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Masuccio FG, Grange E, Di Giovanni R, Rolla M, Solaro CM. Post-Stroke Depression in Older Adults: An Overview. Drugs Aging 2024; 41:303-318. [PMID: 38396311 DOI: 10.1007/s40266-024-01104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/25/2024]
Abstract
Detailed data on post-stroke depression (PSD) in older adults are limited in spite of the high vulnerability of this population to stroke. In fact, PSD prevalence in older adults ranges from 16.0 to 43.9%; however, timing and instruments of evaluation often differ significantly across all available studies. The etiology, genetic and inflammatory factors, as well as structural brain alterations, are claimed as part of a multifaceted mechanism of action in PSD onset. Thus, the aim of this narrative review was to further elaborate on the prevalence, etiology, diagnosis, consequences and treatment of PSD in older adults. The consequences of PSD in older adults may be devastating, including a poor functional outcome after rehabilitation and lower medication adherence. In addition, lower quality of life and reduced social participation, higher risk of new stroke, rehospitalization, and mortality have been reported. In this scenario, treating PSD represents a crucial step to prevent these complications. Both pharmacological and non-pharmacological therapies are currently available. The pharmacological treatment utilizes antidepressant drugs, such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), tricyclic antidepressants (TAs) and new multimodal antidepressants (NMAs). Non-pharmacological therapies include psychological interventions and non-invasive brain stimulation techniques, while excluding drug administration. In the general population experiencing PSD, SSRIs (sertraline in particular) are the most prescribed, whereas the combination of antidepressants and psychotherapy is underused. Furthermore, about one-third of patients do not receive treatment for PSD. In regard to older adults with PSD, the possibility of more adverse effects or contraindications to antidepressant prescription due to comorbidities may limit the therapeutic window. Although drugs such as citalopram, escitalopram, sertraline, venlafaxine, and vortioxetine are usually well tolerated by older patients with PSD, the few randomized controlled trials (RCTs) specifically considering older adults with PSD have been conducted with fluoxetine, fluvoxamine, reboxetine, citalopram and nortriptyline, often with very small patient samples. Furthermore, data regarding the results of non-pharmacological therapies are scarce. High-quality RCTs recruiting large samples of older adults are needed in order to better manage PSD in this population. In addition, adequate screening and diagnosis instruments, with reliable timing of evaluation, should be applied.
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Affiliation(s)
- Fabio Giuseppe Masuccio
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy
| | - Erica Grange
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy
| | - Rachele Di Giovanni
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy
| | - Martina Rolla
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy
| | - Claudio Marcello Solaro
- Department of Rehabilitation, C.R.R.F. "Mons. L. Novarese", Loc. Trompone SNC, 13040, Moncrivello, VC, Italy.
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Zhang H, Feng Y, Lv H, Tang S, Peng Y. The prevalence of apathy in stroke patients: A systematic review and meta-analysis. J Psychosom Res 2023; 173:111478. [PMID: 37651842 DOI: 10.1016/j.jpsychores.2023.111478] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/17/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023]
Abstract
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.
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Affiliation(s)
- Hanrui Zhang
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Yaoting Feng
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Hequn Lv
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Shaowen Tang
- Department of Epidemiology and Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yongjun Peng
- Department of Acupuncture and Rehabilitation, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
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Maurya PK, Qavi A, Deswal S, Singh AK, Kulshreshtha D, Thacker AK. A Comparative Study of Regional Cerebral Blood Flow Asymmetry Index in Stroke Patients with or without Poststroke Depression Using 99mTc-ECD Single-Photon Emission Computed Tomography. World J Nucl Med 2022; 21:222-230. [PMID: 36060079 PMCID: PMC9436511 DOI: 10.1055/s-0042-1751056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction
Stroke is a major cause of death and disability around the globe. The development of depression following a stroke further increases the disability and impairs functional recovery. In recent decades, despite the advancement in structural and nuclear medicine imaging, the pathophysiologic basis of poststroke depression (PSD) is not well understood. Etiopathogenesis of PSD is multifactorial and afflictions of the frontal lobe, hippocampus, limbic region, and basal ganglia projections are implicated.
Aim
The aim of this study was to assess the regional cerebral blood flow (rCBF) using
99m
Tc-ethyl cysteinate dimer single-photon emission computed tomography (SPECT) in patients with (PSD + ) or without PSD (PSD–).
Materials and Methods
To evaluate the hemispheric asymmetry, the percentage of asymmetry index (AI) was calculated for frontal, temporal, parietal, occipital, putamen, caudate, and thalamic regions of brain and compared between PSD+ and PSD–. The correlation between AIs over the different brain regions was also established in patients of PSD+ and PSD–. Our study cohort included 122 patients between 6 weeks and 1 year of stroke. Depression was present in 52 (42.6%) patients, assessed by hospital anxiety and depression scale (HADS) and general health questionnaire-28 items (GHQ-28) scale. The 28 patients with PSD+ and 18 PSD– gave consent for SPECT study.
