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Ashraf F, Mustafa MS, Shafique MA, Haseeb A, Mussarat A, Noorani A, Sohail Rangwala B, Kashif Rasool F, Siddiq MA, Iqbal J. Association between depression and stroke risk in adults: a systematic review and meta-analysis. Front Neurol 2024; 15:1331300. [PMID: 38725648 PMCID: PMC11079212 DOI: 10.3389/fneur.2024.1331300] [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: 11/02/2023] [Accepted: 04/08/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Stroke is a significant global health concern, and numerous studies have established a link between depression and an increased risk of stroke. While many investigations explore this link, some overlook its long-term effects. Depression may elevate stroke risk through physiological pathways involving nervous system changes and inflammation. This systematic review and meta-analysis aimed to assess the association between depression and stroke. Methodology We conducted a comprehensive search of electronic databases (PubMed, Embase, Scopus, and PsycINFO) from inception to 9 April 2023, following the Preferred Reporting Items for Systemic Review and Meta-analysis (PRISMA) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We included all articles assessing the association between different stroke types and depression, excluding post-stroke depression. Two investigators independently extracted data and assessed quality using the Newcastle-Ottawa Scale and Cochrane Risk of Bias tool, utilizing a random-effects model for data synthesis. The primary outcome was the association of depression with stroke, with a secondary focus on the association of antidepressants with stroke. Results The initial search yielded 10,091 articles, and 44 studies were included in the meta-analysis. The pooled analysis revealed a significant association between depression and stroke risk, with an overall hazard ratio of 1.41 (95% CI 1.32, 1.50; p < 0.00001), indicating a moderately positive effect size. Subgroup analyses showed consistent associations with ischemic stroke (HR = 1.30, 95% CI 1.13, 1.50; p = 0.007), fatal stroke (HR = 1.39, 95% CI 1.24, 1.55; p < 0.000001), and hemorrhagic stroke (HR = 1.33, 95% CI 1.01, 1.76; p = 0.04). The use of antidepressants was associated with an elevated risk of stroke (HR = 1.28, 95% CI 1.05, 1.55; p = 0.01). Conclusion and relevance This meta-analysis indicates that depression moderately raises the risk of stroke. Given the severe consequences of stroke in individuals with depression, early detection and intervention should be prioritized to prevent it. Systematic review registration Prospero (CRD42023472136).
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Affiliation(s)
- Farheen Ashraf
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | | | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Abdullah Mussarat
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | - Amber Noorani
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Sindh, Pakistan
| | | | | | | | - Javed Iqbal
- Department of Medicine, King Edward Medical University, Lahore, Punjab, Pakistan
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Cai W, Ma W, Mueller C, Stewart R, Ji J, Shen WD. Association between late-life depression or depressive symptoms and stroke morbidity in elders: A systematic review and meta-analysis of cohort studies. Acta Psychiatr Scand 2023; 148:405-415. [PMID: 37728003 DOI: 10.1111/acps.13613] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE Whether late-life depression or depressive symptoms are a risk factor of future stroke in elders is important for prevention measures. A systematic review and meta-analysis were used to investigate the association between depression or depressive symptoms and risk of stroke in elders. METHODS Embase, MEDLINE, PsychINFO, and Web of Science were searched for studies published from inception to January 6, 2023. Prospective cohort studies reporting quantitative estimates of the association between depression or depressive symptoms and stroke morbidity in participants aged over 60 years were included. Reviews, meta-analyses, case reports, retrospective, cross-sectional, and theoretical studies were excluded. Study screening and data extraction were conducted by two researchers independently. Random-effects meta-analysis was used to estimate pooled adjusted hazard ratios (HRs). Publication bias was evaluated via the symmetry of funnel plots and Egger tests. The Newcastle Ottawa Scale was used to assess the risk of bias. The quality of evidence of synthesis was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The primary outcome was any stroke, including non-fatal, fatal, ischemic and hemorrhagic sub-types. RESULTS Seventeen studies of 57,761 patients in total were included in the meta-analysis. A positive association was found between depressive disorder or symptoms and stroke risk (HR: 1.39; 95% CI: 1.22-1.58; p < 0.001). CONCLUSIONS Late-life depression or depressive symptoms are a significant risk factor for stroke in older people. Regular assessment and more effective management of associated comorbidities are recommended to reduce stroke risk.
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Affiliation(s)
- Wa Cai
- Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Ma
- Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Christoph Mueller
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Psychological Medicine and Older Adults, South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- Department of Psychological Medicine and Older Adults, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jun Ji
- Department of Acupuncture Literature, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Wei-Dong Shen
- Department of Acupuncture, Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Cowdery SP, Bjerkeset O, Sund ER, Mohebbi M, Pasco JA, Berk M, Williams LJ. Depressive symptomology and cancer incidence in men and women: Longitudinal evidence from the HUNT study. J Affect Disord 2022; 316:1-9. [PMID: 35934219 DOI: 10.1016/j.jad.2022.08.002] [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: 02/28/2022] [Revised: 07/21/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Depressive symptoms and mood disorders are associated with a host of physical conditions. However, it is inconclusive whether depressive symptoms are also associated with cancer onset. The aim of this study was to investigate whether depressive symptoms are associated with cancer incidence in a large population-based sample of men and women. METHODS This study examined data from waves two (HUNT 2, 1995-97) and three (HUNT 3, 2006-08) of the Trøndelag Health Study (HUNT). Depressive symptoms were ascertained using the Hospital Anxiety and Depression Scale (HADS-D ≥ 8), cancer onset was identified via linkage with the Cancer Registry of Norway, death records by the national Cause of Death Register (CDR), and information on lifestyle and demographic factors was self-reported. Cox-proportional hazard regression models were used to test associations. Unadjusted, age-adjusted and multivariable best models accounting for smoking, education, marital status and current employment are presented. RESULTS Men and women (n = 61,985; 46.0 % men) were followed from baseline over a period of 778,802 person-years. During the 20-year study period, there were 6856 (11.1 %) individuals with incident cancers and 12,480 (20.1 %) deaths (n = 2498 attributed to cancer). For men with depressive symptoms, 505 (15.3 %) developed incident cancer during the follow-up period, whereas among those without depressive symptoms, 3164 (12.5 %) developed incident cancer. Following adjustment for age, depressive symptomology was not significantly associated with risk of overall cancer onset, nor among prostate, colon or melanoma subtypes. Depressive symptoms were associated with an increased risk of bronchus and lung cancer both before (HR 1.90, 95 % CI 1.43-2.50, p ≤0.001) and after adjustment for age (HR 1.38, 95 % CI 1.04-1.80, p = 0.025). However, further adjustment for additional possible confounders explained this association. For women with depressive symptoms, 384 (11.2 %) developed incident cancer during the follow-up period, whereas among those with no depressive symptomology, 2803 (9.3 %) developed incident cancer. After accounting for age, depressive symptomology was not associated with risk of overall cancer onset, nor among breast, colon, lung and bronchus, or melanoma subtypes. Additional analyses evaluating relationship of depression symptom severity and cancer onset did not alter findings for men or women. LIMITATIONS This report is limited by the post-hoc study design and subsequent non-randomised nature. Future prospective studies are required. CONCLUSION These results suggest that depressive symptoms are not associated with an increased risk of overall or site-specific cancer onset in these men and women. Given the increased co-occurrence of other medical conditions such as cardiovascular disease, diabetes, stroke and musculoskeletal disorders in people with depression, the role of clinically diagnosed depression and other psychiatric disorders in association with cancer onset necessitates further consideration.
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Affiliation(s)
- Stephanie P Cowdery
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia.
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Erik R Sund
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway; Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Levanger, Norway; Levanger Hospital, Trøndelag Hospital Trust, Levanger, Norway.
| | | | - Julie A Pasco
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia; Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia.
| | - Michael Berk
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia.
| | - Lana J Williams
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia.
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Western diet associated with increased post-stroke depressive symptoms. J Nutr Sci 2022; 11:e44. [PMID: 35754983 PMCID: PMC9201874 DOI: 10.1017/jns.2022.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 11/07/2022] Open
Abstract
The present study examines the association of diet with depressive symptoms among stroke survivors from a community cohort of older adults. Depression is common after stroke. A healthy diet has previously been associated with fewer depressive symptoms in older individuals, but it is unknown if this effect is also seen in stroke survivors. Eighty-six participants from the Memory and Aging Project with a history of stroke at their study baseline enrolment, complete dietary data and two or more assessments for depression were included in this observational prospective cohort analysis. Depressive symptoms were assessed annually with a 10-item version of the Center for Epidemiologic Studies Depression scale. Diet was assessed using a validated food-frequency questionnaire administered at baseline. Diet scores were based on analysis of participants' reported intakes of 144 food items. A generalised estimating equation (GEE) model was applied to examine the association of diet score with depressive symptoms. The study participants had a mean age of 82 ± 7⋅17 years and 14⋅42 ± 2⋅61 years of education, and 82⋅56 % were female. Western diet score was positively associated with depressive symptoms over time (diet score tertile 3 v. tertile 1: β = 0⋅22, se = 0⋅09, P = 0⋅02; P for trend = 0⋅022). Interaction with sex suggested a stronger effect in females. A Western diet was associated with more post-stroke depressive symptoms, suggesting nutrition is important not only for reducing cerebrovascular risk, but for protecting post-stoke mental health as well.
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Ece Çetin F, Kumral E, Saffet Gönül A, Nezih Özdemir H, Orman M. Effıcacy of cıtalopram on stroke recurrence: A randomızed clınıcal trıal. J Clin Neurosci 2022; 101:168-174. [PMID: 35597066 DOI: 10.1016/j.jocn.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Post-stroke depression is one of the main causes of cerebrovascular and cardiovascular diseases. The aim of the present study was to investigate the efficacy of citalopram on stroke recurrence. A 52-week, randomized, double-blind, studyinvolved 440 ischemic stroke patients with depression. Patients with depression who met depression criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and V) and Hamilton Depression Rating Scale ≥ 8 (HAM-DRS) were dichotomized into patients receiving citalopram (225 patients), titrated according to clinical response, and patients with placebo (215 patients) for 52 weeks. The primary outcome measure was stroke recurrence and the secondary outcome measures were cardiovascular events and mortality. Stroke recurrence (66% vs 34%; P = 0.001) and cardiovascular events (76% vs. 24%; P = o.oo1) were significantly higher in the placebo group compared to those treated with citalopram. Multivariable analysis showed that hypertension, atrial fibrillation, and large-artery disease were significantly associated with stroke recurrence. Executive processing disorder was more associated with stroke recurrence than other neuropsychological disorders (OR, 1.74; CI95%, 1.04-2.89; P = 0.035). Survival analysis showed that treatment for depression interacted with time to reduce stroke recurrence by nearly half (39% vs. 61%; P = 0.05). The current study supports the importance of depression treatment in protecting the patients from recurrent strokes. This result warrants further studies to demonstrate the efficacy of depression treatment on stroke recurrence.
