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Blake JA, Long DL, Knight AJ, Goodin BR, Crowe M, Judd SE, Rhodes JD, Roth DL, Clay OJ. Stroke Severity, Caregiver Feedback, and Cognition in the REGARDS-CARES Study. J Am Heart Assoc 2024; 13:e033375. [PMID: 39056351 DOI: 10.1161/jaha.123.033375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/10/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Cognitive impairment after stroke is common and is present in up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of 2 stroke severity ratings and a caregiver-report of poststroke functioning with longitudinal cognitive outcomes. METHODS AND RESULTS One hundred fifty-seven caregivers and stroke survivor dyads participated in the CARES (Caring for Adults Recovering From the Effects of Stroke) project, an ancillary study of the REGARDS (Reasons for Geographic and Racial Differences in Stroke) national cohort study. The Glasgow Outcome Scale and modified Rankin Scale scores collected at hospitalization discharge were included as 2 primary predictors of cognitive impairment. The number of caregiver-reported problems and impairments at 9 months following stroke were included as a third predictor. Cognition was measured using a biennial telephone battery and included the domains of learning, memory, and executive functioning. Multiple cognitive assessments were analyzed up to 5 years poststroke, controlling for prestroke cognition and demographic variables of the stroke survivor. Separate mixed models showed significant main effects of the Glasgow Outcome Scale (b=0.3380 [95% CI, 0.14-0.5]; P=0.0009), modified Rankin Scale (b=-0.2119 [95% CI, -0.32 to -0.10]; P=0.0002), and caregiver-reported problems (b=-0.0671 [95% CI, -0.09 to -0.04]; P<0.0001) on longitudinal cognitive scores. In a combined model including all 3 predictors, only caregiver-reported problems significantly predicted cognition (b=-0.0480 [95% CI, -0.08 to -0.03]; P<0.0001). CONCLUSIONS These findings emphasize the importance of caregiver feedback in predicting cognitive consequences of stroke.
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Affiliation(s)
- Jason A Blake
- Department of Psychology University of Alabama at Birmingham Birmingham AL
| | - D Leann Long
- Department of Biostatistics University of Alabama at Birmingham Birmingham AL
| | - Amy J Knight
- Department of Neurology University of Alabama at Birmingham Birmingham AL
| | - Burel R Goodin
- Department of Anesthesiology Washington University in St. Louis St. Louis MO
| | - Michael Crowe
- Department of Psychology University of Alabama at Birmingham Birmingham AL
| | - Suzanne E Judd
- Department of Biostatistics University of Alabama at Birmingham Birmingham AL
| | - J David Rhodes
- Department of Biostatistics University of Alabama at Birmingham Birmingham AL
| | - David L Roth
- Center on Aging and Health Johns Hopkins School of Medicine Baltimore MD
| | - Olivio J Clay
- Department of Psychology University of Alabama at Birmingham Birmingham AL
- Alzheimer's Disease Research Center University of Alabama at Birmingham Birmingham AL
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de Graaf JA, van Miltenburg S, Wermer MJH, Post MWM, Visser-Meily JMA. Gender differences in participation one year after stroke: exploring biopsychosocial predictors for women and men. Top Stroke Rehabil 2024:1-11. [PMID: 39045812 DOI: 10.1080/10749357.2024.2377518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 06/29/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND Women appear to have a higher risk for long term restrictions in participation than men. This gender difference is poorly understood, as solely biomedical factors have been examined to date. OBJECTIVES The aims of this study are (1) to map gender differences in participation outcome one year after stroke, and (2) to identify demographic, stroke-related, or psychological predictors of participation for women and men separately. METHODS A total of 326 patients (mean age 66.5 ± 12.4y, 35.0% women) completed the restriction and satisfaction subscales of the Utrecht Scale of Evaluation of Rehabilitation-Participation (USER-P) at one year after stroke. Bivariate and multiple linear regression analyses were performed. RESULTS Women reported worse scores for restrictions in participation compared to men (median 75.4 versus 87.9 respectively, p = 0.001), especially in physical activities such as daytrips and going out. Satisfaction with participation was similar between women and men. Worse cognitive functioning (β = 0.17) was associated with more restrictions in participation in men only, other predictors of restrictions in participation were similar between women and men. The presence of depressive symptoms (β = -0.49) was associated with worse satisfaction with participation in men, whereas an increased stroke severity (β = -0.29) and the presence of maladaptive psychological factors (β = -0.36) were associated with worse satisfaction with participation in women. CONCLUSIONS Women experience more restrictions in participation compared to men one year after stroke. Taking into account gender-specific predictors of participation in stroke aftercare is important, as different biopsychosocial factors contribute to problems in participation across women and men.
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Affiliation(s)
- Joris A de Graaf
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sanne van Miltenburg
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marieke J H Wermer
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Center for Rehabilitation, Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Shiraishi R, Shiraishi N, Fujimoto Y, Ogawa T. Malnutrition suppresses improvements in depression symptoms in older adult patients with stroke undergoing convalescent rehabilitation. Clin Nutr ESPEN 2024; 63:508-514. [PMID: 39053700 DOI: 10.1016/j.clnesp.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/22/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND & AIMS Depression symptoms are both prevalent and associated with poor prognosis in patients with convalescent stroke. Therefore, the improvement of depression symptoms is important for patients with convalescent stroke. This study aimed to examine whether malnutrition diagnosed using the Global Leadership Initiative on Malnutrition (GLIM) criteria and its components are associated with improvements in depression symptoms in patients with stroke undergoing rehabilitation. METHODS This was a retrospective cohort study of older adult patients with convalescent stroke. Inclusion criteria comprised patients aged ≥65 years experiencing their first occurrence of stroke and admitted for rehabilitation therapy. Patients were classified into either the malnutrition or normal nutrition groups based on the diagnosis of malnutrition using the GLIM criteria. The Geriatric Depression Screening Scale (GDS)-15 was used to evaluate depression symptoms. The primary outcome of the study was the change in depression symptoms, indicating a change in GDS score from admission to discharge. The association between malnutrition diagnosed using the GLIM criteria and change in depression symptoms was assessed using multiple regression analysis. Additionally, associations with the constructs of the GLIM criteria were investigated. RESULTS The malnutrition group comprised 64 (45%) patients, with a mean age of 78.2 years; 77 (54%) and 66 (46%) were males and females, respectively. Multiple regression analysis showed that malnutrition, diagnosed using the GLIM criteria (β: -0.306, p < 0.001), was independently associated with changes in depression symptoms. Moreover, the GLIM criterion component of reduced muscle mass (β: -0.235, p < 0.001) demonstrated a negative association with a change in depression symptoms. CONCLUSION Malnutrition and reduced muscle mass, diagnosed using the GLIM criteria in patients with stroke undergoing convalescent rehabilitation, were found to suppress the improvement of depression symptoms.
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Affiliation(s)
- Ryo Shiraishi
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Department of Clinical Research and Quality Management, Graduate School of Medicine, University of the Ryukyus, Nishihara-cho, Okinawa 903-0215, Japan; Department of Rehabilitation Medicine, Aichi Medical University, Nagakute City, Aichi 480-1103, Japan.
| | - Nami Shiraishi
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan.
| | - Yuta Fujimoto
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan.
| | - Takahiro Ogawa
- Clinical Education and Research Center, Chuzan Hospital, 6-2-1 Matsumoto, Okinawa City, Okinawa 904-2151, Japan; Department of Rehabilitation Medicine, Aichi Medical University, Nagakute City, Aichi 480-1103, Japan.
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Ning L, Fu Y, Wang Y, Deng Q, Lin T, Li J. Fear of disease progression and resilience parallelly mediated the effect of post-stroke fatigue on post-stroke depression: A cross-sectional study. J Clin Nurs 2024. [PMID: 38887145 DOI: 10.1111/jocn.17323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 05/02/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024]
Abstract
AIMS To explore the effect of post-stroke fatigue (PSF) on post-stroke depression (PSD) and examine the mediating effects of fear of disease progression (FOP) and resilience between PSF and PSD. DESIGN A cross-sectional study. METHODS A total of 315 stroke patients participated in the questionnaire survey between November 2022 and June 2023. Data were collected using the General Information Questionnaire, Fatigue Severity Scale, Fear of Disease Progression Questionnaire-Short Form, Connor-Davidson Resilience Scale-10 Item and Hospital Anxiety and Depression Scale-Depression Subscale. Data were analysed by descriptive analysis, Mann-Whitney U-test, Kruskal-Wallis H-test, Pearson or Spearman correlation, hierarchical regression analysis and mediation analysis. RESULTS PSF had a significant positive total effect on PSD (β = .354, 95% CI: .251, .454). Additionally, FOP and resilience played a partial parallel-mediating role in the relationship between PSF and PSD (β = .202, 95% CI: .140, .265), and the total indirect effect accounted for 57.06% of the total effect. CONCLUSIONS FOP and resilience parallelly mediated the effect of PSF on PSD, which may provide a novel perspective for healthcare professionals in preventing PSD. Targeted interventions aiming at reducing PSF, lowering FOP levels and enhancing resilience may be possible ways to alleviate PSD. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Interventions that tail to reducing PSF, lowering FOP levels and enhancing resilience may be considered as possible ways to alleviate PSD. IMPACT This study enriched the literature by exploring the effect of PSF on PSD and further examining the mediating effects of FOP and resilience between PSF and PSD. Findings emphasized the important effects of PSF, FOP and resilience on PSD. REPORTING METHOD The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies was used to guide reporting. PATIENT OR PUBLIC CONTRIBUTION One tertiary hospital assisted participants recruitment.
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Affiliation(s)
- Liuqiao Ning
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yingjie Fu
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yuenv Wang
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qianying Deng
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tingting Lin
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jufang Li
- School of Nursing, Wenzhou Medical University, Wenzhou, Zhejiang, China
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de Geus EQJ, Milders MV, van Horn JE, Jonker FA, Fassaert T, Hutten JC, Kuipers F, Grimbergen C, Noordermeer SDS. A literature review of outcome and treatment options after acquired brain injury: Suggestions for adult offenders using knowledge from the general population. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:311-338. [PMID: 38527155 DOI: 10.1002/cbm.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Acquired brain injury (ABI) is a major health problem, often with negative effects on behaviour and mental health as well as cognition. Prevalence of ABI is exceptionally high among offenders and increases their re-offending risk. Information on risk factors for ABI and its outcomes among offenders that could guide effective treatment for them is, nevertheless, scarce and dispersed. However, there is a more substantial literature about the general population that could inform work with brain-injured offenders, especially when selecting for samples or subgroups with similar relevant characteristics, such as lower socio-economic status (SES), pre-injury lower tested intelligence score (<85) and pre-injury mental health problems. AIMS To explore brain injury data from non-offender samples of otherwise similar socio-economic and mental health and ability characteristics to offenders then, first, to describe their untreated outcomes and, secondly, outcomes after frequently used interventions in these circumstances, noting factors associated with their effectiveness. METHOD Three databases were systematically searched for the years 2010-2022; first, using terms for brain injury or damage and cognitive (dys)function, mental health or quality of life. Second, in a separate search, we used these terms and terms for interventions and rehabilitation. In the second review, studies were selected for clear, distinguishable data on age, sex, SES and lifestyle factors to facilitate inferences for offenders. A narrative analytical approach was adopted for both reviews. RESULTS Samples with characteristics that are typical in offender groups, including lower SES, lower pre-injury intelligence quotient (<85), prior cognitive impairments and prior mental health problems, had poorer cognitive and behavioural outcomes following ABI than those without such additional problems, together with lower treatment adherence. With respect to treatment, adequate motivation and self-awareness were associated with better cognitive and behavioural outcomes than when these were low or absent, regardless of the outcome measured. CONCLUSIONS More complex pre-injury mental health problems and social disadvantages typical of offenders are associated with poorer post-brain injury recovery. This paper adds to practical knowledge by bringing together work that follows specific outcome trajectories. Overall, succesful ABI-interventions in the general population that aim at pre-injury difficulties comparable to those seen among offenders, show that personalising injury-specific treatments and taking account of these difficulties, maximised positive outcomes.
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Affiliation(s)
- Esther Q J de Geus
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maarten V Milders
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Frank A Jonker
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Altrecht, Vesalius, Amsterdam, The Netherlands
| | | | | | | | | | - Siri D S Noordermeer
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Kusec A, Murphy FC, Peers PV, Manly T. Measuring Intolerance of Uncertainty After Acquired Brain Injury: Factor Structure, Reliability, and Validity of the Intolerance of Uncertainty Scale-12. Assessment 2024; 31:794-811. [PMID: 37357954 PMCID: PMC11092298 DOI: 10.1177/10731911231182693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
Intolerance of uncertainty (IU) is a risk factor for poor mental health. Acquired brain injury (ABI; for example, stroke, traumatic brain injury) often brings considerable uncertainty and increased mood disorder vulnerability. The Intolerance of Uncertainty Scale-Short Form (IUS-12) is a brief, well-validated IU measure in non-ABI samples, comprising two subscales, namely, Prospective Anxiety and Inhibitory Anxiety. Here, for the first time, we investigated its reliability and validity (N = 118), and factor structure (N = 176), in ABI. Both subscales had high test-retest reliability (intraclass correlation coefficients [ICCs] of .75 and .86) and were significantly associated with mood disorder symptoms. The two-factor model was superior to a one-factor IU model fit. Some fit statistics were less than optimal (standardized root mean square residual [SRMR] = 0.06, root mean square error of approximation [RMSEA] = 0.09); hence, exploration of other factor structures in other ABI samples may be warranted. Nonetheless, the IUS-12 appears suitable in ABI.