Results
Our results are based on 46 patients who underwent SPECT study. In patients with PSD+ and PSD–, the HADS and GHQ-28 scores were 8.93 ± 2.77 vs. 3.94 ± 2.15 (
p
= 0.001) and 40.96 ± 9.48 vs. 17.72 ± 5.38 (
p
= 0.001), respectively. A significant difference in rCBF AI was found in the temporal lobe (
p
= 0.03) between patients of PSD+ and PSD–. On logistic regression analysis, the odds ratio of rCBF AI for temporal lobe was 0.89 (95% confidence interval [CI]: 0.80–0.99;
p
= 0.04) and caudate nucleus was 0.85 (95% CI: 0.73–0.98;
p
= 0.03), which were statistically significant. PSD correlated with AI in temporal region (
r
= –0.03;
p
= 0.03) but did not show significant correlation with other regions of brain between PSD+ and PSD–.
Conclusion
The presence of temporal lobe rCBF AI on SPECT is significantly associated with PSD. This may reflect the dysfunction of the limbic system and contribute to the occurrence of PSD.
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Affiliation(s)
- Pradeep Kumar Maurya
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abdul Qavi
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Satyawati Deswal
- Department of Nuclear Medicine, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ajai Kumar Singh
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dinkar Kulshreshtha
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anup Kumar Thacker
- Department of Neurology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Chong L, Han L, Liu R, Ma G, Ren H. Association of Lymphocyte-to-Monocyte Ratio with Poststroke Depression in Patients with Acute Ischemic Stroke. Med Sci Monit 2021; 27:e930076. [PMID: 34021110 PMCID: PMC8152443 DOI: 10.12659/msm.930076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Poststroke depression (PSD) is a common neuropsychiatric disorder after stroke. The neuroinflammatory response exerts a vital effect in the development of PSD. Lymphocyte-to-monocyte ratio (LMR), a systemic inflammation biomarker, is associated with poor prognosis of acute ischemic stroke (AIS). The purpose of this study was to determine the association between LMR and PSD at 3 months. Material/Methods AIS patients (507) were included in this study. Patients were categorized into 3 tertiles and each tertile contains 169 patients: tertile1 (>4.85), tertile 2 (2.96 to 4.85), and tertile 3 (<2.96), based on LMR values and the numbers of patients. PSD was diagnosed with a 17-item Hamilton Depression Scale score of 8 or higher. Results Patients (141; 27.8%) were diagnosed with PSD at 3-month follow-up. Patients in the PSD group presented with more severe stroke and lower LMR values (P<0.001). Decreased LMRs were independently associated with occurrence of PSD (middle tertile: odds ratio [OR] 1.823, P=0.037; lowest tertile: OR 3.024, P<0.001). A significant association of a lower LMR value with PSD severity was found (middle tertile: OR 1.883, P=0.031; lowest tertile: OR 2.633, P=0.001). The receiver operating characteristic curve indicates that the optimal threshold of LMR as a predictor for PSD was 3.14, which yielded a sensitivity of 72.4% and a specificity of 68.1%. Conclusions Decreased LMR is independently associated with PSD and increased PSD severity.
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Affiliation(s)
- Lining Chong
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Lin Han
- Department of Neurology, Hengshui Hospital of Traditional Chinese Medicine, Hengshui, Hebei, China (mainland)
| | - Ruqian Liu
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Guomei Ma
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
| | - Hao Ren
- Department of Neurology, Harrison International Peace Hospital, Hengshui, Hebei, China (mainland)
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Wijeratne T, Sales C. Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression. J Clin Med 2021; 10:jcm10081674. [PMID: 33919670 PMCID: PMC8069768 DOI: 10.3390/jcm10081674] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions.
