3p-BDNF interaction. In addition, subsequent to MiR-409-3p overexpression via AAV virus, we assessed mRNA expression and protein levels of key components within the BDNF/TrkB signaling pathway using RT-qPCR, immunohistochemistry, and western blot analysis. RESULTS The observed decrease in apoptosis and amelioration of depression-like behaviors strongly indicate the potential of morroniside as a therapeutic agent for PSD. Furthermore, the upregulation of key proteins within the BDNF/TrkB signaling pathway in the cortex suggests that morroniside activates this pathway. Through bioinformatics analysis, MiR-409-3p was identified and found to bind to the BDNF gene, resulting in the inhibition of BDNF expression. Importantly, we demonstrate that morroniside mitigates this inhibitory effect of MiR-409-3p on BDNF, thereby facilitating the activation of the BDNF/TrkB signaling pathway. CONCLUSION The findings suggest that morroniside demonstrates the ability to improve PSD symptoms through the BDNF/TrkB signaling pathway mediated by MiR-409-3p. These results emphasize the importance of the BDNF signaling pathway in improving PSD symptoms and provide a possible mechanism for morroniside to treat PSD.
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Affiliation(s)
- Lihui Qian
- Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine, 222004, Lianyungang, Jiangsu, China; School of Medicine & Holistic Integrative Medicine, Nanjing University of Chinese Medicine, 210023, Nanjing, Jiangsu, China
| | - Sirui Huang
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, 210023, Nanjing, Jiangsu, China
| | - Xiaoli Liu
- Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine, 222004, Lianyungang, Jiangsu, China
| | - Yongxia Jiang
- Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine, 222004, Lianyungang, Jiangsu, China
| | - Yongqu Jiang
- Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine, 222004, Lianyungang, Jiangsu, China
| | - Yue Hu
- School of Chinese Medicine, School of Integrated Chinese and Western Medicine, Nanjing University of Chinese Medicine, 210023, Nanjing, Jiangsu, China; Shen Chun-ti Nation-Famous Experts Studio for Traditional Chinese Medicine Inheritance, Changzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, 213003, Changzhou, Jiangsu, China.
| | - Zhou Yang
- Lianyungang Hospital of Traditional Chinese Medicine, Lianyungang Affiliated Hospital of Nanjing University of Chinese Medicine, 222004, Lianyungang, Jiangsu, China.
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Shewangizaw S, Fekadu W, Gebregzihabhier Y, Mihretu A, Sackley C, Alem A. Impact of depression on stroke outcomes among stroke survivors: Systematic review and meta-analysis. PLoS One 2023; 18:e0294668. [PMID: 38039323 PMCID: PMC10691726 DOI: 10.1371/journal.pone.0294668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Depression may negatively affect stroke outcomes and the progress of recovery. However, there is a lack of updated comprehensive evidence to inform clinical practice and directions of future studies. In this review, we report the multidimensional impact of depression on stroke outcomes. METHODS Data sources. PubMed, PsycINFO, EMBASE, and Global Index Medicus were searched from the date of inception. Eligibility criteria. Prospective studies which investigated the impact of depression on stroke outcomes (cognition, returning to work, quality of life, functioning, and survival) were included. Data extraction. Two authors extracted data independently and solved the difference with a third reviewer using an extraction tool developed prior. The extraction tool included sample size, measurement, duration of follow-up, stroke outcomes, statistical analysis, and predictors outcomes. Risk of bias. We used Effective Public Health Practice Project (EPHPP) to assess the quality of the included studies. RESULTS Eighty prospective studies were included in the review. These studies investigated the impact of depression on the ability to return to work (n = 4), quality of life (n = 12), cognitive impairment (n = 5), functioning (n = 43), and mortality (n = 24) where a study may report on more than one outcome. Though there were inconsistencies, the evidence reported that depression had negative consequences on returning to work, functioning, quality of life, and mortality rate. However, the impact on cognition was not conclusive. In the meta-analysis, depression was associated with premature mortality (HR: 1.61 (95% CI; 1.33, 1.96)), and worse functioning (OR: 1.64 (95% CI; 1.36, 1.99)). CONCLUSION Depression affects many aspects of stroke outcomes including survival The evidence is not conclusive on cognition and there was a lack of evidence in low-income settings. The results showed the need for early diagnosis and intervention of depression after stroke. The protocol was pre-registered on the International Prospective Register of Systematic Review (PROSPERO) (CRD42021230579).
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Affiliation(s)
- Seble Shewangizaw
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wubalem Fekadu
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yohannes Gebregzihabhier
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Nursing, Debre Berhan University, Debre Berhan, Ethiopia
| | - Awoke Mihretu
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Catherine Sackley
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Atalay Alem
- WHO Collaborating Centre for Mental Health Research and Capacity Building, Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Hu M, Zhang B, Lin Y, Xu M, Zhu C. Trajectories of post-stroke quality of life and long-term prognosis: Results from an eleven-year prospective study. J Psychosom Res 2023; 173:111466. [PMID: 37647831 DOI: 10.1016/j.jpsychores.2023.111466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE The relationship between quality of life (QoL) and long-term prognosis in stroke patients is still unclear. We explored physical and mental QoL trajectories during the first six months after stroke and determined the associations between trajectories and long-term prognosis in patients with first-ever ischemic stroke. METHODS Included were 733 participants from a prospective study. QoL was assessed with the 12-item Short Form Survey (SF-12) at baseline, 3 and 6 months. Patients' prognoses (stroke recurrence and death) were identified from 2010 to 2021. The latent class growth model (LCGM) was used to identify distinct trajectories of physical and mental QoL measured over the first 6 months. We employed the Cox model or Fine-Gray model for prognoses to examine the associations between QoL trajectories and prognosis. RESULTS Five trajectories of physical QoL and five trajectories of mental QoL were identified. For physical QoL of the Poor-Improved, and Moderate-Impaired trajectory versus Moderate-Improved trajectory, the hazard ratio (HR) for death was 2.39 (1.14 to 5.02), and 2.03(0.93 to 4.44); the HR for recurrence was 1.56 (0.83 to 2.94) and 2.33 (1.28 to 4.24). For mental QoL of the Moderate-Impaired trajectory versus the Moderate-Improved trajectory, the HR for death was 2.48 (1.21 to 5.07). The results were robust in the sensitivity analysis. CONCLUSION QoL during the first six months after ischemic stroke can be categorized into distinct groups. Change in QoL was associated with long-term survival. Secondary prevention of recurrent strokes might rely more on improving patients' physical QoL.
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Affiliation(s)
- Meijing Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Baiyang Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yidie Lin
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Minghan Xu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Cairong Zhu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, People's Republic of China.
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Martha SR, Pen AY, McGuire LS, Alaraj A, Maienschein-Cline M, Basu S, Loeb JA, Thompson HJ. Lipidomics, Acute Ischemic Stroke, Symptoms, and Outcomes: Observational Study Protocol. Nurs Res 2023; 72:326-333. [PMID: 36988482 PMCID: PMC10293104 DOI: 10.1097/nnr.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
BACKGROUND Acute ischemic stroke is one of the leading causes of death and disability globally. Recent advances in omics methodology enable lipidomic profiling, which may provide knowledge of the underlying pathology of acute ischemic stroke and its associated outcomes. OBJECTIVE This study aims to examine the longer-term relationships between symptoms and outcomes following acute ischemic stroke and the underlying lipidomic signatures over 6 months during recovery between acute ischemic stroke patients who received reperfusion therapies and those who did not. METHODS This prospective cohort study will enroll 104 participants post-acute ischemic stroke in two groups based on their receipt of reperfusion therapy (Group 1) or not (Group 2; n = 52/group). Peripheral plasma samples will be collected from both groups for lipidomic analysis over 6 months. Arterial blood samples will be collected during the procedure for those receiving reperfusion. Self-reported symptoms and outcome data will be collected from both groups. DISCUSSION We will compare and examine the associations among plasma lipidomic biomarkers and symptoms and cognitive, functional, and health-related quality of life outcomes over 6 months between acute ischemic stroke patients who did and did not receive reperfusion intervention.
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Zhu Q, Chen L, Xu Q, Xu J, Zhang L, Wang J. Association between obstructive sleep apnea and risk for post-stroke anxiety: A Chinese hospital-based study in noncardiogenic ischemic stroke patients. Sleep Med 2023; 107:55-63. [PMID: 37119621 DOI: 10.1016/j.sleep.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/11/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
OBJECTIVE This study explored the role of obstructive sleep apnea (OSA) in post stroke anxiety (PSA) in noncardiogenic ischemic stroke patients. METHODS 180 patients with noncardiogenic ischemic stroke were consecutively enrolled from January 2019 to December 2019. All patients underwent polysomnography (PSG) to assess for OSA. OSA severity was identified based on the apnea hypopnea index (AHI), i.e., no OSA (AHI <5), mild OSA (5 = AHI <15), and moderate to severe OSA (AHI ≥15). Neuropsychological assessments were performed at acute phase and 6 months later to evaluate anxiety (Chinese version of the Zung self-rating anxiety scale [SAS], and Beck Anxiety Inventory [BAI]), depression (Patient Health Questionnaire-9, [PHQ-9]), and cognition (Mini-mental state examination, [MMSE], and Montreal Cognitive Assessment, [MOCA]). Clinical diagnoses of PSA were made based on interviews and the anxiety scales. The correlations between PSA and OSA were investigated in Logistic regression analysis. RESULTS The prevalence of acute-phase and 6-month PSA were 27 (15%) and 52 (28.9%) respectively. Moderate to severe OSA and post-stroke depression (PSD) were the influencing factors of acute-phase PSA. 6-Month PSA was not associated with OSA but was associated with acute-phase anxiety, education status and MOCA. Logistic regression analysis including respiratory and sleeping parameters showed that AHI and micro-arousal index contributed to acute-phase PSA. CONCLUSIONS Acute-phase PSA was associated with OSA severity, potentially through OSA-caused sleep discontinuity. While 6-month PSA was associated with acute-phase anxiety, highlighting the need for integration of screening for and management of OSA and PSA at acute phase.
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Affiliation(s)
- Qiongbin Zhu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Leihui Chen
- Department of Internal Medicine, The Wuyun Mountain Hospital of Hangzhou(The Health Promotion Institute of Hangzhou), Hangzhou, Zhejiang, China
| | - Qinglin Xu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jiahui Xu
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lisan Zhang
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Jin Wang
- Department of Neurology, Sir Run Run Shaw Hospital, Affiliated with School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
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Xiang D, Zhang ZX, Ge S, Wang WN, Lin BL, Chen SY, Guo EF, Zhang PB, Liu ZW, Li H, Mei YX. Physio-psycho-social interaction mechanism in dyadic health of young and middle-aged stroke survivors and their spousal caregivers: a longitudinal observational study protocol. BMJ Open 2023; 13:e065767. [PMID: 37041051 PMCID: PMC10106025 DOI: 10.1136/bmjopen-2022-065767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION In recent years, stroke has become more common among young people. Stroke not only has a profound impact on patients' health but also incurs stress and health threats to their caregivers, especially spousal caregivers. Moreover, the health of stroke survivors and their caregivers is interdependent. To our knowledge, no study has explored dyadic health of young and middle-aged stroke survivors and their spousal caregivers from physiological, psychological and social perspectives. Therefore, this proposed study aims to explore the mechanism of how physiological, psychological and social factors affect dyadic health of young and middle-aged stroke survivors and their spousal caregivers. The findings of this study will provide implications for developing interventions to improve dyadic health of this growing population. METHODS AND ANALYSES We will collect data from 57 dyads of young and middle-aged stroke survivors and their spousal caregivers during hospitalisation and at 1, 3, 6, 9 and 12 months after discharge. Questionnaires will be used to collect participants' demographic information, stress, depression, anxiety, benefit finding, social support, mutuality and quality of life. The following physiological reactions will be collected at baseline, including interleukin 6, tumour necrosis factor-alpha and salivary cortisol. ETHICS AND DISSEMINATION The study was approved by the ethics review committee of life sciences of Zhengzhou University (No. ZZUIRB2020-53). Prior to being enrolled in the study, participants will be given full and detailed information about the possible risks involved, the informed consent process, confidentiality, the study procedure and secure data storage. Participants will be guaranteed that they can withdraw from the study at any time without providing a reason or leading to any consequences. Both oral and written informed consent will be obtained from all participants. The findings of this proposed study will be disseminated through peer-reviewed journals and academic conferences.
