Characteristics of post-stroke depression in Japanese patients

The prevalence of apathy in stroke patients: A systematic review and meta-analysis

BACKGROUND

Apathy is a frequent neuropsychiatric disorder in stroke patients. However, its prevalence rates have conflicting results across studies. This meta-analysis aimed to estimate the overall prevalence of apathy in stroke patients from 1990 to 2022.

METHODS

PubMed, Web of Science, Embase and PsycINFO were systematically searched to identify relevant articles published from January 1, 1990 to October 29, 2022. Literature quality was assessed with the National Institutes of Health Study Quality Assessment Tool. The pooled prevalence, subgroup analyses and meta-regression were calculated by STATA 16.0.

RESULTS

A total of 39 observational studies involving 5168 stroke patients were eligible for this meta-analysis. The pooled prevalence of apathy in stroke patients was 33.0% (95% CI, 27.6-38.4). Subgroup analyses showed that the pooled prevalence of apathy among stroke patients was higher in Japan (36.6%), China (33.7%) and Turkey (63.5%) compared to that in other countries (30.2%). The pooled prevalence of apathy was higher in ischemic stroke samples (36.1%) than in hemorrhagic stroke samples (14.4%). The pooled prevalence of apathy measured with the Apathy Evaluation Scale (38.3%) was the highest in stroke patients. Meta-regression presented that higher literature quality was significantly associated with lower prevalence, while stroke severity, mean age and female percentage were not significantly associated with the prevalence of apathy in stroke patients.

CONCLUSION

Our findings revealed that the overall prevalence of apathy in stroke patients was 33.0% based on the current evidence. Furthermore, the prevalence was significantly correlated with countries, stroke subtypes, apathy criteria, and literature quality.

Effective Tools to Predict Depression in Acute and Subacute Phase of Ischemic Stroke

OBJECTIVE

Despite the high frequency of depression in the first year following stroke, few studies have predicted risk of depression after the acute and subacute stroke periods. The aim of this study was to identify, in the acute and subacute periods, measures that would predict major depression during the first year after stroke.

METHODS

Study subjects were inpatients with ischemic stroke aged 20-85 years within 6 weeks of onset. Patients were evaluated at baseline and at 3, 6, 9, and 12 months. Patients were diagnosed with major depression using the Structured Clinical Interview for DSM-IV. The severity of depressive symptoms was measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery-Åsberg Depression Rating Scale (MADRS).

RESULTS

Of the 152 potential patients who met inclusion criteria, 49 had follow-up evaluations; one patient with major depression in the acute and subacute periods was excluded from the analysis. Among the remaining 48 patients, the number of those with major depression during the first year of stroke onset was five (10.4%). Patients who developed major depression had significantly more depressive symptoms in the acute and subacute stroke phase as assessed by both the PHQ-9 and MADRS. Patients with PHQ-9 scores ≥9 in the acute and subacute stroke phases were significantly more likely to develop major depression in a chronic phase of stroke.

CONCLUSIONS

The self-administered PHQ-9 can identify patients in the acute and subacute stroke periods who are at increased risk for developing major depression during the first year after stroke.

Part II: predictors of depression after stroke and impact of depression on stroke outcome: an updated systematic review of observational studies

BACKGROUND

We previously published a systematic review in 2005 on factors associated with the development of depression in people with stroke.

AIM

To update and expand that review to include published data on the impact of depression on stroke outcome.

METHODS

We included all published observational studies (to May 31, 2013) with prospective consecutive recruitment of people with a clinical diagnosis of stroke where an attempt was made to assess the variables associated with, or predictive of, the development of depression.

RESULTS

We included data from 23 studies including 18,374 people. Depression after stroke was associated with prestroke depression, more severe neurological deficit and physical disability in the acute phase, and later after stroke. No consistent relationship between depression and demographic parameters or stroke features was identified. The review of the impact of depression on stroke outcome included data from 14 cohorts, including 4498 people, and found that depression was negatively associated with functional outcome in stroke survivors.

CONCLUSIONS

Early identification of patients at high risk of depression after stroke, those with a history of depression and physical disability after stroke, would enable the early implementation of effective management and prevention strategies for depression. The reciprocal relationship between depression and physical disability highlights the need for interventions that reduce disability after stroke, which may in turn improve mood and overall recovery for an increasingly large number of stroke survivors.