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Affiliation(s)
| | - Emre Kumral
- Ege University Medical School Hospital, Neurology Department, İzmir, Turkey.
| | - Ali Saffet Gönül
- Ege University Medical School Hospital, Neurology Department, İzmir, Turkey.
| | | | - Mehmet Orman
- Ege University, Department of Administration and Statistics, İzmir, Turkey.
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Lai FTT, Mercer SW, Guthrie B, Yip BHK, Chung GKK, Zou D, Lee KP, Chau PYK, Chung RY, Wong ELY, Yeoh EK, Wong SYS. Sociodemographic moderation of the association between depression and stroke incidence in a retrospective cohort of 0.4 million primary care recipients with hypertension. Psychol Med 2022; 52:283-291. [PMID: 32524935 DOI: 10.1017/s0033291720001920] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Previous research has suggested an association between depression and subsequent acute stroke incidence, but few studies have examined any effect modification by sociodemographic factors. In addition, no studies have investigated this association among primary care recipients with hypertension. METHODS We examined the anonymized records of all public general outpatient visits by patients aged 45+ during January 2007-December 2010 in Hong Kong to extract primary care patients with hypertension for analysis. We took the last consultation date as the baseline and followed them up for 4 years (until 2011-2014) to observe any subsequent acute hospitalization due to stroke. Mixed-effects Cox models (random intercept across 74 included clinics) were implemented to examine the association between depression (ICPC diagnosis or anti-depressant prescription) at baseline and the hazard of acute stroke (ICD-9: 430-437.9). Effect modification by age, sex, and recipient status of social security assistance was examined in extended models with respective interaction terms specified. RESULTS In total, 396 858 eligible patients were included, with 9099 (2.3%) having depression, and 10 851 (2.7%) eventually hospitalized for stroke. From the adjusted analysis, baseline depression was associated with a 17% increased hazard of acute stroke hospitalization [95% confidence interval (CI) 1.03-1.32]. This association was suggested to be even stronger among men than among women (hazard ratio = 1.29, 95% CI 1.00-1.67). CONCLUSION Depression is more strongly associated with acute stroke incidence among male than female primary care patients with hypertension. More integrated services are warranted to address their needs.
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Affiliation(s)
- Francisco T T Lai
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
| | - Stewart W Mercer
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Bruce Guthrie
- Usher Institute, The University of Edinburgh, Edinburgh, Scotland, UK
| | - Benjamin H K Yip
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
| | - Gary K K Chung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
| | - Dan Zou
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
| | - Kam-Pui Lee
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
| | - Patsy Y K Chau
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
| | - Roger Y Chung
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
| | - Eliza L Y Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
| | - Samuel Y S Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong, People's Republic of China
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Cui Y, Zhu C, Lian Z, Han X, Xiang Q, Liu Z, Zhou Y. Prospective association between depressive symptoms and stroke risk among middle-aged and older Chinese. BMC Psychiatry 2021; 21:532. [PMID: 34706692 PMCID: PMC8555147 DOI: 10.1186/s12888-021-03492-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 09/23/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to assess the association between baseline symptoms and changes in depressive symptoms and stroke incidents. METHODS We used data from the Chinese Health and Retirement Longitudinal Study conducted in 2013, 2015, and 2018. In total, 10,100 individuals aged ≥45 years and without a history of stroke in 2013 were included. Depressive symptoms were measured using the 10-item version of the Center for Epidemiological Studied Depression scale (elevated depressive symptoms cutoff ≥10). Changes of depressive symptoms were assessed by two successive surveys (stable low/no, recent onset, recently remitted, and stable high depressive symptoms). We assessed whether baseline depressive symptoms and changes of them were associated with stroke incidents reported through 2018. Logistic regression analyses adjusted for age, gender, education, marital status and other potential confounders were performed. RESULTS For the analysis of baseline depressive symptoms and stroke (n = 10,100), 545 (5.4%) reported stroke incidents in the following 5-year period. Individuals with elevated depressive symptoms in 2013 experienced a markedly higher stroke risk (odds ratio (OR) = 1.53, 95% confidence interval (CI) = 1.28-1.84) compared with those without elevated depressive symptoms. In the analysis of changes in depressive symptoms (n = 8491, 430 (5.1%) stroke events), participants with stable high (OR = 2.01, 95% CI = 1.58-2.56) and recent-onset (OR = 1.39, 95% CI = 1.04-1.85) depressive symptoms presented higher stroke risk compared to those with stable low/no depressive symptoms, while recently remitted symptoms (OR = 1.12, 95% CI = 0.80-1.57) were not associated with stroke risk. CONCLUSIONS In conclusion, stable high and newly started depressive symptoms were associated with increased stroke risk, whereas the improvement of depressive symptoms was not related to increase in stroke risk, suggesting that stroke risk may be decreased by effective management of depressive symptoms.
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Affiliation(s)
- Yimin Cui
- Department of Pharmacy, Peking University First Hospital, No. 6, Dahongluochang Street, Xicheng District, Beijing, 100034, China.
- School of Pharmaceutical Sciences, Peking University, Beijing, China.
| | - Chunsu Zhu
- Department of Pharmacy, Peking University First Hospital, No. 6, Dahongluochang Street, Xicheng District, Beijing, 100034, China
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Zhiwei Lian
- Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Xueyan Han
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Qian Xiang
- Department of Pharmacy, Peking University First Hospital, No. 6, Dahongluochang Street, Xicheng District, Beijing, 100034, China
| | - Zhenming Liu
- School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Ying Zhou
- Department of Pharmacy, Peking University First Hospital, No. 6, Dahongluochang Street, Xicheng District, Beijing, 100034, China
- School of Pharmaceutical Sciences, Peking University, Beijing, China
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Ford CD, Gray MS, Crowther MR, Wadley VG, Austin AL, Crowe MG, Pulley L, Unverzagt F, Kleindorfer DO, Kissela BM, Howard VJ. Depressive Symptoms and Risk of Stroke in a National Cohort of Black and White Participants From REGARDS. Neurol Clin Pract 2021; 11:e454-e461. [PMID: 34484944 DOI: 10.1212/cpj.0000000000000983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022]
Abstract
Objective The purpose of this study was to examine depressive symptoms as a risk factor for incident stroke and determine whether depressive symptomatology was differentially predictive of stroke among Black and White participants. Methods The study comprised 9,529 Black and 14,516 White stroke-free participants, aged 45 and older, enrolled in the REasons for Geographic and Racial Differences in Stroke (2003-2007). Incident stroke was the first occurrence of stroke. Association between baseline depressive symptoms (assessed via the 4-item Center for Epidemiologic Studies Depression Scale [CES-D-4]: 0, 1-3, or ≥4) and incident stroke was analyzed with Cox proportional hazards models adjusted for demographics, stroke risk factors, and social factors. Results There were 1,262 strokes over an average follow-up of 9.21 (SD 4.0) years. Compared to participants with no depressive symptoms, after demographic adjustment, participants with CES-D-4 scores of 1-3 had 39% increased stroke risk (hazard ratio [HR] = 1.39, 95% confidence interval [CI] = 1.23-1.57), with slight attenuation after full adjustment (HR = 1.27, 95% CI = 1.11-1.43). Participants with CES-D-4 scores of ≥4 experienced 54% higher risk of stroke after demographic adjustment (HR = 1.54, 95% CI = 1.27-1.85), with risk attenuated in the full model similar to risk with 1-3 symptoms (HR = 1.25, 95% CI = 1.03-1.51). There was no evidence of a differential effect by race (p = 0.53). Conclusions The association of depressive symptoms with increased stroke risk was similar among a national sample of Black and White participants. These findings suggest that assessment of depressive symptoms should be considered in primary stroke prevention for both Black and White participants.
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Affiliation(s)
- Cassandra D Ford
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Marquita S Gray
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Martha R Crowther
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Virginia G Wadley
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Audrey L Austin
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Michael G Crowe
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - LeaVonne Pulley
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Frederick Unverzagt
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Dawn O Kleindorfer
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Brett M Kissela
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
| | - Virginia J Howard
- Capstone College of Nursing (CDF), the University of Alabama (UA), Tuscaloosa; Department of Biostatistics (MSG), the University of Alabama at Birmingham (UAB); Department of Community Medicine and Population Health (MRC), UA, Tuscaloosa; Division of Gerontology, Geriatrics and Palliative Care (VGW), Department of Medicine, UAB; Tuscaloosa Veterans Affairs Medical Center (ALA), AL; Department of Psychology (MGC), College of Arts and Sciences, UAB; Independent Contractor (LP); Department of Psychiatry (FU), Indiana University School of Medicine, Indianapolis; Department of Neurology and Rehabilitation Medicine (DOK, BMK), University of Cincinnati College of Medicine, OH; and Department of Epidemiology (VJH), School of Public Health, UAB
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Cowdery SP, Stuart AL, Pasco JA, Berk M, Campbell D, Bjerkeset O, Williams LJ. Mood disorder and cancer onset: evidence from a population-based sample of Australian women. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2021; 43:355-361. [PMID: 32965431 PMCID: PMC8352740 DOI: 10.1590/1516-4446-2020-0932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 07/21/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The role of mood disorders in cancer onset is unclear. The aim of this study was to investigate the association between mood disorder and incident cancer in a population-based sample of women. METHODS Data were derived from women aged 28-94 years participating in the Geelong Osteoporosis Study. Mood disorder was identified via Clinical Interview (SCID-I/NP). Cancer data was obtained following linkage with the Victorian Cancer Registry. Demographic and lifestyle factors were self-reported. Nested case-control and retrospective study designs were utilized. RESULTS In the case-control study (n=807), mood disorder was documented for 18 of the 75 (9.3%) cancer cases and among 288 controls (24.0% vs. 39.3%, p = 0.009). Prior exposure to mood disorder was associated with reduced cancer incidence (OR 0.49, 95%CI 0.28-0.84); this was sustained following adjustment for confounders (ORadj 0.52, 95%CI 0.30-0.90). In the retrospective cohort study (n=655), among 154 women with a history of mood disorder at baseline, 13 (8.5%) developed incident cancer during follow-up, whereas among 501 women with no history of mood disorder, 54 (10.8%) developed incident cancer. Exposure to mood disorder was not associated with incident cancer over the follow-up period (HR 0.58, 95%CI 0.31-1.08, p = 0.09). CONCLUSION Mood disorder was associated with reduced odds of cancer onset. However, this finding was not supported in the retrospective cohort study. Larger studies able to investigate specific cancers and mood disorders as well as underlying mechanisms in both men and women are warranted.