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Affiliation(s)
- Andrea Kusec
- University of Cambridge, UK
- University of Oxford, UK
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Dangayach NS, Kreitzer N, Foreman B, Tosto-Mancuso J. Post-Intensive Care Syndrome in Neurocritical Care Patients. Semin Neurol 2024; 44:398-411. [PMID: 38897212 DOI: 10.1055/s-0044-1787011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
Post-intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.
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Affiliation(s)
- Neha S Dangayach
- Department of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natalie Kreitzer
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brandon Foreman
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Jenna Tosto-Mancuso
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
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Zhao B, Wang Y, Xu N, Xu J, Yang K. Knowledge, attitude and practice of poststroke depression among patients with poststroke depression and their family members in Heilongjiang Province, China: a cross-sectional study. BMJ Open 2024; 14:e078276. [PMID: 38749687 PMCID: PMC11097814 DOI: 10.1136/bmjopen-2023-078276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 04/22/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the knowledge, attitude and practice (KAP) of poststroke depression (PSD) among patients with PSD and their family members. DESIGN Web-based cross-sectional study. SETTING This study was conducted in Heilongjiang Province between October 2022 and April 2023. PARTICIPANTS Patients with PSD and their family members. PRIMARY AND SECONDARY OUTCOME MEASURES KAP scores. METHOD The self-administered questionnaire comprised demographic characteristics, knowledge dimension, attitude dimension and practice dimensions. RESULTS A total of 489 valid questionnaires were collected, with the average age of the subjects was 54.68±13.80 years, and including 258 (53.09%) patients who had a stroke. The mean scores for KAP were 6.36±2.66 (possible range: 0-10), 29.07±5.18 (possible range: 8-40) and 37.50±8.49 (possible range: 10-50), respectively. Concerning KAP scores, no differences were found between patients with PSD and their family members. Multivariate logistic regression analysis showed that retirement (OR=0.29, 95% CI 0.11 to 0.77, p=0.012) and monthly income less than ¥2000 (OR=0.46, 95% CI 0.27, 0.79, p=0.005) were independently associated with adequate knowledge. Knowledge (OR=2.12, 95% CI 1.44 to 3.14, p<0.001) was independently associated with positive attitude. Knowledge (OR=3.85, 95% CI 2.53 to 5.86, p<0.001) and attitude (OR=1.62, 95% CI 1.06 to 2.47, p=0.024) were independently associated with proactive practice. CONCLUSION Patients and their family members had insufficient knowledge, positive attitude and moderate practice towards PSD. Retirement and low monthly income were associated with insufficient knowledge, while knowledge was associated with positive attitude and proactive practice.
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Affiliation(s)
- Bin Zhao
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
- Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Yujue Wang
- Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Ning Xu
- First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Jiaben Xu
- Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
| | - Keqin Yang
- Second Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang, China
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Mazzeo S, Pancani S, Sodero A, Castagnoli C, Politi AM, Barnabè M, Ciullini F, Baccini M, Grippo A, Hakiki B, Macchi C, Cecchi F. Depressive Symptoms Moderate the Association Between Functional Level at Admission to Intensive Post-Stroke Rehabilitation and Effectiveness of the Intervention. J Geriatr Psychiatry Neurol 2024; 37:222-233. [PMID: 37828783 DOI: 10.1177/08919887231204543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Previous studies showed that depression acts as an independent factor in functional recovery after stroke. In a prospective cohort of patients admitted to intensive inpatient rehabilitation after a stroke, we aimed to test depression as a moderator of the relationship between the functional level at admission and the effectiveness of rehabilitation at discharge. METHODS All patients admitted to within 30 days from an ischemic or hemorrhagic stroke to 4 intensive rehabilitation units were prospectively screened for eligibility to a multicenter prospective observational study. Enrolled patients underwent an evidence-based rehabilitation pathway. We used clinical data collected at admission (T0) and discharge (T1). The outcome was the effectiveness of recovery at T1 on the modified Barthel Index (proportion of achieved over potential functional improvement). Moderation analysis was performed by using the PROCESS macro for SPSS using the bootstrapping procedure. RESULTS Of 278 evaluated patients, 234 were eligible and consented to enrolment; 81 patients were able to answer to the Hospital Anxiety and Depression Scale (HADS) and were included in this analysis. The relationship between the functional status at admission and rehabilitation effectiveness was significant only in persons with fewer depressive symptoms; depression (HADS cut-off score: 5.9) moderated this relationship (P = .047), independent from age and neurological impairment. CONCLUSIONS Our results suggest that depression moderates between the functional status at admission and the functional recovery after post-stroke rehabilitation. This approach facilitates the identification of subgroups of individuals who may respond differently to stroke rehabilitation based on depression.
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Affiliation(s)
- Salvatore Mazzeo
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Silvia Pancani
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | - Alessandro Sodero
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | | | | | - Monica Barnabè
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | | | - Marco Baccini
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | | | - Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cecchi
- IRCCS Fondazione Don Carlo Gnocchi onlus, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Payne C, Gesch J, Smits E, Brakenridge C, Johnston V, Gardiner PA, Comans T, Bell R, Gane E. Feasibility of a physiotherapist-supervised walking program with telephone coaching to increase physical activity following acquired brain injury. BRAIN IMPAIR 2024; 25:IB23095. [PMID: 38810091 DOI: 10.1071/ib23095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 05/09/2024] [Indexed: 05/31/2024]
Abstract
Background Physical activity has health benefits for adults with acquired brain injury, but it is a challenge to increase physical activity during inpatient rehabilitation. The objectives of this pilot study were to determine whether a physiotherapy-supervised inpatient walking program was feasible and able to improve physical activity and sedentary behaviour in the short and medium term. Methods Adults with acquired brain injury receiving inpatient rehabilitation undertook twice-weekly supervised walks plus behavioural therapy for 4 weeks. Feasibility was measured via recruitment, participation and drop out rates, adverse events and intervention delivery costs. Physical activity and sedentary behaviour were measured with an activPAL. Assessments were conducted at baseline, post-intervention and 3-6 months post-intervention. Results The program was safe to deliver (no adverse events), recruitment rate was 55% (16/29) and the participation rate for eligible individuals was high (14/19, 74%). However, the program had a high drop out rate (7/16, 44%) and physical activity and sedentary behaviour did not significantly change during the 4-week intervention. Costs were AU$427.71/participant. Physical activity and sedentary behaviour did improve 3-6 months after the intervention (vs baseline, on average: +3913 steps per day, 95% CI: 671, 7156). Conclusion This pilot study demonstrated a supervised physiotherapy walking program is safe and feasible to recruit in an inpatient setting. However, drop out during the study was high and behaviour change did not occur. More work is required to boost physical activity during sub-acute rehabilitation for acquired brain injury.
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Affiliation(s)
- Caitlyn Payne
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Janelle Gesch
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; and Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Esther Smits
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia
| | - Charlotte Brakenridge
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Qld, Australia; and School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - Venerina Johnston
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia; and Centre for Health Research, University of Southern Queensland, Darling Heights, Qld, Australia
| | - Paul A Gardiner
- School of Public Health, The University of Queensland, Brisbane, Qld, Australia
| | - Tracy Comans
- Centre for Health Services Research, The University of Queensland, Brisbane, Qld, Australia
| | - Ryan Bell
- Brain Injury Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Elise Gane
- Physiotherapy Department, Princess Alexandra Hospital, Brisbane, Qld, Australia; and School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia; and Centre for Functioning and Health Research, Metro South Health, Brisbane, Qld, Australia
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Hassanein EHM, Althagafy HS, Baraka MA, Abd-Alhameed EK, Ibrahim IM. Pharmacological update of mirtazapine: a narrative literature review. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:2603-2619. [PMID: 37943296 PMCID: PMC11074035 DOI: 10.1007/s00210-023-02818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
Mirtazapine (MTZ) is an antidepressant drug with an exceptional pharmacological profile. It also has an excellent safety and tolerability profile. The present review provides a pharmacological update on MTZ and summarizes the research findings of MTZ's effects on different diseases. MTZ is hypothesized to have antidepressant effects because of the synergy between noradrenergic and serotonergic actions and is effective in treating major depressive disorder and depression associated with epilepsy, Alzheimer's disease, stroke, cardiovascular disease, and respiratory disease. In cancer patients, MTZ significantly reduced sadness, nausea, sleep disruption, and pain and improved quality of life. Also, it has promising effects on Parkinson's disease, schizophrenia, dysthymia, social anxiety disorder, alcohol dependency, posttraumatic stress disorder, panic disorder, pain syndromes, obsessive-compulsive disorder, and sleep disorders. Additionally, MTZ is potentially therapeutic in different situations associated with depression, such as liver, kidney, cardiovascular, respiratory, infertility, heavy metal-induced neurotoxicity, and pruritus. Potent antioxidative, anti-inflammatory, and anti-apoptotic bioactivities mediate these promising effects. These positive outcomes of the scientific investigations motivate more and more clinical trials for a golden exceptional antidepressant in different conditions.
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Affiliation(s)
- Emad H M Hassanein
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, 71524, Egypt.
| | - Hanan S Althagafy
- Department of Biochemistry, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Mohammad A Baraka
- Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut, 71524, Egypt
| | - Esraa K Abd-Alhameed
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Islam M Ibrahim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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12
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Gu P, Ding Y, Ruchi M, Feng J, Fan H, Fayyaz A, Geng X. Post-stroke dizziness, depression and anxiety. Neurol Res 2024; 46:466-478. [PMID: 38488118 DOI: 10.1080/01616412.2024.2328490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 03/03/2024] [Indexed: 04/29/2024]
Abstract
OBJECTIVE Vestibular and psychiatric disorders are very closely related. Previous research shows that the discomfort and dysfunction caused by dizziness in patients can affect psychological processes, leading to anxiety and depression, and the irritation of anxiety and depression can aggravate the discomfort of dizziness. But the causal relationship between dizziness in the recovery period of stroke and Post-stroke depression (PSD) / Post-stroke anxiety (PSA) is not clear. Identifying the causal relationship between them can enable us to conduct more targeted treatments. METHODS We review the epidemiology and relationship of dizziness, anxiety, and depression, along with the related neuroanatomical basis. We also review the pathophysiology of dizziness after stroke, vestibular function of patients experiencing dizziness, and the causes and mechanisms of PSD and PSA. We attempt to explore the possible relationship between post-stroke dizziness and PSD and PSA. CONCLUSION The treatment approach for post-stroke dizziness depends on its underlying cause. If the dizziness is a result of PSD and PSA, addressing these psychological factors may alleviate the dizziness. This can be achieved through targeted treatments for PSD and PSA, such as psychotherapy, antidepressants, or anxiolytics, which could indirectly improve dizziness symptoms. Conversely, if PSA and PSD are secondary to vestibular dysfunction caused by stroke, a thorough vestibular function assessment is crucial. Identifying the extent of vestibular impairment allows for tailored interventions. These could include vestibular rehabilitation therapy and medication aimed at vestibular restoration. By improving vestibular function, secondary symptoms like anxiety and depression may also be mitigated.
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Affiliation(s)
- Pan Gu
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Mangal Ruchi
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jing Feng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Huimin Fan
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Aminan Fayyaz
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, USA
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, Beijing, China
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13
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Xiao W, Liu Y, Huang J, Huang LA, Bian Y, Zou G. Analysis of factors associated with depressive symptoms in stroke patients based on a national cross-sectional study. Sci Rep 2024; 14:9268. [PMID: 38649386 PMCID: PMC11035548 DOI: 10.1038/s41598-024-59837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
Post-stroke depression is commonly experienced by stroke survivors and has a significant negative impact on the physical, cognitive, and social functioning of those affected. This study aims to investigate the prevalence of depressive symptoms and their associated factors in Chinese stroke patients. Research samples were selected from the China Health and Retirement Longitudinal Study 2018 survey. Depression was evaluated using the 10-item Center for Epidemiological Studies Depression Scale, with a score ≥ 10 defined as depression. Univariate and multivariable analyses were performed to examine the associations of depressive symptoms with demographics, family relationships, health status, and lifestyle. A total of 963 stroke patients were included and 57.8% of them had depressive symptoms. Depressive symptoms were significantly associated with female sex (OR 1.762, 95% CI 1.235-2.514), lower education level (non-formal education: OR 2.148, 95% CI 1.235-3.737, primary to secondary school education: OR 1.964, 95% CI 1.272-3.033), dissatisfaction with spouse (OR 1.912, 95% CI 1.075-3.401), dissatisfaction with life (OR 1.779, 95% CI 1.080-2.931), dissatisfaction with health (OR 1.592, 95% CI 1.138-2.226), pain (OR 1.392, 95% CI 1.005-1.928) and abnormal sleep (OR 1.557, 95% CI 1.126-2.152). The findings suggest the need for regular depression screening and evaluation after a stroke, and that a well-functioning support system, effective health management, and lifestyle modifications could potentially improve the mental state of stroke patients.
