Lesion Location and Poststroke Depression

The Relationship Between Poststroke Dysphagia and Poststroke Depression and Its Risk Factors

PURPOSE

A diagnosis of dysphagia and/or depression after stroke can impact the physical, psychological, and social welfare of stroke survivors. Although poststroke depression (PSD) and poststroke dysphagia are known to occur concurrently, there is a paucity of research that has specifically investigated their association. Therefore, we aimed to study the relationship between PSD and poststroke dysphagia during acute inpatient hospitalization and within 90 days after discharge. Furthermore, we aimed to evaluate the odds and hazard of being diagnosed with depression after stroke and estimate the time to depression diagnosis from the initial stroke diagnosis in patients with and without a diagnosis of dysphagia.

METHOD

Using the acute inpatient hospital data set from our previous work, we pulled additional postdischarge administrative claims data from the 2017 Medicare 5% Limited Data Set and conducted a retrospective, cross-sectional study of patients diagnosed with poststroke dysphagia and PSD.

RESULTS

Patients diagnosed with poststroke dysphagia had 2.7 higher odds of being diagnosed with PSD and had an approximately 1.75-fold higher hazard for PSD diagnosis in the 90 days after discharge compared to patients not diagnosed with dysphagia. Risk factors for PSD included having dysphagia, being female, and having dual eligibility.

CONCLUSIONS

Our results demonstrated a significant association between PSD and poststroke dysphagia. Additional research should further explore the impact of PSD on poststroke dysphagia.

Identification of depression in patients with acute coronary syndrome using multiple serum biomarkers

BACKGROUND

Biomarkers for depression in patients with acute coronary syndrome (ACS) have not been identified.

METHODS

This study evaluated multiple serum biomarkers for depressive disorders after ACS. Thirteen serum biomarkers associated with seven functional systems, along with sociodemographic/clinical characteristics, were evaluated in 969 patients within 2 weeks after ACS onset (acute phase). In total, 711 patients were evaluated for depressive disorder using DSM-IV criteria 1 year later (chronic phase). Logistic regression was used for the analysis.

RESULTS

Depressive disorders were observed in 378 patients (39.0%) in the acute phase of ACS and 183 patients (25.7%) in the chronic phase. The weighted scores of five serum biomarkers (high-sensitivity C-reactive protein, interleukin-6, homocysteine, troponin I, and creatine kinase-MB) were significantly associated with depressive disorder diagnosis in the acute phase, and the weighted scores of three other biomarkers (tumor necrosis factor-alpha, interleukin-1 beta, and homocysteine) were significantly associated with depressive disorders in the chronic phase, in a dose-dependent manner after adjusting for relevant covariates (all P-values <0.001).

CONCLUSIONS

The combination of several serum biomarkers exhibited robust associations with depressive disorders in both the acute and chronic phases of ACS.

Predicting suicidal ideation using multiple serum biomarkers in patients with acute coronary syndrome

BACKGROUND

Biomarkers for suicidal behavior in patients with acute coronary syndrome (ACS) have yet to be elucidated. This study aimed to identify a panel of serum biomarkers associated with suicidal ideation (SI) in patients with ACS.

METHODS

The study evaluated 969 patients within 2 weeks of ACS (acute phase) and 711 patients 12 months later (chronic phase). The evaluation included 14 serum biomarkers covering 7 functional systems, socio-demographic/clinical characteristics, and SI assessed by the "suicidal thoughts" item of the Montgomery-Åsberg Depression Rating Scale. Logistic regression models were used to analyze the data. The results showed that 195 patients (20.1 %) had SI in the acute phase, and 87 patients (12.2 %) had SI in the chronic phase.

RESULTS

A combination of five serum biomarkers (tumor necrosis factor-α, interleukin-1β, folate, troponin I, and creatine kinase-MB) was significantly associated with SI in the acute phase, and a combination of three serum biomarkers (tumor necrosis factor-α, interleukin-1β, and folate) was significantly associated with SI in the chronic phase in a clear dose-dependent manner (all P-values < 0.001) after adjustment for relevant covariates.

DISCUSSION

These findings suggest that the application of a combination of multiple serum biomarkers could improve the predictability of SI in patients with ACS at both acute and chronic phases.

Review of EEG-based neurofeedback as a therapeutic intervention to treat depression

Depression, or major depressive disorder, is a common mental disorder that affects individuals' behavior, mood, and physical health, and its prevalence has increased during the lockdowns implemented to curb the COVID-19 pandemic. There is an urgent need to update the treatment recommendations for mental disorders during such crises. Conventional interventions to treat depression include long-term pharmacotherapy and cognitive behavioral therapy. Electroencephalogram-neurofeedback (EEG-NF) training has been suggested as a non-invasive option to treat depression with minimal side effects. In this systematic review, we summarize the recent literature on EEG-NF training for treating depression. The 12 studies included in our final sample reported that despite several issues related to EEG-NF practices, patients with depression showed significant cognitive, clinical, and neural improvements following EEG-NF training. Given its low cost and the low risk of side effects due to its non-invasive nature, we suggest that EEG-NF is worth exploring as an augmented tool for patients who already receive standard medications but remain symptomatic, and that EEG-NF training may be an effective intervention tool that can be utilized as a supplementary treatment for depression. We conclude by providing some suggestions related to experimental designs and standards to improve current EEG-NF training practices for treating depression.

Associations of systemic inflammation and social support with suicidal ideation in patients with acute coronary syndrome and stroke

BACKGROUND

This study aimed to investigate associations of serum high-sensitivity C-reactive protein (hsCRP) and social support (SS) levels with suicidal ideation (SI), and to evaluate potential modifying effects of SS on the associations between serum hsCRP levels and SI in two longitudinal cohorts with cardio-/cerebrovascular diseases.

METHODS

1152 acute coronary syndrome (ACS) and 423 stroke patients were recruited at baseline within 2 weeks of disease onset, and evaluated for: i) serum hsCRP levels; ii) SS by the Social Support Scale and Social Undermining Scale; iii) SI by the "suicidal thoughts" item of the Montgomery-Åsberg Depression Rating Scale; and iv) covariates including socio-demographics, depression, vascular risk factors, and index disease severity. At 12-month follow-up, SI was re-evaluated. Logistic regression models were used to adjust for potential covariates.

RESULTS

In the ACS cohort, higher serum hsCRP and lower SS levels were significantly associated with SI at baseline; and only lower SS levels were significantly associated with SI at follow-up. In the stroke cohort, lower SS levels were significantly associated with SI at baseline; but no other association was found. Associations of serum hsCRP levels with SI at both baseline and follow-up were only significant at higher SS levels with significant interaction terms in both cohorts.

LIMITATIONS

This study evaluated SI, but not suicide attempts or death; it also used a single-center design.

CONCLUSIONS

By considering SS evaluations with routine serum hsCRP levels in cardio-/cerebrovascular disease, clinical prediction of SI both at acute and chronic phases of the diseases might be improved.

Emotional processing in patients with single brain damage in the right hemisphere

BACKGROUND

The interest in the relationship between brain damage and social cognition has increased in recent years. The objectives of the present study were the following: (1) to evaluate and compare emotional facial recognition and subjective emotional experience in patients who have suffered a single ischemic stroke in the right hemisphere (RH) and in healthy people, (2) to analyze the relationship between both variables in both groups of subjects, and (3) to analyze the association between the cerebral location of the stroke and these two variables.

METHODS

Emotional facial recognition and the subjective emotional experience of 41 patients who had suffered a single ischemic stroke in the RH and 45 volunteers without previous cerebrovascular pathology were evaluated.

RESULTS

Brain damaged patients performed lower in facial emotional recognition and had a less intense subjective emotional response to social content stimuli compared to healthy subjects. Likewise, among patients with RH ischemic stroke, we observed negative associations between facial recognition of surprise and reactivity to unpleasant images, and positive associations between recognition of disgust and reactivity to pleasant images. Finally, patients with damage in the caudate nucleus of the RH presented a deficit in the recognition of happiness and sadness, and those with damage in the frontal lobe exhibited a deficit in the recognition of surprise, compared to those injured in other brain areas.