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Affiliation(s)
- Dandan Xiang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhen-Xiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Song Ge
- Department of Natural Science, University of Houston Downtown, Houston, Texas, USA
| | - Wen Na Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Bei-Lei Lin
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Su-Yan Chen
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Er-Feng Guo
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Peng-Bo Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhi-Wei Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Hui Li
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yong-Xia Mei
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
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Sharrief A, Guzik AK, Jones E, Okpala M, Love M, Ranasinghe TIJ, Bushnell C. Telehealth Trials to Address Health Equity in Stroke Survivors. Stroke 2023; 54:396-406. [PMID: 36689591 PMCID: PMC11061884 DOI: 10.1161/strokeaha.122.039566] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Telehealth has seen rapid expansion into chronic care management in the past 3 years because of the COVID-19 pandemic. Telehealth for acute care management has expanded access to equitable stroke care to many patients over the past two decades, but there is limited evidence for its benefit for addressing disparities in the chronic care of patients living with stroke. In this review, we discuss advantages and disadvantages of telehealth use for the outpatient management of stroke survivors. Further, we explore opportunities and potential barriers for telehealth in addressing disparities in stroke outcomes related to various social determinants of health. We discuss two ongoing large randomized trials that are utilizing telehealth and telemonitoring for management of blood pressure in diverse patient populations. Finally, we discuss strategies to address barriers to telehealth use in patients with stroke and in populations with adverse social determinants of health.
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Affiliation(s)
- Anjail Sharrief
- University of Texas Health Sciences Center at Houston, McGovern Medical School, Department of Neurology
- University of Texas Health Sciences Center, McGovern Medical School, Stroke Institute
| | - Amy K Guzik
- Wake Forest Baptist Health, Wake Forest University School of Medicine, Department of Neurology
| | - Erica Jones
- University of Texas Southwestern Medical Center, Department of Neurology
| | - Munachi Okpala
- University of Texas Health Sciences Center at Houston, McGovern Medical School, Department of Neurology
| | - Mary Love
- University of Houston College of Nursing
| | | | - Cheryl Bushnell
- Wake Forest Baptist Health, Wake Forest University School of Medicine, Department of Neurology
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The efficacy of therapist-supported acceptance and commitment therapy-based bibliotherapy for psychological distress after stroke: a single-case multiple-baseline study. Behav Cogn Psychother 2023; 51:87-104. [PMID: 36214628 DOI: 10.1017/s135246582200042x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Psychological distress is common after stroke, and affects recovery. However, there are few evidence-based psychological treatments. This study evaluates a bibliotherapy-based approach to its amelioration. AIMS To investigate a stroke-specific self-management book, based on acceptance and commitment therapy (ACT), as a therapist-supported intervention for psychological distress after stroke. METHOD The design was a single case, randomised non-concurrent multiple-baseline design (MBD). Sixteen stroke survivors, eight males and eight females (mean age 60.6 years), participated in an MBD with three phases: A (randomised-duration baseline); B (intervention); and follow-up (at 3 weeks). During the baseline, participants received therapist contact only. In the bibliotherapy intervention, participants received bi-weekly therapist support. The primary measures of psychological distress (General Health Questionaire-12; GHQ-12) and quality of life (Satisfaction with Life Scale; SWLS) were completed weekly. Secondary measures of mood, wellbeing and illness impact were completed pre- and post-intervention. RESULTS Omnibus whole-group TAU-U analysis was statistically significant for each primary measure with a moderate effect size on both (0.6 and 0.3 for GHQ-12 and SWLS, respectively). Individual TAU-U analyses demonstrated that the majority of individuals exhibited positive change. All the secondary measures showed significant pre-post improvements. Eighty-one per cent of participants reported the book was helpful and 81% also found the ACT-based sections helpful. Relative risk calculations showed finding the book helpful was associated with improvement in GHQ-12 and SWLS scores. CONCLUSIONS ACT-based bibliotherapy, with therapist support, is a promising intervention for psychological difficulties after stroke.
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Zhang J, Zeng C, Huang X, Liao Q, Chen H, Liu F, Sun D, Luo S, Xiao Y, Xu W, Zeng D, Song M, Tian F. Association of homocysteine and polymorphism of methylenetetrahydrofolate reductase with early-onset post stroke depression. Front Nutr 2022; 9:1078281. [PMID: 36562046 PMCID: PMC9763289 DOI: 10.3389/fnut.2022.1078281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
Background Homocysteine (Hcy) has been indicated to be involved in pathophysiology of post stroke depression (PSD). There is a lack of research to study the relationship between Hcy metabolism genes and PSD. Our study aims to investigate the relationship among Hcy metabolism genes, Hcy, and early-onset PSD. Materials and methods We recruited 212 patients with stroke and collected their peripheral blood sample, clinical data, and laboratory test on admission. 12 single nucleotide polymorphisms (SNPs) in methylenetetrahydrofolate reductase (MTHFR), methionine synthase reductase (MTRR), and methionine synthase (MTR) genes were genotyped by high-resolution melt analysis. PSD was diagnosed by DSM-V at 2 weeks after stroke. Binary logistic regression and haplotype analysis were used to examine the association between Hcy metabolism genes and PSD. Mediation analysis was performed to clarify whether the SNPs exerted their effect on PSD by affecting the Hcy level. Results 81 patients were diagnosed with PSD, and the incidence rate was 38.2%. Hcy level in PSD group was significantly higher than it in non-PSD group (p = 0.019). MTHFR rs1801133 AA genotype an A allele were associated with an elevated risk of PSD after adjustment for some confounding factors (OR = 4.021, 95% CI: 1.459∼11.080, p = 0.007 for AA genotype; OR = 1.808, 95% CI: 1.172∼2.788, p = 0.007 for A allele). Furthermore, the effect of MTHFR rs1801133 AA genotype on PSD was mediated by Hcy (OR = 1.569, 95% CI: 0.013∼3.350, p < 0.05). Conclusion MTHFR rs1801133 and Hcy were associated with PSD, and MTHFR rs1801133 may exert an effect on PSD via mediating Hcy level. This offers a new perspective for treating PSD and understanding the mechanism of PSD.
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Affiliation(s)
- Jingyuan Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chang Zeng
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xia Huang
- Department of Critical Care Medicine, The First People’s Hospital of Huaihua, Huaihua, China
| | - Qiao Liao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hengshu Chen
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Fan Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Dongren Sun
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Shihang Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Yeqing Xiao
- Department of Neurology, Hengyang Central Hospital, Hengyang, China
| | - Weiye Xu
- Department of Human Anatomy and Neurobiology, School of Basic Medicine, Central South University, Changsha, China
| | - Danfeng Zeng
- Department of Neurology, Xiangtan Central Hospital, Xiangtan, China
| | - Mingyu Song
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,Mingyu Song,
| | - Fafa Tian
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China,*Correspondence: Fafa Tian,
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11
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Wrapson W, Dorrestein M, Wrapson J, Theadom A, Kayes N, Snell D, Rutherford S, Roche M, Babbage DR, Siegert RJ. Stroke survivors' expectations and post-intervention perceptions of mindfulness training: A qualitative study. Neuropsychol Rehabil 2022; 32:2496-2518. [PMID: 34278952 DOI: 10.1080/09602011.2021.1950777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Depression and anxiety are common sequelae of stroke, occurring in at least one-third of patients. This study evaluated the acceptability and feasibility of providing mindfulness training (MT) to stroke survivors with the aim of reducing depression and anxiety. Following a six-week one-on-one MT course, 17 participants were interviewed. The median age of participants was 71, and 10 participants were male. This paper focuses on participants' expectations of the MT and their views about its impact on their everyday lives. Conventional content analysis was used for coding and analysis. A single theme, Seizing rehabilitation opportunities, was captured in relation to expectations of MT, and four themes provided information relating to participants' perceived impact of the course: Calming the mind, Reduced reactivity, Remedying physical symptoms, and Not quite there yet.Most participants knew little about mindfulness before the MT and did not have specific goals in mind when volunteering to take part. The findings suggest that most participants considered MT beneficial through reducing stress and giving them additional skills to cope with their everyday lives. A tailored mindfulness intervention may be a useful adjunct to other rehabilitation therapies for stroke survivors.
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Affiliation(s)
- Wendy Wrapson
- Auckland University of Technology, Auckland, New Zealand
| | | | - Jill Wrapson
- Auckland University of Technology, Auckland, New Zealand
| | - Alice Theadom
- Auckland University of Technology, Auckland, New Zealand
| | - Nicola Kayes
- Auckland University of Technology, Auckland, New Zealand
| | | | | | - Maree Roche
- University of Waikato, Hamilton, New Zealand
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12
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Broman J, Aarnio K, But A, Marinkovic I, Rodríguez-Pardo J, Kaste M, Tatlisumak T, Putaala J. Association of post-stroke-initiated antidepressants with long-term outcomes in young adults with ischaemic stroke. Ann Med 2022; 54:1757-1766. [PMID: 35786079 PMCID: PMC9258433 DOI: 10.1080/07853890.2022.2089729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE We examined the association between initiation of antidepressants within the first year after ischaemic stroke (IS) in young adults and long-term fatal and non-fatal cardiovascular events, as well as all-cause mortality. PATIENTS AND METHODS The Helsinki Young Stroke Registry (HYSR) includes patients aged 15-49 years with their first-ever IS occurring 1994-2007. From nationwide registers, we obtained data on prescriptions (1993-2011) and outcomes of interest (1994-2011). Time of initiating post-stroke antidepressants (PSADs) was defined as time of the first filled prescription for antidepressants within the first year from IS. To account for non-random assignment of PSADs, we performed propensity score matching and studied the relationship between PSAD initiation and outcomes using Cox regression models with time-varying coefficients. RESULTS Of all patients (n = 888), 206 (23.2%) initiated PSADs within the first year, of which 203 (98.5%) could be matched to 406 non-initiators. In this matched sample of 609 patients, the median follow-up time was 8.1 (interquartile range [IQR] 5.0-12.6) years and 169 (28.9%) patients had any cardiovascular events, 95 (15.8%) had recurrent ischaemic or haemorrhagic strokes and 106 (17.4%) died. Adjusted for sociodemographics and cardiovascular comorbidities, PSAD initiation was associated with recurrent ischaemic or haemorrhagic stroke 5-10 years after IS (hazard ratio [HR] 3.07, 95% confidence interval [CI] 1.32-7.12). No association emerged between PSAD initiation and other outcomes. CONCLUSIONS In young adults, PSAD initiation within the first year after IS was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term. Future studies are needed to verify the results and to further study the nature of this finding.KEY MESSAGESInitiation of post-stroke antidepressants (PSADs) within the first year after ischaemic stroke (IS) was associated with a heightened hazard of recurrent ischaemic or haemorrhagic stroke in the long term.Patients starting antidepressants after IS should be followed up more closely in case of recurrent events.Future studies are needed to verify the results and to further study the nature of this finding.
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Affiliation(s)
- Jenna Broman
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Karoliina Aarnio
- Department of Neurology, Helsinki University Hospital and University of Helsinki, 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, Helsinki, Finland
| | | | - Markku Kaste
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital and University of Helsinki, 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, Helsinki, Finland
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13
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Pompon RH, Fassbinder W, McNeil MR, Yoo H, Kim HS, Zimmerman RM, Martin N, Patterson JP, Pratt SR, Dickey MW. Associations among depression, demographic variables, and language impairments in chronic post-stroke aphasia. JOURNAL OF COMMUNICATION DISORDERS 2022; 100:106266. [PMID: 36150239 DOI: 10.1016/j.jcomdis.2022.106266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 08/19/2022] [Accepted: 09/05/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Depression may influence treatment participation and outcomes of people with post-stroke aphasia, yet its prevalence and associated characteristics in aphasia are poorly understood. Using retrospective data from an overarching experimental study, we examined depressive symptoms and their relationship to demographic and language characteristics in people with chronic aphasia. As a secondary objective, we compared prevalence of depressive symptoms among the overarching study's included and excluded participants. METHODS We examined retrospective data from 121 individuals with chronic aphasia including depression scale scores, demographic information (sex, age, time post onset of stroke, education, race/ethnicity, and Veteran status), and scores on assessments of general and modality-specific language impairments. RESULTS Approximately 50% of participants reported symptoms indicative of depressive disorders: 23% indicative of major depression and 27% indicative of mild depression. Sex (males) and comparatively younger age emerged as statistically significant variables associated with depressive symptoms; naming ability was minimally associated with depressive symptoms. Time post onset of stroke, education level, race/ethnicity, Veteran status, and aphasia severity were not significantly associated with depressive symptoms. Depression-scale scores were significantly higher for individuals excluded from the overarching study compared to those who were included. CONCLUSIONS The rate of depressive disorders in this sample was higher than rates of depression reported in the general stroke literature. Participant sex, age, and naming ability emerged as factors associated with depressive symptoms, though these links appear complex, especially given variable reports from prior research. Importantly, depressive symptoms do not appear to diminish over time for individuals with chronic aphasia. Given these results and the relatively limited documentation of depression in aphasia literature, depression remains a pressing concern for aphasia research and routine clinical care.
