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Zhao Y, Sun W, Fan Q, Huang Y, Ma Y, Zhang S, Gong C, Wang B, Zhang W, Yang Q, Lin S. Exploring the potential molecular intersection of stroke and major depression disorder. Biochem Biophys Res Commun 2024; 720:150079. [PMID: 38759300 DOI: 10.1016/j.bbrc.2024.150079] [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: 01/18/2024] [Revised: 04/22/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024]
Abstract
Stroke and major depression disorder are common neurological diseases, and a large number of clinical studies have shown that there is a close relationship between the two diseases, but whether the two diseases are linked at the genetic level needs to be further explored. The purpose of this study was to explore the comorbidity mechanism of stroke and major depression by using bioinformatics technology and animal experiments. From the GEO database, we gathered transcriptome data of stroke and depression mice (GSE104036, GSE131712, GSE81672, and GSE146845) and identified comorbid gene set through edgR and WGCNA analyses. Further analysis revealed that these genes were enriched in pathways associated with cell death. Programmed cell death gene sets (PCDGs) are generated from genes related to apoptosis, necroptosis, pyroptosis and autophagy. The intersection of PCDGs and comorbid gene set resulted in two hub genes, Mlkl and Nlrp3. Single-cell sequencing analysis indicated that Mlkl and Nlrp3 are mainly influential on endothelial cells and microglia, suggesting that the impairment of these two cell types may be a factor in the relationship between stroke and major depression. This was experimentally confirmed by RT-PCR and immunofluorescence staining. Our research revealed that two specific genes, namely, Mlkl and Nlrp3, play crucial roles in the complex mechanism that links stroke and major depression. Additionally, we have predicted six possible therapeutic agents and the outcomes of docking simulations of target proteins and drug molecules.
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Affiliation(s)
- Yuan Zhao
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China
| | - Wenzhe Sun
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China
| | - Qinlin Fan
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China
| | - Yanjie Huang
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China
| | - Yufan Ma
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China
| | - Shuang Zhang
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China
| | - Changxiong Gong
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China
| | - Bingqiao Wang
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China
| | - Wanyun Zhang
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China
| | - Qingwu Yang
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China; Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing, 400064, China.
| | - Sen Lin
- Department of Neurology, Xinqiao Hospital, The Second Affiliated Hospital, Army Medical University, Chongqing, 400042, China; Chongqing Institute for Brain and Intelligence, Guangyang Bay Laboratory, Chongqing, 400064, China.
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2
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Martins Dos Santos H, Pereira GS, de Oliveira LC, Da Silva PK, Gonçalves Lima M, Faria CDCDM, Silva SM. Biopsychosocial factors associated with the state of disability after hemiparesis in the chronic phase of stroke: exploratory analysis based on the International Classification of Functioning, Disability and Health. Disabil Rehabil 2024; 46:1366-1373. [PMID: 37029629 DOI: 10.1080/09638288.2023.2196444] [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: 07/12/2022] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To identify the main biopsychosocial factors associated with disability level after stroke using the International Classification of Functioning, Disability and Health (ICF) model. METHODS A cross-sectional study was conducted with chronic stroke survivors. Disability was assessed using the World Health Disability Assessment Schedule 2.0. The independent variables were: Body functions: emotional functioning and whether the dominant upper limb was affected. For the Activities & Participation component, satisfaction regarding the execution of activities and participation were assessed using the SATIS-Stroke, as well as the locomotion ability for adults (ABILOCO), manual ability (ABILHAND) and the return to work. For environmental factors, income and facilitators and obstacles were assessed using the Measure of the Quality of the Environment (MQE). Personal factors: age and sex. Multiple Linear Regression was employed. RESULTS Limited locomotor ability (β = -0.281; t = -3.231 p = 0.002), dissatisfaction regarding activities and participation (β = -0.273; t = -3.070 p = 0.003), and the non-return to work (β = 0.162; t = 2.085 p = 0.04) were associated with disability. CONCLUSION The reduction in locomotor ability, dissatisfaction regarding activities and participation and the non-return to work were associated with disability in the chronic phase following a stroke.