CONCLUSIONS

Emotional facial recognition and subjective emotional experience are affected in patients who have suffered a single ischemic stroke in the RH. Professionals caring for stroke patients should improve their understanding of the general condition of affected persons and their environment, assess for risk of depression, and facilitate their adaptation to work, family, and social environments.

Incidence of Poststroke Depression in Patients With Poststroke Dysphagia

PURPOSE

Poststroke dysphagia and poststroke depression (PSD) can have devastating effects on stroke survivors, including increased burden of care, higher health care costs, poor quality of life, and greater mortality; however, there is a dearth of research examining depression in patients diagnosed with dysphagia after stroke. Thus, we aimed to study the incidence of PSD in patients with poststroke dysphagia to provide foundational knowledge about this patient population.

METHOD

We conducted a retrospective, cross-sectional study of individuals with a primary diagnosis of acute ischemic stroke (AIS) and secondary diagnoses of dysphagia and/or depression using administrative claims data from the 2017 Medicare 5% Limited Data Set.

RESULTS

The proportion of depression diagnosis in patients with poststroke dysphagia was significantly higher than the proportion of depression diagnosis in those without poststroke dysphagia during acute hospitalization: 12.01% versus 9.52%, respectively (p = .003).

CONCLUSIONS

Our results demonstrated that persons with poststroke dysphagia were as, or slightly more, likely to have PSD compared to the general stroke population, and to our knowledge, they establish the first reported incidence of PSD in Medicare patients with dysphagia after AIS. Future research is warranted to further explore the effects of PSD on poststroke dysphagia.

Toward unraveling the correlates of fatigue in glioma

BACKGROUND

Even though fatigue is one of the most prevalent and burdensome symptoms in patients with glioma, its etiology and determinants are still poorly understood. We aimed to identify which demographic, tumor- and treatment-related characteristics and patient-reported outcome measures (PROMs) are associated with or are predictors of fatigue in glioma.

METHODS

In this retrospective observational study, we included glioma patients with preoperative and postoperative assessments including PROMs on fatigue, depression, cognitive functioning, and health-related quality of life (HRQoL). Linear mixed models were used to identify which clinical factors and PROMs were associated with fatigue and linear multiple regression was used to detect predictors of postoperative fatigue.

RESULTS

In this study, 222 patients were included (78% grade II-III glioma, 22% grade IV). These patients had performed 333 assessments (193 preoperative and 116 one year postoperatively). Of all assessments, 39% was indicative of severe fatigue. Several HRQoL domains, depression, and right-sided tumors were significantly associated with fatigue (marginal R 2 = 0.63). Contrary to common expectations, tumor type, treatment-related factors, and timing of the assessment, were not associated with fatigue. In a subgroup of 70 patients with follow-up assessments, preoperative fatigue, and physical functioning were predictors of postoperative fatigue (adjusted R 2 = 0.31).

CONCLUSION

Fatigue is a complex symptom, which should not solely be attributed to the tumor or its treatment, but is instead related to different aspects of mood and HRQoL. These insights are important in understanding fatigue and could guide symptom management, especially in patients with lower-grade tumors.

Factors Associated with Post-Stroke Depression in Chinese Stroke Survivors

OBJECTIVES

To explore the relationship between participation self-efficacy, sociodemographic and clinical characteristics, and post-stroke depression in stroke survivors and provide insights into the development of rehabilitation programmes.

MATERIALS AND METHODS

A cross-sectional descriptive study was conducted with 336 participants recruited from five hospitals in Kunming, China. Measures included the Chinese version of the Participation Strategies Self-Efficacy Scale (PS-SES-C), Geriatric Depression Scale (GDS), modified Barthel Index, Rivermead Mobility Index (RMI), Reintegration to Normal Living Index (RNLI), and the Social Support Questionnaire (SSQ6). Logistic regression analyses were performed using SPSS 25.0.

RESULTS

Nearly half (44.6%) of the sample was found to have depression. The mean participation self-efficacy score of stroke survivors with depression was significantly lower than that of those without depression. Logistic regression analyses suggested that participation self-efficacy is a constant and major factor negatively associated with depression, with every 10-pt increase in the PS-SES-C score associated with decreased odds of depression (p<0.001). Other features associated with depression prevalence to varying degrees included education level, marital status, pre-morbid financial role in family, stroke symptom severity, history of heart disease, frequency of stroke, lesion side, stroke type, and use of assistive aids.

CONCLUSIONS

Participation self-efficacy is negatively associated with depression in stroke survivors. Rehabilitation programmes might consider incorporating interventions aimed at boosting participation self-efficacy in order to promote positive recovery outcomes among survivors.

Stroke rehabilitation and recovery

Stroke is the UK's leading cause of disability. Stroke rehabilitation can maximise recovery and improve quality of life. This article discusses some post-stroke impairments, including hemiplegia, dysphagia, communication impairments and neglect, and how rehabilitation can address these. Developing techniques of adaptation or compensation is vital, since the extent of stroke recovery is dependent on successful neuroplasticity, with healthy neurons adapting to compensate for damaged ones.

Lesions in the right Rolandic operculum are associated with self-rating affective and apathetic depressive symptoms for post-stroke patients

Stroke survivors majorly suffered from post-stroke depression (PSD). The PSD diagnosis is commonly performed based on the clinical cut-off for psychometric inventories. However, we hypothesized that PSD involves spectrum symptoms (e.g., apathy, depression, anxiety, and stress domains) and severity levels. Therefore, instead of using the clinical cut-off, we suggested a data-driven analysis to interpret patient spectrum conditions. The patients’ psychological conditions were categorized in an unsupervised manner using the k-means clustering method, and the relationships between psychological conditions and quantitative lesion degrees were evaluated. This study involved one hundred sixty-five patient data; all patients were able to understand and perform self-rating psychological conditions (i.e., no aphasia). Four severity levels—low, low-to-moderate, moderate-to-high, and high—were observed for each combination of two psychological domains. Patients with worse conditions showed the significantly greater lesion degree at the right Rolandic operculum (part of Brodmann area 43). The dissimilarities between stress and other domains were also suggested. Patients with high stress were specifically associated with lesions in the left thalamus. Impaired emotion processing and stress-affected functions have been frequently related to those lesion regions. Those lesions were also robust and localized, suggesting the possibility of an objective for predicting psychological conditions from brain lesions.

Depression in Poststroke Aphasia

Purpose The aim of this tutorial is to provide speech-language pathologists with foundational knowledge of poststroke depression comorbidly occurring with aphasia. Given the negative effect of depression on functional outcomes and mortality, it is crucial that speech-language pathologists possess this knowledge in order to better advocate for and treat their patients. Method and Results Three areas of complementary expertise (speech-language pathology, psychology, and neurology) collaborated on this tutorial to address the following areas: (a) provide terminology associated with depression and related mood disorders, (b) describe the potential underlying pathophysiology of depression in the general population, (c) provide an overview of our existing understanding of comorbid poststroke depression and aphasia, and (d) summarize current assessment methods and interventions for poststroke depression in adults with aphasia. Conclusion Given the compounding impact aphasia and depression have on rehabilitation outcomes, it is imperative that speech-language pathologists understand terminology, assessment, and treatment practices for depression.