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Affiliation(s)
| | - W Fassbinder
- VA Pittsburgh Health Care System, Pittsburgh, PA
| | - M R McNeil
- VA Pittsburgh Health Care System, Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA
| | - H Yoo
- Baylor University, Waco, TX
| | - H S Kim
- Saint Mary's College, Notre Dame, IN
| | | | - N Martin
- Temple University, Philadelphia, PA
| | - J P Patterson
- VA Northern California Health Care System, Martinez, CA
| | - S R Pratt
- VA Pittsburgh Health Care System, Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA
| | - M W Dickey
- VA Pittsburgh Health Care System, Pittsburgh, PA; University of Pittsburgh, Pittsburgh, PA
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14
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Zhou L, Chen L, Ma L, Diao S, Qin Y, Fang Q, Li T. A new nomogram including total cerebral small vessel disease burden for individualized prediction of early-onset depression in patients with acute ischemic stroke. Front Aging Neurosci 2022; 14:922530. [PMID: 36238936 PMCID: PMC9552538 DOI: 10.3389/fnagi.2022.922530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe present study was designed to evaluate the effects of total cerebral small vessel disease (CSVD) on early-onset depression after acute ischemic stroke (AIS), and to develop a new nomogram including total CSVD burden to predict early-onset post-stroke depression (PSD).MethodsWe continuously enrolled patients with AIS who were hospitalized at the First Affiliated Hospital of Soochow University between October 2017 and June 2019. All patients were assessed for depressive symptoms using the 17-item Hamilton Depression Scale (HAMD-17) at 14 ± 2 days after the onset of AIS. The diagnosis for depression was made according to the American Diagnostic and Statistical Manual of Mental Disorders Version 5 (DSM-5). The demographic and clinical data were collected including total CSVD burden. On the basis of a multivariate logistic model, the independent factors of early-onset PSD were identified and the predictive nomogram was generated. The performance of the nomogram was evaluated by Harrell's concordance index (C-index) and calibration plot.ResultsA total of 346 patients were enrolled. When contrasted to a 0 score of total CSVD burden, the score ≥2 (moderate to severe total CSVD burden) was an independent risk factor for early-onset PSD. Besides, gender, cognitive impairments, baseline Barthel Index (BI), and plasma fibrinogen were independently associated with early-onset PSD. The nomogram based on all these five independent risk factors was developed and validated with an Area Under Curve (AUC) of 0.780. In addition, the calibration plot revealed an adequate fit of the nomogram in predicting the risk of early-onset depression in patients with AIS.ConclusionsOur study found the total CSVD burden score of 2–4 points was an independent risk factor of early-onset PSD. The proposed nomogram based on total CSVD burden, gender, cognitive impairments, baseline BI, and plasma fibrinogen concentration gave rise to a more accurate and more comprehensive prediction for early-onset PSD.
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Affiliation(s)
- Lihua Zhou
- Department of Neurology, The People's Hospital of Suzhou New District, Suzhou, China
| | - Licong Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Linqing Ma
- Department of Neurology, The People's Hospital of Suzhou New District, Suzhou, China
| | - Shanshan Diao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yiren Qin
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Qi Fang
| | - Tan Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Tan Li
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15
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Higher Plasma Fibrinogen Level at Admission Is Associated with Post-Stroke Depression at Discharge. Brain Sci 2022; 12:brainsci12081032. [PMID: 36009095 PMCID: PMC9405685 DOI: 10.3390/brainsci12081032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/22/2022] [Accepted: 07/30/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Post-stroke depression (PSD) is a common complication of stroke, which seriously affects the functional outcome of patients. Systemic low-grade inflammation associated with PSD has been shown to occur at several months to years, however, whether these inflammatory markers predicted PSD at an acute stage of stroke is controversial. Method: A total of 625 patients with acute ischemic stroke (219 female, 35.40%) were included in this study. PSD was diagnosed using the 17-item Hamilton depression scale (HAMD) at 7 days following discharge (7−14 days after stroke onset). Multivariable logistic regression analysis was applied to build a prediction model for PSD at discharge. Discrimination and calibration of the model were assessed by C-index, calibration plot. Internal validation was conducted using bootstrapping validation. Results: At discharge of hospitalization, 95 patients (15.20%) were diagnosed with PSD. Multivariable logistic regression suggested that female gender (OR = 2.043, 95% CI = 1.287−3.245, p = 0.002), baseline NIHSS (OR = 1.108, 95% CI = 1.055−1.165, p < 0.001) and fibrinogen (OR = 1.388, 95% CI = 1.129−1.706, p = 0.002) were independent predictors for PSD at discharge. The cut-off of the fibrinogen plasma level was 3.08 g/L. These predictors were included in the nomogram. The model displayed good discrimination, with a C-index of 0.730 (95% CI = 0.683−0.777) and good calibration. Conclusion: Female gender, baseline stroke severity and a higher level of fibrinogen were independently associated with PSD at discharge. A nomogram based on these three predictors can be used to provide an individual, visual prediction of the risk probability of PSD.
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16
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Predictors of Post-Stroke Depression: A Retrospective Cohort Study. Brain Sci 2022; 12:brainsci12080993. [PMID: 35892434 PMCID: PMC9332855 DOI: 10.3390/brainsci12080993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Despite reports of a high incidence and various predictors of post-stroke depression (PSD), the underdiagnosis and undertreatment rates of PSD are still high. This study aimed to examine the incidence of depression in stroke patients and identify factors associated with PSD. This was a retrospective cohort study on ischemic stroke patients from the Geisinger Neuroscience Ischemic Stroke (GNSIS) registry. The following statistical analyses were performed to predict PSD in the studied population: a Kaplan−Meier estimator and a Cox proportional hazards model. A total of 5882 patients were included in the study. The median age at the time of an ischemic stroke was 72 years and 56% were males. A total of 294 patients were diagnosed with PSD within one year of a stroke. The cumulative incidence of depression was found to be 6.4% (95% CI 5.7−7.1%) at one year for the entire cohort. Women were found to have a higher risk of PSD than men (HR for women = 1.47, 95% CI 1.18−1.85, p = 0.001). A history of prior stroke (HR = 1.58, 95% CI 1.18−2.11, p = 0.002) and myocardial infarction (HR = 1.47, 95% CI 1.05−2.06, p = 0.025) were associated with PSD. Medicaid patients had a higher risk for PSD (HR = 2.16, 95% CI 1.5−3.12, p < 0.001) than those with commercial insurance or health maintenance organization plans. Our findings showed that women, patients with a history of prior stroke or myocardial infarction, and with Medicaid insurance were more likely to develop PSD. Through an observational study on the EHR data, we confirmed that chronic stress, including financial and health-related stress, irrespective of age, significantly increased the risk for PSD.
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17
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Duncan Millar J, Mason H, Kidd L. What is important in supporting self-management in community stroke rehabilitation? A Q methodology study. Disabil Rehabil 2022:1-9. [PMID: 35757835 DOI: 10.1080/09638288.2022.2087766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Supported self-management (SSM) is an important part of adapting to life after stroke however it is a complex concept. It is unclear what SSM in stroke consists of or how stroke survivors, families, and clinicians can most effectively work together to support person-centred self-management. In this study, we aimed to explore what was most important in making SSM work in community stroke rehabilitation. METHODS We conducted a Q-methodology study with stroke survivors (n = 20), community-based stroke clinicians (n = 20), and team managers (n = 8) across four health boards in Scotland, United Kingdom. Participants ranked 32 statements according to their importance in making SSM work. Factor analysis was used to identify shared viewpoints. RESULTS We identified four viewpoints: (i) A person-centred approach to build self-confidence and self-worth; (ii) Feeling heard, understood, and supported by everybody; (iii) Preparation of appropriate resources; and (iv) Right thing, right place, right time for the individual. Important across all viewpoints were: a trusting supportive relationship; working in partnership; focusing on meaningful goals; and building self-confidence. CONCLUSIONS Differing views exist on what is most important in SSM. These views could be used to inform quality improvement strategies to support the delivery of SSM that considers the preferences of stroke survivors. IMPLICATIONS FOR REHABILITATIONClinicians should be aware of their own viewpoint of supported self-management and consider how their perspective may differ from stroke survivors' and colleagues' perspectives of what's important to support self-management.Working in partnership with stroke survivors plus developing a trusting and supportive relationship with them are core components of supporting self-management in the longer term after stroke.Building a sense of self-worth and self-confidence, a focus on meaningful goals, training and support for staff, and tailoring support to people's needs at the right time are important considerations for supporting longer-term engagement in self-management.
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Affiliation(s)
- Julie Duncan Millar
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Lisa Kidd
- School of Health & Life Sciences/Research Centre for Health, Glasgow Caledonian University, Glasgow, UK
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18
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Wang Y, Wang H, Sun W, Miao J, Liang W, Qiu X, Lan Y, Pan C, Li G, Zhao X, Zhu Z, Zhu S. Higher Concentration of Adrenocorticotropic Hormone Predicts Post-Stroke Depression. Clin Interv Aging 2022; 17:417-427. [PMID: 35411137 PMCID: PMC8994598 DOI: 10.2147/cia.s356361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke, seriously affecting the quality of survivors’ life. As one of the important causes of PSD, neuroendocrine mechanism has been widely studied in recent years. The main objective of this study was to investigate the relationship between adrenocorticotropic hormone (ACTH) on admission and PSD at 3 months. Methods This is a hospital-based prospective cohort study, which was conducted at three independent hospitals (Tongji Hospital, Wuhan First Hospital and Wuhan Central Hospital) between August 2018 and June 2019. A total of 768 ischemic stroke patients were finally eligible for analysis and categorized into equal tertiles according to the distribution of ACTH and the number of patients. The χ2-test, Mann–Whitney U-test and Kruskal–Wallis test were used to check for statistical significance. And restricted cubic spline (RCS) regression model was used to explore the non-linear relationship between continuous ACTH levels and PSD at 3 months. Results The optimal cut-off points of ACTH were as follows: (T1) 0.32–20.55 pg/mL, (T2) 20.56–39.79 pg/mL, (T3) 39.80–143.40 pg/mL. A total of 305 patients (39.7%) were diagnosed as PSD at 3 months follow-up. Significant differences were found between the PSD and non-PSD groups in ACTH concentration (P = 0.001). After adjustment for all conventional confounders, the odds ratios of PSD were 1.735 (95% CI = 1.176–2.560, P = 0.005) for the highest tertile of ACTH and 1.496 (95% CI = 1.019–2.194, P = 0.040) for the middle tertile of ACTH, as compared with the lowest tertile. In multiple-adjusted RCS regression, continuous ACTH showed saturation effect relation with PSD risk after 31.02 pg/mL (P for nonlinear = 0.0143). Conclusion Higher ACTH level on admission is a significant and independent biomarker to predict the development of PSD at 3 months follow-up. Besides, saturation effect was revealed even if the underlying mechanism is unclear. For stroke patients, doctors should pay attention to the baseline ACTH for screening high-risk PSD in clinical practice.
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Affiliation(s)
- Yanyan Wang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - He Wang
- Department of Medical Affairs, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Wenzhe Sun
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Jinfeng Miao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Wenwen Liang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Xiuli Qiu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Yan Lan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Chensheng Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Guo Li
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Xin Zhao
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
| | - Zhou Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
- Correspondence: Zhou Zhu; Suiqiang Zhu, Tel +86 18171081029; +86 13035101141, Fax +86 27-83663337, Email ;
| | - Suiqiang Zhu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China
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19
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Estevao C, Baldellou Lopez M, Davis RE, Jarret L, Soukup T, Bakolis I, Healey A, Harrington J, Woods A, Crane N, Jones F, Pariante C, Fancourt D, Sevdalis N. Evaluation of a community-based performance arts programme for people who have experienced stroke in the UK: protocol for the SHAPER-Stroke Odysseys study. BMJ Open 2022; 12:e057805. [PMID: 35277410 PMCID: PMC8919447 DOI: 10.1136/bmjopen-2021-057805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Stroke survivors, once in the community, face challenges with their long-term rehabilitation care and present higher levels of loneliness, depression and anxiety than the rest of the population. A community-based performance arts programme, Stroke Odysseys (SO), has been devised to tackle the challenges of living with stroke in the UK. In this study, we aim to evaluate the implementation, impact and experiences of SO for stroke survivors. METHODS AND ANALYSIS Scaling-up Health Arts Programmes: Implementation and Effectiveness Research (SHAPER)-SO aims to scale-up SO to 75 participants and 47 stakeholders, while simultaneously evaluating the effectiveness and implementation of the programme. The main research aim is to evaluate the implementation, effectiveness, impact and experiences of a community-based performance arts programme (SO for stroke survivors). This mixed-methods study will evaluate the experience and impact of SO on those participating using mixed methods (interviews, observations and surveys) before and after each stage and carry out non-participant observations during a percentage of the workshops, training and tour. Data will be analysed using quantitative and qualitative approaches. This is a study within the SHAPER programme. ETHICS AND DISSEMINATION Ethical approval has been granted by the King's College London PNM Research Ethics Panel, REC reference: LRS/DP-20/21-21549. Written informed consent will be sought for participants and stakeholders. The results of the study will be reported and disseminated at international conferences and in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT04864470.