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Affiliation(s)
| | - Gabriela Santos Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Leia Cordeiro de Oliveira
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Paula Karina Da Silva
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Michael Gonçalves Lima
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Soraia Micaela Silva
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
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Trapp NT, Bruss JE, Manzel K, Grafman J, Tranel D, Boes AD. Large-scale lesion symptom mapping of depression identifies brain regions for risk and resilience. Brain 2023; 146:1672-1685. [PMID: 36181425 PMCID: PMC10319784 DOI: 10.1093/brain/awac361] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/15/2022] [Accepted: 09/02/2022] [Indexed: 11/14/2022] Open
Abstract
Understanding neural circuits that support mood is a central goal of affective neuroscience, and improved understanding of the anatomy could inform more targeted interventions in mood disorders. Lesion studies provide a method of inferring the anatomical sites causally related to specific functions, including mood. Here, we performed a large-scale study evaluating the location of acquired, focal brain lesions in relation to symptoms of depression. Five hundred and twenty-six individuals participated in the study across two sites (356 male, average age 52.4 ± 14.5 years). Each subject had a focal brain lesion identified on structural imaging and an assessment of depression using the Beck Depression Inventory-II, both obtained in the chronic period post-lesion (>3 months). Multivariate lesion-symptom mapping was performed to identify lesion sites associated with higher or lower depression symptom burden, which we refer to as 'risk' versus 'resilience' regions. The brain networks and white matter tracts associated with peak regional findings were identified using functional and structural lesion network mapping, respectively. Lesion-symptom mapping identified brain regions significantly associated with both higher and lower depression severity (r = 0.11; P = 0.01). Peak 'risk' regions include the bilateral anterior insula, bilateral dorsolateral prefrontal cortex and left dorsomedial prefrontal cortex. Functional lesion network mapping demonstrated that these 'risk' regions localized to nodes of the salience network. Peak 'resilience' regions include the right orbitofrontal cortex, right medial prefrontal cortex and right inferolateral temporal cortex, nodes of the default mode network. Structural lesion network mapping implicated dorsal prefrontal white matter tracts as 'risk' tracts and ventral prefrontal white matter tracts as 'resilience' tracts, although the structural lesion network mapping findings did not survive correction for multiple comparisons. Taken together, these results demonstrate that lesions to specific nodes of the salience network and default mode network are associated with greater risk versus resiliency for depression symptoms in the setting of focal brain lesions.
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Affiliation(s)
- Nicholas T Trapp
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
| | - Joel E Bruss
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | - Kenneth Manzel
- Department of Neurology, University of Iowa, Iowa City, IA, USA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Jordan Grafman
- Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Daniel Tranel
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
- Department of Neurology, University of Iowa, Iowa City, IA, USA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Aaron D Boes
- Department of Psychiatry, University of Iowa, Iowa City, IA, USA
- Iowa Neuroscience Institute, University of Iowa, Iowa City, IA, USA
- Department of Neurology, University of Iowa, Iowa City, IA, USA
- Department of Pediatrics, University of Iowa, Iowa City, IA, USA
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4
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Niu S, Liu X, Wu Q, Ma J, Wu S, Zeng L, Shi Y. Sleep Quality and Cognitive Function after Stroke: The Mediating Roles of Depression and Anxiety Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20032410. [PMID: 36767777 PMCID: PMC9915208 DOI: 10.3390/ijerph20032410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 01/13/2023] [Accepted: 01/23/2023] [Indexed: 05/19/2023]
Abstract
This study examined the association between post-stroke cognitive function and sleep status at 30 days post-stroke and evaluated the role of anxiety and depression as potential mediators of that association. The participants in this study were 530 acute ischemic stroke (IS) patients. Sleep disturbance at 30 days post-stroke was assessed by the Pittsburgh Sleep Quality Index. Basic patient information, cognitive function, depression, and anxiety status were assessed before discharge from the hospital. Stratified linear regression analysis models were fit to examine the associations between post-stroke sleep quality and the influencing factors. A structural equation model was developed to evaluate the role of anxiety and depression as potential mediators of sleep quality and cognitive function. At 30 days post-stroke, 58.7% of IS patients had sleep disturbance. Women and older IS patients were more likely to suffer poorer sleep quality (p < 0.05). A stratified linear regression analysis showed that the inclusion of cognitive function variables and indicators of depression and anxiety were statistically significant in predicting improvement in the sleep disturbance of AIS patients. Cognitive function, depression, anxiety, and sleep status were selected to construct a structural equation model. The total effect of cognitive function on sleep status was -0.274, with a direct effect of -0.097 and an indirect effect (through depression) of -0.177. The total effect of anxiety on sleep status was 0.235, with a direct effect of 0.186 and an indirect effect (through depression) of 0.049. IS patients often experience poor sleep quality. Depression in IS patients mediates two pathways: the pathway through which cognitive function affects sleep quality and the pathway through which anxiety affects sleep quality.