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Affiliation(s)
- Wenhui Xiao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ying Liu
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinglin Huang
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Li-An Huang
- The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Ying Bian
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China.
- Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macau SAR, China.
| | - Guanyang Zou
- School of Public Health and Management, Guangzhou University of Chinese Medicine, Guangzhou, China.
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14
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Broomfield NM, Blake J, Gracey F, Steverson T. Post-stroke emotionalism: Diagnosis, pathophysiology, and treatment. Int J Stroke 2024:17474930241242952. [PMID: 38503711 DOI: 10.1177/17474930241242952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Post-stroke emotionalism affects one in five stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect. AIM AND METHODS This narrative review presents a summary of the post-stroke emotionalism literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment. RESULTS Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways and those related to serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. Testing for Emotionalism after Recent Stroke-Questionnaire (TEARS-Q) has recently been developed to allow standardized assessment. Treatment options are limited, and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomized-controlled trials of non-pharmacological interventions. CONCLUSIONS More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.
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Affiliation(s)
- Niall M Broomfield
- Department of Clinical Psychology and Psychological Therapies (CPPT), Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joshua Blake
- Department of Clinical Psychology and Psychological Therapies (CPPT), Norwich Medical School, University of East Anglia, Norwich, UK
| | - Fergus Gracey
- Department of Clinical Psychology and Psychological Therapies (CPPT), Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tom Steverson
- Department of Clinical Psychology and Psychological Therapies (CPPT), Norwich Medical School, University of East Anglia, Norwich, UK
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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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16
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Blake J, Beazley P, Steverson T. An evaluation of an open group for depressed mood on a stroke rehabilitation ward: three years of clinical data. Disabil Rehabil 2024; 46:939-946. [PMID: 36916395 DOI: 10.1080/09638288.2023.2186498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/24/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE An open group intervention for stroke inpatients, based on Acceptance and Commitment Therapy, is evaluated using retrospective clinical service data. MATERIALS AND METHODS Participants were included unless severely unwell or unable to provide informed consent. 117 participants attended at least two sessions in a non-controlled, repeated measures design. Two session protocols were delivered on alternating weeks by an Assistant Psychologist and Trainee Psychologist, covering values, committed action, and acceptance. Participants rated their mood each session using the Depression Intensity Scale Circles (DISCs). RESULTS Attended sessions ranged from 1 to 11 (Md: 2). Significant reductions in DISCs scores with medium effect sizes were found among those scoring above the cut-off for depression at baseline, Χ2(3) = 20.87, p < .001. The likelihood of scoring below the cut-off for depression did not change between participants' first and last sessions, X2(1, N = 117) = 1.36, p = .24. The number of sessions attended did not predict outcome, rs(117) = .09, p = .33. CONCLUSIONS Design limitations prevented inferences of clinical effectiveness, but the group met several clinical utility criteria by providing a flexible intervention on a rehabilitation ward with competing demands. We highlight the importance of contrasting findings of clinical trials with data from clinical services.
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Affiliation(s)
- Joshua Blake
- Clinical Psychology, University of East Anglia, Norwich, UK
| | - Peter Beazley
- Deputy Course Director, Doctorate in Clinical Psychology, University of East Anglia, Norwich, UK
| | - Tom Steverson
- Clinical Psychologist, Norfolk Community Health and Care NHS Trust and University of East Anglia, Norwich, UK
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17
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Blake JA, Long DL, Knight AJ, Goodin BR, Crowe M, Judd SE, Rhodes JD, Roth DL, Clay OJ. Stroke Severity, Caregiver Feedback, and Cognition in the REGARDS-CARES Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.10.26.23297649. [PMID: 37961600 PMCID: PMC10635206 DOI: 10.1101/2023.10.26.23297649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Objective Cognitive impairment after stroke is common, present up to 60% of survivors. Stroke severity, indicated by both volume and location, is the most consequential predictor of cognitive impairment, with severe strokes predicting higher chances of cognitive impairment. The current investigation examines the associations of two stroke severity ratings and a caregiver-report of post-stroke functioning with longitudinal cognitive outcomes. Methods The analysis was conducted on 157 caregivers and stroke survivor dyads who participated in the Caring for Adults Recovering from the Effects of Stroke (CARES) project, an ancillary study of the REasons for Geographic and Racial Differences in Stroke (REGARDS) national cohort study. Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) collected at hospitalization discharge were included as two primary predictors of cognitive impairment. The number of caregiver-reported problems and impairments at nine months following stroke were included as a third predictor. Cognition was assessed using a biennial telephone battery, incorporating multiple cognitive assessments to assess learning, memory, and executive functioning. Longitudinal cognitive scores were analyzed up to five years post-stroke, controlling for baseline (pre-stroke) cognitive scores and demographic variables of each stroke survivor collected at CARES baseline. Results Separate mixed models showed significant main effects of GOS (b=0.3280, p=0.0009), mRS (b=-0.2119, p=0.0002), and caregiver-reported impairments (b=-0.0671, p<0.0001) on longitudinal cognitive scores. In a combined model including all three predictors, only caregiver-reported problems significantly predicted cognitive outcomes (b=-0.0480, p<0.0001). Impact These findings underscore the importance of incorporating caregivers feedback in understanding cognitive consequences of stroke.
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18
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MacNeil A, Li G, Gulati I, Taunque A, Jiang Y, de Groh M, Fuller-Thomson E. Depression during the COVID-19 pandemic among older adults with stroke history: Findings from the Canadian Longitudinal Study on Aging. Int J Geriatr Psychiatry 2024; 39:e6062. [PMID: 38380892 DOI: 10.1002/gps.6062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/15/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The COVID-19 pandemic and accompanying public health measures exacerbated many known risk factors for depression, while also increasing numerous health-related stressors for people with stroke history. Using a large longitudinal sample of older adults, the current study examined the prevalence of incident and recurrent depression among participants with stroke history, and also identified factors that were associated with depression during the pandemic among this population. METHODS Data came from four waves of the Canadian Longitudinal Study on Aging's (CLSA) comprehensive cohort (n = 577 with stroke history; 46.1% female; 20.8% immigrants; mean age = 74.56 SD = 9.19). The outcome of interest was a positive screen for depression, based on the CES-D-10, collected during the 2020 CLSA COVID autumn questionnaire. Bivariate and multivariate logistic regression analyses were conducted to identify factors that were associated with depression. RESULTS Approximately 1 in 2 (49.5%) participants with stroke history and a history of depression experienced a recurrence of depression early in the pandemic. Among those without a history of depression, approximately 1 in 7 (15.0%) developed depression for the first time during this period. The risk of depression was higher among immigrants, those who were lonely, those with functional limitations, and those who experienced COVID-19 related stressors, such as increased family issues, difficulty accessing healthcare, and becoming ill or having a loved one become ill or die during the pandemic. CONCLUSIONS Interventions that target those with stroke history, both with and without a history of depression, are needed to buffer against the stressors of the COVID-19 pandemic and support the mental health of this population.
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Affiliation(s)
- Andie MacNeil
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Grace Li
- Department of Sociology, University of Victoria, Victoria, British Columbia, Canada
| | - Ishnaa Gulati
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Aneisha Taunque
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Ying Jiang
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Margaret de Groh
- Applied Research Division, Center for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
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19
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Šaňák D, Gurková E, Štureková L, Šaňáková Š, Zapletalová J, Franc D, Bartoníčková D. Quality of Life in Patients with Excellent 3-Month Clinical Outcome after First-Ever Ischemic Stroke: A Time to Redefine Excellent Outcome? Eur Neurol 2024; 87:1-10. [PMID: 38232714 DOI: 10.1159/000535685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/03/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Ischemic stroke (IS) may have impact on long-term health-related quality of life (HRQoL) even in the patients with good clinical outcome, and tools mostly used for the assessment of outcome may underestimate or not reflect all relevant sequels after IS. We aimed to analyze HRQoL in the patients with excellent outcome after IS. METHODS We analyzed consecutive IS patients enrolled in the prospective FRAILTY study (ClinicalTrials.gov: NCT04839887) with excellent 3-month clinical outcome (score 0-1 in modified Rankin Scale [mRS]). Stroke Impact Scale (SIS) version 3.0 and Hospital Anxiety and Depression Scale (HADS) were used for the HRQoL, anxiety, and depression assessments, and subgroup comparisons were performed according to NIHSS score (0, ≥1), age (50<, ≥50 years), and sex. RESULTS In total, 158 patients (55.7% men, mean age 60.3 ± 13.4 years) were analyzed, and 72.2% of them had score 0 in mRS. The overall lowest median scores were found in the SIS domain "emotion," "strength," and "participation." Patients with NIHSS ≥1 had lower scores in all SIS domains except "emotions" and "mobility." Patients ≥50 years had lower score in "mobility" (p = 0.004) and females in domain of "social participation" (p = 0.044). No differences were found among all subgroups in HADS anxiety and depression. Age, NIHSS score, and depression were found negative predictors for the physical domains of HRQoL. DISCUSSION/CONCLUSIONS Despite excellent 3-month clinical outcome after IS, patients had affected substantially their HRQoL, especially those with NIHSS ≥1. Patients ≥50 years had more affected "mobility" and females "social participation."
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Affiliation(s)
- Daniel Šaňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czechia
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Lenka Štureková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Šárka Šaňáková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Jana Zapletalová
- Department Medical Biophysics, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
| | - David Franc
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czechia
| | - Daniela Bartoníčková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
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De Risio L, Pettorruso M, Collevecchio R, Collacchi B, Boffa M, Santorelli M, Clerici M, Martinotti G, Zoratto F, Borgi M. Staying connected: An umbrella review of meta-analyses on the push-and-pull of social connection in depression. J Affect Disord 2024; 345:358-368. [PMID: 37852587 DOI: 10.1016/j.jad.2023.10.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/18/2023] [Accepted: 10/15/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Depression affects approximately 4 % of the global population and has huge social and economic implications. Social factors, including support, engagement, and stigma, play a crucial role in the development and severity of depression. METHODS We provide a synthesis of the consistency and magnitude of the association between measures of social connection and depression. We searched PubMed, PsycINFO, Cochrane Library, and EMBASE and 47 meta-analyses were included in the umbrella review. The strength of the associations was extracted and compared among different populations. The quality/certainty of evidence was assessed using AMSTAR-2 and GRADE tool. RESULTS Results indicate that social support serves as a protective factor against depression, particularly in peripartum populations, while its impact is weaker in clinical populations. No association was found between social support and depression in post-disaster populations. Stigma and discrimination favour the development and maintenance of depressive symptoms in clinical populations, but have a weaker effect in ethnic minorities. LIMITATIONS The quality and certainty of evidence should be taken into account when interpreting our findings. Further research with more rigorous methodology and higher-quality evidence is needed to better understand the complex relationship between depression and social connection across various populations and contexts. CONCLUSIONS Our findings confirm the role of social determinants in the emergence and severity of depression, particularly in the case of vulnerable populations. Efforts to counteract disconnection at the societal and individual levels and to reduce stigma should be central to an effective depression prevention agenda.