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Affiliation(s)
- Carolina Estevao
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Maria Baldellou Lopez
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Rachel E Davis
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | | | - Tayana Soukup
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Centre for Implementation Science, King's College London, London, UK
| | - Ioannis Bakolis
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Andy Healey
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Health Service and Population Research Department, King's Health Economics, King's College London, London, UK
| | - Jean Harrington
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Anthony Woods
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychological Medicine, King's College London, London, UK
| | - Nikki Crane
- Culture Team, King's College London, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, UK
| | - Carmine Pariante
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychological Medicine, King's College London, London, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, London, UK
| | - Nick Sevdalis
- Centre for Implementation Science, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
- Culture Team, King's College London, London, UK
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Intimate Relationships and Stroke: Piloting a Dyadic Intervention to Improve Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031804. [PMID: 35162827 PMCID: PMC8834869 DOI: 10.3390/ijerph19031804] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 02/01/2023]
Abstract
Stroke affects not only the survivor but also their romantic partner. Post-stroke depression is common in both partners and can have significant negative consequences, yet few effective interventions are available. The purpose of this study was to pilot test a novel 8-week remotely administered dyadic intervention (ReStoreD) designed to help couples better cope with stroke-related changes and reduce depressive symptoms. Thirty-four cohabitating survivor–partner dyads at least 3 months post-stroke and reporting some changes in mood were enrolled. Depressive symptoms were assessed pre- and post-intervention and at 3-month follow-up. Repeated measures analysis of variance was used to assess the effects of ReStoreD over time on depressive symptoms in stroke survivors and their partners. Twenty-six dyads completed the study. Although statistical significance was not reached, there was a large effect size for improvements in depressive symptoms for stroke survivors. There was no significant improvement for partners, and the effect size was minimal. Those with more significant depressive symptoms at baseline were more likely to benefit from the intervention. This pilot study established proof-of-concept by demonstrating that depressive symptoms can be lessened in stroke survivors and partners with more severe depressive symptoms. Future research will establish the efficacy of the intervention in a fully powered study.
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21
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Systemic low-grade inflammation and depressive symptomology at chronic phase of ischemic stroke: The chain mediating role of fibrinogen and neutrophil counts. Brain Behav Immun 2022; 100:332-341. [PMID: 34728390 DOI: 10.1016/j.bbi.2021.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 10/09/2021] [Accepted: 10/18/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is the most common psychological consequence of stroke. Increased inflammatory markers resulting from ischemic stroke may played an important role in the pathogenesis of depressive symptomology. The present study was conducted to further elucidate the relationship between stroke severity, systemic low-grade inflammation and chronic phase post-stroke depressive symptomology (CP-PSDS). METHODS A total of 897 stroke patients were consecutively recruited in this multicenter prospective cohort study and followed up for 1 year. The analytical sample consisted of 436 patients with ischemic stroke (23.4% female, median age = 57 years) from this cohort. Serum concentrations of inflammatory markers were measured in all 436 patients with ischemic stroke, from fasting morning venous blood samples on admission. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) on admission and post-stroke depressive symptomology (PSDS) was evaluated by 17-item Hamilton Rating Scale for Depression (HRSD). RESULTS In the fully adjusted models, we observed that 1) NIHSS (Model 2: β = 0.200, 95%CI, 0.057 ∼ 0.332), fibrinogen (Model 2: β = 0.828, 95%CI, 0.269 ∼ 1.435), white blood cell counts (WBC, model 2: β = 0.354, 95%CI, 0.122 ∼ 0.577) and neutrophil counts (Model 2: β = 0.401, 95%CI, 0.126 ∼ 0.655) can independently predict the CP-PSDS after ischemic stroke onset; 2) fibrinogen (Indirect effect = 0.027, 95%CI, 0.007 ∼ 0.063, 13.4% mediated), WBC (Indirect effect = 0.024, 95%CI, 0.005 ∼ 0.058, 11.8% mediated) and neutrophil counts (Indirect effect = 0.030, 95%CI, 0.006 ∼ 0.069, 14.8% mediated) could partially mediate the association between stroke severity and CP-PSDS, and 3) stroke severity might cause CP-PSDS partly through the chain-mediating role of both fibrinogen and neutrophil counts (chain mediated effect = 0.003, 95%CI, 0.000 ∼ 0.011, p = 0.025, 1.6% mediated). CONCLUSIONS Findings revealed that fibrinogen, WBC and neutrophil counts may be independent predictors of CP-PSDS and partial mediators of the relationship between stroke severity and CP-PSDS among patients with ischemic stroke. In addition, the chain mediating effect of fibrinogen and neutrophil counts might play an important role in the occurrence of CP-PSDS. However, no inflammatory markers were associated with CP-PSDS in females.
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Kidd L, Millar JD, Mason H, Quinn T, Gallacher KI, Jones F, Fisher RJ, Lebedis T, Barber M, Brennan K, Smith M. Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study. BMJ Open 2022; 12:e055491. [PMID: 35058265 PMCID: PMC8783824 DOI: 10.1136/bmjopen-2021-055491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/12/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A growing evidence base demonstrates the effectiveness of supported self-management in stroke for stroke survivors and their families. However, there is significant variation in its implementation in community stroke care and little understanding about how supported self-management works and is delivered across different settings, models used and contexts of community stroke rehabilitation. METHODS AND ANALYSIS Using a mixed method, realist approach across two phases, this protocol describes a study on community-based supported self-management. The aim is to identify the mechanisms and outcomes of supported self-management in stroke and to understand how supported self-management is implemented in different contexts of community stroke rehabilitation. Phase 1 involves (1) a realist synthesis, (2) a scoping and mapping of current community rehabilitation settings and (3) a Q-methodology study to develop initial programme theories about how community-based supported self-management works, for whom and in what contexts. Phase 2 involves realist informed interviews/focus groups with stroke survivors, community rehabilitation practitioners and team managers from across Scotland to test and refine programme theories and an explanatory model for how supported self-management works across different contexts of community-based stroke rehabilitation. ETHICS AND DISSEMINATION Ethical approval and R&D approvals have been granted from East of Scotland Research Ethics Committee (REC reference number: 19/ES/0055) and participating NHS boards. An understanding of how, for whom and in what contexts community-based supported self-management works will help to strengthen its delivery in practice. Such an understanding will enable the design of context-specific recommendations for policy and practice that genuinely reflect the challenges in implementing supported self-management in community stroke care. Results will be disseminated to clinical partners working in community stroke rehabilitation, stroke survivors and families and to policymakers and third sector partners involved in the provision of long-term support for people affected by stroke. PROSPERO REGISTRATION NUMBER CRD42020166208.
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Affiliation(s)
- Lisa Kidd
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | | | - Helen Mason
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Terry Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Katie I Gallacher
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fiona Jones
- Centre for Health and Social Care Research, St Georges University of London, London, UK
| | - Rebecca J Fisher
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Therese Lebedis
- NHS Grampian, Woodend Hospital, Aberdeen, UK
- Scottish Government Stroke Improvement Programme, Edinburgh, UK
| | - Mark Barber
- Scottish Government Stroke Improvement Programme, Edinburgh, UK
- Lanarkshire Acute Hospitals NHS Trust, Bothwell, South Lanarkshire, UK
| | - Katrina Brennan
- Scottish Government Stroke Improvement Programme, Edinburgh, UK
- NHS Lanarkshire, Coathill Hospital, Coatbridge, UK
| | - Mark Smith
- Scottish Government Stroke Improvement Programme, Edinburgh, UK
- NHS Lothian, Leith Community Treatment Centre, Leith, UK
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Jaywant A, DelPonte L, Kanellopoulos D, O'Dell MW, Gunning FM. The Structural and Functional Neuroanatomy of Post-Stroke Depression and Executive Dysfunction: A Review of Neuroimaging Findings and Implications for Treatment. J Geriatr Psychiatry Neurol 2022; 35:3-11. [PMID: 33073704 DOI: 10.1177/0891988720968270] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Post-stroke depression and executive dysfunction co-occur and are highly debilitating. Few treatments alleviate both depression and executive dysfunction after stroke. Understanding the brain network changes underlying post-stroke depression with executive dysfunction can inform the development of targeted and efficacious treatment. In this review, we synthesize neuroimaging findings in post-stroke depression and post-stroke executive dysfunction and highlight the network commonalities that may underlie this comorbidity. Structural and functional alterations in the cognitive control network, salience network, and default mode network are associated with depression and executive dysfunction after stroke. Specifically, post-stroke depression and executive dysfunction are both linked to changes in intrinsic functional connectivity within resting state networks, functional over-connectivity between the default mode and salience/cognitive control networks, and reduced cross-hemispheric frontoparietal functional connectivity. Cognitive training and noninvasive brain stimulation targeted at these brain network abnormalities and specific clinical phenotypes may help advance treatment for post-stroke depression with executive dysfunction.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Larissa DelPonte
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,Weill Cornell Institute of Geriatric Psychiatry, White Plains, NY, USA
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Liu W, Rao C, Zhao Q, Du Y, Nan X, Li Z, Yin C. Effectiveness and safety of manual acupuncture therapy in patients with post-stroke depression: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e048686. [PMID: 34893483 PMCID: PMC8666868 DOI: 10.1136/bmjopen-2021-048686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Acupuncture is widely used on the rehabilitation of stroke survivors, including hemiplegia, constipation, emotional disorders and so on. Although the effectiveness of manual acupuncture therapy on post-stroke depression (PSD) has been confirmed by multiple randomised controlled trials, there were few meta-analyses focused on the connection between different techniques, durations or other detailed operations of manual acupuncture and their effectiveness of improving the depression severity and quality of life for patients with PSD. METHODS AND ANALYSIS A systematic search will be performed on English databases (PubMed, the Cochrane Library, Medline and Embase), Chinese databases (China National Knowledge Infrastructure, WanFang Data, VIP and Chinese biomedical databases) and Japanese databases (Japan Science and Technology Agency and CiNii). The retrieval time limit will be from the establishment of the database to November 2020. Two researchers will independently screen the literature works, extract data and evaluate the quality of the included studies. Meta-analysis will be conducted by using STATA V.14.0 and Review Manager V.5.3. ETHICS AND DISSEMINATION The results of this meta-analysis will be disseminated through publication in peer-reviewed journals or conference presentations. The data used in this meta-analysis will not contain individual patient data; therefore, ethical approval is not required. PROSPERO REGISTRATION NUMBER CRD42020222825.
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Affiliation(s)
- Wei Liu
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Acupuncture Department, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chang Rao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Acupuncture Department, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qi Zhao
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Acupuncture Department, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuzheng Du
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Acupuncture Department, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xi Nan
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Acupuncture Department, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Zefang Li
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Acupuncture Department, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Chunsheng Yin
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Acupuncture Department, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
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Stuckey SM, Ong LK, Collins-Praino LE, Turner RJ. Neuroinflammation as a Key Driver of Secondary Neurodegeneration Following Stroke? Int J Mol Sci 2021; 22:ijms222313101. [PMID: 34884906 PMCID: PMC8658328 DOI: 10.3390/ijms222313101] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/25/2021] [Accepted: 12/01/2021] [Indexed: 01/13/2023] Open
Abstract
Ischaemic stroke involves the rapid onset of focal neurological dysfunction, most commonly due to an arterial blockage in a specific region of the brain. Stroke is a leading cause of death and common cause of disability, with over 17 million people worldwide suffering from a stroke each year. It is now well-documented that neuroinflammation and immune mediators play a key role in acute and long-term neuronal tissue damage and healing, not only in the infarct core but also in distal regions. Importantly, in these distal regions, termed sites of secondary neurodegeneration (SND), spikes in neuroinflammation may be seen sometime after the initial stroke onset, but prior to the presence of the neuronal tissue damage within these regions. However, it is key to acknowledge that, despite the mounting information describing neuroinflammation following ischaemic stroke, the exact mechanisms whereby inflammatory cells and their mediators drive stroke-induced neuroinflammation are still not fully understood. As a result, current anti-inflammatory treatments have failed to show efficacy in clinical trials. In this review we discuss the complexities of post-stroke neuroinflammation, specifically how it affects neuronal tissue and post-stroke outcome acutely, chronically, and in sites of SND. We then discuss current and previously assessed anti-inflammatory therapies, with a particular focus on how failed anti-inflammatories may be repurposed to target SND-associated neuroinflammation.