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Affiliation(s)
- Shuzhen Niu
- Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Xianliang Liu
- College of Nursing and Midwifery, Charles Darwin University, Brisbane 4000, Australia
| | - Qian Wu
- Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Jiajia Ma
- Chest Hospital, Shanghai 200030, China
| | - Songqi Wu
- Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
| | - Li Zeng
- Tongji Hospital, School of Medicine, Tongji University, Shanghai 200065, China
| | - Yan Shi
- Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China
- Correspondence:
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Determinants of post-stroke depression among stroke survivors at University of Gondar Hospital, Northwest Ethiopia: a case-control study. BMC Neurol 2022; 22:446. [PMID: 36456908 PMCID: PMC9714110 DOI: 10.1186/s12883-022-02982-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stroke is one of the most common causes of disability among adults. Post-stroke depression (PSD) is a frequent neuropsychiatric complication in stroke patients. Despite the increasing prevalence of stroke, there is a paucity of data on PSD and its determinants among stroke survivors in developing countries like Ethiopia. We aim to assess the factors associated with PSD in survivors of stroke. METHOD A hospital-based unmatched case-control study was conducted during the period of February to July 2020 at University of Gondar Hospital among stroke survivors. Study subjects were recruited consecutively. Socio-demographic and clinical data were obtained from patients' interviews and medical record reviews. A diagnosis of PSD was made using the Patient Health Questionnaire (PHQ-9). EpiData version 3.1 was used to enter data, and SPSS version 26 was used to analyze it. Bivariate and multivariate logistic regressions were fitted to identify associated variables. The adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value 0.05 were used to determine the significance of the association. RESULT A total of 240 stroke survivors were included in the study (80 cases and 160 controls). The mean age was 60.8 years (SD ± 14.3) with an equal sex distribution. Variables statistically associated with PSD were male gender (AOR = 3.5, 95% CI: 1.64-7.46 C, P-value = 0.001), subcortical location of the largest lesion (AOR = 2.42, 95% CI: 1.06-5.56, p-value = 0.036), severity of the stroke (AOR = 52.34, 95% CI:10.64-256.87, p-value = 0.000), physical disability (AOR = 5.85. 95% CI:1.94-17.65, p-value = 0.002), previous history of stroke or transient ischemic attack (AOR = 5.90, 95% CI:2.04-17.10, p-value = 0.001) and ischemic heart disease (AOR = 9.97, 95% CI:3.4-29.22, p-value = 0.000). CONCLUSION Important factors in the occurrence of PSD in this study include prior history of stroke, physical disability, severity of the stroke, subcortical location of the lesion, male gender, and ischemic heart disease. Stroke patients with such factors need routine screening for PSD, particularly in LMICs where there is uncoordinated post-stroke care, a shortage of neurologists and mental health practitioners.