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Affiliation(s)
- Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne 3000, Australia
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapura 50000, Sri Lanka
- Correspondence:
| | - Carmela Sales
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
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Properties of the Early Symptom Measurement of Post-Stroke Depression: Concurrent Criterion Validity and Cutoff Scores. J Nurs Res 2021; 28:e107. [PMID: 32516198 DOI: 10.1097/jnr.0000000000000380] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Early-stage post-stroke depression (PSD) increases the risk of stroke-related disability and mortality in the first year of recovery. Presently available screening measures were developed to assess major depression, and none used a PSD screening criterion that was systematically developed and tested in populations of patients with acute stroke. PURPOSE The purpose of this study was to evaluate the concurrent criterion validity and cutoff scoring of the Early Symptom Measurement of Post-Stroke Depression (ESM-PSD) instrument in hospitalized patients with acute stroke. METHODS Purposive recruitment of newly admitted patients yielded a qualified sample of 139 nonaphasic participants who were 7-30 days post mild-to-moderate stroke confirmed by computed tomography and magnetic resonance images. Participants responded to the ESM-PSD and Hamilton Rating Scale for Depression-24 (HAMD-24). RESULTS The mean number of post-stroke days was 11.99 (SD = 7.68). Cronbach's alpha estimates of internal consistency were ESM-PSD = .90 and HAMD-24 = .76. ESM-PSD measurement sensitivity and specificity were superior. The following three ESM-PSD cutoff scores, determined by the receiver operating characteristic curve, were used to assess clinically relevant early-symptom levels: no PSD < 14.5, low PSD = 14.5-25.5, moderate PSD = 25.5-45.5, high PSD ≥ 45.5. CONCLUSION/IMPLICATIONS FOR PRACTICE ESM-PSD cutoff scores show the expected correspondence with mild-moderate-severe HAMD-24 symptoms, which was evidenced by the high area under the receiver operating characteristic curve. Planned follow-up research will assess the efficacy of using ESM-PSD scores to detect increased risk of major depression onset in patients with acute stroke.
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Post-stroke depression: frequency, risk factors, and impact on quality of life among 103 stroke patients—hospital-based study. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2020. [DOI: 10.1186/s41983-020-00199-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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8
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Almhdawi KA, Alazrai A, Kanaan S, Shyyab AA, Oteir AO, Mansour ZM, Jaber H. Post-stroke depression, anxiety, and stress symptoms and their associated factors: A cross-sectional study. Neuropsychol Rehabil 2020; 31:1091-1104. [PMID: 32419606 DOI: 10.1080/09602011.2020.1760893] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Individuals post-stroke are subject to increased levels of mental health symptoms. This is a cross-sectional study explored levels of depression, anxiety, and stress symptoms and identified their predictors among Jordanian individuals with stroke. Outcome measures included Depression Anxiety Stress Scale, Fugl-Meyer assessment, goniometry, hand-held dynamometry, nine-hole peg test, Ashworth scale, Motor Activity Log, ten-meter walk test, and 12-item Short-Form health survey (SF-12). Descriptive analyses were used to describe prevalence of mental health symptoms and multiple variable linear regression models were used to identify their predictors. A total of 153 individuals participated in the study. Proportions of participants with mental health symptoms were 74.5% for depression, 52.9% for anxiety, and 68% for stress. Significant predictors of post-stroke mental health symptoms were SF-12 Mental Composite Score and grip strength for depression, anxiety, and stress. Depression and stress symptoms were significantly associated with discontinuation of rehabilitation services. Furthermore, self-reports of fewer sleep hours was significantly associated with anxiety and stress. Finally, Gender and self-reported physical diseases other than stroke were significantly associated with depression symptoms. We conclude that high proportions of Jordanian individuals' post-stroke have suffered mental health symptoms. Future studies are required to design effective interventions to improve post-stroke mental health.
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Affiliation(s)
- Khader A Almhdawi
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Alza Alazrai
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Saddam Kanaan
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Awni A Shyyab
- Division of Neurology, King Hussein Centre, Amman, Jordan
| | - Alaa O Oteir
- Department of Allied Health Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Zaid Modhi Mansour
- Department of Physical and Occupational Therapy, Hashemite University, Zarqa, Jordan
| | - Hanan Jaber
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Demographic Factors and Cognitive Function Assessments Associated with Mild Cognitive Impairment Progression for the Elderly. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3054373. [PMID: 32090075 PMCID: PMC7031731 DOI: 10.1155/2020/3054373] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 09/24/2019] [Accepted: 10/16/2019] [Indexed: 01/09/2023]
Abstract
Objectives In this study, we aimed to conduct a 6-year follow-up and acquire a large sample dataset to analyze the most important demographic factors and cognitive function scale variables associated with mild cognitive impairment (MCI) progression for an elderly cohort (age ≥ 60 years old). Patients and Methods. We analyzed the subjects who had participated in a survey in 2011 and were successfully contacted in the later survey in 2017. For each subject, the basic demographic information was recorded, including sex, age, education level, marital status, working status, income level, and physical mental illness history. Cognitive assessments were performed using the following scales if possible: (1) the mini-mental state examination (MMSE) scale, (2) Montreal cognitive assessment (MoCA), (3) the clinical dementia rating (CDR) scale, and (4) Hamilton Depression Scale (HAMD-17). Results The progression outcomes were different between sexes, among age brackets, education degrees, occupations types, and income levels; different progression groups had distinct children numbers (p < 0.001), heights (p < 0.001), heights (p < 0.001), heights (p < 0.001), heights ( Conclusions In conclusion, the MCI progression outcomes were associated with sex, age, education degrees, occupations types, income level, children number, height, and weight. MoCA and MMSE scales are supporting tools to predict the progression outcomes, especially combined with the demographic data.