Assessing Self-Reported Mood in Aphasia Following Stroke: Challenges, Innovations and Future Directions

Assessment of mood is critical in determining rehabilitation outcomes for stroke and other acquired brain injury, yet a common consequence of such injuries is aphasia, where language is impaired. Consequently, the use of language-based measures in this population is often not possible. Following a critical review of the neuropsychological aspects of self-reported mood, this paper evaluates the problems in reporting mood after stroke due to aphasia, and discusses implications for the design of adapted instruments. The paper then appraises the construction and psychometric properties of existing, adapted self-report measures developed to try and address these problems, and evaluates their utility and limitations. This includes a focus on the recently validated tablet-based Dynamic Visual Analog Mood Scales (D-VAMS), which uses innovative non-verbal assessment methods based on facial expression modulated via a slider control on a touchscreen interface. Currently, most studies evaluating recovery interventions simply omit individuals with aphasia because of the difficulty of assessing mood and quality of life in this population. However, adapted scales such as the D-VAMS appear to represent an important step forward in assessing mood in people with language impairments, with the use of interactive modulated imagery having wider applications for nonverbal communication as well as the quantification of subjective phenomena.

Self-perceived postural balance correlates with postural balance and anxiety during the first year after stroke: a part of the randomized controlled GOTVED study

BACKGROUND

Postural balance is an important rehabilitation outcome, and screening stroke patients for confidence in postural balance during rehabilitation and before hospital discharge is recommended. Early supported discharge could improve postural balance self-confidence. This study aimed to investigate associations between patient self-confidence in postural balance and observer-assessed postural balance and anxiety during the first year after stroke. Whether very early supported discharge (VESD) affects self-confidence in postural balance compared with standard discharge was also evaluated.

METHODS

A longitudinal trial for with data extracted from a randomized controlled study of 140 adults with confirmed stroke was conducted. The experimental group received VESD. The control group was discharged according to the standard routine. Postural balance was assessed with Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Falls Efficacy Scale. Anxiety was assessed with the Hospital Anxiety and Depression Scale. Spearman's rank correlation coefficient (rho) was used to test associations between independent variables. The Wilcoxon signed-rank test was used to examine differences over time. A single test, according to Eid, Gollwitzer, and Schmidt, was used to test temporal differences in correlation.

RESULTS

The correlation between self-confidence in postural balance and observer-assessed postural balance was 0.62-0.78 in the first year after stroke. The correlation between self-confidence and anxiety was 0.22-0.41 in the first year after stroke. Correlations did not differ by group affiliation at any time point when the postural balance was assessed with BBS. The intervention group had a significantly higher correlation (r = - 0.709) than the control group (r = - 0.416) when postural balance was assessed with the TUG test 1 month after discharge. There were no significant differences in correlations between confidence in postural balance and anxiety between the two groups at any time point.

CONCLUSIONS

Patients with mild stroke can accurately assess their confidence in performing daily activities without falling. VESD does not substantially affect the correlation between self-confidence in postural balance and observer assessed postural balance and is safe to use as an alternative to standard discharge. Assessment of self-confidence can provide important information for rehabilitation planning and supporting the physical activity of patients after discharge.

TRIAL REGISTRATION

Clinical Trials.gov: NCT01622205 . Registered 19 June 2012 (retrospectively registered).

Factors related to post-stroke depression during the first 2 weeks after stroke

Introduction

This study aimed to clarify factors associated with post-stroke depression in patients with acute stroke within 2 weeks of onset.

Method

Eighty-eight patients with stroke were divided into post-stroke depression ( n = 49) and non-post-stroke depression ( n = 39) groups based on their Hamilton Depression Rating Scale scores. We evaluated stroke severity, upper limb function, activities of daily living, frontal lobe/cognitive function, and level of apathy. Activity levels were measured using an ActiGraph GT9X Link system. Mann–Whitney U-tests were used to determine differences between the two groups. Spearman’s rank correlation and logistic regression analyses were also performed.

Results

The post-stroke depression and non-post-stroke depression groups exhibited significant differences in National Institutes of Health Stroke Scale scores at admission and discharge; Functional Independence Measure exercise items, cognitive items, and total items at admission; Fugl-Meyer Assessment scores; and Apathy Rating Scale scores. Logistic regression indicated that Fugl-Meyer Assessment scores were associated with post-stroke depression.

Conclusion

Stroke severity, paralysis, and physical function/activities of daily living ability are associated with post-stroke depression in the acute phase. Our findings suggest that increases in physical impairment severity are associated with increased post-stroke depression risks. Rehabilitation professionals should focus on identifying post-stroke depression in early post-stroke stages.

Poststroke depression among stroke survivors in Sub-Himalayan region

INTRODUCTION

Stroke is a leading cause of long-term disability and loss of productive life in developing countries, including India. Ischemic stroke accounts for 85% of all types of stroke with a prevalence of 5%-15% among acute stroke incidents. The prevalence of poststroke depression among acute stroke survivors is varied from 5 to 54%. The study focused on depression among stroke survivors who actively involved in a home-based rehabilitation.

MATERIALS AND METHODS

A descriptive cross-sectional survey was conducted by enrolling 138 stroke survivors consecutively at tertiary care public hospital, North India. A sociodemographic and clinical profile sheet was used to seek information on personal and clinical variables. Information on disability, depression, performance in the activity of daily living, and degree of stroke severity was ascertained by using the Modified Rankin Scale (MRS), Physical Health Questionnaire (PHQ-9), Barthel Index, and National Institutes of Health Stroke (NIHSS). After binary logistic regression model, a multivariate logistic regression was applied to detect the independent predictor of depression.

RESULTS

Over 86% (119) of the stroke survivors had no symptoms of depression, and only 14% (19) were reported to have symptoms of depression. Poststroke depression found significant association with disability (P = 0.029) and functional independence (P = 0.0001). A significant difference was observed in the gender (P = 0.018), types of stroke (P = 0.0001), and location of lesion (P = 0.0001) with depression. Binary logistic regression model shows that disability (MRS) status of stroke survivor (P < 0.0001; 95% CI 1.998-2.638) and functional independence (BI) (P < 0.0001; 95% CI -0.034-0.020) are same as independent predictors for depression.

CONCLUSION

Clinician should use the community reintegration, referral, and mandatory screening of the stroke survivors at follow-up visit to rule out the probability of occurrence of poststroke depression.

PREDICTORS OF EARLY-ONSET DEPRESSION AFTER FIRST-EVER STROKE

Post-stroke depression (PSD) is a severe and frequent stroke complication and one of the crucial factors for the outcome of rehabilitation and life quality after stroke. However, mood disorders frequently remain unnoticed and therefore untreated. The aim of the study was to examine all the potential risk factors and determine the independent predictors of early-onset depression after first-ever stroke, which would help identify high-risk patients, establish early diagnosis and timely treatment that would improve the course and prognosis of this disorder. This prospective study included 60 patients treated for their first-ever stroke; there were 30 patients diagnosed with depression and 30 patients without depression. The study included collection and analysis of all socio-demographic and clinical risk factors for PSD. Testing was performed two weeks after stroke. Depression was diagnosed according to the Mini International Neuropsychiatry Interview, DSM-IV diagnostic criteria, and depression severity was quantified by the Hamilton Depression Rating Scale. Cognitive impairment was assessed by the Mini Mental State Examination. Neurological deficit was assessed by the US National Institute of Health Stroke Scale. Our results showed that the independent predictors of early-onset depression after stroke were previous depressive episodes, cognitive dysfunction, and more severe neurological deficit.

Contact Location and Neuropsychological Outcomes in Subthalamic Deep Brain Stimulation

BACKGROUND

A host of influences contribute to cognitive and behavioral changes following deep brain stimulation. The location of the active cathode is likely an important variable but it has received little attention.

OBJECTIVE

To determine whether active contact location relative to the subthalamic nucleus and other neighboring structures is related to nonmotor outcomes.

METHODS

We identified a retrospective, cross-sectional sample of 46 patients who underwent subthalamic nucleus deep brain stimulation for treatment of idiopathic Parkinson's disease. T-tests or nonparametric equivalents were used to detect baseline differences between unilateral left, unilateral right, and bilateral surgical groups. Correlation and partial correlational analyses identified relationships between contact location variables and alterations in cognitive, mood, quality of life, motor, and disease variables.