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Affiliation(s)
- Stephanie P. Cowdery
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Geelong, Australia
| | - Amanda L. Stuart
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Geelong, Australia
| | - Julie A. Pasco
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Geelong, Australia
- Department of Medicine, Western Campus, University of Melbourne, St Albans, Australia
- University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Michael Berk
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Geelong, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
- Florey Institute of Neuroscience and Mental Health, Parkville, Australia
- Orygen the National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - David Campbell
- University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Norway
| | - Lana J. Williams
- Deakin University, Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Barwon Health, Geelong, Australia
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Rushia SN, Shehab AAS, Motter JN, Egglefield DA, Schiff S, Sneed JR, Garcon E. Vascular depression for radiology: A review of the construct, methodology, and diagnosis. World J Radiol 2020; 12:48-67. [PMID: 32549954 PMCID: PMC7288775 DOI: 10.4329/wjr.v12.i5.48] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 02/06/2023] Open
Abstract
Vascular depression (VD) as defined by magnetic resonance imaging (MRI) has been proposed as a unique subtype of late-life depression. The VD hypothesis posits that cerebrovascular disease, as characterized by the presence of MRI-defined white matter hyperintensities, contributes to and increases the risk for depression in older adults. VD is also accompanied by cognitive impairment and poor antidepressant treatment response. The VD diagnosis relies on MRI findings and yet this clinical entity is largely unfamiliar to neuroradiologists and is rarely, if ever, discussed in radiology journals. The primary purpose of this review is to introduce the MRI-defined VD construct to the neuroradiology community. Case reports are highlighted in order to illustrate the profile of VD in terms of radiological, clinical, and neuropsychological findings. A secondary purpose is to elucidate and elaborate on the measurement of cerebrovascular disease through visual rating scales and semi- and fully-automated volumetric methods. These methods are crucial for determining whether lesion burden or lesion severity is the dominant pathological contributor to VD. Additionally, these rating methods have implications for the growing field of computer assisted diagnosis. Since VD has been found to have a profile that is distinct from other types of late-life depression, neuroradiologists, in conjunction with psychiatrists and psychologists, should consider VD in diagnosis and treatment planning.
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Affiliation(s)
- Sara N Rushia
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
| | - Al Amira Safa Shehab
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
| | - Jeffrey N Motter
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032, United States
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
| | - Dakota A Egglefield
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
| | - Sophie Schiff
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
| | - Joel R Sneed
- Department of Psychology, The Graduate Center, City University of New York, New York, NY 10016, United States
- Department of Psychology, Queens College, City University of New York, Queens, NY 11367, United States
- Division of Geriatric Psychiatry, New York State Psychiatric Institute, New York, NY 10032, United States
- Department of Psychiatry, Columbia University Medical Center, New York, NY 10032, United States
| | - Ernst Garcon
- Department of Radiology, Columbia University Medical Center, New York, NY 10032, United States
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11
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Cai H, Cai B, Zhang H, Sun W, Wang Y, Zhou S, Ye Z, Zhang Z, Liang J. Major depression and small vessel stroke: a Mendelian randomization analysis. J Neurol 2019; 266:2859-2866. [PMID: 31435769 DOI: 10.1007/s00415-019-09511-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Although observational studies have reported a positive association between depression and ischemic stroke, causality remains inconclusive. We aimed to assess the causal relationship of major depressive disorder (MDD) with ischemic stroke, especially with the small vessel stroke (SVS) subtype. METHODS We used 72 independent single-nucleotide polymorphisms associated with MDD in a genome-wide association study (GWAS) from the Psychiatric Genetics Consortium as instrumental variables. The corresponding data for ischemic stroke and its subtypes of European ancestry were available from the MEGASTROKE consortium of 34,217 ischemic stroke cases and 406,111 controls. Primary Mendelian randomization estimates were calculated with inverse-variance weighted method, and several alternate methods and multiple sensitivity analyses were also performed. RESULTS We found that genetic predisposition to higher risk of MDD was associated with higher risk of SVS, with an odds ratio of 1.33 (95% confidence interval, 1.08-1.65; p = 0.009) per log-odds increment in MDD risk, but not with large artery stroke (OR, 1.08; 95% CI 0.83-1.41; p = 0.559), cardioembolic stroke (OR, 0.98; 95% CI 0.80-1.20; p = 0.833), or all ischemic stroke (OR, 1.03; 95% CI 0.92-1.15; p = 0.633). The association of MDD with SVS was overall robust to sensitivity analyses. CONCLUSIONS We provided evidence for a possible causal effect of MDD on increased risk of SVS. Future researches are required to investigate whether rational intervention on depression may help to reduce societal burden of SVS.
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Affiliation(s)
- Huan Cai
- Department of Neurology, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China.
| | - Biyang Cai
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Hao Zhang
- Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, Zhejiang, China
| | - Wen Sun
- Division of Life Sciences and Medicine, Stroke Center and Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230026, Anhui, China
| | - Yingting Wang
- Department of Geriatric Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Shuyu Zhou
- Department of Neurology, Jiangning Hospital Affiliated of Nanjing Medical University, Nanjing, 210002, Jiangsu, China
| | - Zusen Ye
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China
| | - Zhizhong Zhang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China
| | - Jialin Liang
- Department of Endocrinology and Metabolism, Zhongshan City People's Hospital, 2 East Sunwen Road, Zhongshan, 528403, Guangdong, China.
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12
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Graber M, Baptiste L, Mohr S, Blanc-Labarre C, Dupont G, Giroud M, Béjot Y. A review of psychosocial factors and stroke: A new public health problem. Rev Neurol (Paris) 2019; 175:686-692. [PMID: 31130312 DOI: 10.1016/j.neurol.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/11/2019] [Indexed: 11/15/2022]
Abstract
The role of psychosocial factors (PSF) in increased risk of stroke is a novel public health challenge, but unclear definitions for PSF and the multiple stroke subtypes have led to inconsistent reports. A review of this issue is therefore warranted. METHODS Several databases were used for this narrative systematic review (Medline, Embase and Cochrane Library). Two independent reviewers evaluated articles from between 2001 and 2018 on the themes of PSF and stroke/transient ischemic attack (TIA). PSF criteria were job strain, psychological interpersonal and behavioral stress, and social deprivation. Ischemic and hemorrhagic stroke and TIA subtypes were also identified. RESULTS Forty-five cohorts, five case-control studies and two meta-analyses were included. Despite mixed results, PSF were associated with an increased risk of ischemic and hemorrhagic stroke in populations of all ages, and more predominantly in women. CONCLUSION This broad review shows that the presence of PSF is associated with an increased risk stroke and TIA. As such, PSF must figure in both public health policy and stroke prevention programs, similar to other established metabolic and environmental factors.
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Affiliation(s)
- M Graber
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - L Baptiste
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - S Mohr
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - C Blanc-Labarre
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - G Dupont
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - M Giroud
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France.
| | - Y Béjot
- Service de neurologie générale, vasculaire et dégénérative, Registre Dijonnais des AVC (Inserm, santé publique France, EA7460), university of Burgundy and Franche Comté, CHU Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
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13
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Péquignot R, Dufouil C, Pérès K, Artero S, Tzourio C, Empana J. Depression Increases the Risk of Death Independently From Vascular Events in Elderly Individuals: The Three‐City Study. J Am Geriatr Soc 2019; 67:546-552. [DOI: 10.1111/jgs.15731] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/03/2018] [Accepted: 11/05/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Renaud Péquignot
- INSERM U970, Paris Cardiovascular Research Center Paris Descartes University, Sorbonne Paris Cité Paris France
- Service de Médecine et Réadaptation, Hôpitaux de Saint‐Maurice Saint‐Maurice France
| | - Carole Dufouil
- Bordeaux Population Health Research Center, Team HEALTHY, UMR1219 University of Bordeaux, Inserm Bordeaux France
- CHU de Bordeaux, Pole de Sante Publique, Service d'Information Medicale Bordeaux France
| | - Karine Pérès
- Bordeaux Population Health Research Center, Team HEALTHY, UMR1219 University of Bordeaux, Inserm Bordeaux France
| | - Sylvaine Artero
- Inserm, U1061, La Colombière Hospital Montpellier France
- Inserm, U1061, University of Montpellier Montpellier France
| | - Christophe Tzourio
- Bordeaux Population Health Research Center, Team HEALTHY, UMR1219 University of Bordeaux, Inserm Bordeaux France
| | - Jean‐Philippe Empana
- INSERM U970, Paris Cardiovascular Research Center Paris Descartes University, Sorbonne Paris Cité Paris France
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14
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Villa RF, Ferrari F, Moretti A. Post-stroke depression: Mechanisms and pharmacological treatment. Pharmacol Ther 2018; 184:131-144. [DOI: 10.1016/j.pharmthera.2017.11.005] [Citation(s) in RCA: 158] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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15
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Wassertheil-Smoller S, Qi Q, Dave T, Mitchell BD, Jackson RD, Liu S, Park K, Salinas J, Dunn EC, Leira EC, Xu H, Ryan K, Smoller JW. Polygenic Risk for Depression Increases Risk of Ischemic Stroke: From the Stroke Genetics Network Study. Stroke 2018; 49:543-548. [PMID: 29438084 PMCID: PMC5909718 DOI: 10.1161/strokeaha.117.018857] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Although depression is a risk factor for stroke in large prospective studies, it is unknown whether these conditions have a shared genetic basis. METHODS We applied a polygenic risk score (PRS) for major depressive disorder derived from European ancestry analyses by the Psychiatric Genomics Consortium to a genome-wide association study of ischemic stroke in the Stroke Genetics Network of National Institute of Neurological Disorders and Stroke. Included in separate analyses were 12 577 stroke cases and 25 643 controls of European ancestry and 1353 cases and 2383 controls of African ancestry. We examined the association between depression PRS and ischemic stroke overall and with pathogenic subtypes using logistic regression analyses. RESULTS The depression PRS was associated with higher risk of ischemic stroke overall in both European (P=0.025) and African ancestry (P=0.011) samples from the Stroke Genetics Network. Ischemic stroke risk increased by 3.0% (odds ratio, 1.03; 95% confidence interval, 1.00-1.05) for every 1 SD increase in PRS for those of European ancestry and by 8% (odds ratio, 1.08; 95% confidence interval, 1.04-1.13) for those of African ancestry. Among stroke subtypes, elevated risk of small artery occlusion was observed in both European and African ancestry samples. Depression PRS was also associated with higher risk of cardioembolic stroke in European ancestry and large artery atherosclerosis in African ancestry persons. CONCLUSIONS Higher polygenic risk for major depressive disorder is associated with increased risk of ischemic stroke overall and with small artery occlusion. Additional associations with ischemic stroke subtypes differed by ancestry.