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Jaroonpipatkul C, Onwanna J, Tunvirachaisakul C, Jittapiromsak N, Rakvongthai Y, Chutinet A, Supasitthumrong T, Maes M. Depressive symptoms due to stroke are strongly predicted by the volume and location of the cerebral infarction, white matter hyperintensities, hypertension, and age: A precision nomothetic psychiatry analysis. J Affect Disord 2022; 309:141-150. [PMID: 35430315 DOI: 10.1016/j.jad.2022.04.041] [Citation(s) in RCA: 2] [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: 11/08/2021] [Revised: 03/24/2022] [Accepted: 04/09/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To delineate the effects of white matter hyperintensities (WMHs) as measured by Fluid-attenuated inversion recovery (FLAIR) and infarction volume as measured by Diffusion-weighted imaging (DWI) on post-stroke depression symptoms. METHODS Baseline National Institutes of Health Stroke Score (NIHSS) and Modified Rankin Scale (mRS) scores, and FLAIR and DWI MRIs to assess WMHs and acute infarct volumes, respectively, were assessed in 47 patients (≥55 years) with acute ischemic stroke and 17 normal controls. The Montgomery-Åsberg Depression Rating Scale (MDRS) was assessed three months after the stroke. RESULTS The MADRS score was significantly increased in stroke patients as compared with normal controls. The MADRS scale is not unidimensional and cannot be used as an accurate indicator of depression severity in stroke patients. Three months after stroke, key depressive (sadness and inability to feel) and concentration-tension symptoms, and lassitude are significantly predicted by the infarct volume. Right side infarction strongly predicts key depressive symptoms and left side infarction strongly predicts concentration-tension and lassitude scores. Total WMHs significantly predict key depressive and concentration-tension symptoms, and lassitude, with these effects being mediated by right and left DWI stroke volumes and associated disabilities. CONCLUSIONS Interactions between age, hypertension, a chronic atherosclerotic process, and acute stroke account for the onset of key depressive symptoms three months after the acute infarct. Chronic and acute neuro-immune and neuro-oxidative stress pathways associated with the formation of WMHs and acute stroke may explain the incidence of post-stroke key depressive and concentration-tension symptoms, and lassitude.
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Affiliation(s)
| | - Jaruwan Onwanna
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | | | | | - Yothin Rakvongthai
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Aurauma Chutinet
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Chulalongkorn Stroke Center, Chula Neuroscience Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | | | - Michael Maes
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; IMPACT Strategic Research Center, Deakin University, Geelong, Australia
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7
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Mahadevan S, Chan MF, Moghadas M, Shetty M, Burke DT, Al-Rasadi K, Al-Adawi S. Post-Stroke Psychiatric and Cognitive Symptoms in West Asia, South Asia and Africa: A Systematic Review and Meta-Analysis. J Clin Med 2021; 10:3655. [PMID: 34441951 PMCID: PMC8397184 DOI: 10.3390/jcm10163655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/11/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022] Open
Abstract
Recent research has shown that the prevalence of stroke incidents and the number of survivors in developing countries surpass those from developed countries. This study aimed to enumerate the prevalence of post-stroke psychiatric and cognitive symptoms among stroke survivors from West and South Asia and Africa through a systematic review and meta-analysis. Data from each country was systematically acquired from five major databases (PsycINFO, Web of Science, Scopus, PubMed/Medline, and Google Scholar (for any missing articles and grey literature)). Meta-analytic techniques were then used to estimate the prevalence of various post-stoke psychiatric and cognitive symptoms. A total of 36 articles were accrued from 11 countries, of which 25 were evaluated as part of the meta-analysis. The pooled prevalence of post-stroke depression as per the Hospital Anxiety and Depression Scale (HADS), Hamilton Depression Rating Scale, Patient Health Questionnaire, Schedules for Clinical Assessment in Neuropsychiatry (SCAN), Geriatric Depression Scale, and the Montgomery-Asberg Depression Rating Scale ranged from 28.00 to 50.24%. Pooled prevalence of post-stroke anxiety based on the HADS and SCAN was 44.19% and 10.96%, respectively. The pooled prevalence of post-stroke cognitive impairment as per the Mini-Mental Status Examination was 16.76%. This present review has suggested that both psychiatric and cognitive symptoms are common among stroke survivors. Concerted efforts are needed to institute robust studies using culturally sensitive measures to contemplate mechanisms that address the unmet needs of this vulnerable population.