RESULTS

Medial contact locations within the left subthalamic nucleus were correlated with improvements in self-reported mood (r12 = -0.78, P = .001; 95% confidence interval [CI] = -0.43 to -0.93) but worsening semantic fluency (r26 = -0.38, P = .048; 95% CI = -0.01 to -0.66). Phonemic fluency worsened with more posterior left placement (r34 = 0.35, P = .036; 95% CI = 0.03 to 0.61). Memory outcome was related to right hemisphere stimulation voltage (r29 = -0.40, P = .022; 95% CI = -0.05 to -0.66), which is likely a proxy for variable electrode location.

CONCLUSION

Location of the active contact is related to nonmotor outcomes, even in electrodes that are adequately placed. This is relevant to clinical care as there appears to be a trade-off between mood and fluency abilities that should be considered during surgical planning according to preoperative patient characteristics.

Correlated Resting-State Functional MRI Activity of Frontostriatal, Thalamic, Temporal, and Cerebellar Brain Regions Differentiates Stroke Survivors with High Compared to Low Depressive Symptom Scores

Background

One in three survivors of stroke experience poststroke depression (PSD). PSD has been linked with poorer recovery of function and cognition, yet our understanding of potential mechanisms is currently limited. Alterations in resting-state functional MRI have been investigated to a limited extent. Fluctuations in low frequency signal are reported, but it is unknown if interactions are present between the level of depressive symptom score and intrinsic brain activity in varying brain regions.

Objective

To investigate potential interaction effects between whole-brain resting-state activity and depressive symptoms in stroke survivors with low and high levels of depressive symptoms.

Methods

A cross-sectional analysis of 63 stroke survivors who were assessed at 3 months poststroke for depression, using the Montgomery–Åsberg Depression Rating Scale (MÅDRS-SIGMA), and for brain activity using fMRI. A MÅDRS-SIGMA score of >8 was classified as high depressive symptoms. Fractional amplitude of frequency fluctuations (fALFF) data across three frequency bands (broadband, i.e., ~0.01–0.08; subbands, i.e., slow-5: ~0.01–0.027 Hz, slow-4: 0.027–0.07) was examined.

Results

Of the 63 stroke survivors, 38 were classified as “low-depressive symptoms” and 25 as “high depressive symptoms.” Six had a past history of depression. We found interaction effects across frequency bands in several brain regions that differentiated the two groups. The broadband analysis revealed interaction effects in the left insula and the left superior temporal lobe. The subband analysis showed contrasting fALFF response between the two groups in the left thalamus, right caudate, and left cerebellum. Across the three frequency bands, we found contrasting fALFF response in areas within the fronto-limbic-thalamic network and cerebellum.

Conclusions

We provide evidence that fALFF is sensitive to changes in poststroke depressive symptom severity and implicates frontostriatal and cerebellar regions, consistent with previous studies. The use of multiband analysis could be an effective method to examine neural correlates of depression after stroke. The START-PrePARE trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12610000987066.

Does stroke laterality predict major depression and cognitive impairment after stroke? Two-year prospective evaluation in the EMMA study

Depression and cognitive impairment are common conditions following stroke. We aimed to evaluate stroke laterality as predictor of post-stroke depression (PSD) and cognitive impairment (PCI) in a stroke cohort. Major depression (Patient Health Questionnaire-9, score ≥ 10) and cognitive impairment (Modified Telephone Interview for Cognitive Status, score < 14) were evaluated at 6 months and yearly up to 2 years. Survival analyses were performed by Kaplan-Meier curves and Cox logistic regression models, adjusted for potential confounders (cumulative hazard ratio, HR; 95% confidence interval, CI), for the likelihood of subsequent PSD or PCI progression at 6 months and 2 years, according to stroke laterality (right hemisphere-reference). Among 100 stroke patients, we found 19% had PSD and 38% had PCI 2 years after stroke. Most participants (53%) presented right-sided stroke. However, right-sided stroke was not associated with PSD or PCI. Overall, left-sided stroke was an independent and long-term predictor of PCI, but not of major depression. Left-sided stroke was associated with a high probability of PCI (42.6% and 53.2%, respectively at 6 months and 2 years, p-log-rank: 0.002). The HR of PCI due to left-sided stroke was 3.25 (95%CI, 1.30-8.12) at 6 months and remained almost the same at 2 years (HR,3.22;95%CI, 1.43-7.28). The risk of having worse cognition status increased by >3 times, 2 years after stroke. The results support the hypothesis that involvement of networks in the left, but not in the right hemisphere, contribute to long-term cognitive impairment. Lesion laterality did not influence the risk of PSD.

A cross-sectional study to assess the association between major depression and inflammatory markers in patients with acute ischemic stroke

BACKGROUND

Increased interest in the relationship between affective disorder and long-term health consequences has generated recent examinations of depression and stroke. Observations suggest that depressive disorder is associated with abnormal physiological and immunological responses and a resultant increase in inflammatory markers. Given the high prevalence of stroke and associated costs for the community, it is important to understand the mechanisms that may impact on the outcome to achieve the best possible prognosis.

AIMS

The view that inflammatory factors contribute to depression is predicated on findings that circulating cytokines and other inflammatory factors are increased in depressed patients. Therefore, it has been hypothesized that inflammation could be one of the mechanisms by which depression increases risk for ischemic stroke. Our aim was to determine whether there is any relationship between major depression and tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β), IL-18, brain-derived neurotrophic factor (BDNF), and neuron-specific enolase (NSE) in patients with acute ischemic stroke (AIS).

STUDY DESIGN

This was as a cross-sectional design.

MATERIALS AND METHODS

This study has a cross-sectional design, and it was conducted in Necmettin Erbakan University, the Meram Faculty of Medicine in Konya, Turkey, between 2014 and 2015. Fifty-three AIS patients admitted to the hospital within the first 24 h after stroke onset were recruited. Major depression was ascertained by means of the structured clinical interview for the diagnostic and statistical manual of mental disorders, Fourth Edition/Clinical Version. The enzyme-linked immunosorbent assay was used to measure the serum levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE at admission.

RESULTS

A total of 53 patients with a mean age of 65.9 years were recruited. Of these patients, 17 (32.1%) had major depression. Depressive and nondepressive patients had similar demographical and clinical features. There was no significant statistical difference between depressive and nondepressive patients with AIS with respect to levels of TNF-α, IL-1 β, IL-18, BDNF, and NSE.

CONCLUSION

This study suggests that in patients who have experienced AIS, there is no significant relationship between major depression and basal proinflammatory cytokines (TNF-α, IL-1 β, IL-18), BDNF, and NSE.

Post-stroke depression and cognitive impairment: Study design and preliminary findings in a Brazilian prospective stroke cohort (EMMA study)

BACKGROUND

Post-stroke depression (PSD) and cognitive impairment (PCI) are common conditions. This study aims to describe the protocol and preliminary findings of an investigation into factors associated with PSD and PCI 1-3 months after stroke (subacute phase) in survivors from the Study of Stroke Mortality and Morbidity (EMMA study).

METHODS

Stroke patients underwent to clinical and neurological evaluations on admission to hospital. Cerebral magnetic resonance and biomarkers (serotonin, BDNF, IL-6 and IL-18) were carried out in the subacute phase. DSM-IV major depression for the diagnosis of PSD, cognitive functioning for the diagnosis of PCI and functional disability were also recorded at same time.

RESULTS

Of the 103 eligible patients, 85.4% had ischemic stroke and 73.7% had first-ever stroke. In the subacute phase, 27.2% had PCI and 13.6% had current PSD (5.8% with 'first episode' and 7.8% with 'recurrent' depression). PCI was associated with low education (0-7 years of formal education: 75%) and ageing (median age: 70; interquartile range: 59-75 y-old). Left-sided stroke was more frequently associated with increased PCI than right-sided stroke (71.4% vs. 28.4%, p = 0.005). PSD was neither associated with stroke laterality nor tentorial area. Overall, biomarkers levels were not alterated in patients with PSD and PCI.