Part I: frequency of depression after stroke: an updated systematic review and meta-analysis of observational studies

BACKGROUND

Approximately 15 million people who suffer a stroke globally each year are at risk of developing depression.

AIM

To update our systematic review and meta-analysis of the frequency of depression after stroke published in 2005, including studies published before July 2004.

METHODS

We included all published observational studies (to 31 May 2013) with prospective consecutive recruitment and quantification of the proportion of people with depression after stroke. We included studies of adult (>18 years) patients with a clinical diagnosis of stroke, where an assessment of depression or depressive symptom burden was performed at a pre-specified time-point for all study participants.

RESULTS

Data were available from 61 studies including 25,488 people. The proportional frequency of depression varied considerably across studies; however, the pooled frequency estimate of 31% (95% confidence interval 28% to 35%) was not significantly different from the 33% (difference of 2%, 95% confidence interval <1% to 3%) reported in the 2005 review. The proportion with depression between one and five-years (25%; 95% confidence interval 16 to 33%) and at five years after stroke (23%; 95% confidence interval 14 to 31%) was significantly lower.

CONCLUSION

Despite systematic review evidence describing validated depression screening tools and effective treatment and prevention strategies for depression after stroke, there has not been a significant reduction in the proportion of people experiencing depression after stroke. There is a pressing need for increased clinical uptake of evidenced-based strategies to screen for, prevent, and treat depression after stroke.

Improved functional status by comprehensive physical and psychosocial approach through right insula activation in poststroke vascular dementia

The aim is to investigate the effect of a comprehensive physical and psychosocial approach on functional outcome and cerebral glucose metabolism in poststroke vascular dementia (PSVaD). Ten PSVaD patients participated in the study. They were diagnosed according to the National Institute of Neurological Disorders and Stroke and Association Internationale pour la Recherché et l'Enseignement en Neurosciences (NINDS-AIREN) criteria and needed physical assistance in sit-to-stand transfer activities. Six were enrolled in a comprehensive program consisted of an individualized task-specific exercise regimen of transfer training and a psychosocial intervention program. The other 4 patients participated in the control group. The programs were undertaken over a period of 2 months. Outcomes were the scores on the Mini-Mental State Examination and the Functional Independence Measure (FIM), and on cerebral glucose metabolism determined by (18)F-fluorodeoxyglucose positron emission tomography performed before and at the end of the program. The score on the transfer mobility subscale of the FIM increased at the end of the program in all patients who received the comprehensive program. Regional glucose metabolism was increased in the right insular cortex at the end of the combined program. Control patients showed no change in FIM score or regional cerebral metabolism. A combined approach may be associated with an increase in glucose metabolism of the right insula cortex in PSVaD patients.

Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis

BACKGROUND

Depression after stroke is a distressing problem that may be associated with other negative health outcomes.

AIMS

To estimate the natural history, predictors and outcomes of depression after stroke.

METHOD

Studies published up to 31 August 2011 were searched and reviewed according to accepted criteria.

RESULTS

Out of 13 558 references initially found, 50 studies were included. Prevalence of depression was 29% (95% CI 25-32), and remains stable up to 10 years after stroke, with a cumulative incidence of 39-52% within 5 years of stroke. The rate of recovery from depression among patients depressed a few months after stroke ranged from 15 to 57% 1 year after stroke. Major predictors of depression are disability, depression pre-stroke, cognitive impairment, stroke severity and anxiety. Lower quality of life, mortality and disability are independent outcomes of depression after stroke.

CONCLUSION

Interventions for depression and its potential outcomes are required.

Predictors of the depressive symptomatology of the family caregivers of Chinese stroke patients in Hong Kong

The aim of this cross-sectional study was to determine the socio-demographic and clinical factors associated with depressive symptoms in the family caregivers of Hong Kong Chinese stroke patients. One hundred and twenty-three patients at a stroke clinic and their family caregivers formed the study sample. The depressive symptoms of both the patients and their family caregivers were rated with the Chinese version of the 15-item Geriatric Depression Scale (GDS). Participants' socio-demographic data and clinical characteristics served as the independent variables in relation to the caregivers' GDS scores. Patients' and caregivers' somatic and psychological conditions were measured with 10 scales. In univariate analysis, caregivers' GDS scores were significantly correlated with certain of their characteristics [Modified Life Event Scale (MLES), Cumulative Illness Rating Scale (CIRS) and Lubben Social Network Scale (LSNS) scores, sex and being a housewife] and those of the patients (GDS score and being a housewife). Multiple regression analysis showed caregivers' MLES and CIRS scores and patients' GDS scores to be independent correlates of caregivers' GDS scores. Adverse events encountered by caregivers in the past 6 months, their current health problems and patients' depressive symptoms were found to be the principal factors associated with caregivers' depressive symptoms.