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Affiliation(s)
- Sangeetha Mahadevan
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
| | - Moon Fai Chan
- Department of Family Medicine & Public Health, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| | - Marzieh Moghadas
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
| | - Maithili Shetty
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
| | - David T. Burke
- Department of Rehabilitation Medicine in the Emory University School of Medicine, 1441 Clifton Road N.E., Atlanta, GA 30322, USA;
| | - Khalid Al-Rasadi
- Department of Biochemistry, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman;
| | - Samir Al-Adawi
- Department of Behavioural Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman; (S.M.); (M.M.); (M.S.)
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A User-Driven Approach to Prosthetic Upper Limb Development in Korea. Healthcare (Basel) 2021; 9:healthcare9070839. [PMID: 34356217 PMCID: PMC8303819 DOI: 10.3390/healthcare9070839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/21/2021] [Accepted: 06/29/2021] [Indexed: 11/17/2022] Open
Abstract
Despite recent significant advances in technology and medicine, the number of patients who undergo amputation of body parts for various reasons continues to increase. Assistive devices such as prosthetic arms can enable limited activities in upper limb amputees and improve their quality of life. This study aims to help in the development of user-centered prosthetics by identifying user requirements and key considerations during selection of prosthetics. This study conducted a questionnaire survey after obtaining prior consent for persons with disabilities with upper limb amputation who visited orthosis companies, rehabilitation centers for the disabled, veteran’s hospitals, and labor welfare corporations. A modified questionnaire was conducted to upper limb prosthetic users and results were analysed using descriptive statistics and t-test. Results of the study showed that the main reasons for discontinuing the use of prosthetics were discomfort (discomfort in wear, weight, and difficulty of detachment) and complaints regarding design and function. Regardless of the prosthesis type, the color and design of the prosthesis were key considerations in prosthesis choices. Respondents indicated that they needed various prostheses designed according to the purpose and situation, such as for sports like golf and cycling as well as everyday use. Most of the respondents answered that buttoning shirts, tying knots, and using chopsticks were challenging or impossible to do on their own. Based on the results of this study, the quality of life of upper limb amputees can be improved if a prosthetic arm with various functions that can satisfy both the user’s needs and wants is developed.
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Sharma GS, Gupta A, Khanna M, Prakash NB. Post-Stroke Depression and Its Effect on Functional Outcomes during Inpatient Rehabilitation. J Neurosci Rural Pract 2021; 12:543-549. [PMID: 34295110 PMCID: PMC8289524 DOI: 10.1055/s-0041-1731958] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective
The aim of the study is to observe the effect of post-stroke depression on functional outcomes during inpatient rehabilitation.
Materials and Methods
The design involved is prospective observational study. The location involved is Neurological Rehabilitation unit in a tertiary care university hospital. The study period ranges from October 2019 to April 2020. The participants involved are the patients with first ever stroke, male and female with age ≥18 years and duration less than 1 year. All participants were assessed at admission and after 14 sessions of inpatient rehabilitation by depression subscale of Hospital Anxiety and Depression Scale (HADS-D) and Hamilton Depression Rating Scale (HDRS). The stroke outcomes measures used were: Barthel Index (BI), Scandinavian Stroke Scale (SSS), and Modified Rankin Scale (MRS).
Results
There are a total of 30 participants (18 males) with median stroke duration of 90 days. The median age of the patients was 58 years. Sixteen patients had ischemic and 14 had hemorrhagic stroke. Out of these, 57% (
n
= 17) had symptoms of depression (HADS-D >7). Participants in both groups (with and without depression) showed improvement in all the functional outcome measures (BI, SSS, MRS) at the time of discharge as compared with admission scores. The changes in the outcome measures were statistically significant within groups (
p
< 0.05) but not significant between the groups (
p
> 0.05).
Conclusion
The post-stroke depression is common among stroke survivors of less than 1 year duration. There was no significant difference in the functional outcomes between stroke patients with depression and those without depression with inpatient rehabilitation program.