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Affiliation(s)
- Shannon M. Stuckey
- Discipline of Anatomy and Pathology, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide 5005, Australia; (S.M.S.); (L.E.C.-P.)
| | - Lin Kooi Ong
- School of Pharmacy, Monash University Malaysia, Subang Jaya 47500, Malaysia;
- School of Biomedical Sciences and Pharmacy and the Priority Research Centre for Stroke and Brain Injury, The University of Newcastle, Callaghan 2308, Australia
| | - Lyndsey E. Collins-Praino
- Discipline of Anatomy and Pathology, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide 5005, Australia; (S.M.S.); (L.E.C.-P.)
| | - Renée J. Turner
- Discipline of Anatomy and Pathology, School of Biomedicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide 5005, Australia; (S.M.S.); (L.E.C.-P.)
- Correspondence: ; Tel.: +61-8-8313-3114
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Lee EH, Kim JW, Kang HJ, Kim SW, Shin IS, Kim JT, Park MS, Cho KH, Kim JM. Effects of acute and chronic depression on 12-year long-term outcomes after stroke. Int J Geriatr Psychiatry 2021; 36:1759-1766. [PMID: 34227701 DOI: 10.1002/gps.5597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 06/20/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES This study aimed to investigate whether acute and chronic poststroke depression (PSD) were associated with cardio-cerebrovascular events (CVEs). METHODS A total of 423 patients with recent stroke were recruited from 2006 to 2009. They were diagnosed with major or minor depressive disorder during the acute phase (within 2 weeks) after stroke. Of these, 284 completed the same diagnostic evaluation during the chronic phase (1 year) after stroke. An average 12-year (range 8.7-14.1 years) follow-up was conducted to assess composite CVEs including recurrent stroke, myocardial infarction, and vascular death after the index stroke. During the follow-up, Kaplan-Meier event rates for outcomes were calculated, and hazard ratios were estimated using Cox regression models after adjusting for a range of covariates. RESULTS The composite CVE incidence was higher in patients with acute or chronic PSD than in those without. Composite event incidence was highest in patients with PSD during both the acute and chronic phases. CONCLUSIONS The presence of depression at acute and chronic phase of stroke predicted worse long-term cardio-cerebrovascular outcomes. Evaluation of PSD during both the acute and chronic phases is recommended.
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Affiliation(s)
- Eun-Hye Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ki-Hyun Cho
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Selvaraj S, Arora T, Casameni Montiel T, Grey I, Alfraih H, Fadipe M, Suchting R, Savitz S, Sanner Beauchamp JE, Östlundh L. Early screening for post-stroke depression, and the effect on functional outcomes, quality of life and mortality: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e050451. [PMID: 34404715 PMCID: PMC8372879 DOI: 10.1136/bmjopen-2021-050451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Post-stroke depression (PSD) is a severe complication of cerebrovascular stroke affecting about one-third of stroke survivors. Moreover, PSD is associated with functional recovery and quality of life (QOL) in stroke survivors. Screening for PSD is recommended. There are, however, differences in the literature on the impact of early screening on functional outcomes. In this systematic review, we synthesise the currently available literature regarding the associations between timing and setting of PSD screening and mortality, QOL and functional outcomes in stroke survivors. METHODS AND ANALYSIS We will systematically search electronic databases including PubMed, Embase, APA PsycINFO, Web of Science, Scopus and CINAHL from inception to August 2021. Four reviewers will screen the title and abstract and full-text level records identified in the search in a blinded fashion to determine the study eligibility. Any selection disagreements between the reviewers will be resolved by the study investigator. Data extraction of eligible studies will be conducted by two reviewers using a predefined template. We will complete the quality assessment of included articles independently by two reviewers using the Newcastle Ottawa Scale. Eventual discrepancies will be resolved by the principal investigator. ETHICS AND DISSEMINATION Due to the nature of the study design, ethical approval is not required. The systematic review and meta-analysis findings will be published and disseminated in a peer-reviewed journal. Our results will also be disseminated through posters and presentations at appropriate scientific conferences. PROSPERO REGISTRATION NUMBER CRD42021235993.
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Affiliation(s)
- Sudhakar Selvaraj
- Louis Faillace, MD, Department of Psychiatry, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Teresa Arora
- College of Natural & Health Sciences, Zayed University, Abu Dhabi, UAE
| | - Tahani Casameni Montiel
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Ian Grey
- Department of Cognitive Science, United Arab Emirates University, Al Ain, UAE
| | - Hind Alfraih
- Department of Psychology, College of Natural & Health Sciences, Zayed University, Abu Dhabi, UAE
| | - Melissa Fadipe
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Robert Suchting
- Louis Faillace, MD, Department of Psychiatry, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sean Savitz
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Neurology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jennifer E Sanner Beauchamp
- Institute for Stroke and Cerebrovascular Disease, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Linda Östlundh
- National Medical Library, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
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Hu J, Wang L, Fan K, Ren W, Wang Q, Ruan Y, Yuan C, Huang G, He J. The Association Between Systemic Inflammatory Markers and Post-Stroke Depression: A Prospective Stroke Cohort. Clin Interv Aging 2021; 16:1231-1239. [PMID: 34234423 PMCID: PMC8243596 DOI: 10.2147/cia.s314131] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/10/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Inflammation plays an important role in stroke. Many inflammatory markers in peripheral blood are proved to be associated with stroke severity or prognosis. But few comprehensive models or scales to evaluate the post-stroke depression (PSD) have been reported. In this study, we aimed to compare the level of systemic inflammation markers between PSD and non-PSD patients and explore the association of these inflammatory markers with PSD. Methods Totally, 432 ischemic stroke patients were consecutively enrolled in the study and received 1 month follow-up. We used the 17-Hamilton Rating Scale to measure depressive symptoms at 1 month after stroke. With the Hamilton Depression Scale score of >7, patients were diagnosed with PSD. Systemic immune-inflammation index (SII), neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR) and derived neutrophil-to-lymphocyte ratio (dNLR) were calculated from the admission blood work. Results Finally, 129 patients (30.5%) were diagnosed with PSD at 1 month. PSD patients showed significantly higher levels of SII (501.27 (345.43-782.58) vs 429.60 (315.64-570.98), P=0.001), NLR (2.36 (1.77-3.82) vs 2.17 (1.56-2.80), P=0.010), dNLR (1.67 (1.30-2.51) vs 1.54 (1.16-1.99), P=0.009), PLR (124.65 (95.25-155.15) vs 109.22 (92.38-142.03), P=0.015), especially SII at admission as compared to non-PSD patients. In the logistic analysis, SII value (>547.30) was independently associated with the occurrence of PSD (OR=2.181, 95% CI=1.274-3.732, p =0.004), better than dNLR (OR=1.833, 95% CI=1.071-3.137, p =0.027), PLR (OR= 1.822, 95% CI=1.063-3.122, p =0.029) and NLR (OR =1.728, 95% CI=1.009-2.958, p =0.046). Conclusion Increased SII, PLR, dNLR, NLR, particularly SII at admission, are significantly correlated with PSD and may add some prognostic clues to find early discovery of PSD.
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Affiliation(s)
- Jingjie Hu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Liuyuan Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Kaili Fan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Wenwei Ren
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Qiongzhang Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yiting Ruan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Chengxiang Yuan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, People's Republic of China
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Rabat Y, Sibon I, Berthoz S. Implication of problematic substance use in poststroke depression: an hospital-based study. Sci Rep 2021; 11:13324. [PMID: 34172774 PMCID: PMC8233374 DOI: 10.1038/s41598-021-92639-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/14/2021] [Indexed: 11/21/2022] Open
Abstract
The prevalence of clinically defined problematic substance use among stroke patients is overlooked and its association with post-stroke depression (PSD) is unknown. Our aims were to: (1) estimate the proportion of stroke patients with a problematic substance use as defined by clinical screening scales; (2) determine the proportion of PSD at three months of follow-up; (3) explore if the baseline severity in substance use and its evolution are independent predictors of PSD. A cohort of first-ever non-severe stroke adult patients was screened at baseline and three months post-stroke using recommended cut-off scores of standardized scales for tobacco, alcohol and cannabis abuse. PSD was defined using the Center of Epidemiological Studies Depression scale score. Out of the 244 eligible patients, 74 (30.3%) presented a problematic substance use, including 21 (8.6%) polydrug abusers. Among these patients, the prevalence of PSD was 50.8%, including 29.5% of severe depression. The severity of tobacco dependence at baseline was found to double the risk (OR 1.59, 95% CI 1.05–2.43) of presenting a PSD, independently of previously reported risk factors. We found no significant evidence for an effect of the evolution in substance use at follow-up. Addictive disorders are part of the critical unmet needs that should be addressed in the management of PSD.
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Affiliation(s)
- Yolaine Rabat
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, 33000, Bordeaux, France.
| | - Igor Sibon
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, 33000, Bordeaux, France.,Stroke Unit, Department of Neurology, CHU Bordeaux, Bordeaux, France
| | - Sylvie Berthoz
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, 33000, Bordeaux, France.,Department of Psychiatry for Adolescents and Young Adults, Institut Mutualiste Montsouris, Paris, France
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30
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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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Khazaal W, Taliani M, Boutros C, Abou-Abbas L, Hosseini H, Salameh P, Sadier NS. Psychological Complications at 3 Months Following Stroke: Prevalence and Correlates Among Stroke Survivors in Lebanon. Front Psychol 2021; 12:663267. [PMID: 34177717 PMCID: PMC8222528 DOI: 10.3389/fpsyg.2021.663267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/13/2021] [Indexed: 02/02/2023] Open
Abstract
Introduction: Stroke continues to be a common and debilitating medical condition which has a significant effect on public health as the second primary source of mortality and the third major root of disability worldwide. A wide range of complications affecting the survivor's life and interfering with the recovery process usually follows stroke; anxiety and depression are considered one of the major complications post-stroke. This study sought to investigate the short-term psychological consequences of stroke among Lebanese survivors and to identify their correlates. Methods: This study is a prospective observational epidemiological study. 143 stroke patients admitted to hospitals in Mount Lebanon and Beirut between February and May 2018.were included in this study. Assessments of complications were carried out at 3 months post-stroke by completing a 30-min face-to-face interview questionnaire. The survey included the socio-demographic -characteristics of the patients, their lifestyle, health indicators, the severity of stroke, and the post-stroke consequences disturbing their quality of life. Results: Complications were recorded for 117 stroke survivors (mean age, 72.46 years; 60.7% male). The analysis of results 3 months post stroke showed that 29 survivors suffered from neuropathic pain (24.8%), 110 (94%) suffered from fatigue, and 81 (69.2%) from cognitive impairment. High rates of anxiety (51.3%), and depression (76.1%) were recorded as well. Multivariate logistic regression confirmed that there is a significant association between depression and the following variables: anxiety (OR = 4.814, p-value = 0.017), pain (OR = 6.868, p-value = 0.002), and physical activity, which acts as a protective factor against depression (OR = 0.261; p-value = 0.029). However, the results of the multivariate logistic regression analysis for anxiety indicated that immobility-related complications increase the risk of anxiety by 8.457 in sedentary duration longer than 12 h (ORa = 8.457, p-value = 0.01). Furthermore, patients with neuropathic pain (24.8%) are 3.858 times more likely to have anxiety compared to patients without neuropathic pain (ORa = 3.858, p-value = 0.019). Conclusion: Using a patient-centered structure more interventions should take place to evaluate stroke survivors' outcomes, and organize rehabilitation services that deal with stroke consequences, particularly high anxiety and depression levels, which are prevalent and persistent among the Lebanese stroke survivors.