Burden of Chinese stroke family caregivers: the Hong Kong experience

OBJECTIVE

To ascertain the clinical and sociodemographic factors associated with family caregivers' burden in Chinese patients with stroke in Hong Kong.

DESIGN

Cross-sectional design.

SETTING

Stroke Clinic.

PARTICIPANTS

Patients (N=123) from a stroke clinic and their family caregivers.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Predictive factors of family caregivers' burden in Chinese stroke patients in Hong Kong. Caregivers' burden was assessed with the Caregiving Burden Scale (CBS). Patients' and caregivers' sociodemographic data and clinical characteristics were recorded. Physical and psychological conditions were measured and rated with the following instruments: Cumulative Illness Rating Scale, Geriatric Depression Scale (GDS), Barthel Index, Instrumental Activities of Daily Living, Mini-Mental State Examination, Lubben Social Network Scale, Modified Life Event Scale (MLES), Hospital Anxiety and Depression Scale (HADS), and a single question about fatigue.

RESULTS

In the univariate analysis, the CBS score had significant correlations with certain characteristics of caregivers (sex, GDS, HADS, depressive symptoms, fatigue, and MLES) and those of patients' (sex, age, education, GDS). Regression analysis revealed that caregivers' GDS and patients' education were the independent correlates of the CBS.

CONCLUSIONS

The severity of depressive symptoms in Chinese stroke caregivers and patients' education are independent factors associated with the caregivers' burden. Further studies evaluating interventions on caregivers' burden should include the assessment and management of mood disorders.

Correlations between Pre-morbid Personality and Depression Scales in Stroke Patients

Objective

To investigate the correlation between pre-morbid personality and depression scales in patients with stroke.

Method

The subjects of this study included 45 patients with stroke and their caregivers. We conducted an interview of patients with Beck Depression Inventory (BDI) and also evaluated general characteristic (age, sex, location of lesion, cause of stroke, duration of illness, educational background, history of medication for depression) and functional level. Caregivers were evaluated with Hamilton Rating Scale for Depression (HRSD) for depressive mood, with NEO-PI (Neuroticism, Extraversion and Openness Personality Inventory) for pre-morbid personality. The results of each questionnaire were analyzed in order to investigate their correlation. The results were statistically analyzed with independent t-test, ANOVA, and Pearson correlation test.

Results

The HRSD score of the caregivers had a significant correlation with the BDI score (p=0.001) of the patients. The BDI score correlated with Neuroticism (p=0.021) and the HRSD score also correlated with Neuroticism (p=0.015). There were no statistical correlation of depression with sex, age, case of stroke, location of lesion, duration of illness and functional level.

Conclusion

Among pre-morbid personalities, neuroticism of NEO-PI is the only factor which is significantly correlated with depression scales in stroke patients. Evaluating pre-morbid personality can be helpful in predicting the depressive mood in stroke patients, so we may have early intervention for it.

A prospective cohort study of the incidence and determinants of post-stroke depression among the mainland Chinese patients

BACKGROUND

Post-stroke depression is a common consequence of stroke and can negatively affect the rehabilitation process in patients. This work was undertaken to examine the incidence, demographic factors and clinical determinants of post-stroke depression in 3 months after ischemic stroke in mainland Chinese patients.

METHODS

One hundred and sixty-five patients with acute ischemic stroke were included in the present work. The Diagnostic and Statistical Manual of Mental Disorders (fourth edition) diagnosis of post-stroke depression was evaluated by the World Health Organization Composite International Diagnostic Interview during the follow-up exam at 3 months after the stroke. The demographic factors and clinical variables at the time of stroke onset and 14 days after stroke were also examined.