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Affiliation(s)
- Luisa De Risio
- Department of Psychiatry and Addiction, ASL Roma 5, Colleferro, Rome, Italy
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy.
| | - Rebecca Collevecchio
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
| | - Barbara Collacchi
- Center for Behavioural Science and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marta Boffa
- Center for Behavioural Science and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Mario Santorelli
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Massimo Clerici
- School of Medicine and Surgery, University of Milano - Bicocca, Milano, Italy
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti-Pescara, Italy
| | - Francesca Zoratto
- Center for Behavioural Science and Mental Health, Istituto Superiore di Sanità, Rome, Italy
| | - Marta Borgi
- Center for Behavioural Science and Mental Health, Istituto Superiore di Sanità, Rome, Italy
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Köhler-Forsberg O, Stiglbauer V, Brasanac J, Chae WR, Wagener F, Zimbalski K, Jefsen OH, Liu S, Seals MR, Gamradt S, Correll CU, Gold SM, Otte C. Efficacy and Safety of Antidepressants in Patients With Comorbid Depression and Medical Diseases: An Umbrella Systematic Review and Meta-Analysis. JAMA Psychiatry 2023; 80:1196-1207. [PMID: 37672261 PMCID: PMC10483387 DOI: 10.1001/jamapsychiatry.2023.2983] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/21/2023] [Indexed: 09/07/2023]
Abstract
Importance Every third to sixth patient with medical diseases receives antidepressants, but regulatory trials typically exclude comorbid medical diseases. Meta-analyses of antidepressants have shown small to medium effect sizes, but generalizability to clinical settings is unclear, where medical comorbidity is highly prevalent. Objective To perform an umbrella systematic review of the meta-analytic evidence and meta-analysis of the efficacy and safety of antidepressant use in populations with medical diseases and comorbid depression. Data Sources PubMed and EMBASE were searched from inception until March 31, 2023, for systematic reviews with or without meta-analyses of randomized clinical trials (RCTs) examining the efficacy and safety of antidepressants for treatment or prevention of comorbid depression in any medical disease. Study Selection Meta-analyses of placebo- or active-controlled RCTs studying antidepressants for depression in individuals with medical diseases. Data Extraction and Synthesis Data extraction and quality assessment using A Measurement Tool for the Assessment of Multiple Systematic Reviews (AMSTAR-2 and AMSTAR-Content) were performed by pairs of independent reviewers following PRISMA guidelines. When several meta-analyses studied the same medical disease, the largest meta-analysis was included. Random-effects meta-analyses pooled data on the primary outcome (efficacy), key secondary outcomes (acceptability and tolerability), and additional secondary outcomes (response and remission). Main Outcomes and Measures Antidepressant efficacy presented as standardized mean differences (SMDs) and tolerability (discontinuation for adverse effects) and acceptability (all-cause discontinuation) presented as risk ratios (RRs). Results Of 6587 references, 176 systematic reviews were identified in 43 medical diseases. Altogether, 52 meta-analyses in 27 medical diseases were included in the evidence synthesis (mean [SD] AMSTAR-2 quality score, 9.3 [3.1], with a maximum possible of 16; mean [SD] AMSTAR-Content score, 2.4 [1.9], with a maximum possible of 9). Across medical diseases (23 meta-analyses), antidepressants improved depression vs placebo (SMD, 0.42 [95% CI, 0.30-0.54]; I2 = 76.5%), with the largest SMDs for myocardial infarction (SMD, 1.38 [95% CI, 0.82-1.93]), functional chest pain (SMD, 0.87 [95% CI, 0.08-1.67]), and coronary artery disease (SMD, 0.83 [95% CI, 0.32-1.33]) and the smallest for low back pain (SMD, 0.06 [95% CI, 0.17-0.39]) and traumatic brain injury (SMD, 0.08 [95% CI, -0.28 to 0.45]). Antidepressants showed worse acceptability (24 meta-analyses; RR, 1.17 [95% CI, 1.02-1.32]) and tolerability (18 meta-analyses; RR, 1.39 [95% CI, 1.13-1.64]) compared with placebo. Antidepressants led to higher rates of response (8 meta-analyses; RR, 1.54 [95% CI, 1.14-1.94]) and remission (6 meta-analyses; RR, 1.43 [95% CI, 1.25-1.61]) than placebo. Antidepressants more likely prevented depression than placebo (7 meta-analyses; RR, 0.43 [95% CI, 0.33-0.53]). Conclusions and Relevance The results of this umbrella systematic review of meta-analyses found that antidepressants are effective and safe in treating and preventing depression in patients with comorbid medical disease. However, few large, high-quality RCTs exist in most medical diseases.
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Affiliation(s)
- Ole Köhler-Forsberg
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Victoria Stiglbauer
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Jelena Brasanac
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Woo Ri Chae
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
- BIH Charité Clinician Scientist Program, BIH Biomedical Innovation Academy, Berlin Institute of Health at Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Frederike Wagener
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Kim Zimbalski
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Oskar H. Jefsen
- Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Shuyan Liu
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Malik R. Seals
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Stefanie Gamradt
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph U. Correll
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, New York
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, New York
| | - Stefan M. Gold
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
- Department of Psychosomatic Medicine, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Institute of Neuroimmunology and Multiple Sclerosis, Universitätsklinikum Hamburg–Eppendorf, Hamburg, Germany
| | - Christian Otte
- Department of Psychiatry and Neuroscience, Campus Benjamin Franklin, Charité–Universitätsmedizin Berlin, Berlin, Germany
- DZPG (German Center for Mental Health), partner site Berlin, Berlin, Germany
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22
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Simon E, Barlinn K, Siepmann T. [Prevention of Post-Stroke Depression]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2023; 91:510-515. [PMID: 38081164 DOI: 10.1055/a-2190-9141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Post-stroke depression (PSD) is a clinically relevant complication of ischemic and hemorrhagic cerebral infarction that affects about 30% of all stroke survivors. It is associated with reduced quality of life as well as delayed recovery from neurological deficits and functional impairment, frequently leading to impeded rehabilitation. Suitable screening methods allow early detection of PSD. Timely initiation of treatment in patients with manifest PSD as well as implantation of effective prevention strategies can help reduce medical and socioeconomic burden associated with the disease. We reviewed the current literature on pharmacological and non-pharmacological prevention of PSD.
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Affiliation(s)
- Erik Simon
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Kristian Barlinn
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Timo Siepmann
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Dresden, Germany
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23
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Zhou J, Fangma Y, Chen Z, Zheng Y. Post-Stroke Neuropsychiatric Complications: Types, Pathogenesis, and Therapeutic Intervention. Aging Dis 2023; 14:2127-2152. [PMID: 37199575 PMCID: PMC10676799 DOI: 10.14336/ad.2023.0310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/10/2023] [Indexed: 05/19/2023] Open
Abstract
Almost all stroke survivors suffer physical disabilities and neuropsychiatric disturbances, which can be briefly divided into post-stroke neurological diseases and post-stroke psychiatric disorders. The former type mainly includes post-stroke pain, post-stroke epilepsy, and post-stroke dementia while the latter one includes post-stroke depression, post-stroke anxiety, post-stroke apathy and post-stroke fatigue. Multiple risk factors are related to these post-stroke neuropsychiatric complications, such as age, gender, lifestyle, stroke type, medication, lesion location, and comorbidities. Recent studies have revealed several critical mechanisms underlying these complications, namely inflammatory response, dysregulation of the hypothalamic pituitary adrenal axis, cholinergic dysfunction, reduced level of 5-hydroxytryptamine, glutamate-mediated excitotoxicity and mitochondrial dysfunction. Moreover, clinical efforts have successfully given birth to many practical pharmaceutic strategies, such as anti-inflammatory medications, acetylcholinesterase inhibitors, and selective serotonin reuptake inhibitors, as well as diverse rehabilitative modalities to help patients physically and mentally. However, the efficacy of these interventions is still under debate. Further investigations into these post-stroke neuropsychiatric complications, from both basic and clinical perspectives, are urgent for the development of effective treatment strategies.
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Affiliation(s)
| | | | - Zhong Chen
- Correspondence should be addressed to: Prof. Zhong Chen () and Dr. Yanrong Zheng (), Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yanrong Zheng
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China.
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24
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Oei CW, Ng EYK, Ng MHS, Tan RS, Chan YM, Chan LG, Acharya UR. Explainable Risk Prediction of Post-Stroke Adverse Mental Outcomes Using Machine Learning Techniques in a Population of 1780 Patients. SENSORS (BASEL, SWITZERLAND) 2023; 23:7946. [PMID: 37766004 PMCID: PMC10538068 DOI: 10.3390/s23187946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
Post-stroke depression and anxiety, collectively known as post-stroke adverse mental outcome (PSAMO) are common sequelae of stroke. About 30% of stroke survivors develop depression and about 20% develop anxiety. Stroke survivors with PSAMO have poorer health outcomes with higher mortality and greater functional disability. In this study, we aimed to develop a machine learning (ML) model to predict the risk of PSAMO. We retrospectively studied 1780 patients with stroke who were divided into PSAMO vs. no PSAMO groups based on results of validated depression and anxiety questionnaires. The features collected included demographic and sociological data, quality of life scores, stroke-related information, medical and medication history, and comorbidities. Recursive feature elimination was used to select features to input in parallel to eight ML algorithms to train and test the model. Bayesian optimization was used for hyperparameter tuning. Shapley additive explanations (SHAP), an explainable AI (XAI) method, was applied to interpret the model. The best performing ML algorithm was gradient-boosted tree, which attained 74.7% binary classification accuracy. Feature importance calculated by SHAP produced a list of ranked important features that contributed to the prediction, which were consistent with findings of prior clinical studies. Some of these factors were modifiable, and potentially amenable to intervention at early stages of stroke to reduce the incidence of PSAMO.
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Affiliation(s)
- Chien Wei Oei
- Management Information Department, Office of Clinical Epidemiology, Analytics and kNowledge (OCEAN), Tan Tock Seng Hospital, Singapore 308433, Singapore;
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Eddie Yin Kwee Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Matthew Hok Shan Ng
- Rehabilitation Research Institute of Singapore, Nanyang Technological University, Singapore 308232, Singapore;
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore 169609, Singapore;
- Duke-NUS Medical School, Singapore 169857, Singapore
| | - Yam Meng Chan
- Department of General Surgery, Vascular Surgery Service, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Lai Gwen Chan
- Department of Psychiatry, Tan Tock Seng Hospital, Singapore 308433, Singapore;
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore
| | - Udyavara Rajendra Acharya
- School of Mathematics, Physics and Computing, University of Southern Queensland, Springfield, QLD 4305, Australia;
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25
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Blake JJ, Gracey F, Whitmore S, Broomfield NM. Comparing the Symptomatology of Post-stroke Depression with Depression in the General Population: A Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09611-5. [PMID: 37667057 DOI: 10.1007/s11065-023-09611-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 07/12/2023] [Indexed: 09/06/2023]
Abstract
Previous research into the phenomenological differences of post-stroke depression (PSD) has typically focused on comparisons of symptom profiles between stroke and non-stroke population controls. This systematic review aimed to synthesize these findings with results from other methodological approaches that contribute to an understanding of phenomenological differences. Articles were identified via a systematic search of seven databases and additional manual searching. A narrative synthesis approach was adopted because of the high methodological heterogeneity. Twelve articles comparing the symptomatology of depression between stroke and non-stroke controls were included. Three distinct methodological approaches, relevant to the aim, were identified: comparisons of profiles among groups with similar overall depression severity, comparisons of the strengths of correlations between a symptom and depression, and comparisons of latent symptom severity. The symptomatology of depression was generally similar between the groups, including somatic symptoms, despite the hypothesized interference of comorbid physical stroke effects. Despite high heterogeneity, there was a tentative indication that post-stroke depression manifests with comparatively less severe/prevalent anhedonia. Possible mechanisms for the observed similarities and differences are explored, including suggestions for future research.
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Affiliation(s)
- J J Blake
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - F Gracey
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - S Whitmore
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - N M Broomfield
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
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26
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Ho CN, Sun CK, Wu JY, Chen JY, Chang YJ, Chen IW, Hung KC. Association of vitamin D deficiency with post-stroke depression: a retrospective cohort study from the TriNetX US collaborative networks. Front Nutr 2023; 10:1236233. [PMID: 37599698 PMCID: PMC10436528 DOI: 10.3389/fnut.2023.1236233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
Background Post-stroke depression (PSD) affects up to one-third of patients who survive stroke. This matched cohort study aimed to investigate the relationship between vitamin D deficiency (VDD) and PSD using a global health research network. Methods Adult patients with first-ever stroke were eligible for inclusion if their circulating vitamin D levels were available within 3 months before the onset of stroke. Patients were subdivided into those with VDD [VDD group, 25(OH) D < 20 ng/mL] and those with normal vitamin D levels [control group, 25(OH) D: 30-80 ng/mL]. By using propensity score matching (PSM), potential confounding factors were adjusted. The primary outcomes were the association of VDD with the risk of PSD at the 3-month and 12-month follow-ups, while the secondary outcomes were the relationships between VDD and the risk of pneumonia as well as emergency department visits at the 12-month follow-up. Results After PSM, 758 individuals were included in each group, with no significant differences in baseline characteristics. Musculoskeletal diseases, metabolic disorders, and hypertension were the three leading comorbidities in both the groups. The incidence of PSD was not significantly different between the two groups at the 3-month (5.8% vs. 4.7%, p = 0.358) and 12-month (11.6% vs. 10.2%, p = 0.364) follow-up. VDD was not associated with an increased risk of PSD at the 3-month [hazard ratio (HR) = 1.258, p = 0.358] or 12-month follow-up (HR = 1.210, p = 0.364). In addition, VDD was not associated with an increased risk of pneumonia (HR = 1.053, p = 0.823) or emergency visits at the 12-month follow-up (HR = 1.206, p = 0.148). Conclusion The results revealed no significant link between VDD and PSD risk during the 3-month and 12-month follow-up periods, suggesting that VDD might not play a substantial role in PSD risk. However, further extensive studies employing a prospective design are necessary to explore the potential protective effects of vitamin D against PSD and validate these findings.