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Affiliation(s)
- Walaa Khazaal
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Maram Taliani
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Celina Boutros
- Institut Mondor de Recherche Biomedicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est, Creteil, Paris, France
| | - Linda Abou-Abbas
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Hassan Hosseini
- Institut Mondor de Recherche Biomedicale (IMRB)-Inserm U955, Ecole Doctorale Science de la Vie et de la Santé, Université Paris-Est, Creteil, Paris, France
| | - Pascale Salameh
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon.,Institut National de Sante Publique, Epidémiologie Clinique et Toxicologie (INSPECT-LB), Beirut, Lebanon.,University of Nicosia Medical school, Nicosia, Cyprus
| | - Najwane Said Sadier
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon.,College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
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Cheng JH, Wang QZ, Luan XQ, Zhu J, Feng WQ, Huang GQ, Lin SS, He JC. The Association Between Admission Anemia and Poststroke Depression. J Nerv Ment Dis 2021; 209:421-425. [PMID: 33660687 DOI: 10.1097/nmd.0000000000001314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Poststroke depression (PSD) is the most frequent and important neuropsychiatric problem afflicting these patients. Anemia is common in many of these individuals presenting with acute stroke. This study determined whether there is a relationship between anemia on hospital admission and PSD. Two hundred eighty-four acute stroke patients were included in the study. Among them, there were 88 PSD patients, whereas another 196 were non-PSD patients. Clinical depression symptoms were diagnosed according to DSM-4 (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria and a HAMD-17 (the 17-item Hamilton Depression Scale) score ≥8 at 1 month after stroke. In the PSD patients, 27.3% of them presented with anemia, whereas only 12.8% of the non-PSD patients had this condition. There was a negative correlation between hemoglobin level and HAMD-17 score in all patients. A binary logistic regression analysis revealed that anemia was independently associated with PSD after adjustment for sex, National Institutes of Health Stroke Scale scores, mRS (modified Rankin Scale) scores, BI (Barthel Index) scores, RBC (red blood cell), and hematocrit. In conclusion, anemia at admission is associated with PSD seen in these patients 1 month later. Therefore, anemia is a possible predictor of PSD.
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Affiliation(s)
- Jian-Hua Cheng
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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33
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Kwon B, Lee EJ, Park S, Lee JS, Lee MH, Jeong D, Lee D, Kwon HS, Chang DI, Park JH, Cha JK, Heo JH, Sohn SI, Kim DE, Choi-Kwon S, Kim JS. Long-Term Changes in Post-Stroke Depression, Emotional Incontinence, and Anger. J Stroke 2021; 23:263-272. [PMID: 34102761 PMCID: PMC8189860 DOI: 10.5853/jos.2020.04637] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 02/22/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND PURPOSE Long-term changes in post-stroke depression (PSD), post-stroke emotional incontinence (PSEI), and post-stroke anger (PSA) have rarely been studied. METHODS This is a sub-study of EMOTION, a randomized, placebo-controlled trial, that examined the efficacy of escitalopram on PSD, PSEI, and PSA in patients with stroke. We interviewed patients at the long-term period (LTP) using predefined questionnaires: Montgomery-Åsberg depression rating scale (MADRS) for PSD, modified Kim's criteria for PSEI, and Spielberger trait anger scale for PSA. Additionally, the ENRICHD Social Support Instrument (ESSI) for the social support state and the modified Rankin Scale (mRS) were measured. We investigated the changes in and factors behind PSD, PSEI, and PSA at LTP. RESULTS A total of 222 patients were included, and the median follow-up duration was 59.5 months (interquartile range, 50 to 70). Compared to the data at 6 months post-stroke, the prevalence of PSEI (11.7% at 6 months, 6.3% at LTP; P=0.05) and mean anger score (21.62, 16.24; P<0.01) decreased, while the prevalence of PSD (35.6%, 44.6%; P=0.03) and mean MADRS (6.16, 8.67; P<0.01) increased at LTP. ESSI was associated with PSD and PSA, but not with PSEI. The effect of the baseline National Institutes of Health Stroke Scale score on PSD decreased over time. The effect of low social support on PSD was greater than that of mRS at LTP. CONCLUSIONS The prevalence and degree of PSD significantly increased, while those of PSEI and PSA decreased at LTP. PSD in this stage appeared to be more closely associated with a lack of social support than patients' physical disabilities.
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Affiliation(s)
- Boseong Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seongho Park
- Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Min Hwan Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Daeun Jeong
- Department of Neurology, Veterans Health Service Medical Center, Seoul, Korea
| | - Dongwhane Lee
- Department of Neurology, Gachon University Gil Medical Center, Incheon, Korea
| | - Hyuk Sung Kwon
- Department of Neurology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Dae-Il Chang
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Jong-Ho Park
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Korea
| | - Ji Hoe Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Smi Choi-Kwon
- College of Nursing, Seoul National University, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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34
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Liang C, Van Laar Veth AJ, Li Q, Zheng D, Hackett ML. Effect of mood on long-term disability in younger stroke survivors: results from the Psychosocial Outcomes In StrokE (POISE) study. Top Stroke Rehabil 2021; 29:286-294. [PMID: 34018471 DOI: 10.1080/10749357.2021.1922802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background & Purpose: Anxiety and depression are common among stroke survivors, and their effect on long-term outcome remains unknown in those under 65 years of age. We investigated the association between early anxiety/depression after stroke and 12-month disability, and whether this is modified by sex.Methods: The Psychosocial Outcomes In StrokE (POISE) study was a prospective observational cohort study that recruited 441 younger (< 65 years) stroke survivors ≤28 days of acute stroke. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale, and disability using the World Health Organization Disability Assessment Scale version II (WHODAS-II). Associations between baseline anxiety/depression, and disability at 12-months was tested using analysis of covariance. Subgroup analysis was conducted using interaction term.Results: 92 (25%) had anxiety and 53 (14%) depression at baseline. Multivariable models showed significant association between baseline anxiety and 12-month disability (WHODAS-II score 15.24 vs. 11.49, p < .05). Those with anxiety had more impairment in 'cognition' (WHODAS-II score 18.26 vs. 8.71, p < .001), 'getting along' (WHODAS-II score 11.87 vs. 7.42, p < .05) and 'participation' (WHODAS-II score 22.37 vs. 15.92, p < .005) WHODAS-II. No significant relationship was found between baseline depression and long-term disability. There was no differential effect of anxiety by sex found in this study.Conclusions: Post-stroke anxiety has an adverse effect on disability at one year among young stroke survivors.
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Affiliation(s)
- C Liang
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - A J Van Laar Veth
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Q Li
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - D Zheng
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Translational Australian Clinical Toxicology program, Biomedical Informatics in Digital Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - M L Hackett
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, UK
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Wijeratne T, Sales C. Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression. J Clin Med 2021; 10:jcm10081674. [PMID: 33919670 PMCID: PMC8069768 DOI: 10.3390/jcm10081674] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions.
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Affiliation(s)
- Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne 3000, Australia
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapura 50000, Sri Lanka
- Correspondence:
| | - Carmela Sales
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
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de Souza MDFD, Cardoso MGDF, Vieira ÉLM, Rocha NP, Vieira THFE, Pessoa AE, Pedroso VSP, Rachid MA, de Souza LC, Teixeira AL, Mourão AM, de Miranda AS. Clinical correlates of social cognition after an ischemic stroke: preliminary findings. Dement Neuropsychol 2021; 15:223-229. [PMID: 34345364 PMCID: PMC8283877 DOI: 10.1590/1980-57642021dn15-020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/29/2020] [Indexed: 11/22/2022] Open
Abstract
The co-occurrence of post-stroke behavioral disorders and cognitive impairment has been extensively investigated. However, studies usually do not include social cognition among the assessed cognitive domains. Objective To investigate the potential association between facial emotion recognition, a measure of social cognition, and behavioral and cognitive symptoms in the subacute phase of ischemic stroke. Methods Patients admitted to a Stroke Unit with ischemic stroke were followed up to 60 days. At this time point, they were evaluated with the following tools: Mini-Mental State Examination (MMSE); Frontal Assessment Battery (FAB); Visual Memory Test of the Brief Cognitive Battery (VMT); Phonemic Verbal Fluency (F-A-S Test); Digit Span; Facial Emotion Recognition Test (FERT) and Hospital Anxiety and Depression Scale (HADS). A control group composed of 21 healthy individuals also underwent the same evaluation. Results Eighteen patients with ischemic stroke were enrolled in this study. They had similar age, sex and schooling years compared to controls. Depression symptoms and episodic memory deficits were significantly more frequent in patients compared to controls. The recognition of sadness expression positively correlated with the levels of anxiety and depression, while and the recognition of fear expression negatively correlated with depression in the stroke group. Conclusions After an ischemic stroke, patients exhibit impairment in social cognition skills, specifically facial emotion recognition, in association with behavioral symptoms.
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Affiliation(s)
- Maria de Fátima Dias de Souza
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Maíra Glória de Freitas Cardoso
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Érica Leandro Marciano Vieira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Natália Pessoa Rocha
- The Mitchell Center for Alzheimer's Disease and Related Brain Disorders, Department of Neurology, McGovern Medical School, The University of Texas Health Science Center at Houston - Houston, TX, USA
| | - Talita Hélen Ferreira E Vieira
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil.,Departamento de Fisioterapia, Faculdade Sete Lagoas - Sete Lagoas, MG, Brazil
| | | | - Vinicius Sousa Pietra Pedroso
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Milene Alvarenga Rachid
- Departamento de Patologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Leonardo Cruz de Souza
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Antônio Lúcio Teixeira
- Santa Casa BH Ensino e Pesquisa - Belo Horizonte, MG, Brazil.,Neuropsychiatry Program, Department of Psychiatry & Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston - Houston, TX, USA
| | - Aline Mansueto Mourão
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
| | - Aline Silva de Miranda
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil.,Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais - Belo Horizonte, MG, Brazil
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Martin NH, Cornish B, Browning S, Simister R, Werring DJ, Cipolotti L, Chan E. The neuropsychology needs of a hyper-acute stroke unit. J Neurol Sci 2021; 423:117382. [PMID: 33714086 DOI: 10.1016/j.jns.2021.117382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/03/2021] [Accepted: 02/26/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND AIM Guidelines recommend routine assessment and management of mood and cognition after stroke, but little is known about the value or feasibility of providing neuropsychology input during the hyper-acute period. We aimed to identify and describe the extent and nature of neuropsychological needs and to investigate the feasibility of providing direct neuropsychology input within a hyper-acute setting. METHODS Over a 7-month period, Multidisciplinary Team (MDT) members of a central London Hyper-Acute Stroke Unit (HASU) identified stroke patients who they believed would benefit from neuropsychology input, and categorised the nature of neuropsychology intervention required. We examined the demographic and clinical characteristics of the patients identified and the type of intervention required. RESULTS 23% of patients (101/448) were identified as requiring neuropsychology input. Patients deemed to require input were younger, more likely to be male and more functionally disabled than those not requiring input. Cognitive assessment was the main identified need (93%) followed by mood (29%) and family support (9%). 30% of patients required two types of intervention. During a pilot of neuropsychology provision, 17 patients were seen; 15 completed a full cognitive assessment. All patients assessed presented with cognitive impairment despite three being deemed cognitively intact (> standardised cut-off) using a cognitive screening tool. CONCLUSION We showed that direct neuropsychology input on a HASU is necessary for complex and varied interventions involving cognition, mood and family support. Furthermore, input is feasible and useful in detecting cognitive impairment not revealed by screening instruments.
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Affiliation(s)
- Naomi H Martin
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Bronwyn Cornish
- Occupational Therapy Department, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
| | - Simone Browning
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
| | - Robert Simister
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
| | - David J Werring
- Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
| | - Edgar Chan
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK; Comprehensive Stroke Service, University College London Hospitals NHS Trust, London, UK; Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, National Hospital for Neurology and Neurosurgery, Russell Square House, London, UK.