LIMITATIONS

Findings are based on small sample and less disabled stroke participants, e.g. those without aphasia and deafness.

CONCLUSIONS

Findings reinforce the need of early recognition and rehabilitation of PCI and PSD, mainly among those less educated and with left-sided stroke. PSD might occur through a pathophysiological pathway other than classical depression.

Positive Correlation between Left Hemisphere Lesion and Erectile Dysfunction in Post-Stroke Patients

BACKGROUND:

Stroke is a serious health condition and the leading cause of disability, including erectile dysfunction (ED). The mechanisms and factors that predict ED in stroke are not fully elucidated. Several studies have shown a relationship between the location of the lesion in stroke with the onset of ED. The left hemispheric lesion was believed to disrupt the parasympathetic nervous system which is responsible for the regulation of erection. Stroke attack in this region therefore can be the underlying reason for ED. However, there are still contradictory findings in this area, and very few studies attempted to look at this problem, particularly among Asian male.

AIM:

We would like to evaluate the association between left hemisphere lesion after ischemic stroke and the subsequent risk of developing ED.

METHODS:

The study was conducted in the neurology polyclinic of Sanglah and Wangaya Hospital from February to August 2013. Subjects are all post-stroke patients who visited the neurology polyclinic of Sanglah and Wangaya Hospital that met inclusion and exclusion criteria.

RESULTS:

There is a significant positive correlation (p < 0.05) between left hemisphere lesions and ED in stroke patients with a correlation coefficient (r) = 0.361 which means weak correlation and p = 0.032.

CONCLUSION:

Left hemisphere lesions positively correlated with ED in stroke patients. Further longitudinal research is needed to see whether left hemisphere lesion in post-stroke patients is a risk factor for ED.

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

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

Behavioral tests that reveal long-term deficits after permanent focal cerebral ischemia in mouse

Efforts are still needed regarding the research of therapeutics for ischemic stroke. While in experimental studies the protective effect of pharmacological agents is often highlighted by a reduction of the lesion size evaluated in the short term (days), in clinical studies a functional recovery of patients suffering from stroke is expected on the long-term (months and years). Long-term functional preclinical studies are highly recommended to evaluate potential neuroprotective agents for stroke, rather than an assessment of the infarction size at a short time point. The present study thus aimed to select among various behavioral tests those able to highlight long-term deficits (3 months) after cerebral ischemia in mice. Permanent focal cerebral ischemia was carried out in male Swiss mice by intraluminal occlusion of the left middle cerebral artery (MCA). Fourteen behavioral tests were assessed from 7 days to 90 days after ischemia (locomotor activity, neurological score, exit circle test, grip and string tests, chimney test, adhesive removal test, pole test, beam-walking tests, elevated plus maze, marble burying test, forced swimming test, novel object recognition test). The present study clearly identified a battery of behavioral tests able to highlight deficits up to 3 months in our mouse model of permanent MCA occlusion (locomotor activity, neurological score, adhesive removal test, pole test, beam-walking tests, elevated plus maze, marble burying test, forced swimming test and novel object recognition test). This battery of behavioral tests highlighting long-term deficits is useful to study future neuroprotective strategies for stroke treatment.

Impact of acute phase depression on functional outcomes in stroke patients over 1 year

This study examined the influence of acute phase post-stroke depression (PSD) on various functional outcomes over 1 year after stroke. PSD was diagnosed at 2 weeks after stroke using the Mini International Neuropsychiatric Interview and functional outcomes were assessed via the National Institutes of Health Stroke Scale, the Barthel Index, and the Mini-Mental State Examination at 2 weeks and 1 year. Acute phase PSD was an independent predictor of poor functional outcomes during both the acute and chronic phases. Considering the negative impact of PSD on stroke outcomes, identification of acute phase PSD is important for improving functional outcomes.

Poststroke Depression Biomarkers: A Narrative Review

Poststroke depression (PSD) is the most prevalent psychiatric disorder after stroke, which is independently correlated with negative clinical outcome. The identification of specific biomarkers could help to increase the sensitivity of PSD diagnosis and elucidate its pathophysiological mechanisms. The aim of current study was to review and summarize literature exploring potential biomarkers for PSD diagnosis. The PubMed database was searched for papers published in English from October 1977 to December 2017, 90 of which met inclusion criteria for clinical studies related to PSD biomarkers. PSD biomarkers were subdivided into neuroimaging, molecular, and neurophysiological. Some of them could be recommended to support PSD diagnosing. According to the data, lesions affecting the frontal-subcortical circles of mood regulation (prefrontal cortex, basal nuclei, and thalamus) predominantly in the left hemisphere can be considered as neuroimaging markers and predictors for PSD for at least 1 year after stroke. Additional pontine and lobar cerebral microbleeds in acute stroke patients, as well as severe microvascular lesions of the brain, increase the likelihood of PSD. The following molecular candidates can help to differentiate PSD patients from non-depressed stroke subjects: decreased serum BDNF concentrations; increased early markers of inflammation (high-sensitivity C-reactive protein, ferritin, neopterin, and glutamate), serum pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-18, IFN-γ), as well as pro-inflammatory/anti-inflammatory ratios (TNF-α/IL-10, IL-1β/IL-10, IL-6/IL-10, IL-18/IL-10, IFN-γ/IL-10); lowered complement expression; decreased serum vitamin D levels; hypercortisolemia and blunted cortisol awakening response; S/S 5-HTTLPR, STin2 9/12, and 12/12 genotypes of the serotonin transporter gene SLC6A4, 5-HTR2a 1438 A/A, and BDNF met/met genotypes; higher SLC6A4 promoter and BDNF promoter methylation status. Neurophysiological markers of PSD, that reflect a violation of perception and cognitive processing, are the elongation of the latency of N200, P300, and N400, as well as the decrease in the P300 and N400 amplitude of the event-related potentials. The selected panel of biomarkers may be useful for paraclinical underpinning of PSD diagnosis, clarifying various aspects of its multifactorial pathogenesis, optimizing therapeutic interventions, and assessing treatment effectiveness.

Best Practices for The Interdisciplinary Rehabilitation Team: A Review of Mental Health Issues in Mild Stroke Survivors

Individuals with mild strokes are generally considered fully functional and do not traditionally receive rehabilitation services. Because patients with mild stroke are assumed to have a good recovery, they may have deficits in other areas, including mental health, that are not addressed. As a result, patients with mild stroke are unable to meet quality of life standards. In addition, healthcare professionals are likely unaware of the potential mental health issues that may arise in mild stroke. To address this gap in knowledge, we review the evidence supporting mental health evaluation and intervention in mild stroke. Specifically, we review comorbid diagnoses including depression, anxiety, fatigue, and sleep disturbances and their potential effects on health and function. Finally, we conclude with general recommendations describing best practice derived from current evidence.

Depressive Symptoms in Individuals after Stroke in a Home-Based Rehabilitation Setting

Poststroke depression has been shown to affect rehabilitation progress. This study evaluated patients after stroke who actively participated in a home-based rehabilitation program to determine variables that correlated with depressive symptoms in this population. A retrospective review of patients who were provided rehabilitation by Community Stroke Rehabilitation Team clinicians between January 1, 2009, and September 30, 2015, was completed. Logistic regression analysis was conducted to determine which demographic and outcome variables (Functional Independence Measure [FIM™] and Reintegration to Normal Living Index [RNLI]) were independently associated with depressive symptoms, as defined by Patient Health Questionnaire (PHQ-9) scores. 889 patients (53.2% male, mean age = 69.8 years) were included. Based on PHQ-9 scores, 89.7% of patients presented with no or mild depressive symptoms (PHQ-9 < 10) and 10.3% were considered to have moderate to severe depressive symptoms (PHQ-9 ≥ 10). The regression demonstrated that referral from outpatient, community care access centre, or community settings (OR = 1.89, p = 0.04), low RNLI scores (OR = 0.92; p = 0.001), and younger age (OR = 0.96; p < 0.001) predicted patients having moderate to severe depressive symptoms. Given the impact of poststroke depression on rehabilitation, clinicians should consider the potential impact of referral source, community reintegration, and age when monitoring and treating depressive symptoms.