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Affiliation(s)
- Chun-Ning Ho
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
- Department of Biotechnology and Food Technology, Southern Taiwan University of Science and Technology, Tainan City, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Jheng-Yan Wu
- Department of Nutrition, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- College of Medicine, National Sun Yat-sen University, School of Medicine, Kaohsiung City, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- College of Medicine, National Sun Yat-sen University, School of Medicine, Kaohsiung City, Taiwan
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27
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Devereux N, Berns AM. Evaluation & Treatment of Psychological Effects of Stroke. Dela J Public Health 2023; 9:62-69. [PMID: 37701469 PMCID: PMC10494802 DOI: 10.32481/djph.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Strokes are a common medical condition in the United States, including in Delaware. An under-recognized effect of stroke is the impact on mood that often occurs. Many individuals develop depression, anxiety, PTSD, and other psychological sequelae. These disorders can significantly affect their lives and their relationships. The emotional effects of stroke pose a public health problem for our residents, leading to devastating decreases in the quality of life for the patient and the family. These challenges negatively impact the community due to the associated healthcare and economic burdens. The population of the State of Delaware is growing, and the proportion of senior residents, who are also at greater risk for strokes, is also increasing. Strokes will remain an ongoing important clinical concern for our healthcare providers. Emotional changes after a stroke will occur in many Delaware residents who suffer a stroke. The emotional sequelae of stroke are under-treated. It is critical for healthcare professionals to be trained to recognize, assess, and treat the psychological disorders that can result from having a stroke. This article provides an overview of the major psychological effects of stroke, recommended assessment tools, promising treatment trends, and directions for further research. Improving our ability to detect and treat these difficult emotional challenges can facilitate effective treatment and prevention strategies and increase quality of life for stroke survivors, their loved ones, and their communities.
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Affiliation(s)
- Nancy Devereux
- Clinical Neuropsychologist, ChristianaCare; Delaware Stroke System of Care Subcommittee
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28
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Nguyen TTP, Nguyen TX, Nguyen TC, Nguyen HTT, Nguyen TN, Nguyen TTH, Nguyen HTT, Hoang HB, Vu HTT. Post-stroke depression in Vietnamese patients is associated with decreased sleep quality and increased fatigue: a one-institution cross-sectional analysis. Sleep Breath 2023; 27:1629-1637. [PMID: 36434377 PMCID: PMC9702659 DOI: 10.1007/s11325-022-02745-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 10/18/2022] [Accepted: 11/14/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to determine the prevalence of post-stroke depression (PSD) during the first year and its associated factors, especially focusing on sleep quality and fatigue severity. METHODS A cross-sectional study was conducted among stroke patients in Vietnam's National Geriatric Hospital. Data were collected by using standardized questionnaires for interviewing and evaluating patients at the research site. Several covariables were presented including demographics, stroke-related characteristics, activities of daily living, post-stroke fatigue, and sleep quality (Pittsburgh Sleep Quality Index [PSQI] scale). PSD was assessed as an outcome variable through the Patient Health Questionnaire-9 scale. To summarize sociodemographic and clinical variables, descriptive statistics were performed. A logistic regression model was used to explore the factors related to PSD. RESULTS Of 157 patients with stroke, mean age 73.1 (± 9.6), PSD was present in 60 patients (38%). The global score and all PSQI components of participants with PSD showed worse levels than those without depression. Furthermore, the prevalence of PSD was higher in patients with low IADL scores and functional disability at high levels. In the multivariate logistic regression analysis, the patients with PSD showed higher Fatigue Severity Scale (FSS) scores (OR = 4.11; 95% CI = 1.39; 12.19) and higher scores in two domains of the PSQI scale including subjective sleep quality (OR = 3.03; 95% CI = 1.21; 7.58) and sleep disturbance (OR = 5.22; 95% CI = 1.33; 20.47). CONCLUSION There is a significant prevalence of depression following stroke. Furthermore, post-stroke fatigue and two PSQI scale components (subjective sleep quality and sleep disturbance) were shown to be associated with PSD. This finding may guide early screening and intervention strategies to address depression following stroke.
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Affiliation(s)
- Thao Thi Phuong Nguyen
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Tat Cuong Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
- Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam
| | - Huong Thi Thanh Nguyen
- Dinh Tien Hoang Institute of Medicine, Hanoi, Vietnam
- Physiology Department, Hanoi Medical University, Hanoi, Vietnam
| | - Hai Bui Hoang
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
- Emergency and Critical Care Department, Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, Vietnam.
- Scientific Research Department, National Geriatric Hospital, Hanoi, Vietnam.
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29
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Wen L, Yan C, Zheng W, Li Y, Wang Y, Qu M. Metabolic Alterations and Related Biological Functions of Post-Stroke Depression in Ischemic Stroke Patients. Neuropsychiatr Dis Treat 2023; 19:1555-1564. [PMID: 37435550 PMCID: PMC10332415 DOI: 10.2147/ndt.s415141] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023] Open
Abstract
Background Post-stroke depression (PSD) is one of the most common neuropsychiatric complications after stroke. However, the underlying mechanisms of PSD remain ambiguous, and no objective diagnosis tool is available to diagnose PSD. Previous metabolomic studies on PSD included patients with ischemic and hemorrhagic stroke indiscriminately, which is not conducive to elucidating and predicting the occurrence of PSD. The aim of this study is to elucidate the pathogenesis of PSD and provide potential diagnostic markers for PSD in ischemic stroke patients. Methods In total, 51 ischemic stroke patients at 2 weeks were included in this study. Those with depressive symptoms were assigned to the PSD group, while the others were assigned to the non-PSD group. Plasma metabolomics based on liquid chromatography-mass spectrometry (LC-MS) was performed to explore the differential plasma metabolites between the PSD and non-PSD groups. Results Principal component analysis (PCA), partial least squares discriminant analysis (PLS-DA) and orthogonal partial least-squares discriminant analysis (OPLS-DA) showed significant metabolic alterations between PSD patients and non-PSD patients. In total, 41 differential metabolites were screened out, mainly including phosphatidylcholines (PCs), L-carnitine and acyl carnitines, succinic acid, pyruvic acid and L-lactic acid. Metabolite-related pathway analysis revealed that alanine, aspartate and glutamate metabolism, glycerophospholipid metabolism and the citrate cycle (TCA cycle) may contribute to the pathogenesis of PSD. A panel of three signature metabolites [PC(22:5(7Z,10Z,13Z,16Z,19Z)/15:0), LysoPA(18:1(9Z)/0:0) and 1,5-anhydrosorbitol] was determined as potential biomarkers for PSD in ischemic stroke patients. Conclusion These findings are conducive to providing new insights into the pathogenesis of PSD and developing objective diagnostic tools for PSD in ischemic stroke patients.
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Affiliation(s)
- Lulu Wen
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Chuming Yan
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Wancheng Zheng
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, People’s Republic of China
| | - Yi Li
- Neurology Department, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Yuhui Wang
- Neurology Department, Third Affiliated Hospital, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Miao Qu
- Neurology Department, Xuan Wu Hospital Capital Medical University, Beijing, People’s Republic of China
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30
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He L, Wang J, Wang F, Wang L, Liu Y, Zhou F, Xu F. Depression status and functional outcome of patients with ischemic stroke and the impact on caregivers living in Chengdu: a cross-sectional study. Front Psychiatry 2023; 14:1166273. [PMID: 37469357 PMCID: PMC10353739 DOI: 10.3389/fpsyt.2023.1166273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/13/2023] [Indexed: 07/21/2023] Open
Abstract
Objectives To investigate the associations between risk factors and depression symptoms in ischemic stroke (IS) survivors and the effect of IS survivors' depression status and functional outcomes on caregiver burden in Chengdu, China. Methods In this cross-sectional study, we recruited a convenience sample of patients with IS and paired caregivers living in Chengdu from February 2022 to May 2022. Depression symptoms were assessed using the 17-item Chinese Hamilton Depression Rating Scale, the social support of patients was assessed using the perceived social support scale (PSSS), caregiver burden was assessed using the Zarit burden interview (ZBI). Multivariable logistic regression analysis was used to analyze the data between risk factors and depression symptoms, and multiple linear regression models were constructed to examine the depression symptoms and functional outcomes of stroke survivors, and caregiver burden. Results In total, 966 IS survivors and paired caregivers were included in this study. Among IS survivors, 35.51% (343/966) experienced depression. Age [adjusted odds ratio (aOR), 1.02; 95% confidence interval (CI), 1.00-1.04; p = 0.036], the National Institutes of Health Stroke Scale (NIHSS) score (aOR, 1.57; 95% CI, 1.47-1.68; p < 0.001), and PSSS score (aOR, 0.86; 95% CI, 0.84-0.89; p < 0.001) were associated with an increased risk of depression. The NIHSS score (b = 2.57, p < 0.001), patients' depression status (b = 2.54, p < 0.001), duration of care (b = 0.359, p = 0.006), and social support of caregivers (b = -0.894, p = 0.038) were significantly associated with the ZBI score. Conclusion The PSSS score was a major risk factor for the development of depression in IS survivors, and patients' depression status and severe functional deficits had a negative impact on the ZBI score of the main caregivers. Social support can reduce the ZBI score.
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Affiliation(s)
- Lanying He
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Jian Wang
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Feng Wang
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Lu Wang
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Yinglin Liu
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Fanfan Zhou
- Department of Neurology, The Second People’s Hospital of Chengdu, Chengdu, China
| | - Fan Xu
- Department of Public Health, Chengdu Medical College, Chengdu, Sichuan, China
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Liu X, Zhang Z, Lin B, Guo Y, Mei Y, Ping Z, Wang W, Jiang H, Wang S, Zhang C, Chen S, Zhang Q. Relationship between perceptions of recurrence risk and depression state among first-episode ischemic stroke patients in rural areas: The mediating role of coping style. Nurs Open 2023; 10:4515-4525. [PMID: 37014075 PMCID: PMC10277436 DOI: 10.1002/nop2.1695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/05/2023] [Accepted: 02/14/2023] [Indexed: 04/05/2023] Open
Abstract
AIMS To investigate the relationship between stroke survivors' perceptions of recurrence risk, coping styles and depression state, and the role coping styles play in mediating that relationship. DESIGN A cross-sectional descriptive study. METHODS From one hospital in Huaxian, China, 320 stroke survivors were randomly selected as a convenience sample. In this research, the Simplified Coping Style Questionnaire, the Patient Health Questionnaire-9 and the Stroke Recurrence Risk Perception Scale were all used. Structural equation modelling and correlation analysis were used to analyse the data. This research followed the EQUATOR and STROBE checklists. RESULTS There were 278 valid survey responses. There were mild to severe depressive symptoms in 84.8% of stroke survivors. In stroke survivors, there was a significant negative relationship (p < 0.01) between the positive coping of perceptions of recurrence risk and their depression state. Recurrence risk perception's impact on depression state was partly mediated, according to mediation studies, by coping style, with the mediation effect accounting for 44.92% of the overall effect. CONCLUSIONS The connection between perceptions of recurrence risk and depression state was mediated by the coping mechanisms of stroke survivors. A lower degree of depression state among survivors was connected with positive coping to the beliefs of recurrence risk.
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Affiliation(s)
- Xueting Liu
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Zhenxiang Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Beilei Lin
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
- Academic of Medical Science, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Yunfei Guo
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou City, China
| | - Yongxia Mei
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Zhiguang Ping
- School of Public Health, Zhengzhou University, Zhengzhou City, China
| | - Wenna Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Hu Jiang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Shaoyang Wang
- The Second Affiliated Hospital, Zhengzhou University, Zhengzhou City, China
| | - Chunhui Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Suyan Chen
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Qiushi Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
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32
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Liao W, Chen D, Wu J, Liu K, Feng J, Li H, Jiang J. Risk factors for post-stroke depression in patients with mild and moderate strokes. Medicine (Baltimore) 2023; 102:e34157. [PMID: 37390261 PMCID: PMC10313280 DOI: 10.1097/md.0000000000034157] [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: 05/05/2023] [Accepted: 06/09/2023] [Indexed: 07/02/2023] Open
Abstract
To determine the possible risk factors for post-stroke depression in patients with mild and moderate acute strokes. A cross-sectional descriptive study was conducted involving 129 patients with mild and moderate acute strokes. The patients were divided into post-stroke depression and non-depressed stroke groups according to the Hamilton Depression Rating Scale for Depression-17 item and Patient Health Questionnaire-9 item assessments. All participants were evaluated based on clinical characteristics and a battery of scales. Patients with post-stroke depression had an increased stroke frequency, severe stroke symptoms and poor performance in activities of daily living (ADL), cognitive function, sleep quality, interest in pleasurable activities, negative life events, and utilization of social support compared to stroke patients without depression. The Negative Life Event Scale (LES) score was significantly and independently associated with an increased probability of depression in stroke patients. Negative life events were shown to be independently associated with the incidence of depression in patients with mild and moderate acute strokes, likely mediating the influence of other predictors of depression, such as a history of stroke, decreased ADL ability, and utilization of support.