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Affiliation(s)
- Gurumayum Sonachand Sharma
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Naveen Bangarpet Prakash
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Facucho-Oliveira J, Esteves-Sousa D, Espada-Santos P, Moura N, Albuquerque M, Fraga AM, Sousa S, Cintra P, Mendonça L, Pita F. Depression after stroke. Pract Neurol 2021; 21:384-391. [PMID: 33990426 DOI: 10.1136/practneurol-2020-002622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 01/01/2023]
Abstract
Stroke treatment has dramatically improved in recent decades. However, although new treatments have reduced its mortality and the severity of its physical and cognitive sequelae, many people still have incapacitating disabilities following a stroke. Depression is the most common psychiatric disorder following stroke; it is important to recognise and treat as it limits motor and cognitive rehabilitation. Antidepressant medication is an effective treatment and can improve adherence to clinically recommended physical and cognitive tasks, thereby enhancing functional remodelling of neuronal pathways and improving rehabilitation outcomes.
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Affiliation(s)
| | - Daniel Esteves-Sousa
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Pedro Espada-Santos
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Nuno Moura
- Department of Mental Health and Psychiatry, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | | | - Ana Margarida Fraga
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Sandra Sousa
- Department of Neurology, Lusiadas Health Group, Lisboa, Portugal
| | - Pedro Cintra
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Luis Mendonça
- Department of Mental Health and Psychiatry, Lusiadas Health Group, Lisboa, Portugal
| | - Fernando Pita
- Department of Neurology, Lusiadas Health Group, Lisboa, Portugal
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11
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Isuru A, Hapangama A, Ediriweera D, Samarasinghe L, Fonseka M, Ranawaka U. Prevalence and predictors of new onset depression in the acute phase of stroke. Asian J Psychiatr 2021; 59:102636. [PMID: 33848806 DOI: 10.1016/j.ajp.2021.102636] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/25/2021] [Accepted: 03/25/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Post-stroke depression (PSD) is known to be associated with poor functional outcome and high mortality. There is limited data on the prevalence and associated factors of depression in the acute phase after stroke. OBJECTIVES To determine the prevalence of PSD in the acute phase and its correlates among patients with stroke in a tertiary care hospital in Sri Lanka. METHOD A cross sectional descriptive study was conducted among patients with stroke admitted to the stroke unit of a tertiary care hospital in Sri Lanka over a 3-year period. Demographic and clinical information was obtained using an interviewer administered questionnaire. Depression was diagnosed using the ICD-10 criteria. Group comparisons were performed using Pearson's Chi-square test and Mann-Whitney U test Multiple logistic regression was used to identify factors associated with PSD. RESULTS Of 374 patients, 106 patients experienced moderate to severe PSD, with a prevalence of 28.3 % (95 % CI: 23.8 %-32.9 %). Of them, 54.7 % were females, 49 % were above the age of 60 years, and 79.9 % had ischemic strokes. Female gender (OR-2.77, 95 % CI: 1.46-5.07, P = 0.002), a longer duration of hypertension (OR-1.31, 95 % CI: 1.01-1.721, P = 0.004), strokes involving the temporal lobe (OR-7.25, 95 % CI: 2.81-20.25, P < 0.001) and post-stroke functional disability (OR- O.98, 95 % CI:0.97-0.99, P = 0.001) were associated with PSD on multivariate analysis. CONCLUSION More than one fourth of the patients suffered from PSD in the acute phase of stroke. Female gender, longer history of hypertension, physical dependence and temporal lobe strokes were predictive of PSD.
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Affiliation(s)
- Amila Isuru
- Department of Psychiatry, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka and University Psychiatry Unit, Colombo North Teaching Hospital, Ragama, Sri Lanka.