Relation among Psychopathological Symptoms, Neuropsychological Domains, and Functional Disability in Subacute Poststroke Rehabilitation

BACKGROUND

Neuropsychiatric disorders are commonly observed in patients following a stroke. Among 30%-60% of poststroke patients suffer from depression and anxiety (18%-25%). Some authors suggest an association between psychological symptoms and lesions in specific brain areas. In particular, lesions in left frontal cortex and left basal ganglia are frequently associated with poststroke depression and with comorbidity of anxiety and depression, whereas isolated anxiety symptoms are frequently observed after right hemispheric lesions.

METHODS

We investigated the relationship between depressive symptoms and anxiety in patients with subacute stroke and lesion side, motor disability, and cognitive impairment. We enrolled 100 patients undergoing a rehabilitative program within 1-3 months after a first-onset stroke.

RESULTS

Our patients presented mild to moderate depressive and anxious symptoms after stroke. In the comparison between patients with right and left lesions, during subacute poststroke phase, we did not find a specific link between existence of psychiatric symptoms and lesion side. However, in left lesion, depression correlated with age and alteration in delayed memory and attention, whereas memory deficit influenced anxiety symptoms. On the contrary, in right lesion, depressive symptoms were associated with attention ability, whereas anxiety was related to memory and attention. Depression and anxiety were not related to degree of neurological and functional deficits.

CONCLUSIONS

The comorbidity between stroke and psychopathological disorders has been recognized as syndrome and should be diagnosed early and treated in order to improve the quality of life of patients and caregivers, and to improve rehabilitative process.

Longitudinal Impact of Depression on Quality of Life in Stroke Patients

OBJECTIVE

Stroke is associated with significant long-term morbidity and poor quality of life (QOL). Depression is one of the most common complications after stroke and has been associated with QOL cross-sectionally. We investigated the longitudinal impact of depression in the acute phase of stroke on QOL 1 year after stroke.

METHODS

In total, 423 patients were evaluated 2 weeks after stroke, and 288 (68%) were followed 1 year later. QOL was assessed using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF) at baseline and follow-up. Depression was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-IV criteria; demographic and clinical characteristics data, including stroke severity, were obtained at baseline. The longitudinal associations of post-stroke depression (PSD) at baseline with QOL across two evaluation points were assessed using a repeated-measures analysis of variance.

RESULTS

The WHOQOL-BREF scores were significantly and persistently lower 1 year after stroke in patients with PSD at baseline compared with those without PSD at baseline independent of demographic and clinical characteristics, including stroke severity.

CONCLUSION

PSD in the acute phase of stroke is an independent predictor of QOL in both the acute and chronic phases of stroke. Our findings underscore the importance of evaluating depression in the acute phase of stroke.

Functional connectivity between salience, default mode and frontoparietal networks in post-stroke depression

BACKGROUND

Previous studies have demonstrated altered resting state functional connectivity (rsFC) in patients with post-stroke depression (PSD). It remains unclear whether rsFC is changed at the network level as was shown for major depressive disorder (MDD). To address this question, we investigated rsFC of resting sate networks (RSNs) in PSD.

METHODS

Eleven subjects with PSD underwent fMRI scanning at rest before and after treatment. The severity of depression was assessed using the aphasic depression rating scale (ADRS). We performed functional network connectivity (FNC) analysis for RSNs, region of interest - FC analysis (ROI-FC) and calculation of brain matter volumes in ROIs overlapping with RSNs and in other brain regions associated with mood maintenance.

RESULTS

We found positive correlation of FNC between anterior default mode network (aDMN) and salience network (SAL) with depression severity before treatment, the latter accompanied by the increase of white matter in the middle frontal and left angular gyri. FNC of aDMN and left frontoparietal network (LFP) decreased after treatment. ROI-FC and the brain matter volumes of several regions of DMN, LFP and SAL also showed a correlation with ADRS or significant change after treatment.

LIMITATIONS

Limitations include small sample size and methodological issues concerning altered hemodynamics in stroke. However, we took complex preprocessing steps to overcome these issues.

CONCLUSION

Present results of altered rsFC in PSD are consistent with previous findings in MDD. The convergence of results obtained in PSD and MDD supports the validity of rsFC approach for investigation of brain network dysfunctions underling these psychiatric symptoms.

Genetic variations in the p11/tPA/BDNF pathway are associated with post stroke depression

BACKGROUND

The effects of BDNF on post stroke depression (PSD) may be influenced by genetic variations in intracellular signal transduction pathways, such as the p11/tPA/BDNF pathway. In this study, we aimed to determine the association of polymorphisms in candidate genes of the gene transduction pathway with PSD, as well as the effects of the interactions between genes in our Chinese sample.

METHODS

Two-hundred-fifty-four Chinese samples with acute ischaemic stroke included 122 PSD patients and 132 nonPSD patients. Sixty-five single nucleotide polymorphisms (SNPs) in six genes (p11, tPA, PAI-1, BDNF, TrkB and p75NTR) of the p11/tPA/BDNF pathway with minor allele frequencies > 5% were successfully genotyped from an initial series of 76 SNPs. The severity of depressive symptoms was assessed by the 17-item Hamilton Depression Rating scale score. Environmental factors were measured with the life events scale and social support rating scale for all patients. SNP and haplotype associations were analysed using gPLINK software. Gene-gene interactions were evaluated with generalized multifactor dimensionality reduction software.

RESULTS

The results showed that TrkB polymorphisms (rs11140793AC genotype, rs7047042CG genotype, rs1221CT genotype, rs2277193TC genotype and rs2277192AG genotype) were significantly associated with PSD. Three haplotypes (AT, GG, and AAT) of TrkB were significantly associated with PSD. Seven haplotypes (GC, AG, ACG, CGC, GCT, ACGC and ACAT) of BDNF were significantly correlated with PSD. We identified significant gene-gene interactions between the p11 (rs11204922 SNP), tPA (rs8178895, rs2020918 SNPs) and BDNF (rs6265, rs2049046, rs16917271, rs727155 SNPs) genes in the PSD group. We also identified significant gene-gene interactions between the BDNF (rs2049046, rs7931247 SNPs) and TrkB (rs7816 SNP) genes with increased occurrence of PSD and sig gene-gene interactions between the BDNF gene (rs6265, rs56164415, rs2049046, rs4923468, rs2883187, rs16917271, rs1491850, rs727155, rs2049048 SNPs) and p75NTR gene (rs2072446, rs11466155) in the PSD group.

CONCLUSION

These findings provides evidence that the TrkB gene, BDNF and TrkB haplotypes, and gene-gene interactions between p11, tPA and BDNF are all associated with PSD, which suggests that genetic variations in the p11/tPA/BDNF pathway may play a central role in regulating the underlying mechanism of PSD.

Diversiform Etiologies for Post-stroke Depression

After the onset of stroke, many patients suffer from emotional behavior changes. Approximately, one-third of stroke survivors are affected by post-stroke depression (PSD), making it a serious social and public health problem. Post-stroke depression (PSD) has an important impact on the course, recovery, and prognosis of stroke. The pathogenesis of PSD is very complex, involving many factors such as biological mechanism and social psychological mechanisms. This article provides a brief review of the hot issues related to etiologies of PSD.

Associations of Tumor Necrosis Factor-α and Interleukin-1β Levels and Polymorphisms with Post-Stroke Depression

OBJECTIVE

Proinflammatory cytokines have been implicated in the pathophysiology of post-stroke depression (PSD), and their production levels are influenced by the transcriptional activity of genetic polymorphisms. The present study aimed to investigate the roles of tumor necrosis factor (TNF)-α and interleukin (IL)-1β in the serum on the risk of PSD while taking into account the TNF-α -850C/T and -308G/A polymorphisms and the IL-1β -511C/T and +3953C/T polymorphisms.