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Affiliation(s)
- Sylvia Wassertheil-Smoller
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City.
| | - Qibin Qi
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Tushar Dave
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Braxton D Mitchell
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Rebecca D Jackson
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Simin Liu
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Ki Park
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Joel Salinas
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Erin C Dunn
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Enrique C Leira
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Huichun Xu
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Kathleen Ryan
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
| | - Jordan W Smoller
- From the Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (S.W.-S., Q.Q.); University of Maryland School of Medicine, Baltimore (T.D., B.D.M., H.X., K.R.); Department of Medicine, Ohio State University, Columbus (R.D.J.); Department of Epidemiology (S.L.) and Department of Medicine (S.L.), Brown School of Public Health and Alpert Medical School, Providence, RI; Division of Cardiology, University of Florida, Gainesville (K.P.); Department of Neurology (J.S.) and Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Center for Genomic Medicine (E.C.D., J.W.S.), Massachusetts General Hospital, Harvard Medical School, Boston; Department of Neurology, Carver College of Medicine (E.C.L.) and Department of Epidemiology, College of Public Health (E.C.L.), University of Iowa, Iowa City
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Péquignot R, Dufouil C, Prugger C, Pérès K, Artero S, Tzourio C, Empana JP. High Level of Depressive Symptoms at Repeated Study Visits and Risk of Coronary Heart Disease and Stroke over 10 Years in Older Adults: The Three-City Study. J Am Geriatr Soc 2016; 64:118-25. [PMID: 26782860 DOI: 10.1111/jgs.13872] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKROUND Baseline depressive symptoms have been consistently associated with the onset of cardiovascular disease (CVD). OBJECTIVES Since depressive symptoms vary over time in elderly persons, and to help clarify whether or not depression is an etiological factor for CVD, we quantified the association between the course of depressive symptoms and occurrence of first coronary heart disease (CHD) and stroke events in older adults. DESIGN A population-based prospective observational study. SETTING Participants were randomly selected from the electoral rolls of three large French cities. PARTICIPANTS A total of 9,294 participants were examined at baseline between 1999 and 2001, and thereafter at repeated study visits over 10 years. MEASUREMENTS High levels of depressive symptoms (HLDS) were defined as a score≥16 on the 20-item Center for Epidemiologic Studies Depression Scale. The number of study visits with HLDS was used as a time dependent variable in Cox proportional hazard models. RESULTS There were 7,313 participants (36.6% males) aged 73.8±5.4 years with no history of CHD, stroke or dementia at baseline. After a median follow-up of 8.4 years (SD 2.3 years), 629 first CHD or stroke events occurred. After adjustment for sociodemographic characteristics and vascular risk factors, the risk of CHD and stroke combined increased 1.15-fold (95% CI: 1.06 to 1.25) per each additional study visit with HLDS. The results remained unchanged when accounting for the presence of disability and antidepressant intake at baseline and during follow-up. CONCLUSION Elderly persons exposed to HLDS at several occasions over 10 years showed substantial increased risk of coronary heart disease and stroke events.
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Affiliation(s)
- Renaud Péquignot
- INSERM U970, Paris Cardiovascular Research Center, Paris, F-75015, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Service de Médecine et Réadaptation, Hôpitaux de Saint-Maurice, Saint-Maurice, F-94415, France
| | - Carole Dufouil
- INSERM, U897, Bordeaux, France.,Bordeaux 2 University, Bordeaux, France.,CIC-1401, Clinical Epidemiology Branch, Bordeaux Hospital, Bordeaux, France
| | - Christof Prugger
- INSERM U970, Paris Cardiovascular Research Center, Paris, F-75015, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Karine Pérès
- INSERM, U897, Bordeaux, France.,Bordeaux 2 University, Bordeaux, France
| | - Sylvaine Artero
- INSERM U1061, Neuropsychiatry, Montpellier, France.,University of Montpellier 1, Montpellier, France
| | | | - Jean-Philippe Empana
- INSERM U970, Paris Cardiovascular Research Center, Paris, F-75015, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
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17
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Key Factors Associated with Major Depression in a National Sample of Stroke Survivors. J Stroke Cerebrovasc Dis 2016; 25:1090-1095. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/28/2015] [Accepted: 12/30/2015] [Indexed: 11/19/2022] Open
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Åberg MAI, Torén K, Nilsson M, Henriksson M, Kuhn HG, Nyberg J, Rosengren A, Åberg ND, Waern M. Nonpsychotic Mental Disorders in Teenage Males and Risk of Early Stroke: A Population-Based Study. Stroke 2016; 47:814-21. [PMID: 26846861 PMCID: PMC4760382 DOI: 10.1161/strokeaha.115.012504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 01/04/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although the incidence of stroke is on the decline worldwide, this is not the case for early stroke. We aimed to determine whether nonpsychotic mental disorder at the age of 18 years is a risk factor for early stroke, and if adolescent cardiovascular fitness and intelligence quotient might attenuate the risk. METHOD Population-based Swedish cohort study of conscripts (n=1 163 845) who enlisted during 1968 to 2005. At conscription, 45 064 males were diagnosed with nonpsychotic mental disorder. Risk of stroke during follow-up (5-42 years) was calculated with Cox proportional hazards models. Objective baseline measures of fitness and cognition were included in the models in a second set of analyses. RESULTS There were 7770 first-time stroke events. In adjusted models, increased risk for stroke was observed in men diagnosed with depressive/neurotic disorders (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.11-1.37), personality disorders (HR, 1.52; 95% CI, 1.29-1.78), and alcohol/substance use disorders (HR, 1.61; 95% CI, 1.41-1.83) at conscription. Corresponding figures for fatal stroke were HR, 1.38; 95% CI, 1.06 to 1.79; HR, 2.26; 95% CI, 1.60 to 3.19; and HR, 2.20; 95% CI, 1.63 to 2.96. HRs for stroke were attenuated when fitness level and intelligence quotient were introduced. Associations remained significant for personality disorders and alcohol/substance use in the fully adjusted models. The interaction term was statistically significant for fitness but not for intelligence quotient. CONCLUSIONS Our findings suggest that fitness may modify associations between nonpsychotic disorders and stroke. It remains to be clarified whether interventions designed to improve fitness in mentally ill youth can influence future risk of early stroke.
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Affiliation(s)
- Maria A I Åberg
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.).
| | - Kjell Torén
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Michael Nilsson
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Malin Henriksson
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - H Georg Kuhn
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Jenny Nyberg
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Annika Rosengren
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - N David Åberg
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
| | - Margda Waern
- From the Center for Brain Repair and Rehabilitation, Institute of Neuroscience and Physiology (M.A.I.Å., M.N., M.H., H.G.K., J.N.), Department of Primary Health Care (M.A.I.Å., M.H.), Occupational and Environmental Medicine (K.T.), Departments of Molecular and Clinical Medicine (A.R.), Department of Internal Medicine (N.D.Å.), Institute of Medicine, Neuropsychiatric Epidemiology Unit, and Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology (M.W.) Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia (M.N.)
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BozkurtZincir S, Ozdilek BF, Zincir S. Association of quetiapine with ischemic brain stem stroke: a case report and discussion. Ther Adv Psychopharmacol 2015; 5:246-9. [PMID: 26301082 PMCID: PMC4535042 DOI: 10.1177/2045125315583819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Selma BozkurtZincir
- Associate Professor of Psychiatry, Erenkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - Betul F Ozdilek
- Associate Professor of Neurology, Erenkoy Training and Research Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
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20
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Freak-Poli R, Mirza SS, Franco OH, Ikram MA, Hofman A, Tiemeier H. Positive affect is not associated with incidence of cardiovascular disease: a population-based study of older persons. Prev Med 2015; 74:14-20. [PMID: 25661731 DOI: 10.1016/j.ypmed.2015.01.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/22/2015] [Accepted: 01/24/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The relationship between positive psychological well-being (PPWB) and cardiovascular disease (CVD) is inconsistent across different CVD outcomes and for different PPWB constructs, such as positive affect. In addition, the relationship between PPWB and CVD as a composite measure is rarely assessed. OBJECTIVE To assess whether positive affect is protective of incident CVD. METHOD Positive affect was assessed in two cohorts between 1993 and 2001 in Rotterdam using relevant questions from the Center for Epidemiological Studies Depression (CES-D) scale and the Hospital Anxiety and Depression Scale (HADS; in a sub-sample) in 6349 non-demented, CVD-free, consenting adults, aged 55+years. Composite CVD was defined as stroke, heart failure and coronary heart disease, which were continuously monitored through medical records until 1st April 2010. RESULTS There were 1480 (23.3%) first time CVD events during follow-up (11.9 ± 2.8 SD years, 58,416 person-years). Positive affect was not associated with incident CVD (CES-D HR: 1.00 per point, 95% CI: 0.98-1.02; HADS HR: 0.98, 95% CI: 0.92-1.05). Stratification by age or sex and assessment of separate CVD outcome did not change results. CONCLUSION In this large, population-based study, there was no association between positive affect and twelve-year incident CVD in older adults who were free of diagnosed CVD at baseline.
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Affiliation(s)
- Rosanne Freak-Poli
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Saira Saeed Mirza
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Neurology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Child and Adolescent Psychiatry, Erasmus Medical Centre, The Netherlands; Department of Psychiatry, Erasmus Medical Centre, The Netherlands
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Impact of depression on incident stroke: A meta-analysis. Int J Cardiol 2015; 180:103-10. [DOI: 10.1016/j.ijcard.2014.11.198] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Revised: 10/24/2014] [Accepted: 11/24/2014] [Indexed: 11/23/2022]
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Zotto ED, Costa P, Morotti A, Poli L, Giuli VD, Giossi A, Volonghi I, Callea A, Padovani A, Pezzini A. Stroke and depression: A bidirectional link. World J Meta-Anal 2014; 2:49-63. [DOI: 10.13105/wjma.v2.i3.49] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Revised: 04/07/2014] [Accepted: 06/11/2014] [Indexed: 02/05/2023] Open
Abstract
A number of studies have assessed the influence of depression on the risk of cardiovascular disease. A growing literature indicates a link between depression and cerebrovascular events, although the direction of this association remains unclear. Numerous data have emerged suggesting an association between depressive symptoms and subsequent risk of stroke, thus leading to the hypothesis that a direct causality between depression and stroke exists. Notwithstanding, how depression may act as a risk factor for stroke is still unclear. Depression might be linked to stroke via neuroendocrine and inflammation effects, through correlation with major comorbidities such as hypertension and diabetes or by intervention of lifestyle behavioral mediators. Finally, antidepressant medications have recently drawn attention for a possible association with increased risk of stroke, although such findings remain uncertain. Depression has been also established as an important consequence after stroke, exerting a significant adverse impact on the course of motor recovery, social functioning and, overall, on quality of life. Post stroke depression occurs in nearly one third of stroke cases, but the exact mechanism leading to depression after stroke is still incompletely understood. In this article, we will review contemporary epidemiologic studies, discuss potential mechanisms and specific aspects of the complex relation between depression and stroke.
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Nobel L, Mayo NE, Hanley J, Nadeau L, Daskalopoulou SS. MyRisk_Stroke Calculator: A Personalized Stroke Risk Assessment Tool for the General Population. J Clin Neurol 2014; 10:1-9. [PMID: 24465256 PMCID: PMC3896642 DOI: 10.3988/jcn.2014.10.1.1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 06/19/2013] [Accepted: 06/19/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND PURPOSE There is a variety of stroke risk factors, and engaging individuals in reducing their own personal risk is hugely relevant and could be an optimal dissemination strategy. The aim of the present study was to estimate the stroke risk for specific combinations of health- and lifestyle-related factors, and to develop a personalized stroke-risk assessment tool for health professionals and the general population (called the MyRisk_Stroke Calculator). METHODS This population-based, longitudinal study followed a historical cohort formed from the 1992 or 1998 Santé Québec Health Surveys with information for linkage to health administrative databases. Stroke risk factors were ascertained at the time of survey, and stroke was determined from hospitalizations and death records. Cox proportional hazards models were used, modeling time to stroke in relationship to all variables. RESULTS A total of 358 strokes occurred among a cohort of 17805 persons (men=8181) who were followed for approximately 11 years (i.e., -200000 person-years). The following regression parameters were used to produce 10-year stroke-risk estimates and assign risk points: for age (1 point/year after age 20 years), male sex (3 points), low education (4 points), renal disease (8 points), diabetes (7 points), congestive heart failure (5 points), peripheral arterial disease (2 points), high blood pressure (2 points), ischemic heart disease (1 point), smoking (8 points), >7 alcoholic drinks per week (3 points), low physical activity (2 points), and indicators of anger (4 points), depression (4 points), and anxiety (3 points). According to MyRisk_Stroke Calculator, a person with <50, 75, and 90 risk points has a 10-year stroke risk of <3%, 28%, and >75%, respectively. CONCLUSIONS The MyRisk_Stroke Calculator is a simple method of disseminating information to the general population about their stroke risk.