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Affiliation(s)
- Wenxiang Liao
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Danlei Chen
- Geriatrics Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Jing Wu
- Neurology Department, Graduate College of Guilin Medical University, Guilin, Guangxi, China
| | - Kaixiang Liu
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Junlin Feng
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Hao Li
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
| | - Jingzi Jiang
- Neurology Department, Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China
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Wagner F, Rogenz J, Opitz L, Maas J, Schmidt A, Brodoehl S, Ullsperger M, Klingner CM. Reward network dysfunction is associated with cognitive impairment after stroke. Neuroimage Clin 2023; 39:103446. [PMID: 37307650 PMCID: PMC10276182 DOI: 10.1016/j.nicl.2023.103446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023]
Abstract
Stroke survivors not only suffer from severe motor, speech and neurocognitive deficits, but in many cases also from a "lack of pleasure" and a reduced motivational level. Especially apathy and anhedonic symptoms can be linked to a dysfunction of the reward system. Rewards are considered as important co-factor for learning, so the question arises as to why and how this affects the rehabilitation of stroke patients. We investigated reward behaviour, learning ability and brain network connectivity in acute (3-7d) mild to moderate stroke patients (n = 28) and age-matched healthy controls (n = 26). Reward system activity was assessed using the Monetary Incentive Delay task (MID) during magnetoencephalography (MEG). Coherence analyses were used to demonstrate reward effects on brain functional network connectivity. The MID-task showed that stroke survivors had lower reward sensitivity and required greater monetary incentives to improve performance and showed deficits in learning improvement. MEG-analyses showed a reduced network connectivity in frontal and temporoparietal regions. All three effects (reduced reward sensitivity, reduced learning ability and altered cerebral connectivity) were found to be closely related and differed strongly from the healthy group. Our results reinforce the notion that acute stroke induces reward network dysfunction, leading to functional impairment of behavioural systems. These findings are representative of a general pattern in mild strokes and are independent of the specific lesion localisation. For stroke rehabilitation, these results represent an important point to identify the reduced learning capacity after stroke and to implement individualised recovery exercises accordingly.
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Affiliation(s)
- Franziska Wagner
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany.
| | - Jenny Rogenz
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Laura Opitz
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Johanna Maas
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Alexander Schmidt
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Stefan Brodoehl
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Markus Ullsperger
- Faculty of Natural Sciences, Institute of Psychology, 39106 Magdeburg, Germany; Center for Behavioral Brain Sciences, Magdeburg, Otto-von-Guericke University Magdeburg, Germany
| | - Carsten M Klingner
- Department of Neurology, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany; Biomagnetic Centre, 07747 Jena University Hospital, Friedrich Schiller University Jena, Germany
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Zheng Z, Li C, Xie RH, Xie H, Fu F, Pan Y, Liao J, Chen X, Yue L. Effectiveness of telehealth interventions on depression symptoms after stroke: A systematic review and meta-analysis. J Affect Disord 2023:S0165-0327(23)00730-9. [PMID: 37247784 DOI: 10.1016/j.jad.2023.05.084] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Depression symptoms are common after stroke, and affect survivors' recovery of neurological function, ability to return to society, and quality of life. Telehealth has been shown to improve depression symptoms and quality of life among patients post-stroke. However, evidence from clinical trials has not previously been systematically synthesized. OBJECTIVE This study aimed to systematically evaluate the effectiveness of telehealth interventions in reducing depression symptoms among patients post-stroke. METHODS Following the PRISMA guidelines, we conducted a meta-analysis of randomized control trials of telehealth interventions for post-stroke depression symptoms. The quality of included studies was assessed using the Cochrane risk of bias tool. RevMan 5.4 software was used for the meta-analysis. Data were synthesized by fixed (I2 ≤ 50 %) or random (I2 > 50 %) effects models based on a heterogeneity test. RESULTS In total, 10 studies with 1717 participants were included, eight of which were eligible for the meta-analysis. There were no significant differences in efficacy between the telehealth and control groups for depression symptoms (standardized mean difference [SMD] = -0.16, 95 % confidence interval [CI] -0.67 to 0.36; P = .54), quality of life (SMD = 0.00, 95%CI -0.18 to 0.18; P = .99), limb function (SMD = 0.46, 95%CI -0.26 to 1.18; P = .21), and daily living ability (SMD = 0.38, 95%CI -1.39 to 2.15; P = .67). The telemedicine group had significantly lower anxiety scores than the control group (SMD = -1.05, 95%CI -1.22 to -0.89; P < .001). LIMITATIONS The number of RCTs included in the review was relatively small. CONCLUSIONS The efficacy of telehealth interventions in reducing depression symptoms in patients post-stroke is no different from conventional nursing. However, large-scale, high-quality randomized controlled trials are needed to further explore the potential of telehealth interventions in improving mental health among patients post-stroke.
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Affiliation(s)
- Zhimin Zheng
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chunxia Li
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ri-Hua Xie
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China; Department of Nursing, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Hualing Xie
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Fen Fu
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuhua Pan
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jinyu Liao
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoying Chen
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liqun Yue
- Department of Nursing, The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
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Tang S, Gao M, Cheng X, Ji L. Scientometric analysis of post-stroke depression research based on CiteSpace. Medicine (Baltimore) 2023; 102:e33633. [PMID: 37145004 PMCID: PMC10158871 DOI: 10.1097/md.0000000000033633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/06/2023] [Indexed: 05/06/2023] Open
Abstract
Post-stroke depression (PSD) has served as a severe and common complication leading to a higher level of mortality. Though various studies have been focused on PSD, limited research endeavor has been dedicated to bibliometric analysis in the past. In view of this, the current analysis serves to elucidate the latest status of global research and pinpoint the emerging area of interest for PSD, in order to support further investigation of the field. Publications related to PSD were retrieved from the Web of Science Core Collection database on September 24, 2022, and included in the bibliometric analysis. VOSviewer and CiteSpace software were used to visually analyze publication outputs, scientific cooperation, highly-cited references, and keywords to identify the current status and future trends in PSD research. A total of 533 publications were retrieved. The annual number of publications showed an increasing trend from 1999 to 2022. In terms of country and academic institution, the USA and Duke University have topped the list of PSD research respectively. Meanwhile, Robinson RG and Alexopoulos GS have been the most representative investigators of the field. In the past, researchers focused on the risk factors of PSD, late-life depression, and Alzheimer disease. In recent years, further research effort has been placed on meta-analysis, ischemic stroke, predictor, inflammation, mechanism, and mortality. In conclusion, in the past 20 years, PSD research has been progressing and gaining more attention. The bibliometric analysis successfully unveiled the field's major contributing countries, institutions, and investigators. Furthermore, current hot spots and future trends in the field of PSD were identified, which included meta-analysis, ischemic stroke, predictor, inflammation, mechanism, and mortality.
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Affiliation(s)
- Saixue Tang
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
- The Affiliated Hospital of Shandong University of TCM, Jinan, Shandong Province, China
| | - Mingzhou Gao
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Xunshu Cheng
- Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Lijin Ji
- Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian Province, China
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36
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Kim M, Lee YH. Gender Differences in the Risk of Depression in Community-Dwelling Stroke Survivors Compared to the General Population without Stroke. Chonnam Med J 2023; 59:134-139. [PMID: 37303822 PMCID: PMC10248390 DOI: 10.4068/cmj.2023.59.2.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/17/2023] [Accepted: 01/22/2023] [Indexed: 06/13/2023] Open
Abstract
This study examined the gender-specific association between stroke status and depression in South Korea. A total of 5,746 men and 7,608 women aged ≥30 years who participated in the 2014, 2016, and 2018 Korea National Health and Nutrition Examination Survey were included in the analysis. The cross-sectional surveys targeted the general population consisting of nationally representative adults (≥19 years) residing in Korea. A 9-item Patient Health Questionnaire score of 10 or more was regarded as depression. A higher risk of depression in stroke survivors compared to the non-stroke population was not observed in men (odds ratio [OR], 1.51; 95% confidence intervals [CI], 0.82-2.81), while it was observed in women (OR, 2.49; 95% CI, 1.64-3.77). Compared to non-stroke women, women stroke survivors with a younger age at diagnosis (<60 years) (OR, 4.05; 95% CI, 2.28-7.20) and stroke with duration of ≥10 years (OR, 3.12; 95% CI, 1.63-5.97) had a higher risk for depression. Gender aspects should be more intensively considered in the association between stroke status and depression in community settings.
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Affiliation(s)
- Mina Kim
- Jeollabukdo Public Health Care Policy Institution, Iksan, Korea
- Department of Nursing, Graduate School, Chonnam National University, Gwangju, Korea
| | - Young-Hoon Lee
- Jeollabukdo Public Health Care Policy Institution, Iksan, Korea
- Department of Preventive Medicine, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
- Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
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37
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Elias S, Benevides ML, Pereira Martins AL, Martins GL, Sperb Wanderley Marcos AB, Nunes JC. In-Hospital Symptoms of Depression and Anxiety are Strong Risk Factors for Post-Stroke Depression 90 Days After Ischemic Stroke. Neurohospitalist 2023; 13:121-129. [PMID: 37064927 PMCID: PMC10091427 DOI: 10.1177/19418744221132675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background and Purpose Acute ischemic stroke (AIS) and depression are the major causes of disability and decreased quality of life worldwide. Psychiatric disorders are common after stroke, especially post-stroke depression (PSD), which affects one-third of survivors. Although frequent, little is known about the real complexity of the pathophysiology and the factors associated with PSD. Methods This research aimed to provide data about risk factors and predictors of PSD 90 days after AIS. A cohort study was conducted in a tertiary stroke center located in southern Brazil. We interviewed 148 patients with AIS who were consecutively hospitalized between January 2020 and January 2021. The Hospital Anxiety and Depression Scale (HADS) was applied during hospitalization and at follow-up 90 days after AIS. Furthermore, sociodemographic, clinical, and radiological variables were investigated. Predictive factors were assessed using univariate and multivariate linear regression. The impact of the COVID-19 pandemic on the data was also evaluated. Results The frequency of PSD 90 days after AIS was 33.9%. In-hospital symptoms of depression and anxiety each represented a 2-fold risk for PSD at follow-up. Furthermore, the HADS - anxiety score 90 days after AIS was strongly associated with the HADS - depression value 90 days after stroke (R: .71; B: .56; P < .01). Conclusions The present study highlighted a noteworthy frequency of PSD 90 days after AIS. Psychiatric variables during hospitalization and in the follow-up appeared to be the leading associated factors with PSD. These data might support the determination of which patients require more psychiatric management.
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Affiliation(s)
- Stefany Elias
- University of Southern Santa
Catarina, Santa Catarina, Brazil
| | | | | | - Gladys Lentz Martins
- Department of Neurology, Hospital Governador Celso Ramos
(HGCR), Florianópolis, Brazil
| | - Ana Beatriz Sperb Wanderley Marcos
- Department of Medical Sciences,
Hospital Polydoro Ernani de São Thiago, Federal University of Santa Catarina
(UFSC), Florianópolis, Brazil
| | - Jean Costa Nunes
- Department of Pathology, Federal University of Santa Catarina
(UFSC), Florianópolis, Brazil
- Neurodiagnostic Brasil – Diagnósticos
em Neuropatologia, Florianópolis, Brazil
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Toh ZA, Cheng LJ, Wu XV, De Silva DA, Oh HX, Ng SX, He HG, Pikkarainen M. Positive airway pressure therapy for post-stroke sleep disordered breathing: a systematic review, meta-analysis and meta-regression. Eur Respir Rev 2023; 32:32/167/220169. [PMID: 36889784 PMCID: PMC10032615 DOI: 10.1183/16000617.0169-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/24/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Sleep disordered breathing (SDB) is an under-recognised independent risk factor and a potential consequence of stroke. We systematically reviewed and meta-analysed the effectiveness of positive airway pressure (PAP) therapy in improving post-stroke outcomes. METHODS We searched CENTRAL, Embase, PubMed, CINAHL, PsycINFO, Scopus, ProQuest, Web of Science and CNKI (China National Knowledge Infrastructure) for randomised controlled trials comparing PAP therapy against a control or placebo group. We evaluated the pooled effects of PAP therapy on recurrent vascular events, neurological deficit, cognition, functional independence, daytime sleepiness and depression using random effects meta-analyses. RESULTS We identified 24 studies. Our meta-analyses showed that PAP therapy reduced recurrent vascular events (risk ratio 0.47, 95% CI 0.28-0.78), and showed significant beneficial effects on neurological deficit (Hedges' g= -0.79, 95% CI -1.19- -0.39), cognition (g=0.85, 95% CI 0.04-1.65), functional independence (g=0.45, 95% CI 0.01-0.88) and daytime sleepiness (g= -0.96, 95% CI -1.56- -0.37). However, there was insignificant reduction in depression (g= -0.56, 95% CI -2.15-1.02). No publication bias was detected. CONCLUSIONS Post-stroke patients with SDB benefited from PAP therapy. Prospective trials are needed to determine the ideal initiation period and the minimum effective therapeutic dose.