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38
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Zeng YY, Wu MX, Geng DD, Cheng L, Zhou SN, Fan KL, Yu X, Tang WJ, He JC. Early-Onset Depression in Stroke Patients: Effects on Unfavorable Outcome 5 Years Post-stroke. Front Psychiatry 2021; 12:556981. [PMID: 34248685 PMCID: PMC8267172 DOI: 10.3389/fpsyt.2021.556981] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Post-stroke depression (PSD) constitutes an essential complication of stroke and is associated with high-risk unfavorable outcome after stroke. The main objective of this prospective study was to determine the relationship between early-onset PSD (1 month after stroke) and functional outcomes 5 years after baseline enrollment. Methods: Four hundred thirty-six patients who met the criteria were included in this study from October 2013 to February 2015. The follow-up time for each patient was ~5 years, with follow-up every 3 months. Patients received questionnaires including the 17-item Hamilton Depression Scale (HAMD), the Mini-Mental State Examination (MMSE), the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Barthel Index (BI). Results: Of the 436 patients, 154 (35.3%) patients with the prevalence of PSD status at baseline, 26 (7.2%) patients with the prevalence of PSD status, and 73 (20.1%) had an unfavorable outcome 5 years after stroke. The odds ratio (OR) for unfavorable outcome at 5 years in the PSD group was ~2.2 relative to the non-PSD group after adjusting for potential risk factors [OR = 2.217, 95% confidence interval (CI) = 1.179-4.421, P = 0.015]. In the early-onset PSD group, HAMD scores were independently associated with 5-year unfavorable outcome rates (OR = 1.168, 95% CI = 1.015-1.345, P = 0.031). Conclusions: Our findings indicate that early-onset PSD status in Chinese patients is an independent risk factor for unfavorable outcome 5 years after stroke, and that the severity of PSD is also related to unfavorable outcome.
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Affiliation(s)
- Ya-Ying Zeng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Meng-Xuan Wu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Dan-Dan Geng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Lin Cheng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Sheng-Nan Zhou
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kai-Li Fan
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Xin Yu
- First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Wen-Jie Tang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,First School of Clinical Medicine, Wenzhou Medical University, Wenzhou, China
| | - Jin-Cai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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López-Espuela F, Roncero-Martín R, Canal-Macías MDLL, Moran JM, Vera V, Gomez-Luque A, Lendinez-Mesa A, Pedrera-Zamorano JD, Casado-Naranjo I, Lavado-García J. Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249542. [PMID: 33419273 PMCID: PMC7766010 DOI: 10.3390/ijerph17249542] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/11/2020] [Accepted: 12/16/2020] [Indexed: 12/14/2022]
Abstract
We aimed to know the prevalence of post-stroke depression (PSD) in our context, identify the variables that could predict post-stroke depression, by using the Hamilton Depression Rating Scale, occurring within six months after stroke, and identify patients at high risk for PSD. Methods: descriptive, cross-sectional and observational study. We included 173 patients with stroke (transient ischemic attack (TIA) included) and collected sociodemographic and clinical variables. We used the Hamilton Depression Scale (HDS) for depression assessment and Barthel Index and modified Rankin Scale (mRS) for functional assessment. The neurological severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Results: 35.5% were women, aged 71.16 (±12.3). Depression was present in 42.2% patients (n = 73) at six months after stroke. The following variables were significantly associated with PSD: diagnosis of previous depression (p = 0.005), the modified Rankin Scale at discharge (p = 0.032) and length of hospital stay (p = 0.012). Conclusion: PSD is highly prevalent after stroke and is associated with the severity, left location of the stroke, and the degree of disability at discharge. Its impact justifies the evaluation and early treatment that still continues to be a challenge today.
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Affiliation(s)
- Fidel López-Espuela
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Raúl Roncero-Martín
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Maria de la Luz Canal-Macías
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
- Correspondence: ; Tel.: +34-927257450
| | - Jose M. Moran
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Vicente Vera
- Department of Stomatology II, School of Dentistry, Complutense University, 28040 Madrid, Spain;
| | - Adela Gomez-Luque
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | - Alejandro Lendinez-Mesa
- Nursing Department, Faculty of Health Sciences, Alfonso X el Sabio University, 28691 Madrid, Spain;
| | - Juan Diego Pedrera-Zamorano
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
| | | | - Jesus Lavado-García
- Metabolic Bone Diseases Research Group, Nursing Department, Nursing and Occupational Therapy College, University of Extremadura, 10003 Cáceres, Spain; (F.L.-E.); (R.R.-M.); (J.M.M.); (A.G.-L.); (J.D.P.-Z.); (J.L.-G.)
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Ouk M, Wu CY, Colby-Milley J, Fang J, Zhou L, Shah BR, Herrmann N, Lanctôt KL, Linkewich E, Law M, Swartz RH, Kapral MK, Black SE, MacIntosh BJ, Edwards JD, Swardfager W. Depression and Diabetes Mellitus Multimorbidity Is Associated With Loss of Independence and Dementia Poststroke. Stroke 2020; 51:3531-3540. [DOI: 10.1161/strokeaha.120.031068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background and Purpose:
Many patients with ischemic stroke present with multiple comorbidities that threaten survival and recovery. This study sought to determine the risks of adverse long-term stroke outcomes associated with multimorbid diabetes mellitus and depression.
Methods:
Retrospective analysis of prospectively collected data on consecutive patients without premorbid dementia admitted from the community for a first-ever acute ischemic stroke to comprehensive stroke centers across Ontario, Canada (2003–2013). Premorbid histories of diabetes mellitus and depression were ascertained within 5 years before stroke admission. Adjusted hazard ratios (aHR [95% CI]) of admission to long-term care, incident dementia, readmission for stroke or transient ischemic attack and all-cause mortality, over time among those discharged back into the community poststroke.
Results:
Among 23 579 stroke admissions, n=20 201 were discharged back into the community. Diabetes mellitus and depression were associated with synergistic hazards of admission to long-term care (X
2
=5.4;
P
=0.02) over a median follow-up of 5.6 years. This interaction was observed among women specifically; depression multimorbidity showed particularly high hazards of admission to long-term care (aHR
Depression
=1.57 [1.24–1.98]) and incident dementia (aHR
Depression
=1.85 [1.40–2.44]) among women with diabetes mellitus. In the whole cohort, diabetes mellitus and depression were associated individually with long-term care admission (aHR
Diabetes
=1.20 [1.12–1.29]; aHR
Depression
=1.19 [1.04–1.37]), incident dementia (aHR
Diabetes
=1.14 [1.06–1.23]; aHR
Depression
=1.27 [1.08–1.49]), stroke/transient ischemic attack readmission (aHR
Diabetes
=1.18 [1.10–1.26]; aHR
Depression
=1.24 [1.07–1.42]), and all-cause mortality (aHR
Diabetes
=1.29 [1.23–1.36]; aHR
Depression
=1.16 [1.05–1.29]).
Conclusions:
The risks of dementia and needing long-term care in the years after surviving a stroke were particularly elevated among women when premorbid diabetes mellitus and depression occurred together. Long-term stroke recovery strategies might target high-risk patients with mood and metabolic multimorbidity.
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Affiliation(s)
- Michael Ouk
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
| | - Che-Yuan Wu
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
| | - Jessica Colby-Milley
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
| | - Jiming Fang
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Limei Zhou
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Baiju R. Shah
- Department of Medicine and Institute for Health Policy, Management, and Evaluation, (B.R.S., M.K.K.), University of Toronto, ON
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
- Divisions of Endocrinology and Obstetric Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON (B.R.S.)
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre (N.H., K.L.L.), University of Toronto, ON
| | - Krista L. Lanctôt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
- Department of Medicine (Psychiatry), Sunnybrook Health Sciences Centre (N.H., K.L.L.), University of Toronto, ON
- University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)
| | - Elizabeth Linkewich
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Occupational Science and Occupational Therapy (E.L.), University of Toronto, ON
| | - Marcus Law
- Department of Family and Community Medicine (M.L.), University of Toronto, ON
- University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)
| | - Richard H. Swartz
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (R.H.S., S.E.B.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Moira K. Kapral
- Department of Medicine and Institute for Health Policy, Management, and Evaluation, (B.R.S., M.K.K.), University of Toronto, ON
- ICES, Toronto, ON (J.F., L.Z., B.R.S., R.H.S., M.K.K.)
| | - Sandra E. Black
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (R.H.S., S.E.B.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
| | - Bradley J. MacIntosh
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Medical Biophysics (B.J.M.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
| | - Jodi D. Edwards
- University of Ottawa Heart Institute (J.D.E.), University of Ottawa, ON
- School of Epidemiology and Public Health (J.D.E.), University of Ottawa, ON
| | - Walter Swardfager
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON (M.O., C.-Y.W., J.C.-M., N.H., K.L.L., E.L., R.H.S., S.E.B., B.J.M., W.S.)
- Department of Pharmacology and Toxicology (M.O., C.-Y.W., K.L.L., W.S.), University of Toronto, ON
- Canadian Partnership for Stroke Recovery, Toronto, ON (J.C.-M., R.H.S., S.E.B., B.J.M., W.S.)
- University Health Network Toronto Rehabilitation Institute, Toronto, ON (K.L.L., M.L., W.S.)
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Williams MW, Li CY, Hay CC. Validation of the 10-item Center for Epidemiologic Studies Depression Scale Post Stroke. J Stroke Cerebrovasc Dis 2020; 29:105334. [PMID: 32992164 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105334] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To establish reliability and validity of the abbreviated (10-item) Center for Epidemiologic Studies Depression Scale (CESD-10) among individuals post stroke. METHOD The psychometric properties of the CESD-10 were evaluated in 1219 adults with stroke admitted to an eligible inpatient rehabilitation facilities (n = 11) across 9 different states post stroke during 2005 to 2006. This study was a secondary data analysis of the existing publicly available clinical trial dataset, Stroke Recovery in Underserved Populations study. Reliability, validity, factory structure and item-level psychometrics of the CESD-10 were examined. In addition, the predictive accuracy of the CESD-10 was compared against the CESD-20 (criterion). RESULTS The CESD-10 was highly correlated with the CESD-20 (r = 0.97). The CESD-10 had good internal reliability (Cronbach's α = 0.86). The CESD-20 and CESD-10 had similar accuracy in classifying individuals as depressed (Kappa = 0.85). CONCLUSION The 10-item CESD is a valid measure of depression for individuals post stroke.
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Affiliation(s)
| | - Chih-Ying Li
- University of Texas Medical Branch, Department of Occupational Therapy, Galveston, TX, USA
| | - Catherine C Hay
- Texas Woman's University, Houston, TX & TIRR Memorial Hermann, Houston, TX, USA
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Uchida H, Hiragaki Y, Nishi Y, Nakahara S, Koumoto J, Onmyoji Y, Fujimoto N, Kawakami K, Ishii M, Hirao K. An iPad application-based intervention for improving post-stroke depression symptoms in a convalescent rehabilitation ward: A pilot randomized controlled clinical trial protocol. Internet Interv 2020; 21:100340. [PMID: 32944505 PMCID: PMC7481559 DOI: 10.1016/j.invent.2020.100340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is a neuropsychiatric sequela that causes serious adverse effects on the prognosis of stroke patients. Our developed iPad application is a very innovative approach designed to improve participants' depressive symptoms by presenting positive words stimuli in a video. Although this application has fewer side effects than existing pharmacological and non-pharmacological interventions and is likely less burdensome for patients and caregivers, its efficacy for PSD has not been investigated. Here we present a pilot randomized controlled trial (RCT) protocol to investigate the therapeutic potential of this application intervention for PSD patients. METHODS This study is designed as a 5-week, single-center, open-label, parallel-group, pilot RCT. Thirty-two patients with PSD will be randomly assigned to a combination of the iPad application and usual rehabilitation or usual rehabilitation alone (1:1 allocation ratio). The iPad application intervention lasts 3 min a day, and the usual rehabilitation lasts 3 h a day. The primary outcome is the change from baseline in The Center for Epidemiologic Studies Depression Scale score at the end of the 5-week intervention. DISCUSSION This pilot RCT is the first study to investigate the potential of iPad application interventions to reduce depressive symptoms in PSD patients. This pilot RCT determines whether this is a viable and effective intervention and informs the design for a full-scale trial. If our hypothesis is correct, this trial can provide evidence to augment the standard practice of iPad application interventions to improve depressive symptoms in patients with PSD.
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Key Words
- API, Application Programming Interface
- CBT, Cognitive Behavioral Therapy
- CRW, Convalescent Rehabilitation Ward
- Depression
- Mobile applications
- OT, Occupational Therapists
- PSD, Post-stroke Depression
- PT, Physical Therapists
- RCT, Randomized Controlled Trial
- Rehabilitation
- SPSRS, Subliminal Priming with Supraliminal Reward Stimulation
- ST, Speech Therapists
- Stroke
- rTMS, Repetitive Transcranial Magnetic Stimulation
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Affiliation(s)
- Hiroyuki Uchida
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Yoshiya Hiragaki
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Yuta Nishi
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Shiori Nakahara
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Junki Koumoto
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Yusuke Onmyoji
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Norimasa Fujimoto
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kazuho Kawakami
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Masato Ishii
- Department of Rehabilitation, Kurashiki Heisei Hospital, Kurashiki, Japan
| | - Kazuki Hirao
- Graduate School of Health Sciences, Gunma University, Maebashi, Japan
- Corresponding author at: Graduate School of Health Sciences, Gunma University, 3-39-22 Showa, Maebashi, Gunma 371-8514, Japan.