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Mohammed GF, Azab HM, Sayed MAE, Elnady HM, Youssif H, Mahmoud OAA. Risk factors for post-stroke depression in Sohag University Hospital. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0057-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors. Sci Rep 2019; 9:16248. [PMID: 31700058 PMCID: PMC6838079 DOI: 10.1038/s41598-019-52721-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/22/2019] [Indexed: 01/14/2023] Open
Abstract
Few previous studies have focused on affective impairment after transient ischemic attack (TIA) and/or minor stroke. The aim was to establish the prevalence, evolution and predictors of post-stroke depression (PSD) and post-stroke apathy (PSA) over a 12-month follow-up period. We prospectively included TIA and minor stroke patients (NIHSS ≤4) who had undergone magnetic resonance imaging <7 days. PSD was diagnosed according to DSM-5 criteria and PSA was defined based on an Apathy Evaluation Scale (AES-C) score of ≥37. Clinical and neuroimaging variables (presence and patterns of lesion, cerebral bleeds and white matter disease) were analysed in order to find potential predictors for PSD and PSA. Follow-up was performed at 10 days and after 2, 6, 9 and 12 months. 82 patients were included (mean 66.4 [standard deviation11.0] years) of whom 70 completed the follow-up. At 10 days, 36 (43.9%) and 28 (34.1%) patients respectively were diagnosed with PSD and PSA. At 12 months, 25 of 70 (35.7%) patients still had PSA, but only 6 of 70 (8.6%) had PSD. Beck Depression Inventory-II score, mini mental state examination (MMSE) and a previous history of depression or anxiety were predictors for PSD. While MMSE score, The Montgomery Asberg Depression Rating Scale and having previously suffered a stroke were also risk factors for PSA. Acute basal ganglia lesion and periventricular leukoaraiosis were associated with PSA while deep leukorariosis with PSD. Despite the presence of few or only transient symptoms, PSD and PSA frequent appear early after TIA and minor stroke. Unlike PSD, apathy tends to persist during follow-up.
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12
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Abstract
Background:
Apathy is defined as diminished motivation free from altered consciousness,
cognitive impairment or emotional distress. It is a prevalent syndrome in different disorders,
which share brain system alterations despite very different underlying pathologies. However, to
date, little research has be en devoted to the subject.
Aim:
To review the concept of apathy and clarify its aetiology, structural and functional neural
bases and treatment options.
Methods:
Literature search and review, with “apathy” as a term, using all main databases (Medline,
Psychinfo, Cochrane) included in our organization’s (RSMB; Osakidetza/Basque Health Service)
Ovid search engine, together with a manual search of relevant papers.
Results:
The literature reviewed shows that apathy is a multi-dimensional clinical construct with a
current definition and validated diagnostic criteria. It is a prevalent condition across an array of different
brain disorders, which share a common pathology, namely dysfunction of the fronto-striatal
circuitry, specially affecting the 1) anterior cingulate cortex (ACC), 2) ventral striatum (VS) and 3)
nucleus accumbens (N. Acc.). Different theories have emerged regarding the role of the ACC in the
genesis of apathy. The neuromodulator dopamine is heavily implicated in 1- ACC, 2- VS, 3- in particulat
the N. Acc., and 4- the genesis of apathy, although other neurotransmitters could also be
involved to a lesser degree. There is a patent lack of RCTs on the efficiency of current therapeutic options.
Conclusion:
Further research is needed to help understand the functional neuroanatomy, neuromodulators
involved and possible treatment options of this clinical construct.