RESULTS

The 3 month cumulative incidence of post-stroke depression was 27.3% in this patient population. The univariate analysis suggests that the female gender, past history of depression, marital status and level of handicap at 14 days after stroke were factors associated with the development of post-stroke depression. In the multivariate model, female gender [p=0.0040; odds ratio (OR)=3.550; 95% confidence interval (CI): 1.499-8.408], past history of depression (p=0.0010; OR=5.225; 95% CI: 1.959-13.940) and level of handicap at 14 days after stroke (p=0.0066; OR=1.607; 95% CI: 1.141-2.262) were further confirmed as demographic and clinical factors that correlate with the development of post-stroke depression.

CONCLUSION

The present work suggests that female gender, history of depression and level of handicap at 14 days after stroke are three independent determinants of post-stroke depression occurrence during the first 3 months after ischemic stroke in mainland Chinese patients.

Characteristics of mood disorders in Japanese patients with medication-overuse headache

OBJECTIVE

The importance of psychiatric comorbidity in migraine has long been recognized. There is a growing body of evidence that these psychiatric comorbidities share diverse epidemiological properties, pathophysiological mechanisms, and treatment response. The prevalence of psychiatric comorbidities is high in patients with medication-overuse headache (MOH).

METHODS

To understand the characteristics of mood disorders in MOH in Japanese patients, we studied and evaluated the characteristics of psychiatric comorbidities in MOH.

RESULTS

The results suggested that mood disorders in MOH are similar to those in endogenous depression but different from those of secondary mood disorders associated with other diseases. Suspicion of depression and intervention are essential for providing medical care for patients with MOH.

CONCLUSION

Affective disorders diagnosed in migraine patients might later progress to MOH. In contrast, migraine patients without MOH and healthy subjects had a similar prevalence of mood disorders.

Circadian variation of core body temperature in Parkinson disease patients with depression: a potential biological marker for depression in Parkinson disease

BACKGROUND

The biological rhythm in comorbidity of depression and Parkinson disease (PD) is still unclear. For early diagnosis or clarification of the pathologic condition of comorbidity of depression and PD, the present study investigated the presence of circadian rhythm abnormalities in patients with depression.

METHODS

We measured the rectal temperature (RT) in 30 PD patients with or without depression during 48 consecutive hours using the maximum entropy method (MEM) and least-squares method (COSINOR). The presence of major or minor depression was evaluated by the Mini International Neuropsychiatric Interview based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders, and the Hamilton Depression Scale.

RESULTS

The RT rhythms of patients without depression predominately showed a circadian rhythm. However, 2 of 6 patients with depression showed an infradian rhythm using MEM. COSINOR revealed that PD patients with depression showed lower amplitudes of core body temperature (p = 0.012) and higher minimum RT (p = 0.031) relative to those of patients without depression.

CONCLUSION

PD patients with depression show an altered RT circadian rhythm. The results suggest that the characteristics of core body temperature could be potentially used as a biological marker for depression in PD.

A prospective study in one year cumulative incidence of depression after ischemic stroke and Parkinson's disease: a preliminary study

BACKGROUND AND AIMS

1) To measure the one year cumulative incidence of depression after ischemic stroke event and 2) to compare its incidence with that of Parkinson's disease (PD) in an outpatient neurology department.

MATERIALS AND METHODS

Stroke patients were recruited after their first diagnosis and PD patients were recruited during the same recruitment period. Main measures included: 1) disability (Barthel Index and Modified Rankin Scale), 2) cognitive function (Thai Mental State Examination and 3) depression (Clinical Interview Schedule-Revised). The patients were assessed at 1, 2, 3, 6 and 12 months.

RESULTS

Seventy-seven stroke patients with hemispheric infarction and 59 PD patients were recruited. The baseline characteristics of the two groups were comparable except that stroke patients were 4 years younger. The cumulative one year incidence of depression was 12% after stroke and 5.1% in PD with no significant difference. Cox regression analysis showed that the risk for depression among stroke cohort was almost three times higher, although not statistically significant, than that among PD cohort (hazard ratio 2.92). In stroke, depression mainly occurred within 3 months after the event but in PD, depression developed randomly throughout the follow up period.

CONCLUSION

The one year cumulative incidence of post-stroke depression in the Thai population is much lower than in the Caucasian population. However, its adjusted cumulative incidence was much higher to that of PD. The findings are in line with previous studies that stroke significantly contributes to the pathogenesis of depression.