METHODS

A total of 286 patients were evaluated at 2 weeks post stroke and 222 (78%) of these patients were followed up 1 year later. Depressive (major or minor) disorders were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria during both examinations; evaluations of cytokine concentrations and polymorphisms and demographic and clinical covariates were performed at 2 weeks. The effects of TNF-α and IL-1β concentrations and genotypes on PSD status were investigated using multivariate logistic regression models.

RESULTS

Higher TNF-α levels were associated with PSD at 2 weeks in the presence of the -850T allele with a significant interaction term; higher IL-1β levels were associated with PSD at 2 weeks in the presence of the -511T allele with a borderline significant interaction term and with any +3953C/T polymorphism without a significant interaction term. No associations were found with PSD at 1 year.

CONCLUSIONS

These findings indicate the important roles that TNF-α and IL-1β serum levels play regarding the risk of PSD, particularly during the acute phase of stroke and in patients with genetic susceptibility.

Alleviative effects of fluoxetine on depressive-like behaviors by epigenetic regulation of BDNF gene transcription in mouse model of post-stroke depression

Fluoxetine, one of the selective serotonin reuptake inhibitor (SSRI) antidepressants, has been thought to be effective for treating post-stroke depression (PSD). Recent work has shown that fluoxetine may exert an antidepressive effect through increasing the level of brain-derived neurotrophic factor (BDNF), but the underlying mechanism still remains unclear. In the present study, we successfully established the PSD model using male C57BL/6 J mice by photothrombosis of the left anterior cortex combined with isolatied-housing conditions. In the process, we confirmed that fluoxetine could improve the depression-like behaviors of PSD mice and upregulate the expression of BDNF in the hippocampus. However, depletion of BDNF by transfecting lentivirus-derived shBDNF in hippocampus suppressed the effect of fluoxetine. Furthermore, we demonstrated the epigenetic mechanisms involved in regulation of BDNF expression induced by fluoxetine. We found a statistically significant increase in DNA methylation at specific CpG sites (loci 2) of Bdnf promoter IV in the hippocampus of PSD mice. We also found that fluoxetine treatment could disassociate the MeCP2-CREB-Bdnf promoter IV complex via phosphorylation of MeCP2 at Ser421 by Protein Kinase A (PKA). Our research highlighted the importance of fluoxetine in regulating BDNF expression which could represent a potential strategy for preventing PSD.

The factors related to early-onset depression after first stroke

BACKGROUND

The biological and psychological aspects of post-stroke depression (PSD) may vary based on the time since stroke onset. The sociodemographic and clinical correlates of early-onset PSD are not yet well understood. In the present study, we aimed to investigate the clinical correlates of early-onset depression following first stroke. We hypothesized that the severity of a stroke or disability (other than lesion characteristics) would likely be related to PSD in a sample of first stroke patients with single and unilateral lesions.

METHODS

Post-stroke patients with (n = 40) and without (n = 51) early-onset depression were compared with respect to several demographic and clinical variables.

RESULTS

There were no significant differences between the groups with respect to lesion location, lateralization, or volume. Scores on the Brief Disability Questionnaire, National Institutes of Health Stroke Scale, and Modified Rankin Scale were significantly higher in depressed post-stroke patients than in non-depressed patients. The anxiety, depression, and total scores of the Hospital Anxiety and Depression Scale were positively correlated with the Modified Rankin Scale, National Institutes of Health Stroke Scale, and Brief Disability Questionnaire scores. A previous history of depression and Brief Disability Questionnaire score were strongly associated with the occurrence of early-onset PSD.

CONCLUSION

Our findings suggest that early-onset PSD is likely to be correlated with the severity of stroke and functional disability.

Correlation between cerebellar metabolism and post-stroke depression in patients with ischemic stroke

The neurochemical changes that occur in the brain of patients with post-stroke depression (PSD) are not fully understood. This study aims to explore the correlation between cerebellar metabolism changes and PSD using proton magnetic resonance spectroscopy (¹H-MRS). Participants were assigned to 3 groups: 60 patients with PSD (PSD group), 60 stroke patients without depression (NOPSD group), and 60 healthy volunteers (HEAL group). T1 WI, T2 WI, DWI and ¹H-MRS examination were performed for patients at 14 days, 3 months after the stroke, respectively, and for healthy volunteers once when included in the study. Cho/Cr and Cho/NAA ratios in the cerebellar hemisphere contralateral to the lesion were higher in the PSD group than those in the HEAL and NOPSD groups on 14th day after the stroke (P < 0.05). In PSD group, Cho/Cr and Cho/NAA ratios in the cerebellar hemisphere contralateral to the lesion were positively correlated to the HAMD scale scores at both 14 days and 3 months after stroke (P < 0.05); Higher Cho/Cr and Cho/NAA ratios, and lower NAA/Cr ratio in the cerebellar hemisphere contralateral to the lesion were observed at 3 months after stroke compared to that at 14 days after stroke. Cerebellar damage may lead to PSD, and the degree of cerebellar damage may be associated with severity of PSD.

Acute Poststroke Depression Is Associated with Thalamic Lesions and Clinical Outcomes: A Case-Control Study

BACKGROUND

We investigated the role of acute-phase stroke lesions and patient characteristics in poststroke depression (PSD) and its effect on the clinical outcome.

PATIENTS AND METHODS

Five and 30 days after admission, 175 patients self-reported their depressive symptoms on the Patient Health Questionnaire-9. We compared the clinical characteristics and outcomes in patients with (n = 41) and without PSD (n = 134). Stroke severity was assessed with the National Institutes of Health Stroke Scale (NIHSS); the modified Rankin Scale (mRS) was used to determine the functional outcome.

RESULTS

There was no significant difference between patients with and without PSD in the age, gender ratio, lesion side, and the history of hypertension, diabetes mellitus, alcohol and tobacco use, and previous stroke. Thalamic lesions were significantly associated with PSD (P = .03), although there was no significant difference in both the NIHSS score and the final mRS score of patients with thalamic lesions. Backward stepwise logistic regression analysis showed that a higher NIHSS score and thalamic lesions were independent predictors of PSD. Total hospitalization was significantly longer in patients with PSD. At the time of admission, the NIHSS score was significantly higher in patients who developed moderate to severe PSD than in those with mild PSD or without PSD.

CONCLUSIONS

PSD in the acute phase was associated with thalamic lesions and severe stroke. Hospitalization was significantly longer in patients with PSD and their functional disability was more severe, suggesting that PSD played a role in the unsatisfactory results of poststroke rehabilitation.

Alterations of emotional reactivity following righttemporal lobectomy

To learn if a right temporal lobectomy altered a patient's autonomic and cognitive responses to aversive and appetitive pictures, we investigated a man whose right anterior temporal lobe and amygdala had been resected to remove an arteriovenous malformation. This patient revealed unusually low self-reports of arousal with a lack of heightened skin conductance responses to aversive pictures. For pleasant pictures, his self-reports of arousal and his physiological responses were similar to healthy men. This patient's responses are consistent with a bivalent model of emotional processing, with a right temporal lobectomy compromising the activation of his defensive action response system.

The association between lesion location, sex and poststroke depression: Meta-analysis

BACKGROUND

Poststroke depression (PSD) is a common form of stroke patients. Whether the risk of PSD is influenced by the stroke lesion location and sex remains a matter of debate. The objective of this study was to examine the association between the risk of PSD and the stroke lesion location and sex by performing a systematic meta-analysis.

METHODS

Subgroup analyses were performed according to the time interval after stroke onset to assessment for PSD. A total of 31 reports involving 5,309 subjects (for lesion location analysis) and 5,489 subjects (for sex analysis) suffering from stroke were included in this meta-analysis.