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Chen L, Xiong S, Liu Y, Lin M, Zhu L, Zhong R, Zhao J, Liu W, Wang J, Shang X. Comparison of Motor Relearning Program versus Bobath Approach for Prevention of Poststroke Apathy: A Randomized Controlled Trial. J Stroke Cerebrovasc Dis 2019; 28:655-664. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 02/05/2023] Open
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14
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Lisiecka-Ford DM, Tozer DJ, Morris RG, Lawrence AJ, Barrick TR, Markus HS. Involvement of the reward network is associated with apathy in cerebral small vessel disease. J Affect Disord 2018; 232:116-121. [PMID: 29481995 PMCID: PMC5884309 DOI: 10.1016/j.jad.2018.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 01/25/2018] [Accepted: 02/12/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Apathy is a common yet under-recognised feature of cerebral small vessel disease (SVD), but its underlying neurobiological basis is not yet understood. We hypothesized that damage to the reward network is associated with an increase of apathy in patients with SVD. METHODS In 114 participants with symptomatic SVD, defined as a magnetic resonance imaging confirmed lacunar stroke and confluent white matter hyperintensities, we used diffusion tensor imaging tractography to derive structural brain networks and graph theory to determine network efficiency. We determined which parts of the network correlated with apathy symptoms. We tested whether apathy was selectively associated with involvement of the reward network, compared with two "control networks" (visual and motor). RESULTS Apathy symptoms negatively correlated with connectivity in network clusters encompassing numerous areas of the brain. Network efficiencies within the reward network correlated negatively with apathy scores; (r = - 0.344, p < 0.001), and remained significantly correlated after co-varying for the two control networks. Of the three networks tested, only variability in the reward network independently explained variance in apathetic symptoms, whereas this was not observed for the motor or visual networks. LIMITATIONS The analysis refers only to cerebrum and not cerebellum. The apathy measure is derivative of depression measure. DISCUSSION Our results suggest that reduced neural efficiency, particularly in the reward network, is associated with increased apathy in patients with SVD. Treatments which improve connectivity in this network may improve apathy in SVD, which in turn may improve psychiatric outcome after stroke.
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Affiliation(s)
- Danuta M Lisiecka-Ford
- Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, Cambridge, UK.
| | - Daniel J Tozer
- Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, Cambridge, UK
| | - Robin G Morris
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Andrew J Lawrence
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Thomas R Barrick
- St. Georges, University of London, Neurosciences Research Centre, London, UK
| | - Hugh S Markus
- Stroke Research Group, University of Cambridge, Department of Clinical Neurosciences, Cambridge, UK
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Shi Y, Yang D, Zeng Y, Wu W. Risk Factors for Post-stroke Depression: A Meta-analysis. Front Aging Neurosci 2017; 9:218. [PMID: 28744213 PMCID: PMC5504146 DOI: 10.3389/fnagi.2017.00218] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/23/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Stroke not only impacts patients physically but also economically. Post-stroke depression (PSD), as a common complication of stroke, always obstructs the process of stroke rehabilitation. Accordingly, defining the risk factors associated with PSD has extraordinary importance. Although there have been many studies investigating the risk factors for PSD, the results are inconsistent. Objectives: The objectives of this study were to identify the risk factors for PSD by evidence-based medicine. Data sources: A systematic and comprehensive database search was performed of PubMed, Medline, CENTRAL, EMBASE.com, the Cochrane library and Web of Science for Literature, covering publications from January 1, 1998 to November 19, 2016. Study Selection: Studies on risk factors for PSD were identified, according to inclusion and exclusion criteria. The risk of bias tool, described in the Cochrane Handbook version 5.1.0, was used to assess the quality of each study. Meta-analysis was performed using RevMan 5.3 software. Results: Thirty-six studies were included for review. A history of mental illness was the highest ranking modifiable risk factor; other risk factors for PSD were female gender, age (<70 years), neuroticism, family history, severity of stroke, and level of handicap. Social support was a protective factor for PSD. Conclusion: There are many factors that have effects on PSD. The severity of stroke is an important factor in the occurrence of PSD. Mental history is a possible predictor of PSD. Prevention of PSD requires social and family participation.
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Affiliation(s)
- Yu Shi
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical UniversityGuangzhou, China
| | - Dongdong Yang
- Department of Neurology, Zhengzhou People's HospitalZhengzhou, China
| | - Yanyan Zeng
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical UniversityGuangzhou, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical UniversityGuangzhou, China
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Metoki N, Sugawara N, Hagii J, Saito S, Shiroto H, Tomita T, Yasujima M, Okumura K, Yasui-Furukori N. Relationship between the lesion location of acute ischemic stroke and early depressive symptoms in Japanese patients. Ann Gen Psychiatry 2016; 15:12. [PMID: 27042194 PMCID: PMC4818403 DOI: 10.1186/s12991-016-0099-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/23/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Approximately one-third of stroke survivors suffer from post-stroke depression (PSD) in the acute or chronic stages. The presence of PSD in the acute stage after stroke is reportedly associated with poor patient prognosis; therefore, early recognition and treatment of PSD may alleviate these consequences. The aim of the current study was to examine the relationship between the lesion location and the presence of early depressive symptoms after acute ischemic stroke in Japanese patients. METHODS Our study included 421 patients who suffered from acute ischemic stroke. On the day of admission, the lesion location was determined using magnetic resonance imaging (MRI). Stroke severity was measured on the seventh day of hospitalization withat the National Institutes of Health Stroke Scale (NIHSS). On the tenth day of hospitalization, depressive symptoms were measured and functional assessments were performed with the Japan Stroke Scale (Depression Scale) (JSS-D) and functional independence measure (FIM), respectively. RESULTS A total of 71 subjects (16.9 %) were diagnosed with depression. According to the multiple logistic regression analysis, the infarcts located at frontal and temporal lobes were found to be a significant independent risk factor of early depressive symptoms in the acute stage of stroke. CONCLUSIONS Patients suffering from acute ischemic stroke, particularly in the frontal and temporal lobes, should be carefully assessed to detect and treat early depressive symptoms; such treatment may improve patient outcomes.