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Affiliation(s)
- Lisa Nobel
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. ; Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Nancy E Mayo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. ; Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - James Hanley
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. ; Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Lyne Nadeau
- Division of Clinical Epidemiology, Department of Internal Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
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Carey LM, Crewther S, Salvado O, Lindén T, Connelly A, Wilson W, Howells DW, Churilov L, Ma H, Tse T, Rose S, Palmer S, Bougeat P, Campbell BCV, Christensen S, Macaulay SL, Favaloro J, Collins VO, McBride S, Bates S, Cowley E, Dewey H, Wijeratne T, Gerraty R, Phan TG, Yan B, Parsons MW, Bladin C, Barber PA, Read S, Wong A, Lee A, Kleinig T, Hankey GJ, Blacker D, Markus R, Leyden J, Krause M, Grimley R, Mahant N, Jannes J, Sturm J, Davis SM, Donnan GA. STroke imAging pRevention and Treatment (START): A Longitudinal Stroke Cohort Study: Clinical Trials Protocol. Int J Stroke 2013; 10:636-44. [DOI: 10.1111/ijs.12190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Accepted: 08/05/2013] [Indexed: 02/03/2023]
Abstract
Rationale Stroke and poststroke depression are common and have a profound and ongoing impact on an individual's quality of life. However, reliable biological correlates of poststroke depression and functional outcome have not been well established in humans. Aims Our aim is to identify biological factors, molecular and imaging, associated with poststroke depression and recovery that may be used to guide more targeted interventions. Design In a longitudinal cohort study of 200 stroke survivors, the START – STroke imAging pRevention and Treatment cohort, we will examine the relationship between gene expression, regulator proteins, depression, and functional outcome. Stroke survivors will be investigated at baseline, 24 h, three-days, three-months, and 12 months poststroke for blood-based biological associates and at days 3–7, three-months, and 12 months for depression and functional outcomes. A sub-group ( n = 100), the PrePARE: Prediction and Prevention to Achieve optimal Recovery Endpoints after stroke cohort, will also be investigated for functional and structural changes in putative depression-related brain networks and for additional cognition and activity participation outcomes. Stroke severity, diet, and lifestyle factors that may influence depression will be monitored. The impact of depression on stroke outcomes and participation in previous life activities will be quantified. Study Outcomes Clinical significance lies in the identification of biological factors associated with functional outcome to guide prevention and inform personalized and targeted treatments. Evidence of associations between depression, gene expression and regulator proteins, functional and structural brain changes, lifestyle and functional outcome will provide new insights for mechanism-based models of poststroke depression.
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Affiliation(s)
- Leeanne M. Carey
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- Department of Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Vic., Australia
| | - Sheila Crewther
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- School of Psychological Sciences, La Trobe University, Bundoora, Vic., Australia
| | - Olivier Salvado
- Preventative Health National Research Flagship, The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Qld, Australia
| | - Thomas Lindén
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Alan Connelly
- Brain Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia
| | - William Wilson
- Preventative Health National Research Flagship, Neurodegenerative Diseases, Mental Disorders and Brain Health, CSIRO, North Ryde, NSW, Australia
| | - David W. Howells
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Leonid Churilov
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Henry Ma
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- Stroke Unit, Monash Medical Centre, Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Tamara Tse
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
- Department of Occupational Therapy, School of Allied Health, La Trobe University, Bundoora, Vic., Australia
| | - Stephen Rose
- Preventative Health National Research Flagship, The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Qld, Australia
| | - Susan Palmer
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Pierrick Bougeat
- Preventative Health National Research Flagship, The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Qld, Australia
| | - Bruce C. V. Campbell
- Department of Medicine, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Soren Christensen
- Department of Medicine, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - S. Lance Macaulay
- Preventative Health National Research Flagship, Neurodegenerative Diseases, Mental Disorders and Brain Health, CSIRO, Parkville, Vic. Australia
| | - Jenny Favaloro
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Victoria O' Collins
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
| | - Simon McBride
- Preventative Health National Research Flagship, The Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Herston, Qld, Australia
| | - Susan Bates
- Neuroscience Trials Australia, Melbourne Brain Centre – Austin Campus, Heidelberg, Vic., Australia
| | - Elise Cowley
- Neuroscience Trials Australia, Melbourne Brain Centre – Austin Campus, Heidelberg, Vic., Australia
| | - Helen Dewey
- Department of Neurology, Austin Health, Heidelberg, Vic., Australia
| | - Tissa Wijeratne
- Department of Neurology, Western Hospital, Western Health, Melbourne, Vic., Australia
| | | | - Thanh G. Phan
- Stroke Unit, Monash Medical Centre, Department of Medicine, Monash University, Clayton, Vic., Australia
| | - Bernard Yan
- Department of Medicine, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Mark W. Parsons
- Department of Neurology, John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
| | - Chris Bladin
- Department of Neurology, Box Hill Hospital, Eastern Health, Melbourne, Vic., Australia
| | - P. Alan Barber
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Stephen Read
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Andrew Wong
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Andrew Lee
- Flinders Comprehensive Stroke Centre, Flinders Medical Centre and University, Adelaide, SA
| | - Tim Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Graeme J. Hankey
- School of Medicine and Pharmacology, The University of Western Australia, Perth, WA, Australia
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - David Blacker
- Department of Neurology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Romesh Markus
- Departmentof Neurology, St. Vincent's Hospital, Sydney, NSW, Australia
| | - James Leyden
- Department of Neurology, Lyell McEwin Hospital, Adelaide, SA, Australia
| | - Martin Krause
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Rohan Grimley
- Department of Neurology, Nambour General Hospital, Nambour, Qld, Australia
| | - Neil Mahant
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Jim Jannes
- Department of Neurology, The Queen Elizabeth Hospital, SA
| | - Jonathan Sturm
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - Stephen M. Davis
- Department of Medicine, Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Geoffrey A. Donnan
- National Stroke Research Institute, Florey Institute of Neuroscience and Mental Health, Heidelberg, Vic., Australia)
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The incidence and relative risk of stroke among patients with bipolar disorder: a seven-year follow-up study. PLoS One 2013; 8:e73037. [PMID: 24023667 PMCID: PMC3758282 DOI: 10.1371/journal.pone.0073037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022] Open
Abstract
Objective This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality among patients with bipolar disorder. Methods This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 16,821 patients with bipolar disorder and 67,284 age- and sex-matched control participants without bipolar disorder. The participants who had experienced a stroke between 1999 and 2003 were excluded and were randomly selected from the NHIRD. The incidence of stroke (ICD-9-CM code 430–438) and patient survival after stroke were calculated for both groups using data from the NIHRD between 2004 and 2010. A Cox proportional-hazards model was used to compare the seven-year stroke-free survival rate and all-cause mortality rate across the two cohorts after adjusting for confounding risk factors. Results A total of 472 (2.81%) patients with bipolar disorder and 1,443 (2.14%) controls had strokes over seven years. Patients with bipolar disorder were 1.24 times more likely to have a stroke (95% CI = 1.12–1.38; p<0.0001) after adjusting for demographic characteristics and comorbid medical conditions. In addition, 513 (26.8%) patients who had a stroke died during the follow-up period. The all-cause mortality hazard ratio for patients with bipolar disorder was 1.28 (95% CI = 1.06–1.55; p = 0.012) after adjusting for patient, physician and hospital variables. Conclusions The likelihood of developing a stroke was greater among patients with bipolar disorder than controls, and the all-cause mortality rate was higher among patients with bipolar disorder than controls during a seven-year follow-up period.
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Péquignot R, Tzourio C, Péres K, Ancellin ML, Perier MC, Ducimetière P, Empana JP. Depressive symptoms, antidepressants and disability and future coronary heart disease and stroke events in older adults: the Three City Study. Eur J Epidemiol 2013; 28:249-56. [PMID: 23338904 DOI: 10.1007/s10654-013-9765-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 01/07/2013] [Indexed: 01/15/2023]
Abstract
To investigate the association between baseline depressive symptoms and first fatal and non fatal coronary heart disease (CHD) and stroke in older adults, taking antidepressants and disability into account. In the Three City Study, a community-based prospective multicentric observational study cohort, 7,308 non-institutionalized men and women aged ≥65 years with no reported history of CHD, stroke or dementia, completed the 20-item Center for Epidemiologic Studies depression scale (CESD) questionnaire. First CHD and stroke events during follow-up were adjudicated by an independent expert committee. Hazard ratios (HRs) were estimated by Cox proportional hazard model. After a median follow-up of 5.3 years, 338 subjects had suffered a first non-fatal CHD or stroke event, and 82 had died from a CHD or stroke. After adjustment for study center, baseline socio-demographic characteristics, and conventional risk factors, depressive symptoms (CESD ≥ 16) were associated with fatal events only: fatal CHD plus stroke (HR = 2.50; 95% CI 1.57-3.97), fatal CHD alone (n = 57; HR = 2.21 ; 95%CI 1.27-3.87), and fatal stroke alone (n = 25; HR = 3.27; 95% CI 1.42-7.52). These associations were even stronger in depressed subjects receiving antidepressants (HR = 4.17; 95% CI 1.84-9.46) and in depressed subjects with impaired Instrumental Activities of Daily Living (HR = 8.93; 95% CI 4.60-17.34). By contrast, there was no significant association with non fatal events (HR for non-fatal CHD or stroke = 0.94; 95% CI 0.66-1.33). In non-institutionalized elderly subjects without overt CHD, stroke or dementia, depressive symptoms were selectively and robustly associated with first fatal CHD or stroke events.
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Affiliation(s)
- Renaud Péquignot
- INSERM U970, Paris Cardiovascular Research Centre, Paris Descartes University, Sorbonne Paris Cité, UMR-S970, 75015, Paris, France.