RESULTS

The pooled odds ratio (OR) of PSD after a left-hemisphere stroke, compared with a right-hemisphere stroke was 1.11 (95% confidence interval [CI] 0.82-1.49) and OR of PSD after a male stroke, compared with a female stroke was 0.68 (95% CI 0.58-0.81). Subacute poststroke subgroup (1-6 months) significantly favored PSD occurring after a left hemisphere stroke (OR = 1.50, 95% CI 1.21-1.87). Furthermore, there was a statistically significant association between PSD and female stroke for studies with acute poststroke group (OR = 0.73, 95% CI 0.62-0.86) and subacute poststroke stroke phase (OR = 0.69, 95% CI 0.56-0.86).

CONCLUSIONS

This systematic review suggests that patients with left hemisphere stroke may be more susceptible to PSD during subacute phase of stroke and female stroke may be more susceptible to PSD during acute and subacute phase of stroke.

Post-Stroke Depression: Impact of Lesion Location and Methodological Limitations-A Topical Review

Post-stroke depression (PSD) affects approximately one-third of all stroke patients. It hinders rehabilitation and is associated with worse functional outcome and increased mortality. Since the identification of PSD is a significant clinical problem, clinicians and researchers have tried to identify predictors that indicate patients at risk of developing PSD. This also includes the research question whether there is an association between PSD and stroke lesion characteristics, e.g., lesion size and lesion location. Early studies addressing this question are largely limited by technical constraints and, thus, focused on simple lesion characteristics such as lesion side or proximity of the lesion to the frontal pole of the brain. More recent studies have addressed the impact of involvement of specific neuronal circuits in the stroke lesion. State-of-the-art methods of lesion symptom mapping to study PSD have only been applied to small patient samples. Overall, results are controversial and no clear pattern of stroke lesions associated with PSD has emerged, though there are findings suggesting that more frontal stroke lesions are associated with higher incidence of PSD. Available studies are hampered by methodological limitations, including drawbacks of lesion analysis methods, small sample size, and the issue of patient selection. These limitations together with differences in approaches to assess PSD and in methods of image analysis limit the comparability of results from different studies. To summarize, as of today no definite association between lesion location and PSD can be ascertained and the understanding of PSD rests incomplete. Further insights are expected from the use of modern lesion inference analysis methods in larger patient samples taking into account standardized assessment of possible confounding parameters, such as stroke treatment and reperfusion status.

Burden and factors associated with post-stroke depression in East central Nigeria

OBJECTIVE

To determine the burden and factors associated with post-stroke depression in East central Nigeria.

METHOD

We carried out this cross-sectional study of 50 stroke survivors (mean age=54.8 ± 8.8 years), at the physiotherapy Department of the University of Nigeria Teaching Hospital, Enugu. Data were collected using Becks Depression Inventory , it was analyzed using Z-scores, Chi-square test and univariate logistic regression.

RESULTS

PSD was more common in females (45.45%); middle-age(60%) adults(27-36/47-56 years respectively); living with spouse (45%); left cerebral lesions (40.74%). Self-employed and unemployed (66.67%), respectively. Age was significantly associated with depression (p=0.03), and was related to the risk ofOR3.7 (95% CI 1.1-12.0 ).

CONCLUSION

Age could be a risk factor for PSD, which was more prevalent in the elderly than young/middle-age adults, female gender, left cerebral lesion, complications, cold case; those living with a spouse, self-employed and unemployed.

Long-range temporal correlations of broadband EEG oscillations for depressed subjects following different hemispheric cerebral infarction

Abnormal long-range temporal correlation (LRTC) in EEG oscillation has been observed in several brain pathologies and mental disorders. This study examined the relationship between the LRTC of broadband EEG oscillation and depression following cerebral infarction with different hemispheric lesions to provide a novel insight into such depressive disorders. Resting EEGs of 16 channels in 18 depressed (9 left and 9 right lesions) and 21 non-depressed (11 left and 10 right lesions) subjects following cerebral infarction and 19 healthy control subjects were analysed by means of detrended fluctuation analysis, a quantitative measurement of LRTC. The difference among groups and the correlation between the severity of depression and LRTC in EEG oscillation were investigated by statistical analysis. The results showed that LRTC of broadband EEG oscillations in depressive subjects was still preserved but attenuated in right hemispheric lesion subjects especially in left pre-frontal and right inferior frontal and posterior temporal regions. Moreover, an association between the severity of psychiatric symptoms and the attenuation of the LRTC was found in frontal, central and temporal regions for stroke subjects with right lesions. A high discriminating ability of the LRTC in the frontal and central regions to distinguish depressive from non-depressive subjects suggested potential feasibility for LRTC as an assessment indicator for depression following right hemispheric cerebral infarction. Different performance of temporal correlation in depressed subjects following the two hemispheric lesions implied complex association between depression and stroke lesion location.

Prevalence and predictors of post-stroke mood disorders: A meta-analysis and meta-regression of depression, anxiety and adjustment disorder

OBJECTIVE

To ascertain the prevalence and predictors of mood disorders, determined by structured clinical interviews (ICD or DSM criteria) in people after stroke.

METHODS

Major electronic databases were searched from inception to June 2016 for studies involving major depression (MDD), minor depression (MnD), dysthymia, adjustment disorder, any depressive disorder (any depressive disorder) and anxiety disorders. Studies were combined using both random and fixed effects meta-analysis and results were stratified as appropriate.

RESULTS

Depression was examined on 147 occasions from 2days to 7years after stroke (mean 6.87months, N=33 in acute, N=43 in rehabilitation and N=69 in the community/outpatients). Across 128 analyses involving 15,573 patients assessed for major depressive disorder (MDD), the point prevalence of depression was 17.7% (95% CI=15.6% to 20.0%) 0.65 analyses involving 9720 patients determined MnD was present in 13.1% in all settings (95% CI=10.9% to 15.8%). Dysthymia was present in 3.1% (95% CI=2.1% to 5.3%), adjustment disorder in 6.9% (95% CI=4.6 to 9.7%) and anxiety in 9.8% (95% CI=5.9% to 14.8%). Any depressive disorder was present in 33.5% (95% CI=30.3% to 36.8%). The relative risk of any depressive disorder was higher following left (dominant) hemisphere stroke, aphasia, and among people with a family history and past history of mood disorders.

CONCLUSION

Depression, adjustment disorder and anxiety are common after stroke. Risk factors are aphasia, dominant hemispheric lesions and past personal/family history of depression but not time since stroke.

Quantitative EEG abnormalities in major depressive disorder with basal ganglia stroke with lesions in different hemispheres

BACKGROUND

This study aimed to examine the aberrant EEG oscillation in major depressive subjects with basal ganglia stroke with lesions in different hemispheres.

METHODS

Resting EEG of 16 electrodes in 58 stroke subjects, 26 of whom had poststroke depression (13 with left-hemisphere lesion and 13 with right) and 32 of whom did not (18 with left lesion and 14 with right), was recorded to obtain spectral power analysis for several frequency bands. Multiple analysis of variance and receiver operating characteristic (ROC) curves were used to identify differences between poststroke depression (PSD) and poststroke non-depression (PSND), treating the different lesion hemispheres separately. Moreover, Pearson linear correlation analysis was conducted to test the severity of depressive symptoms and EEG indices.

RESULTS

PSD with left-hemisphere lesion showed increased beta2 power in frontal and central areas, but PSD with right-hemisphere lesion showed increased theta and alpha power mainly in occipital and temporal regions. Additionally, for left-hemisphere lesions, beta2 power in central and right parietal regions provided high discrimination between PSD and PSND, and for right-hemisphere lesions, theta power was similarly discriminative in most regions, especially temporal regions. We also explored the association between symptoms of depression and the power of abnormal bands, but we found no such relationship.

LIMITATIONS

The sample size was relatively small and included subjects with different lesions of the basal ganglia.

CONCLUSIONS

The aberrant EEG oscillation in subjects with PSD differs between subjects with lesions of the left and right hemispheres, suggesting a complex association between depression and lesion location in stroke patients.