| | - Aruni Hapangama
- Department of Psychiatry, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | - Dileepa Ediriweera
- Health Data Science Unit, Faculty of Medicine, University of Kelaniya, Sri Lanka
| | | | - Madhavi Fonseka
- University Psychiatry Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka
| | - Udaya Ranawaka
- Department of Medicine, University of Sri Lanka, Sri Lanka
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12
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Patra A, Nitin K, Devi NM, Surya S, Lewis MG, Kamalakannan S. Prevalence of Depression among Stroke Survivors in India: A Systematic Review and Meta-Analysis. FRONTIERS IN NEUROLOGY AND NEUROSCIENCE RESEARCH 2021; 2:100008. [PMID: 34179896 PMCID: PMC7611044 DOI: 10.51956/fnnr.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To estimate the prevalence of depression among stroke survivors in India. PARTICIPANTS Stroke survivors diagnosed with depression. OUTCOMES Prevalence of Depression. METHODS Cochrane systematic review methods were followed. The literature search was from 1960-2019. We searched the following electronic databases Medline, ERIC, Embase, IndMED, PsycEXTRA, Global Health, Cochrane, CENTRAL Register, Econ Lit, and conference abstracts to identify studies for inclusion. A search strategy was appropriately developed and performed from May 2019 to December 2019. All included studies were assessed for their content and methodological quality using JBI Critical Appraisal Checklist. RESULTS A total of 15 studies were included in this study. Prevalence of post-stroke depression in the studies varied from 24% to 90%. The pooled prevalence was 55% (95% CI 43%, 65%) with high heterogeneity (I2=94.83%). Prevalence also varied between the tools (HAMD -60%, GDS -70%, HADS -40%). The overall methodological quality of the included studies was very poor. CONCLUSION It is evident from the meta-analysis that about half of those who survive a stroke experience post-stroke depression. The methods and tools used to investigate this was not rigorous and homogeneous. Hence results of this review imply the need to rigorously assess and effectively address post-stroke depression in India. Also, this review recommends future research to ensure methodological quality and generalizability of the study findings. This would help develop scalable, innovative public health intervention for post-stroke depression in the future.
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Affiliation(s)
- Abhilash Patra
- Indian Institute of Public Health, Kaloji Narayana Rao University of Health Sciences, India
| | - Karakapatla Nitin
- Indian Institute of Public Health, Kaloji Narayana Rao University of Health Sciences, India
| | - Ng Marina Devi
- Indian Institute of Public Health, Kaloji Narayana Rao University of Health Sciences, India
| | - Srinivasan Surya
- Indian Institute of Public Health, Kaloji Narayana Rao University of Health Sciences, India
| | - Melissa G. Lewis
- Indian Institute of Public Health, Kaloji Narayana Rao University of Health Sciences, India
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13
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Abdullah AH, Sharip S, Rahman AHA, Bakar L. Cognitive reserve in stroke patients. Psych J 2021; 10:444-452. [PMID: 33517588 DOI: 10.1002/pchj.423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 11/11/2022]
Abstract
At present, a limited amount of information exists on the association between cognitive reserve and cognitive impairment in stroke populations. To determine predictors of cognitive reserve among stroke patients, 80 stroke patients attending the neurological and rehabilitation clinic in two different Malaysian general hospitals participated in this study. The Malay Cognitive Reserve Index questionnaire (CRIq-M), Depression Anxiety and Stress Scales-Short Form (DASS-21), WHO Quality of Life assessment BREF-21 (WHO-QOL BREF-21), Montreal Cognitive Assessment (MoCA), and modified Rankin Scale (mRS) were used as instruments in this study. The study found that cognitive reserve (CRIq-M) is positively correlated with cognitive function (MoCA), r = 0.529, p < .01. Multiregression showed that education was a significant predictor of cognitive impairment whereas cognitive impairment as assessed by the MoCA is a significant predictor for cognitive reserve in people with stroke. Early identification of cognitive impairment among stroke patients is important so that effective individual rehabilitation can be designed to enhance individual cognitive reserve and quality of life.