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Affiliation(s)
- Zheng An Toh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nursing, National University Hospital, Singapore
- National University Health System, Singapore
| | - Ling Jie Cheng
- National University Health System, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xi Vivien Wu
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Health System, Singapore
| | - Deidre Anne De Silva
- Department of Neurology, Singapore General Hospital Campus, National Neuroscience Institute, Singapore
| | - Hui Xian Oh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nursing, National University Hospital, Singapore
- National University Health System, Singapore
| | - Si Xian Ng
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Nursing, National University Hospital, Singapore
- National University Health System, Singapore
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- National University Health System, Singapore
| | - Minna Pikkarainen
- Department of Occupational Therapy, Prosthetics and Orthoptics, Faculty of Health Sciences and Department of Product Design, Faculty of Technology, Art and Design, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, University of Oulu, Oulu, Finland
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Dulay MF, Criswell A, Hodics TM. Biological, Psychiatric, Psychosocial, and Cognitive Factors of Poststroke Depression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5328. [PMID: 37047944 PMCID: PMC10093888 DOI: 10.3390/ijerph20075328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/06/2023] [Accepted: 03/11/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Depression is the most common psychiatric condition that occurs after cerebrovascular accident, especially within the first year after stroke. Poststroke depression (PSD) may occur due to environmental factors such as functional limitations in daily activities, lower quality of life, or biological factors such as damage to areas in the brain involved in emotion regulation. Although many factors are hypothesized to increase the risk of PSD, the relative contribution of these factors is not well understood. PURPOSE We evaluated which cross-sectional variables were associated with increased odds of PSD in our adult outpatient stroke neuropsychology clinic population. METHODS The sample included 325 patients (49.2% female; mean age of 59-years old) evaluated at an average of 8.1 months after an ischemic or hemorrhagic stroke. Variables included in logistic regression were stroke characteristics, demographics, psychosocial factors, comorbid medical problems, comorbid psychiatric conditions, and cognitive status. The Mini International Neuropsychiatric Inventory was used to determine DSM-defined PSD and anxiety disorders. A standard neuropsychological test battery was administered. RESULTS PSD occurred in 30.8% of the sample. Logistic regression indicated that increased odds of PSD were associated with a comorbid anxiety disorder (5.9 times more likely to suffer from PSD, p < 0.001). Further, increased odds of PSD were associated with a history of depression treatment before stroke (3.0 times more likely to suffer from PSD), fatigue (2.8 times more likely), memory impairment (2.4 times more likely), and younger age at stroke (all p values < 0.006). DISCUSSION Results suggest that PSD is likely multifactorial and extends the literature by demonstrating that a comorbid anxiety disorder correlated strongest with PSD. Poststroke screening and treatment plans should address not only depression but comorbid anxiety.
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Affiliation(s)
- Mario F. Dulay
- Houston Methodist Neurological Institute, 6560 Fannin Suite 944, Houston, TX 77030, USA
- Department of Neurosurgery, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Amber Criswell
- Houston Methodist Neurological Institute, 6560 Fannin Suite 944, Houston, TX 77030, USA
- Department of Neurology and Eddy Scurlock Stroke Center, Houston Methodist Hospital, Houston, TX 77030, USA
| | - Timea M. Hodics
- Houston Methodist Neurological Institute, 6560 Fannin Suite 944, Houston, TX 77030, USA
- Department of Neurology and Eddy Scurlock Stroke Center, Houston Methodist Hospital, Houston, TX 77030, USA
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Lin HL, Sung FC, Muo CH, Chen PC. Depression Risk in Post-Stroke Aphasia Patients: A Nationwide Population-Based Cohort Study. Neuroepidemiology 2023; 57:162-169. [PMID: 36972565 DOI: 10.1159/000530070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/22/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Depression and aphasia impair the quality of life after a stroke. Studies linking depression risk to post-stroke aphasia (PSA) lacked confirmation using a large database. METHODS Using Taiwan's National Health Insurance claims data, we identified ≥18-year-old patients hospitalized for stroke from 2005 to 2009, and those diagnosed with aphasia during hospitalization or within 3 months after discharge were selected to form the aphasic group. We estimated depression incidence by December 31, 2018, and used the Cox proportional hazards model to estimate aphasia group to non-aphasia group hazard ratios (HRs). RESULTS With a median follow-up period of 7.91 and 8.62 years for aphasia (n = 26,754) and non-aphasia groups (n = 139,102), respectively, the incidence of depression was higher in the aphasia group than in the non-aphasia group (9.02 vs. 8.13 per 1,000 person-years), with an adjusted HR (95% confidence intervals [CI]) of 1.21 (1.15-1.29) for depression. The adjusted HRs (95% CI) of depression were homogenous for females, 1.26 (1.15-1.37); for males, 1.18 (1.09-1.27); for hemorrhagic stroke, 1.22 (1.09-1.37); and for ischemic stroke, 1.21 (1.13-1.30). Results in analyzing 25,939 propensity score-matched pairs demonstrated an equivalent effect. CONCLUSION Patients with PSA are at an increased risk of developing depression, regardless of sex or stroke type.
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Affiliation(s)
- Hui-Lin Lin
- Program for Aging, China Medical University, Taichung, Taiwan,
- Department of Physical Medicine and Rehabilitation, Lin Shin Hospital, Taichung, Taiwan,
- Taichung Hospital of the Ministry of Health and Welfare, Taichung, Taiwan,
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Chih-Hsin Muo
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, China Medical University, Taichung, Taiwan
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Liu H, Cheng Z, Wang S, Jia Y. Effects of virtual reality-based intervention on depression in stroke patients: a meta-analysis. Sci Rep 2023; 13:4381. [PMID: 36928345 PMCID: PMC10020160 DOI: 10.1038/s41598-023-31477-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/13/2023] [Indexed: 03/18/2023] Open
Abstract
As one of the most common neuropsychiatric complications after stroke, post-stroke depression can significantly affect the initiative of rehabilitation exercise and the rehabilitation of neurological function of patients. Virtual reality (VR) has been widely used in health-related fields in recent years. There is some evidence that VR-based interventions have benefits for depression. The aim of this study was to assess the effectiveness of VR-based intervention on depression in stroke patients. A total of 752 patients with stroke from 11 randomized controlled trials (RCTs) studies were included in this meta-analysis and the studies derived from seven electronic databases searched from database inception to August 2021. Different tools were used to measure depression. For continuous results, the standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated to synthesize the effects. We assessed the risk of bias by using the Cochrane Collaboration criteria. The results showed that compared to the control group, VR-based interventions significantly decreased the depression scale score (SMD = - 0.75, 95% CI - 1.35, - 0.15). The meta-analysis indicated that VR-based intervention had a moderate effect on depression in stroke patients compared to control group. There was no evidence of potential publication bias as assessed by visual inspection of funnel plots in Egger and Begg tests. Substantial heterogeneity between studies was observed, meta-regression analysis showed that mean age might be the source of heterogeneity.
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Affiliation(s)
- Hebing Liu
- The Second Hospital, Jilin University, No. 218 Ziqiang Street, Changchun, 130021, Jilin, China
| | - Zhaohua Cheng
- The Second Hospital, Jilin University, No. 218 Ziqiang Street, Changchun, 130021, Jilin, China
| | - Shuo Wang
- School of Nursing, Xuzhou Medical University, Tongshan Road, Xuzhou, 221004, Jiangsu, China
| | - Yong Jia
- School of Nursing, Jilin University, No.965 Xinjiang Street, Changchun, 130021, Jilin, China.
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Chow EOW, Fung SF, Singh H. Actor-partner effects of wellbeing, hope and self-esteem on depression in stroke survivor-caregiver dyads: A randomized controlled trial. Clin Rehabil 2023; 37:394-406. [PMID: 36453001 PMCID: PMC9912309 DOI: 10.1177/02692155221128758] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Stroke is a disabling, long-term condition that challenges the mental and physical health of stroke-survivors concurrently with their primary family-caregivers (dyad). However, there has been a lack of emphasis on this dyadic need. Thus, this study aims to investigate the impacts of two interventions on hope, self-esteem and hedonic wellbeing on depression among the stroke-survivor-caregiver dyad. METHODS This randomized-controlled-trial applied the actor-partner interdependence model to 100 randomly-selected dyads (N = 200) of stroke-survivors, mean (SD) age was 73.63(7.22) and family-caregivers, mean (SD) age was 62.49(14.44) years, recruited from Hong Kong hospitals and rehabilitation centres. The intervention was eight-weekly two-hour narrative therapy group sessions (n = 54 dyads), compared with the current model of psychoeducational group to each dyad as needed. Outcomes were collected via questionnaires and interviews, at four time-points: baseline (T1), during-intervention (T2) (1-month), immediately post-intervention (T3) (2-months) and follow-up (T4) (6-months). RESULTS The results demonstrated that there are actor effects on stroke-survivors (β = -0.353, p < 0.05) and caregivers (β = -0.383, p < 0.05), where higher levels of hedonic wellbeing were associated with fewer depressive symptoms. Partner effects were observed as caregivers' depressive symptoms were possessing a significant negative relationship with stroke survivors' wellbeing (β = -0.387, p < 0.05). Those stroke survivors in the intervention group had a significantly higher level of self-esteem associated with lower levels of depression (β = -0.314, p < 0.05). CONCLUSIONS Improving hope, self-esteem and wellbeing through narrative therapy significantly mediates depressive symptoms, strengthening the dyadic support of stroke survivors and family caregivers.
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Affiliation(s)
- Esther OW Chow
- Department of Social and Behavioural Sciences, City University of Hong
Kong, Hong Kong, China,Esther OW Chow, Department of Social and
Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon,
Hong Kong.
| | - Sai-fu Fung
- Department of Social and Behavioural Sciences, City University of Hong
Kong, Hong Kong, China
| | - Hardev Singh
- Department of Social and Behavioural Sciences, City University of Hong
Kong, Hong Kong, China
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Abstract
Despite contemporary rehabilitation strategies, stroke remains a leading cause of loss of function, limited mobility, psycho-social complications, and decreased quality of life. Stroke rehabilitation is a process that aims to prevent deterioration of function, increase function, and assist the patient in achieving the highest possible level of independence physically, socially, spiritually, psychologically, vocationally, and economically. The process begins with relearning activities of daily living such as grooming, bathing, toileting, eating, and dressing. As the patient progresses, stroke rehabilitation works on instrumental activities of daily living such as housekeeping, cooking, driving, and managing financial responsibilities.
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Affiliation(s)
- Helen P Neil
- Louisiana State University Health New Orleans, School of Nursing, 1900 Gravier Street Room 328, New Orleans, LA 70112, USA.
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Tziaka E, Christidi F, Tsiptsios D, Sousanidou A, Karatzetzou S, Tsiakiri A, Doskas TK, Tsamakis K, Retzepis N, Konstantinidis C, Kokkotis C, Serdari A, Aggelousis N, Vadikolias K. Leukoaraiosis as a Predictor of Depression and Cognitive Impairment among Stroke Survivors: A Systematic Review. Neurol Int 2023; 15:238-272. [PMID: 36810471 PMCID: PMC9944578 DOI: 10.3390/neurolint15010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/02/2023] [Accepted: 02/06/2023] [Indexed: 02/15/2023] Open
Abstract
Stroke survivors are at increased risk of developing depression and cognitive decline. Thus, it is crucial for both clinicians and stroke survivors to be provided with timely and accurate prognostication of post-stroke depression (PSD) and post-stroke dementia (PSDem). Several biomarkers regarding stroke patients' propensity to develop PSD and PSDem have been implemented so far, leukoaraiosis (LA) being among them. The purpose of the present study was to review all available work published within the last decade dealing with pre-existing LA as a predictor of depression (PSD) and cognitive dysfunction (cognitive impairment or PSDem) in stroke patients. A literature search of two databases (MEDLINE and Scopus) was conducted to identify all relevant studies published between 1 January 2012 and 25 June 2022 that dealt with the clinical utility of preexisting LA as a prognostic indicator of PSD and PSDem/cognitive impairment. Only full-text articles published in the English language were included. Thirty-four articles were traced and are included in the present review. LA burden, serving as a surrogate marker of "brain frailty" among stroke patients, appears to be able to offer significant information about the possibility of developing PSD or cognitive dysfunction. Determining the extent of pre-existing white matter abnormalities can properly guide decision making in acute stroke settings, as a greater degree of such lesioning is usually coupled with neuropsychiatric aftermaths, such as PSD and PSDem.