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Affiliation(s)
- Norifumi Metoki
- />Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Norio Sugawara
- />Department of Neuropsychiatry, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Aomori Japan
| | - Joji Hagii
- />Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Shin Saito
- />Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Hiroshi Shiroto
- />Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Tetsu Tomita
- />Department of Neuropsychiatry, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Aomori Japan
| | - Minoru Yasujima
- />Hirosaki Stroke and Rehabilitation Center, Hirosaki, Japan
| | - Ken Okumura
- />Department of Cardiology, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Norio Yasui-Furukori
- />Department of Neuropsychiatry, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki, 036-8562 Aomori Japan
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A case of abulia, status/post right middle cerebral artery territory infarct, treated successfully with olanzapine. Clin Neuropharmacol 2015; 37:186-9. [PMID: 25384076 DOI: 10.1097/wnf.0000000000000053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abulia refers to a pathological deficit of willpower. Disruption of frontal-subcortical-mesolimbic circuits caused by lesions in certain central nervous system structures has been associated with abulia. Given the neurobiological link between the dopaminergic reward system and the psychological phenomenon of motivation, it has been speculated that modulating dopaminergic neurotransmission will potentially alter the clinical presentation of abulia. We present a case of abulia S/P right middle cerebral artery, treated successfully with olanzapine.
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Yang S, Hua P, Shang X, Cui Z, Zhong S, Gong G, Humphreys GW. A significant risk factor for poststroke depression: the depression-related subnetwork. J Psychiatry Neurosci 2015; 40:259-68. [PMID: 25871495 PMCID: PMC4478059 DOI: 10.1503/jpn.140086] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Despite being one of the direct causes of depression, whether stroke-induced neuroanatomical deterioration actually plays an important role in the onset of poststroke depression (PSD) is controversial. We assessed the structural basis of PSD, particularly with regard to white matter connectivity. METHODS We evaluated lesion index, fractional anisotropy (FA) reduction and brain structural networks and then analyzed whole brain voxel-based lesions and FA maps. To understand brain damage in the context of brain connectivity, we used a graph theoretical approach. We selected nodes whose degree correlated with the Hamilton Rating Scale for Depression score (p < 0.05, false discovery rate-corrected), after controlling for age, sex, years of education, lesion size, Mini Mental State Examination score and National Institutes of Health Stroke Scale score. We used Poisson regression with robust standard errors to assess the contribution of the identified network toward poststroke major depression. RESULTS We included 116 stroke patients in the study. Fourteen patients (12.1%) had diagnoses of major depression and 26 (22.4%) had mild depression. We found that lesions in the right insular cortex, left putamen and right superior longitudinal fasciculus as well as FA reductions in broader areas were all associated with major depression. Seventeen nodes were selected to build the depression-related subnetwork. Decreased local efficiency of the subnetwork was a significant risk factor for poststroke major depression (relative risk 0.84, 95% confidence interval 0.72-0.98, p = 0.027). LIMITATIONS The inability of DTI tractography to process fibre crossings may have resulted in inaccurate construction of white matter networks and affected statistical findings. CONCLUSION The present study provides, to our knowledge, the first graph theoretical analysis of white matter networks linked to poststroke major depression. These findings provide new insights into the neuroanatomical substrates of depression that develops after stroke.