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Spurgeon L, Humphreys G, James G, Sackley C. A Q-Methodology Study of Patients' Subjective Experiences of TIA. Stroke Res Treat 2012; 2012:486261. [PMID: 22848864 PMCID: PMC3398653 DOI: 10.1155/2012/486261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 11/17/2022] Open
Abstract
Background. An expanding body of research has focused on a range of consequences of TIA. However, no work has been conducted on the patient's subjective experience of TIA. Aim. To capture patients' first-hand experiences of TIA. Method. Using Q-methodology which employs both qualitative and quantitative approaches, 39 statements relating to the clinical, physical, affective, and psychological impact of TIA were distilled from the literature and from patient narratives. Consistent with conventional Q-methodology, a purposive sample of twentythree post-TIA patients sorted these statements into a normally-distributed 39-cell grid, according to the extent to which each represented their experience of TIA. Results. Casewise factoranalysis was conducted on the sorted statements. Eight factors emerged which were labelled: lack of knowledge/awareness of TIA; life impact; anxiety; interpersonal impact; depression; physical consequences; cognitive avoidance/denial; constructive optimism. Conclusions. Five of the eight factors confirmed existing research on the impact of TIA, but three new issues emerged: deep-seated anxiety, denial and constructive optimism. The emerging perspectives highlight areas to target in the management of TIA and could inform health education messages, patient information, individualised caremanagement, and enhancement of coping strategies. With development, the findings could be used as a basis for psychometric risk assessment of TIA patients.
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Affiliation(s)
- Laura Spurgeon
- Department of Primary Care, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Glyn Humphreys
- Department of Experimental Psychology, University of Oxford, OX1 3UD, UK
| | - Gill James
- Department of Nursing and Physiotherapy, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Cath Sackley
- Department of Primary Care, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
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Andreeva VA, Galan P, Torrès M, Julia C, Hercberg S, Kesse-Guyot E. Supplementation with B vitamins or n-3 fatty acids and depressive symptoms in cardiovascular disease survivors: ancillary findings from the SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids (SU.FOL.OM3) randomized trial. Am J Clin Nutr 2012; 96:208-14. [PMID: 22648722 DOI: 10.3945/ajcn.112.035253] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Dietary factors might affect depressive symptoms. OBJECTIVE In secondary data analyses, we examined effects of supplementation with B vitamins or n-3 (omega-3) fatty acids on depressive symptoms in cardiovascular disease survivors. DESIGN The SUpplementation with FOLate, vitamins B-6 and B-12 and/or OMega-3 fatty acids (SU.FOL.OM3) trial was a secondary prevention trial (2003-2009; n = 2501) in which individuals aged 45-80 y were randomly assigned, by using a 2 × 2 factorial design, to receive 0.56 mg 5-methyl-tetrahydrofolate and vitamins B-6 (3 mg) and B-12 (0.02 mg); EPA and DHA (600 mg) in a 2:1 ratio; B vitamins and n-3 fatty acids; or a placebo. Depressive symptoms were evaluated at years 3 and 5 with the 30-item Geriatric Depression Scale (GDS). Overall and sex-specific ORs and 95% CIs were estimated in 2000 participants by using factorial logistic regression. RESULTS After a median of 4.7 y of supplementation, there was no association between allocation to receive B vitamins and depressive symptoms. However, the allocation to receive n-3 fatty acids was positively associated with depressive symptoms (GDS >10) in men (adjusted OR: 1.28; 95% CI: 1.03, 1.61) but not in women. CONCLUSIONS We showed no beneficial effects of a long-term, low-dose supplementation with B vitamins or n-3 fatty acids on depressive symptoms in cardiovascular disease survivors. The adverse effects of n-3 fatty acids in men merit confirmation.
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Affiliation(s)
- Valentina A Andreeva
- Nutritional Epidemiology Research Unit, University of Paris 13, Bobigny, France.
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Hamer M, Kivimaki M, Stamatakis E, Batty GD. Psychological distress as a risk factor for death from cerebrovascular disease. CMAJ 2012; 184:1461-6. [PMID: 22711734 DOI: 10.1503/cmaj.111719] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Little is known about psychological risk factors in cerebrovascular disease. We examined the association between psychological distress and risk of death due to cerebrovascular disease. METHODS We obtained data from 68 652 adult participants of the Health Survey for England (mean age 54.9 [standard deviation 13.9] yr, 45.0% male sex) with no known history of cardiovascular diseases at baseline. We used the 12-item General Health Questionnaire (GHQ-12) to assess the presence of psychological distress. We followed participants for eight years for cause-specific death using linkage to national registers. RESULTS There were 2367 deaths due to cardiovascular disease during follow-up. Relative to participants with no symptoms of psychological distress (GHQ-12 score 0) at baseline, people with psychological distress (GHQ-12 score ≥ 4, 14.7% of participants) had an increased risk of death from cerebrovascular disease (adjusted hazard ratio [HR] 1.66, 95% confidence interval [CI] 1.32-2.08) and ischemic heart disease (adjusted HR 1.59, 95% CI 1.34-1.88). There was also evidence of a dose-response effect with increasing GHQ-12 score (p for trend < 0.001 in all analyses). Associations were only marginally attenuated after we adjusted for possible confounders, including socioeconomic status, smoking and use of antihypertensive medications. INTERPRETATION Psychological distress was associated with increased risk of death due to cerebrovascular disease in a large population-representative cohort. These data suggest that the cardiovascular effects of psychological distress are not limited to coronary artery disease.
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Affiliation(s)
- Mark Hamer
- Department of Epidemiology and Public Health, University College London, London, UK.
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Majed B, Arveiler D, Bingham A, Ferrieres J, Ruidavets JB, Montaye M, Appleton K, Haas B, Kee F, Amouyel P, Ducimetiere P, Empana JP. Depressive symptoms, a time-dependent risk factor for coronary heart disease and stroke in middle-aged men: the PRIME Study. Stroke 2012; 43:1761-7. [PMID: 22517599 DOI: 10.1161/strokeaha.111.645366] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE To date, the association between depressive symptoms and the risk of cardiovascular diseases remains controversial. We investigated prospectively, within the same population, the time course of the association between baseline depressive symptoms and first stroke or coronary heart disease event. METHODS In the Prospective Epidemiological Study of Myocardial Infarction (PRIME) Study, a multicenter, observational, prospective cohort, 9601 men from France and Northern Ireland were surveyed for the occurrence of first coronary heart disease (n=647) and stroke events (n=136) over 10 years. At baseline, the fourth quartile of a 13-item modified Center for Epidemiological Studies questionnaire was used to define the presence of depressive symptoms. We sought the best time-dependent function to assess the association between depressive symptoms and outcomes. Thus, the hazard ratios were estimated by a Cox proportional hazard model after splitting the follow-up before and after 5 years of follow-up time periods. RESULTS Depressive symptoms at baseline were associated with coronary heart disease in the first 5 years of follow-up (hazard ratio, 1.43; 1.10-1.87) and with stroke in the second 5 years of follow up (hazard ratio, 1.96; 1.21-3.19) after adjustment for age, study centers, baseline socioeconomic factors, traditional vascular risk factors, and antidepressant treatment. The association was even stronger for ischemic stroke (n=108; hazard ratio, 2.48; 1.45-4.25). CONCLUSIONS The current study suggests that in healthy, European, middle-aged men, baseline depressive symptoms are associated with an increased risk of coronary heart disease in the short-term, and for stroke in the long-term.
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Affiliation(s)
- Bilal Majed
- INSERM U970, Paris Cardiovascular Research Center, Equipe 4: Epidémiologie cardiovasculaire et mort subite, 56 rue Leblanc, 75015 Paris, France.
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Sulfur dioxide and emergency department visits for stroke and seizure. Stroke Res Treat 2012; 2012:824724. [PMID: 22577602 PMCID: PMC3329739 DOI: 10.1155/2012/824724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 01/10/2012] [Accepted: 01/10/2012] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to assess an association between ambient sulfur dioxide and the number of emergency department (ED) visits for ischemic stroke and seizure. The study used data collected in a Vancouver (Canada) hospital in the years 1999–2003. Daily ED visits diagnosed as ministroke, stroke, or seizure were investigated using the case-crossover technique. Conditional logistic regression models were applied to estimate the odds ratios (ORs) and their respective 95% confidence intervals (CIs). The models included temperature and relative humidity in the form of natural splines. The results were reported for an increase in interquartile range ((IQR), IQR = 1.9 ppb for SO2). Positive and statistically significant associations were obtained for SO2 and ischemic stroke for all patients (OR = 1.12; CI 1.02, 1.23; lag 3) and for female patients (OR = 1.17; CI 1.01, 1.33; lag 0). In the case of ED visits for seizure, for female patients the results were also statistically significant (OR = 1.15; CI 1.02, 1.28; lag 1 and OR = 1.18; CI 1.05, 1.32; lag 2). These findings suggest that cases of ischemic cerebrovascular accidents are associated with acute exposure to ambient sulfur dioxide.
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Wulsin L, Alwell K, Moomaw CJ, Lindsell CJ, Kleindorfer DO, Woo D, Flaherty ML, Khatri P, Adeoye O, Ferioli S, Broderick JP, Kissela BM. Comparison of two depression measures for predicting stroke outcomes. J Psychosom Res 2012; 72:175-9. [PMID: 22325695 PMCID: PMC3742310 DOI: 10.1016/j.jpsychores.2011.11.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 11/25/2011] [Accepted: 11/25/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVES Little is known about the effect of lifetime history of depression on ischemic stroke outcomes. This study compared a measure of current symptoms of depression at the time of the stroke and a measure of lifetime history of depression for their ability to predict quality of life and functioning at 3 and 12 months after stroke. METHODS A cohort of 460 ischemic stroke patients from the 2005 Greater Cincinnati/North Kentucky Stroke Study was assessed within 2 weeks of the stroke, including the 10-item Center for Epidemiological Studies Depression Scale (CESD) for current symptoms of depression. Lifetime history of depression was also assessed by a 2-question measure at 3 and 12 months after stroke. Two outcome measures, Stroke Specific Quality of Life (SSQOL) and the modified Rankin Scale (mRS) to assess functional status, were also collected at 3 and 12 months. RESULTS Of the 322 survivors included in the analysis, 52.2% reported depression on at least one measure. Both current symptoms and lifetime history of depression predicted poor functional outcomes and poor quality of life at 3 and 12 months, after adjustment for age, race, sex, prior stroke, baseline functional status, and stroke severity. The combination of depression measures was a better predictor of poor outcomes than either measure alone. CONCLUSION Depression by either measure was a frequent, substantial, and independent predictor of poor outcomes at 3 and 12 months after stroke. Stroke outcomes studies should further examine the predictive value of assessing both depressive symptoms at the time of the stroke and lifetime history of depression.