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Affiliation(s)
- Eftychia Tziaka
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Correspondence: ; Tel.: +30-6944320016
| | - Anastasia Sousanidou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK
| | - Nikolaos Retzepis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Christos Konstantinidis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
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Quality of life and mood disorders of mild to moderate stroke survivors in the early post-hospital discharge phase: a cross-sectional survey study. BMC Psychol 2023; 11:32. [PMID: 36721206 PMCID: PMC9890754 DOI: 10.1186/s40359-023-01068-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Exploring sociodemographic and disease characteristics that contribute to patient-reported outcomes can inform targeting of strategies to support recovery and adaptation to stroke. This study aimed to examine among a sample of stroke survivors at three months post-hospital discharge: (1) self-reported physical and mental health quality of life scores; (2) self-reported depressive and anxiety symptoms; and (3) sociodemographic and clinical predictors of these outcomes. METHODS This cross-sectional survey study recruited stroke survivors from eight hospitals in one Australian state. Adult survivors recently discharged from hospital stroke wards (within 3 months) were mailed a study information package and invited to complete a pen-and paper survey. Survey items assessed: quality of life (SF12v2), depression (PHQ-9), anxiety (GAD-7) and sociodemographic and clinical characteristics. Predictors were examined using multiple linear regression analysis. RESULTS Of the 1161 eligible patients who were posted a recruitment pack, 401 (35%) returned a completed survey. Participants reported a mean SF-12v2 Physical Composite Score (PCS) quality of life score of 44.09 (SD = 9.57); and a mean SF-12v2 Mental Composite Score (MCS) quality of life score of 46.84 (SD = 10.0). Approximately one third of participants (34%; n = 132) were classified as depressed (PHQ-9 ≥ 10); and 27% (n = 104) were classified as anxious (GAD-7 ≥ 8). Lower PCS was associated with being female, not employed and having a comorbid diagnosis of diabetes and atrial fibrillation. Lower MCS was associated with a history of transient ischemic attack (TIA). Males and those with higher levels of education, had greater odds of having lower depression severity; those with a history of TIA or diabetes had lower odds of having lower depression severity. Males had greater odds of having lower anxiety severity; those with a history of TIA had lower odds of having lower anxiety severity. CONCLUSION Sub-groups of stroke survivors may be at-risk of poorer quality of life and psychological morbidity in the early post-discharge phase. These findings support the role of early identification and prioritisation of at-risk survivors at discharge, as they may require modifications to standard hospital discharge processes tailored to their level of risk.
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46
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Choi HL, Yang K, Han K, Kim B, Chang WH, Kwon S, Jung W, Yoo JE, Jeon HJ, Shin DW. Increased Risk of Developing Depression in Disability after Stroke: A Korean Nationwide Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:842. [PMID: 36613164 PMCID: PMC9819798 DOI: 10.3390/ijerph20010842] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 06/17/2023]
Abstract
Stroke is a leading cause of mortality and a major cause of disability worldwide. A significant number of stroke survivors suffer from depression, impeding the activities of daily living and rehabilitation. Here, we examined the risk of depression among stroke survivors according to the severity of disabilities and compared its incidence with a matched control group. We included data from the Korean National Health Insurance Service of 207,678 stroke survivors. Cox proportional hazard models were used to calculate the risk of depression among stroke survivors. Stroke survivors had a greater risk of developing depression than the matched control group with an adjusted hazard ratio of 2.12 (95% confidence interval 2.09-2.15). Stroke survivors with more severe disabilities were associated with a higher risk of depression than those with mild disabilities. The risk of developing depression was prominently high within the first year after a stroke. Males and younger people (<65 years) were independent risk factors for depression in stroke survivors. This study demonstrated an increased risk of developing depression in stroke survivors compared to control subjects, and a higher risk of depression was associated with a more severe degree of disability. Clinicians should be aware of the risk of depression developing in stroke survivors, especially those with disabilities.
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Affiliation(s)
- Hea Lim Choi
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Kyojin Yang
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Bongsung Kim
- Department of Medical Statistics, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Soonwook Kwon
- Department of Neurology, Inha University Hospital, Incheon 22332, Republic of Korea
| | - Wonyoung Jung
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jung Eun Yoo
- Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul 06236, Republic of Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine/Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
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47
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Depressive symptoms occurring after stroke by age, sex and socioeconomic status in six population-based studies: Longitudinal analyses and meta-analyses. Asian J Psychiatr 2023; 79:103397. [PMID: 36508782 DOI: 10.1016/j.ajp.2022.103397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 10/08/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
AIMS Population-based cohort studies that examined the effects of stroke on depressive symptoms in elderly participants with and without stroke in different countries/regions had yielded scant evidence. The objectives of this multi-cohort study were to identify the relationships between stroke and depressive symptoms and to assess the pooled risks of depressive symptoms in total populations and in stratified samples by age, sex, education levels, and total household income in large-scale studies. METHODS The associations in the overall participants in the six cohorts were examined using univariate and multivariable Cox proportional hazards models. The relationships in the population subgroups of the cohorts were determined using multivariable Cox regression models. Crude hazard ratios (HRs) were estimated, and adjusted or time-varying HRs were calculated and then pooled by meta-analyses. RESULTS During a median follow-up time of 3.8 (interquartile range [IQR]: 2.2-4.5) -7.9 (IQR: 4.0-8.0) years, 18267 participants out of 62150 participants developed incident cases of depressive symptoms. In the univariate Cox regression analyses, stroke was consistently linked to depressive symptoms across all studies, with HRs ranging from 1.39 (95% confidence interval [CI]: 1.04-1.85) to 1.84 (95% CI: 1.38-2.46). Adjusted HRs varied between 1.19 (95% CI: 0.89-1.59) and 1.48 (95% CI: 1.00-1.98), and time-varying HRs remained largely unchanged. According to the meta-analysis of overall HRs, stroke survivors were more likely than non-survivors to develop depressive symptoms (pooled HR: 1.35 (95% CI: 1.26-1.44)). CONCLUSIONS In general, stroke significantly increased the risk of depressive symptoms in total and stratified participants in most cohorts. In the future, extensive research will be needed to assess the variations in associations between various population subgroups.
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48
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Ashaie SA, Funkhouser CJ, Jabbarinejad R, Cherney LR, Shankman SA. Longitudinal Trajectories of Post-Stroke Depression Symptom Subgroups. Neurorehabil Neural Repair 2023; 37:46-52. [PMID: 36524237 DOI: 10.1177/15459683221143464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Post-stroke depressive symptoms are prevalent and impairing, and elucidating their course and risk factors is critical for reducing their public health burden. Previous studies have examined the course of post-stroke depression, but distinct depressive symptom dimensions (eg, somatic symptoms, negative affect [eg, sadness], anhedonia [eg, loss of interest]) may vary differently over time. OBJECTIVE The present study examined within-person and between-person associations between depressive symptom dimensions across 3 timepoints in the year following discharge from in-patient rehabilitation hospitals, as well as the impact of multiple clinical variables (eg, aphasia). METHODS Stroke survivors completed the Center for Epidemiologic Depression Scale (CES-D) at discharge from post-stroke rehabilitation ("T1") and at 3-month ("T2") and 12-month ("T3") follow-ups. Scores on previously identified CES-D subscales (somatic symptoms, anhedonia, and negative affect) were calculated at each timepoint. Random intercept cross-lagged panel model analysis examined associations between symptom dimensions while disaggregating within-person and between-person effects. RESULTS There were reciprocal, within-person associations between somatic symptoms and anhedonia from T1 to T2 and from T2 to T3. Neither dimension was predictive of, or predicted by negative affect. CONCLUSIONS The reciprocal associations between somatic symptoms and anhedonia may reflect a "vicious cycle," and suggest these 2 symptom dimensions may be useful indicators of risk and/or intervention targets. Regularly assessing depression symptoms starting during inpatient rehabilitation may help identify stroke survivors at risk for depression symptoms and facilitate early intervention.
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Affiliation(s)
- Sameer A Ashaie
- Think and Speak, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Carter J Funkhouser
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Psychology, University of Illinois at Chicago, Chicago, IL, USA
| | - Roxana Jabbarinejad
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Leora R Cherney
- Think and Speak, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Stewart A Shankman
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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49
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Apriliyasari RW, Budi IS, Tan MP, Tsai PS. Physical activity and depression in Indonesian adults with stroke: A nationwide survey. J Nurs Scholarsh 2023; 55:356-364. [PMID: 36262085 DOI: 10.1111/jnu.12823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/22/2022] [Accepted: 09/12/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To examine the associations between physical activity and depressive symptoms in adults with stroke. DESIGN We conducted a cross-sectional study involving the data of 3234 adults with stroke obtained from the 2018 Basic Health Research (Riset Kesehatan Dasar, RISKESDAS). METHODS Physical activity level in metabolic equivalents-minutes per week were determined using the Global Physical Activity Questionnaire according to the World Health Organization (WHO) guidelines on physical activity and sedentary behavior recommendations. Depression was assessed using the Mini-International Neuropsychiatric Interview. Multivariate binomial logistic regression analysis was performed to examine the predictive role of physical activity for depression after adjusting for confounders. RESULTS Adults with stroke who met the WHO recommendation of physical activity were independently and significantly associated with lower odds of depression after adjustment for confounders (adjusted OR = 0.757, p = 0.017). CONCLUSIONS Performing physical activity according to the WHO recommendation is associated with a lower likelihood of depression among Indonesian adults with stroke. CLINICAL RELEVANCE Clinicians should be informed by the findings of this study and prescribe exercise interventions or plan physical activities to optimize recovery and prevent poststroke depression.
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Affiliation(s)
- Renny Wulan Apriliyasari
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Institut Teknologi Kesehatan (ITEKES) Cendekia Utama Kudus, Kudus, Indonesia
| | - Ilham Setyo Budi
- Department of Nursing, Institut Teknologi Kesehatan (ITEKES) Cendekia Utama Kudus, Kudus, Indonesia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pei-Shan Tsai
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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50
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Fast L, Temuulen U, Villringer K, Kufner A, Ali HF, Siebert E, Huo S, Piper SK, Sperber PS, Liman T, Endres M, Ritter K. Machine learning-based prediction of clinical outcomes after first-ever ischemic stroke. Front Neurol 2023; 14:1114360. [PMID: 36895902 PMCID: PMC9990416 DOI: 10.3389/fneur.2023.1114360] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
Background Accurate prediction of clinical outcomes in individual patients following acute stroke is vital for healthcare providers to optimize treatment strategies and plan further patient care. Here, we use advanced machine learning (ML) techniques to systematically compare the prediction of functional recovery, cognitive function, depression, and mortality of first-ever ischemic stroke patients and to identify the leading prognostic factors. Methods We predicted clinical outcomes for 307 patients (151 females, 156 males; 68 ± 14 years) from the PROSpective Cohort with Incident Stroke Berlin study using 43 baseline features. Outcomes included modified Rankin Scale (mRS), Barthel Index (BI), Mini-Mental State Examination (MMSE), Modified Telephone Interview for Cognitive Status (TICS-M), Center for Epidemiologic Studies Depression Scale (CES-D) and survival. The ML models included a Support Vector Machine with a linear kernel and a radial basis function kernel as well as a Gradient Boosting Classifier based on repeated 5-fold nested cross-validation. The leading prognostic features were identified using Shapley additive explanations. Results The ML models achieved significant prediction performance for mRS at patient discharge and after 1 year, BI and MMSE at patient discharge, TICS-M after 1 and 3 years and CES-D after 1 year. Additionally, we showed that National Institutes of Health Stroke Scale (NIHSS) was the top predictor for most functional recovery outcomes as well as education for cognitive function and depression. Conclusion Our machine learning analysis successfully demonstrated the ability to predict clinical outcomes after first-ever ischemic stroke and identified the leading prognostic factors that contribute to this prediction.
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Affiliation(s)
- Lea Fast
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Uchralt Temuulen
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Kersten Villringer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany
| | - Anna Kufner
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany
| | - Huma Fatima Ali
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Eberhard Siebert
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neuroradiology, Berlin, Germany
| | - Shufan Huo
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauferkrankungen, DZHK), Partner Site Berlin, Berlin, Germany
| | - Sophie K Piper
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Biometry and Clinical Epidemiology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Informatics, Berlin, Germany
| | - Pia Sophie Sperber
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, NeuroCure Clinical Research Center (NCRC), Berlin, Germany.,Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Thomas Liman
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauferkrankungen, DZHK), Partner Site Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen, DZNE), Partner Site Berlin, Berlin, Germany.,Department of Neurology, Evangelical Hospital Oldenburg, Carl von Ossietzky-University, Oldenburg, Germany
| | - Matthias Endres
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Center for Stroke Research Berlin (CSB), Berlin, Germany.,Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, Berlin, Germany.,German Center for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauferkrankungen, DZHK), Partner Site Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NeuroCure Cluster of Excellence, NeuroCure Clinical Research Center (NCRC), Berlin, Germany.,German Center for Neurodegenerative Diseases (Deutsches Zentrum für Neurodegenerative Erkrankungen, DZNE), Partner Site Berlin, Berlin, Germany
| | - Kerstin Ritter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Bernstein Center for Computational Neuroscience (BCCN), Berlin, Germany
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