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Affiliation(s)
- Songran Yang
- Correspondence to: S. Yang, Department of Experimental Psychology, University of Oxford, 9 South Parks Road, Oxford OX1 3UD, United Kingdom;
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Yang SR, Shang XY, Tao J, Liu JY, Hua P. Voxel-based analysis of fractional anisotropy in post-stroke apathy. PLoS One 2015; 10:e116168. [PMID: 25555189 PMCID: PMC4282201 DOI: 10.1371/journal.pone.0116168] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 11/24/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To explore the structural basis of post-stroke apathy by using voxel-based analysis (VBA) of fractional anisotropy (FA) maps. METHODS We enrolled 54 consecutive patients with ischemic stroke during convalescence, and divided them into apathy (n = 31) and non-apathy (n = 23) groups. We obtained magnetic resonance images of their brains, including T1, T2 and DTI sequences. Age, sex, education level, Hamilton Depression Scale (HAMD) scores, Mini-Mental State Examination (MMSE) scores, National Institutes of Health Stroke Scale (NIHSS) scores, and infarct locations for the two groups were compared. Finally, to investigate the structural basis of post-stroke apathy, VBA of FA maps was performed in which we included the variables that a univariate analysis determined had P-values less than 0.20 as covariates. RESULTS HAMD (P = 0.01) and MMSE (P<0.01) scores differed significantly between the apathy and non-apathy groups. After controlling for age, education level, HAMD scores, and MMSE scores, significant FA reduction was detected in four clusters with peak voxels at the genu of the corpus callosum (X = -16, Y = 30, Z = 8), left anterior corona radiata (-22, 30, 10), splenium of the corpus callosum (-24, -56, 18), and right inferior frontal gyrus white matter (52, 24, 18), after family-wise error correction for multiple comparisons. CONCLUSIONS Post-stroke apathy is related to depression and cognitive decline. Damage to the genu of the corpus callosum, left anterior corona radiata, splenium of the corpus callosum, and white matter in the right inferior frontal gyrus may lead to apathy after ischemic stroke.
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Affiliation(s)
- Song-ran Yang
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Xin-yuan Shang
- Department of Neurology, Guangzhou First People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jun Tao
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian-yang Liu
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ping Hua
- Department of Cardiovascular Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- * E-mail:
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Abstract
Cerebrovascular diseases are associated with a high incidence of psychiatric disorders. Depressive illness after stroke has been extensively investigated during the last three decades. Post-stroke depression is estimated to occur in 30-35% of the patients during the first year after stroke. Numerous studies have given information on its prevalence, pathogenesis, clinical course, treatment and prevention. Despite the high level of comorbidity, depressive symptoms appear to remain frequently unrecognized and untreated. This has a negative effect on the rehabilitation, quality of live, cognitive function and mortality of stroke patients.
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Affiliation(s)
| | - Dániel Bereczki
- Semmelweis Egyetem, Általános Orvostudományi Kar Neurológiai Klinika Budapest Balassa u. 6. 1083
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21
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Yang S, Hua P, Shang X, Cui Z, Zhong S, Gong G, William Humphreys G. Deficiency of brain structural sub-network underlying post-ischaemic stroke apathy. Eur J Neurol 2014; 22:341-7. [PMID: 25319873 DOI: 10.1111/ene.12575] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
- S. Yang
- Department of Experimental Psychology; University of Oxford; Oxford UK
- Department of Neurology; Guangzhou First People's Hospital; Guangzhou Medical University; Guangzhou China
| | - P. Hua
- Department of Cadio-vascular surgery; Sun Yat-sen Memorial Hospital; Sun Yat-sen University; Guangzhou China
| | - X. Shang
- Department of Neurology; Guangzhou First People's Hospital; Guangzhou Medical University; Guangzhou China
| | - Z. Cui
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research; Beijing Normal University; Beijing China
| | - S. Zhong
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research; Beijing Normal University; Beijing China
| | - G. Gong
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research; Beijing Normal University; Beijing China
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Affiliation(s)
- Guido Chiti
- From the NEUROFARBA Department, University of Florence (G.C.) and Stroke Unit and Neurology, Cardiovascular Department (L.P.), Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Leonardo Pantoni
- From the NEUROFARBA Department, University of Florence (G.C.) and Stroke Unit and Neurology, Cardiovascular Department (L.P.), Azienda Ospedaliero Universitaria Careggi, Florence, Italy
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Hua P, Pan XP, Hu R, Mo XE, Shang XY, Yang SR. Factors related to executive dysfunction after acute infarct. PLoS One 2014; 9:e108574. [PMID: 25247604 PMCID: PMC4172700 DOI: 10.1371/journal.pone.0108574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 09/01/2014] [Indexed: 11/21/2022] Open
Abstract
Aim The aim of this study was to investigate the association of infarct location with post-stroke executive dysfunction. Methods One hundred seventy-seven patients hospitalized with acute infarction were enrolled. General information and NIHSS score at admission were recorded. The infarct site was recorded from magnetic resonance T2-W1 and FLAIR images, and the extent of white matter disease was assessed using the Fazekas score. Seven days after symptoms, executive function was assessed using the validated Chinese version of Mattis Dementia Rating Scale (MDRS) Initiation/Perseveration (I/P) [MDRS I/P]. Results The average MDRS I/P score of the 177 infarction patients was 24.16±5.21, considerably lower than the average score (32.7±3.1) of a control group of normal individuals. Patients with infarcts in the corona radiata or basal ganglia had significantly lower MDRS I/P scores that those without infarcts at these locations. The number of infarcts in the basal ganglia was also significantly associated with low MDRS I/P scores. Male gender and low NIHSS score were significantly associated with low MDRS I/P score, and high-density lipoprotein cholesterol was significantly associated with high MDRS I/P score. The number of infarcts in areas other than the basal ganglia as well as corona radiata and the extent of white matter disease had no influence on this score. Conclusions The number of infarcts in the basal ganglia corona radiata, low NIHSS score, and male gender are significantly and independently related to poor executive function (that is, low MDRS I/P score) after acute infarct.