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Affiliation(s)
- Lawson Wulsin
- University of Cincinnati, Department of Psychiatry, Cincinnati, OH 45267-0559, United States.
| | - Kathleen Alwell
- University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Charles J. Moomaw
- University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Christopher J. Lindsell
- University of Cincinnati, Department of Emergency Medicine, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Dawn O. Kleindorfer
- University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Daniel Woo
- University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Matthew L. Flaherty
- University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Pooja Khatri
- University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Opeolu Adeoye
- University of Cincinnati, Department of Emergency Medicine, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States,University of Cincinnati, Department of Neurosurgery, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Simona Ferioli
- University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Joseph P. Broderick
- University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
| | - Brett M. Kissela
- University of Cincinnati, Department of Neurology, 231 Albert Sabin Way, ML 559, Cincinnati, OH 45267-0559, United States
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Hanaoka H, Muraki T, Yamane S, Shimizu H, Okamura H. Testing the Feasibility of Using Odors in Reminiscence Therapy in Japan. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2011. [DOI: 10.3109/02703181.2011.628064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND AND PURPOSE A history of depression may be associated with an increased risk of stroke. We aimed to determine the association between depression and risk of stroke by performing a meta-analysis of prospective studies. METHODS Relevant studies were identified by a PubMed database search through May 2011 without restrictions and by reviewing reference lists of obtained articles. Community-based or population-based prospective studies that reported relative risk estimates with 95% confidence intervals for the association between depression and stroke were selected. Studies that enrolled participants with preexisting stroke at baseline were excluded. A random-effects model was used to compute the pooled risk estimate. RESULTS Random-effects meta-analysis of 17 prospective studies involving 206 641 participants and 6086 cases demonstrated a significant positive association between depression and subsequent risk of stroke (pooled relative risk, 1.34; 95% confidence interval, 1.17-1.54) after adjustment for potential confounding factors. The associations were similar between men and women. Potential publication bias may exist, but correction for this bias using a formal statistical method did not materially alter the combined risk estimate. CONCLUSIONS Depression significantly increased the risk of development of stroke, and this increase was probably independent of other risk factors, including hypertension and diabetes.
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Affiliation(s)
- Jia-Yi Dong
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, 199 Renai Road, Dushu Lake Higher Education Town, Suzhou, 215123 China.
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Pan A, Sun Q, Okereke OI, Rexrode KM, Hu FB. Depression and risk of stroke morbidity and mortality: a meta-analysis and systematic review. JAMA 2011; 306:1241-9. [PMID: 21934057 PMCID: PMC3242806 DOI: 10.1001/jama.2011.1282] [Citation(s) in RCA: 547] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Several studies have suggested that depression is associated with an increased risk of stroke; however, the results are inconsistent. OBJECTIVE To conduct a systematic review and meta-analysis of prospective studies assessing the association between depression and risk of developing stroke in adults. DATA SOURCES A search of MEDLINE, EMBASE, and PsycINFO databases (to May 2011) was supplemented by manual searches of bibliographies of key retrieved articles and relevant reviews. STUDY SELECTION We included prospective cohort studies that reported risk estimates of stroke morbidity or mortality by baseline or updated depression status assessed by self-reported scales or clinician diagnosis. DATA EXTRACTION Two independent reviewers extracted data on depression status at baseline, risk estimates of stroke, study quality, and methods used to assess depression and stroke. Hazard ratios (HRs) were pooled using fixed-effect or random-effects models when appropriate. Associations were tested in subgroups representing different participant and study characteristics. Publication bias was evaluated with funnel plots and Begg test. RESULTS The search yielded 28 prospective cohort studies (comprising 317,540 participants) that reported 8478 stroke cases (morbidity and mortality) during a follow-up period ranging from 2 to 29 years. The pooled adjusted HRs were 1.45 (95% CI, 1.29-1.63; P for heterogeneity <.001; random-effects model) for total stroke, 1.55 (95% CI, 1.25-1.93; P for heterogeneity = .31; fixed-effects model) for fatal stroke (8 studies), and 1.25 (95% CI, 1.11-1.40; P for heterogeneity = .34; fixed-effects model) for ischemic stroke (6 studies). The estimated absolute risk differences associated with depression were 106 cases for total stroke, 53 cases for ischemic stroke, and 22 cases for fatal stroke per 100,000 individuals per year. The increased risk of total stroke associated with depression was consistent across most subgroups. CONCLUSION Depression is associated with a significantly increased risk of stroke morbidity and mortality.
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Affiliation(s)
- An Pan
- Department of Nutrition, Harvard School of Public Health, 655 Huntington Ave, Boston, MA 02115, USA
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Paulson D, Bowen ME, Lichtenberg PA. Successful aging and longevity in older old women: the role of depression and cognition. J Aging Res 2011; 2011:912680. [PMID: 21766034 PMCID: PMC3134221 DOI: 10.4061/2011/912680] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 05/02/2011] [Accepted: 05/17/2011] [Indexed: 11/22/2022] Open
Abstract
Based in successful aging theory and terminal cognitive drop research, this paper investigates cerebrovascular burden (CVB), depressive symptoms, and cognitive decline as threats to longevity. A subsample of stroke-free women over the age of 80 was identified in the Health and Retirement Survey (years 2000–2008). Mortality at 2, 6, and 8 year intervals was predicted using CVB (diabetes, heart disease, hypertension), depressive symptoms (Center for Epidemiological Studies Depression Scale), and cognitive decline (decline of 1 standard deviation or more on the 35-point Telephone Interview for Cognitive Status over 2 years). At most waves (2002, 2004, and 2006) mortality was predicted by CVB, depressive symptoms, and cognitive drop measured 2 years prior. CVB and depressive symptoms at the 2000 wave predicted mortality at 6 and 8 years. Older women with the greatest longevity had low CVB, robust cognitive functioning, and few depression symptoms, supporting successful aging theory and terminal cognitive drop.
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Affiliation(s)
- Daniel Paulson
- Department of Psychology and Institute of Gerontology, Wayne State University, Detroit, MI 48202-3801, USA
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Skoog I. Psychiatric disorders in the elderly. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:387-97. [PMID: 21835102 DOI: 10.1177/070674371105600702] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent research has shown that depression, anxiety disorders, and psychosis are more common than previously supposed in elderly populations without dementia. It is unclear whether the frequency of these disorders increases or decreases with age. Clinical expression of psychiatric disorders in old age may be different from that seen in younger age groups, with less and often milder symptoms. Concurrently, comorbidity between different psychiatric disorders is immense, as well as comorbidity with somatic disorders. Cognitive function is often decreased in people with depression, anxiety disorders, and psychosis, but whether these disorders are risk factors for dementia is unclear. Psychiatric disorders in the elderly are often related to cerebral neurodegeneration and cerebrovascular disease, although psychosocial risk factors are also important. Psychiatric disorders, common among the elderly, have consequences that include social deprivation, poor quality of life, cognitive decline, disability, increased risk for somatic disorders, suicide, and increased nonsuicidal mortality.
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Affiliation(s)
- Ingmar Skoog
- Institute of Neuroscience and Physiology, Section for Psychiatry Section, Unit of Neuropsychiatric Epidemiology, University of Gothenburg, Sweden.
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Glymour MM, Yen JJ, Kosheleva A, Moon JR, Capistrant BD, Patton KK. Elevated depressive symptoms and incident stroke in Hispanic, African-American, and White older Americans. J Behav Med 2011; 35:211-20. [PMID: 21656258 PMCID: PMC3305882 DOI: 10.1007/s10865-011-9356-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 05/24/2011] [Indexed: 11/28/2022]
Abstract
Although depressive symptoms have been linked to stroke, most research has been in relatively ethnically homogeneous, predominantly white, samples. Using the United States based Health and Retirement Study, we compared the relationships between elevated depressive symptoms and incident first stroke for Hispanic, black, or white/other participants (N = 18,648) and estimated the corresponding Population Attributable Fractions. The prevalence of elevated depressive symptoms was higher in blacks (27%) and Hispanics (33%) than whites/others (18%). Elevated depressive symptoms prospectively predicted stroke risk in the whites/other group (HR = 1.53; 95% CI: 1.36-1.73) and among blacks (HR = 1.31; 95% CI: 1.05-1.65). The HR was similar but only marginally statistically significant among Hispanics (HR = 1.33; 95% CI: 0.92-1.91). The Population Attributable Fraction, indicating the percent of first strokes that would be prevented if the incident stroke rate in those with elevated depressive symptoms was the same as the rate for those without depressive symptoms, was 8.3% for whites/others, 7.8% for blacks, and 10.3% for Hispanics.
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Affiliation(s)
- M Maria Glymour
- Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Avenue, Kresge 617, Boston, MA 02115, USA.
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Krijthe BP, Walter S, Newson RS, Hofman A, Hunink MG, Tiemeier H. Is positive affect associated with survival? A population-based study of elderly persons. Am J Epidemiol 2011; 173:1298-307. [PMID: 21454828 DOI: 10.1093/aje/kwr012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Study results on the association of positive affect with survival are conflicting. This disagreement potentially arises from poor control for health or negative affect and for the various age groups studied. The authors examined if positive affect predicts survival; whether this association is preserved after controlling for negative affect, socioeconomic status, lifestyle, and health; and whether this association varies with age. The study is set within the population-based Rotterdam Study (1997-2007) and included 4,411 participants aged 61 years or older, followed for on average 7.19 (standard deviation = 2.20) years. Positive affect was not consistently associated with survival across all ages. A significant interaction of positive affect with age on survival (P = 0.02) was found. Subsequent age stratification revealed that positive affect independently predicted survival in elderly persons aged <80 years (per affect score, hazard ratio = 0.96, 95% confidence interval: 0.93, 0.99) but not in those aged ≥80 years in fully adjusted models (hazard ratio = 1.00, 95% confidence interval: 0.96, 1.04). In the oldest old, the association was partly explained by differences in baseline health. In conclusion, the results suggest that there may be an association of positive affect with survival in the younger and middle old but not in the oldest old in whom perception of positive affect is more likely to be determined by health.
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Affiliation(s)
- Bouwe P Krijthe
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
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Atlantis E, Grayson DA, Browning C, Sims J, Kendig H. Cardiovascular disease and death associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA). Int J Geriatr Psychiatry 2011; 26:341-50. [PMID: 20690128 DOI: 10.1002/gps.2532] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and death may be associated with depression and antidepressants, but published findings remain equivocal. The authors aimed to determine the risk of CVD incidence and death associated with several classifications of depression. METHODS A prospective cohort study was conducted (1994-2006) in a regionally representative sample of 1000 non-institutionalised older Australians age 65+ years (47% men). Endpoints were non-fatal CVD incidence and death over 10 and 12-years, respectively. Depression incidence was assessed at 2-years. Depression related predictors were defined by symptoms (Psychogeriatric Assessment Scales, depression scale) and/or antidepressants to determine independent and/or joint effects on endpoints. Cox regressions determined unadjusted and multiple-adjusted (for significant covariates) hazard ratios (HR). RESULTS Baseline response rate was 70.3%. Aggregate dropout rate was approximately 24% for survivors at biennial follow-ups, but death status was ascertained for all participants. Several classifications of depression predicted death in unadjusted analyses (39-60% >1), but effects disappeared in multiple-adjusted analyses (in which all HRs became <1 and non-significant). Depression related predictors were thus not associated with CVD incidence; or death after accounting for confounding mostly by CVD, diabetes and poor functional health covariates. Prevalent arthritis, respiratory disease and daily pain were predictors (P < 0.05) of depression incidence. CONCLUSIONS Depression related predictors were not independently associated with CVD incidence or death in older people. Antidepressants were not associated with CVD or premature death, accounting for whether participants' remained symptomatic or not. Depression co-occurs with and might be partly caused by chronic disease and poor functional health.
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Affiliation(s)
- Evan Atlantis
- Royal Adelaide Hospital/Institute of Medical and Veterinary Science, South Australia Health, Government of South Australia, Adelaide, Australia.