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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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Association between obstructive sleep apnea and risk of post-stroke depression: A hospital-based study in ischemic stroke patients. J Stroke Cerebrovasc Dis 2020; 29:104876. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.104876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/04/2020] [Accepted: 04/07/2020] [Indexed: 01/01/2023] Open
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45
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Schöttke H, Gerke L, Düsing R, Möllmann A. Post-stroke depression and functional impairments - A 3-year prospective study. Compr Psychiatry 2020; 99:152171. [PMID: 32179262 DOI: 10.1016/j.comppsych.2020.152171] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 02/28/2020] [Accepted: 03/06/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Post-Stroke Depression (PSD) is a severe condition, affecting about 30% of stroke survivors within a five-year period after stroke. Post-stroke functional impairments (FI) and social support are associated with PSD. It is inconclusive, whether one of the factors, post-stroke FI and PSD, shows a stronger predictive value on the respective other over time. The aims of the present study were to 1) investigate the relationship between PSD, FI, and social support of stroke patients in a 3-year prospective design, and 2) address methodological shortcomings of previous studies. METHODS We investigated 174 stroke survivors and assessed PSD with a structured clinical interview and a dimensional symptom rating scale. We conducted regression analyses and applied the approach of multiple imputations (MI) for missing data due to dropout during follow-up. RESULTS PSD prevalence was 32.2% in the acute phase after stroke. Individuals with a PSD in this phase revealed a fivefold higher risk for PSD 3 years later. FI in the acute phase did not additionally contribute to the prediction of PSD at follow-up. Compared to individuals without PSD in the acute phase, individuals with PSD had an increased risk for FI at follow-up. Limitations regarding sample characteristics, design, and dropout are discussed. CONCLUSIONS Results indicate that PSD rather than FI represents a crucial risk factor for negative long-term consequences regarding physical and psychological health after stroke. Post-stroke treatment might be optimized by a routine assessment of PSD and FI after stroke and considering the results for personalized treatment options.
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Affiliation(s)
- Henning Schöttke
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Osnabrück, Osnabrück, Germany.
| | - Leonie Gerke
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Osnabrück, Osnabrück, Germany; Clinical Psychology and Psychotherapy, Department of Psychology, Helmut-Schmidt-University/University of the German Federal Armed Forces Hamburg, Hamburg, Germany
| | - Rainer Düsing
- Research Methods, Diagnostics, and Evaluation, Department of Psychology, University of Osnabrück, Osnabrück, Germany
| | - Anne Möllmann
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Osnabrück, Osnabrück, Germany; Clinical Psychology and Psychotherapy, Department of Psychology, University of Bremen, Bremen, Germany
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Hu J, Zhou W, Zhou Z, Yang Q, Xu J, Dong W. miR-22 and cerebral microbleeds in brainstem and deep area are associated with depression one month after ischemic stroke. ACTA ACUST UNITED AC 2020; 53:e9162. [PMID: 32348425 PMCID: PMC7197650 DOI: 10.1590/1414-431x20209162] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
In this study, we aimed to explore the relationship among miR-22, deep cerebral microbleeds (CMBs), and post-stroke depression (PSD) 1 month after ischemic stroke. We consecutively recruited 257 patients with first-ever and recurrent acute cerebral infarction and performed PSD diagnosis in accordance with the Diagnostic and Statistical Manual IV criteria for depression. Clinical information, assessments of stroke severity, and imaging data were recorded on admission. We further detected plasma miR-22 using quantitative PCR and analyzed the relationship among miR-22, clinical data, and PSD using SPSS 23.0 software. Logistic regression showed that deep (OR=1.845, 95%CI: 1.006-3.386, P=0.047) and brain stem CMBs (OR=2.652, 95%CI: 1.110–6.921, P=0.040), as well as plasma miR-22 levels (OR=2.094, 95%CI: 1.066–4.115, P=0.032) were independent risk factors for PSD. In addition, there were significant differences in baseline National Institutes of Health Stroke Scale scores (OR=1.881, 95%CI: 1.180–3.011, P=0.007) and Widowhood scores (OR=1.903, 95%CI: 1.182–3.063, P=0.012). Analysis of the receiver operating curve (AUC=0.723, 95%CI: 0.562–0.883, P=0.016) revealed that miR-22 could predict PSD one month after ischemic stroke. Furthermore, plasma miR-22 levels in brainstem and deep CMBs patients showed an upward trend (P=0.028) relative to the others. Patients with acute ischemic stroke, having brainstem and deep cerebral microbleeds, or a higher plasma miR-22 were more likely to develop PSD. These findings indicate that miR-22 might be involved in cerebral microvascular impairment and post-stroke depression.
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Affiliation(s)
- Jia Hu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wei Zhou
- Department of Cardiovascular surgery, First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Zhiming Zhou
- Department of Neurology, First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Qian Yang
- Department of Neurology, First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Junfeng Xu
- Department of Neurology, First Affiliated Hospital, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Wanli Dong
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Padberg I, Hotter B, Liebenau A, Knispel P, Lehnerer S, Heel S, Wellwood I, Meisel A. Unmet Need for Social and Emotional Support and Lack of Recalled Screening Is Associated with Depression in the Long-Term Course After Stroke. Risk Manag Healthc Policy 2020; 13:285-293. [PMID: 32280291 PMCID: PMC7131991 DOI: 10.2147/rmhp.s228265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/22/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Details on adequate care and prevalence of depression in long-term stroke aftercare are limited. We aimed to determine long-term depression rates after stroke and to test for an association between depression and inadequate screening, socio-economic complications and lack of sub-optimal care. Patients and Methods In this cross-sectional study, 57 patients were re-invited into the clinic 2-3 years after stroke. Patients were interviewed about recalled screening concerning depression and unmet needs. Depression, the patient's social situation, and confounders were assessed by standardized scores. Results In our study, 20% (n = 11) of patients were classified as depressed by the HDRS-17 score result. However, only 36% of all patients recalled to have been previously screened for depression and only 43% of those patients also recalled out-patient screening. Patients classified as depressed reported significantly lower recalled screening rates (9% vs 43%; p = 0.036) and higher rates of self-reported unmet need with emotional problems (72% vs 18%; p < 0.001). Depression in our study was further associated with a worse socio-economic situation, fewer social contacts, unmet needs with regard to emotional problems and higher rates of recommendations to apply for additional social support. Conclusion Our data suggest that systematic out-patient screening for depression is lacking in stroke aftercare. Furthermore, the high rate of unmet emotional needs, the poor socio-economic situation and the higher rates of recommendations for social counselling and application for benefits suggest an undersupply of care in the out-patient setting that is more prominent in patients with depression and warrants further studies to investigate the underlying causes.
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Affiliation(s)
- Inken Padberg
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Benjamin Hotter
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Neurocure Clinical Research Center, Department of Neurology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Andrea Liebenau
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Petra Knispel
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berliner Schlaganfall-Allianz e.V., Berlin, Germany
| | - Sophie Lehnerer
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Neurocure Clinical Research Center, Department of Neurology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Sabine Heel
- Zentrum für Ambulante Neuropsychologie und Verhaltenstherapie (ZANV), Berlin, Germany
| | - Ian Wellwood
- Department of Public-Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Andreas Meisel
- Center for Stroke Research Berlin (CSB), Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Neurocure Clinical Research Center, Department of Neurology, Charité Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Berliner Schlaganfall-Allianz e.V., Berlin, Germany
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Kidd L, Booth J, Lawrence M, Rowat A. Implementing Supported Self-Management in Community-Based Stroke Care: A Secondary Analysis of Nurses' Perspectives. J Clin Med 2020; 9:E985. [PMID: 32244792 PMCID: PMC7230474 DOI: 10.3390/jcm9040985] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/19/2020] [Accepted: 03/30/2020] [Indexed: 11/27/2022] Open
Abstract
The provision of supported self-management (SSM) is recommended in contemporary guidelines to address the longer-term needs and outcomes of stroke survivors and their families, yet its implementation across stroke pathways has been inconsistent. This paper presents a secondary analysis of qualitative data, which aims to identify and offer insight into the challenges of implementing SSM from the perspectives of community stroke nurses (n = 14). The findings revealed that the implementation of SSM in stroke is influenced by factors operating at multiple levels of the healthcare system. Contextual challenges arise because of different understandings and interpretations of what SSM is, what it comprises and professionals' perceptions of their roles in its implementation in practice. A professionally controlled, one-size-fits-all model of SSM continues to be reinforced within organizations, offering few opportunities for nurses to deliver contextually tailored and person-centred SSM. In conclusion, there are many professional concerns and organizational tensions that need to be addressed across multiple layers of the healthcare system to achieve the consistent implementation of contextually tailored and person-centred SSM following a stroke. Attempts to address these challenges will help to narrow the gap between policy and practice of implementing SSM, ensuring that stroke survivors and families benefit from SSM in the longer-term.
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Affiliation(s)
- Lisa Kidd
- Nursing & Healthcare, School of Medicine, Dentistry & Nursing, University of Glasgow; Glasgow G12 8LL, UK
| | - Joanne Booth
- School of Health & Life Sciences, Glasgow Caledonian University; Glasgow G4 0BA, UK; (J.B.); (M.L.)
| | - Maggie Lawrence
- School of Health & Life Sciences, Glasgow Caledonian University; Glasgow G4 0BA, UK; (J.B.); (M.L.)
| | - Anne Rowat
- School of Health & Social Care, Edinburgh Napier University; Edinburgh EH11 4DY, UK;
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Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort. Chin Med J (Engl) 2020; 132:2206-2212. [PMID: 31436596 PMCID: PMC6797138 DOI: 10.1097/cm9.0000000000000400] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Whether the time course of post-stroke depression (PSD) can be used to predict the quality of life (QoL) of patients with late-stage stroke remains unclear, this study investigated whether persistent depression at 1 year after stroke predicts QoL at 5 years following stroke. METHODS We analyzed the demographic and clinical data of patients with stroke in 56 hospitals across China that participated in the Prospective Cohort Study on the Incidence and Outcome of Patients with PSD in China Study. Follow-up assessments were performed at the following time points after stroke: in person, 2 weeks, 3 months, 6 months, and 1 year; by telephone, 5 years. National Institutes of Health Stroke Scale (NIHSS) score on admission, recurrence, disability, depression, QoL, and chronic complications were recorded. Depression was diagnosed using the Diagnostic and Statistical Manual of Mental Disorders. QoL was measured using short form-12 (SF-12). Multivariable ordinal logistic regression analysis was used to identify factors that independently affected the physical component summary (PCS) and mental component summary (MCS) scores of the SF-12. RESULTS Of the 801 patients evaluated in this study, 80 had persistent depression. The multivariable regression analysis of data obtained at 5 years showed that persistent depression at 1 year (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29-0.81) and disability at 5 years (OR: 0.34; 95% CI: 0.23-0.49) were associated with poor MCS scores at 5 years. Old age, a high NIHSS score on admission, disability at 5 years, and stroke recurrence within 5 years were associated with poor PCS scores at the 5-year follow-up. CONCLUSIONS Persistent depression at the 1-year follow-up could predict poor MCS scores at the 5-year follow-up. The development of interventional strategies targeting post-stroke patients with persistent depression is warranted.
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Wijekoon S, Wilson W, Gowan N, Ferreira L, Phadke C, Udler E, Bontempo T. Experiences of Occupational Performance in Survivors of Stroke Attending Peer Support Groups. The Canadian Journal of Occupational Therapy 2020; 87:173-181. [PMID: 32115988 DOI: 10.1177/0008417420905707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. Survivors of stroke often experience environmental isolation and decreased occupational performance after discharge from the hospital. Peer groups benefit psychological, social, and cognitive functioning, though few studies have examined their influence on occupational performance of survivors of stroke. PURPOSE. This study explores the experiences of occupational performance in survivors of stroke attending an outpatient peer support group. METHOD. An interpretive qualitative study using semi-structured interviews was conducted with seven survivors of stroke attending an outpatient peer support group. Data was thematically analyzed. FINDINGS. Four themes related to the experience of peer support on occupational performance emerged: finding hope to return to meaningful occupation, a place for belonging, problem-solving occupational concerns, and finding purpose beyond oneself. IMPLICATIONS. This research adds to the existing literature that peer support groups help survivors of stroke reengage in meaningful occupations, manage their stroke experience, and move positively through recovery.
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