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Affiliation(s)
- Ping Hua
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-ping Pan
- Department of Neurology, Guangzhou First People's Hospital, Guangzhou Medical College, Guangzhou, China
| | - Rong Hu
- Department of Neurology, Guangzhou First People's Hospital, Guangzhou Medical College, Guangzhou, China
| | - Xiao-en Mo
- Department of Neurology, Guangzhou First People's Hospital, Guangzhou Medical College, Guangzhou, China
| | - Xin-yuan Shang
- Department of Neurology, Guangzhou First People's Hospital, Guangzhou Medical College, Guangzhou, China
| | - Song-ran Yang
- Department of Neurology, Guangzhou First People's Hospital, Guangzhou Medical College, Guangzhou, China
- * E-mail:
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Mpembi Nkosi M, Mampunza Ma Miezi S, Massamba Kubuta V, Matonda Ma Nzuzi T, Dubois V, De Partz MP, Peeters A, Macq J, Constant E. [Clinical course of post-stroke depression in Kinshasa]. Rev Neurol (Paris) 2014; 170:614-20. [PMID: 24854963 DOI: 10.1016/j.neurol.2014.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 02/24/2014] [Accepted: 03/04/2014] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To describe the evolution of the clinical profile of post-stroke depression over a period of one year and to determine factors associated with changes in post-stroke depression. METHODS Prospective cohort study with a follow-up of 1year including 30 consecutive eligible patients. The severity of depression was assessed with the patient health questionnaire (PHQ9). RESULTS The mean age was 55.87±12.67years. Seventy percent of patients were men. The two assessments for neurological status, perceived health status and test results of attention were not statistically different. The rate of depressive symptoms was 26.67% in 2011 and 20% in 2012. Disability and apathy were significantly improved. The average for disability increased from 2.77±1.19 to 2.46±2.19 (P=0.002). From 66.7% in 2011, the proportion of patients able to walk without assistance rose to 93.3% in 2012 (P=0.03). In addition, the proportion of patients apathetic decreased from 43.3% to 13.3% (P=0.01). Greater age, female sex, sleep disorders and post-stroke apathy remained associated with DPAVC between the two assessments, with an increase in the strength of the association for apathy. CONCLUSIONS The frequency of post-stroke depression is high and remains stable over time. Disability is the clinical feature that evolved more favorably. The association with apathy, present at the beginning, of the study was strengthened one year later.
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Affiliation(s)
- M Mpembi Nkosi
- Département de psychiatrie, université catholique de Louvain, institut de recherche santé publique, santé et société, place de l'Université 1, 1348 Louvain-La-Neuve, Belgique; Département de psychiatrie, université de Kinshasa, Lemba, Kinshasa, Congo.
| | | | - V Massamba Kubuta
- École de santé publique, université Libre de Bruxelles, avenue Franklin-Roosevelt 50, 1050 Bruxelles, Belgique
| | - T Matonda Ma Nzuzi
- Département de psychiatrie, université catholique de Louvain, institut de recherche santé publique, santé et société, place de l'Université 1, 1348 Louvain-La-Neuve, Belgique; Département de psychiatrie, université de Kinshasa, Lemba, Kinshasa, Congo
| | - V Dubois
- Département de psychiatrie, université catholique de Louvain, institut de recherche santé publique, santé et société, place de l'Université 1, 1348 Louvain-La-Neuve, Belgique
| | - M-P De Partz
- Unité de neuropsychologie, université catholique de Louvain, cliniques universitaires Saint-Luc, avenue Hippocrate 10, 1200 Woluwe-Saint-Lambert, Belgique
| | - A Peeters
- Département de neurologie, université catholique de Louvain, place de l'Université 1, 1348 Louvain-La-Neuve, Belgique
| | - J Macq
- Université catholique de Louvain, institut de recherche santé publique santé et société, Clos Chapelle-aux-Champs, 30 boîte 3016, 1200 Bruxelles, Belgique
| | - E Constant
- Département de psychiatrie, université catholique de Louvain, institut de recherche santé publique, santé et société, place de l'Université 1, 1348 Louvain-La-Neuve, Belgique
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