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Aloisi AM, Ceccarelli I, Carlucci M, Suman A, Sindaco G, Mameli S, Paci V, Ravaioli L, Passavanti G, Bachiocco V, Pari G. Hormone replacement therapy in morphine-induced hypogonadic male chronic pain patients. Reprod Biol Endocrinol 2011; 9:26. [PMID: 21332999 PMCID: PMC3049183 DOI: 10.1186/1477-7827-9-26] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 02/18/2011] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In male patients suffering from chronic pain, opioid administration induces severe hypogonadism, leading to impaired physical and psychological conditions such as fatigue, anaemia and depression. Hormone replacement therapy is rarely considered for these hypogonadic patients, notwithstanding the various pharmacological solutions available. METHODS To treat hypogonadism and to evaluate the consequent endocrine, physical and psychological changes in male chronic pain patients treated with morphine (epidural route), we tested the administration of testosterone via a gel formulation for one year. Hormonal (total testosterone, estradiol, free testosterone, DHT, cortisol), pain (VAS and other pain questionnaires), andrological (Ageing Males' Symptoms Scale-AMS) and psychological (POMS, CES-D and SF-36) parameters were evaluated at baseline (T0) and after 3, 6 and 12 months (T3, T6, T12 respectively). RESULTS The daily administration of testosterone increased total and free testosterone and DHT at T3, and the levels remained high until T12. Pain rating indexes (QUID) progressively improved from T3 to T12 while the other pain parameters (VAS, Area%) remained unchanged. The AMS sexual dimension and SF-36 Mental Index displayed a significant improvement over time. CONCLUSIONS In conclusion, our results suggest that a constant, long-term supply of testosterone can induce a general improvement of the male chronic pain patient's quality of life, an important clinical aspect of pain management.
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Affiliation(s)
- Anna Maria Aloisi
- Department of Physiology, Section of Neuroscience and Applied Physiology, University of Siena, Siena, Italy
- San Carlo Clinic, Paderno Dugnano, Milano, Italy
| | - Ilaria Ceccarelli
- Department of Physiology, Section of Neuroscience and Applied Physiology, University of Siena, Siena, Italy
| | - Maria Carlucci
- Department of Physiology, Section of Neuroscience and Applied Physiology, University of Siena, Siena, Italy
| | - Annalisa Suman
- Department of Physiology, Section of Neuroscience and Applied Physiology, University of Siena, Siena, Italy
| | - Gianfranco Sindaco
- Pain Medicine Unit, Villa Serena Hospital and Advanced Algology Research, Forlì, Italy
| | | | - Valentina Paci
- Pain Medicine Unit, Villa Serena Hospital and Advanced Algology Research, Forlì, Italy
| | - Laura Ravaioli
- Pain Medicine Unit, Villa Serena Hospital and Advanced Algology Research, Forlì, Italy
| | | | - Valeria Bachiocco
- Department of Physiology, Section of Neuroscience and Applied Physiology, University of Siena, Siena, Italy
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Glymour MM, Maselko J, Gilman SE, Patton KK, Avendaño M. Depressive symptoms predict incident stroke independently of memory impairments. Neurology 2010; 75:2063-70. [PMID: 21135381 PMCID: PMC2995534 DOI: 10.1212/wnl.0b013e318200d70e] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND We evaluated whether depressive symptoms predict the onset of first stroke independently of memory impairment. We conceptualized memory impairment as a marker of preexisting cerebrovascular disease. We hypothesized that if depressive symptoms are causally related to stroke through mechanisms unrelated to cerebrovascular disease, depressive symptoms should predict stroke independently of memory impairment. METHODS Incidence of first stroke was assessed with self or proxy reports from 19,087 participants in the Health and Retirement Study cohort (1,864 events). Elevated depressive symptoms (3+ on an 8-item Centers for the Epidemiologic Study of Depression scale) and memory impairment (score of ≤6 on a combined immediate and delayed recall of a 10-word list) were used as predictors of incident stroke in Cox survival models with adjustment for sociodemographic and cardiovascular risk factors. RESULTS After adjustment for sociodemographic and cardiovascular risk factors, elevated depressive symptoms (hazard ratio = 1.25; 95% confidence interval 1.12-1.39) and memory impairment (hazard ratio = 1.26; 95% confidence interval 1.13-1.41) each predicted stroke incidence in separate models. Hazard ratios were nearly unchanged and remained significant (1.23 for elevated depressive symptoms and 1.25 for memory impairment) when models were simultaneously adjusted for both elevated depressive symptoms and memory impairment. Elevated depressive symptoms also predicted stroke when restricting analyses to individuals with median memory score or better. CONCLUSIONS Memory impairments and depressive symptoms independently predict stroke incidence. Memory impairment may reflect undiagnosed cerebrovascular disease. These results suggest that depressive symptoms might be directly related to stroke rather than merely indicating preexisting cerebrovascular disease.
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Affiliation(s)
- M M Glymour
- Department of Society, Harvard School of Public Health, Boston, MA 02115, USA.
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The effect of stress on stroke recovery in a photothrombotic stroke animal model. Brain Res 2010; 1363:191-7. [PMID: 20887717 DOI: 10.1016/j.brainres.2010.09.081] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 09/18/2010] [Accepted: 09/21/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND AIMS Several studies have provided convincing evidence that psychosocial factors, chronic stress and emotional factors are all independent predictors of atherosclerosis and cardiovascular events as well. However, psychosocial factors have received little attention in the medical setting. The purpose of this study is to evaluate the influence of stress on photothrombotic ischemic cortical injury in an animal model. METHODS Sprague-Dawley rats were assigned to the four groups and cortical photothrombosis was induced in the sensorimotor cortex. The stress groups were subjected to restraint stress for five days. We evaluate the behavioral function, infarct volume, apoptotic cell death and the activations of mitogen-activated protein kinases (MAPK: Erk1/Erk2, and p38MAPK) for the evaluation of stress effects on stroke. RESULTS There was a significant increase in cortical infarct volume and apoptotic cell death at the stroke group subjected to restraint stress (p<0.05, and p<0.01, respectively). The functional recovery was worst in restraint stress group during five days (p<0.05). The activation of Erk1 and Erk2 were increased by restraint stress in sham operation group but decreased in stroke-stress group than stroke control group (p<0.01). The activation of p38MAPK was increased by stroke but this effect was decreased by restraint stress (p<0.05, and p<0.01, respectively). Our data demonstrates that restraint stress increases infarction volume and decreases functional recovery in rat stroke models by modulation of the MAPK pathway.
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Cumming TB, Churilov L, Skoog I, Blomstrand C, Linden T. Little evidence for different phenomenology in poststroke depression. Acta Psychiatr Scand 2010; 121:424-30. [PMID: 20384602 DOI: 10.1111/j.1600-0447.2010.01558.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE It remains unclear whether mood depressive disorders after stroke have a distinct phenomenology. We evaluated the symptom profile of poststroke depression (PSD) and assessed whether somatic symptoms were reported disproportionately by stroke patients. METHOD The sample was 149 stroke patients at 18 months poststroke and 745 age- and sex-matched general population controls. A comprehensive psychiatric interview was undertaken and depression was diagnosed according to DSM-III-R criteria. RESULTS Depressed controls reported more 'inability to feel' (P = 0.002) and 'disturbed sleep' (P = 0.008) than depressed stroke patients. Factor analysis of the 10 depressive symptoms identified two main factors, which appeared to represent somatic and psychological symptoms. There was no difference in scores on these two factors between stroke patients and controls. CONCLUSION Phenomenology of depression at 18 months poststroke is broadly similar but not the same as that described by controls. Somatic symptoms of depression were not over-reported by stroke patients.
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Affiliation(s)
- T B Cumming
- National Stroke Research Institute, Melbourne, Vic., Australia
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Nabi H, Kivimäki M, Suominen S, Koskenvuo M, Singh-Manoux A, Vahtera J. Does depression predict coronary heart disease and cerebrovascular disease equally well? The Health and Social Support Prospective Cohort Study. Int J Epidemiol 2010; 39:1016-24. [PMID: 20360321 DOI: 10.1093/ije/dyq050] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The relationship between depression and cerebrovascular disease (CBVD) continues to be debated although little research has compared the predictive power of depression for coronary heart disease (CHD) with that for CBVD within the same population. This study aimed to compare the importance of depression for CHD and CBVD within the same population of adults free of apparent cardiovascular disease. METHODS A random sample of 23,282 adults (9507 men, 13,775 women) aged 20-54 years were followed up for 7 years. Fatal and first non-fatal CHD and CBVD events were documented by linkage to the National-hospital-discharge and mortality registers. RESULTS Sex-age-education-adjusted hazard ratio (HR) for CHD was 1.66 [95% confidence interval (CI) 1.24-2.24] for participants with mild to severe depressive symptoms, i.e. those scoring > or =10 on the 21-item Beck Depression Inventory, and 2.04 (1.27-3.27) for those who filled antidepressant prescriptions compared with those without depression markers in 1998, i.e. at study baseline. For CBVD, the corresponding HRs were 1.01 (0.67-1.53) and 1.77 (0.95-3.29). After adjustment for behavioural and biological risk factors these associations were reduced but remained evident for CHD, the adjusted HRs being 1.47 (1.08-1.99) and 1.72 (1.06-2.77). For CBVD, the corresponding multivariable adjusted HRs were 0.87 (0.57-1.32) and 1.52 (0.81-2.84). CONCLUSIONS Self-reported depression using a standardized questionnaire and clinical markers of mild to severe depression were associated with an increased risk for CHD. There was no clear evidence that depression is a risk factor for CBVD, but this needs further confirmation.
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Hofman A, Breteler MMB, van Duijn CM, Janssen HLA, Krestin GP, Kuipers EJ, Stricker BHC, Tiemeier H, Uitterlinden AG, Vingerling JR, Witteman JCM. The Rotterdam Study: 2010 objectives and design update. Eur J Epidemiol 2009; 24:553-72. [PMID: 19728115 PMCID: PMC2744826 DOI: 10.1007/s10654-009-9386-z] [Citation(s) in RCA: 201] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 08/19/2009] [Indexed: 12/19/2022]
Abstract
The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. The findings of the Rotterdam Study have been presented in close to a 1,000 research articles and reports (see www.epib.nl/rotterdamstudy). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.
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Affiliation(s)
- Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam. The Netherlands.
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Sobesky J. [Stroke prevention outside the pharmacy : risk factors and lifestyle]. DER NERVENARZT 2008; 79:1156-1163. [PMID: 18806982 DOI: 10.1007/s00115-008-2528-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Advice on modifiable risk and lifestyle factors for stroke prevention should be an established component of medical consultation. It is most important to explain that alterations to the lifestyle can be highly efficient with respect to the individual risk profile. The following review describes the importance of lifestyle factors such as nutrition, smoking, alcohol consumption, psychiatric condition, sport, dental hygiene and sleep disturbances for the risk of stroke using current data. It provides evidence that lifestyle modifications are highly effective with respect to stroke prevention. Corresponding recommendations and preventive strategies are presented.
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Affiliation(s)
- J Sobesky
- Klinik und Poliklinik für Neurologie, Universitätsklinik Köln, Kerpenerstrasse 62, 50924, Köln, Deutschland.
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