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Affiliation(s)
- Ahmad H Abdullah
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Department of Psychiatry, Hospital Sultan Haji Ahmad Shah, Temerloh, Malaysia
| | - Shalisah Sharip
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Abdul H A Rahman
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Lazli Bakar
- Department of Psychiatry, Hospital Sultan Haji Ahmad Shah, Temerloh, Malaysia
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14
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Silva LC, Silva A, Rangel MFDA, Caetano LCG, Teixeira-Salmela LF, Scianni AA. Depressive symptoms and functional status are associated with sleep quality after stroke. Top Stroke Rehabil 2020; 28:573-580. [DOI: 10.1080/10749357.2020.1864964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Leonardo Carvalho Silva
- Graduate Program in Rehabilitation Sciences, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | - Andressa Silva
- Graduate Program in Rehabilitation Sciences, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
| | | | | | | | - Aline Alvim Scianni
- Graduate Program in Rehabilitation Sciences, Universidade Federal De Minas Gerais, Belo Horizonte, Brazil
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15
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Jackson HM, Troeung L, Martini A. Prevalence, Patterns, and Predictors of Multimorbidity in Adults With Acquired Brain Injury at Admission to Staged Community-Based Rehabilitation. Arch Rehabil Res Clin Transl 2020; 2:100089. [PMID: 33543112 PMCID: PMC7853357 DOI: 10.1016/j.arrct.2020.100089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To describe the prevalence, patterns, and predictors of multimorbidity in adults with an acquired brain injury (ABI) on presentation to a community-based neurorehabilitation service. DESIGN Retrospective cohort study using routinely collected admissions and clinical data. SETTING Community-based neurorehabilitation. PARTICIPANTS Individuals (N=263) with non-traumatic brain injury (NTBI; n=187 [71.1%]) versus traumatic brain injury (TBI; n=76 [28.9%]). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Comorbidity was defined as the co-occurrence of at least one chronic condition in conjunction with a primary diagnosis of ABI. Multimorbidity was defined as the co-occurrence of 2 or more chronic conditions across 2 or more body systems, in conjunction with a primary diagnosis of ABI. RESULTS Comorbidity was present in 72.2% of participants overall, whereas multimorbidity was present in 35.4% of the cohort. The prevalence of comorbidity (76% vs 63%; P=.036) and multimorbidity (40% vs 24%; P=.012) was higher in NTBI compared with participants with TBI. Participants with NTBI had a higher prevalence of physical health multimorbidities, including cardiovascular (44% vs 6%; P<.001) and endocrine (34% vs 10%; P=.002) disease, whereas participants with TBI had a higher prevalence of mental health conditions (79% vs 48%; P<.001). Depression (36.3%) and hypertension (25.8%) were the most common diagnoses. Increasing age was the only significant predictor of multimorbidity. CONCLUSIONS Most participants experienced multimorbidity. Effective management of multimorbidity should be included as part of individual rehabilitation for ABI and planning of resource allocation and service delivery. The results of this study can help guide the provision of treatment and services for individuals with ABI in community-based rehabilitation. Our study highlights access to mental health, cardiovascular, endocrine, and neurology services as essential components of rehabilitation for ABI.
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Affiliation(s)
- Hayley M. Jackson
- Brightwater Care Group, Brightwater Research Centre, Perth, Australia
- School of Psychological Science, University of Western Australia, Crawley, Australia
| | - Lakkhina Troeung
- Brightwater Care Group, Brightwater Research Centre, Perth, Australia
| | - Angelita Martini
- Brightwater Care Group, Brightwater Research Centre, Perth, Australia
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16
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Saroja AO, Thorat NN, Naik KR. Depression and Quality of Life after Cerebral Venous Sinus Thrombosis. Ann Indian Acad Neurol 2020; 23:487-490. [PMID: 33223665 PMCID: PMC7657299 DOI: 10.4103/aian.aian_191_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/01/2019] [Accepted: 05/27/2019] [Indexed: 11/08/2022] Open
Abstract
Introduction: Cerebral venous sinus thrombosis (CVST) is an important cause of stroke in young and has a favorable outcome. Long-term sequelae of CVST include motor disability, cognitive impairment, depression, anxiety, fatigue, impaired employment and poor quality of life. Objective: To evaluate depression and quality of life after CVST. Methods: Patients who completed at least 1 year after discharge were recruited for this cross-sectional observational study from our CVST cohort. Quality of life was assessed using Stroke-Adapted Sickness Impact Profile (SA-SIP 30) and depression using Hamilton Depression scale (HAM-D). Results: A total of 100 patients (60 men and 40 women) were included in the study. Their age ranged from 14 to 60 years (34.97 ± 10.06). The interval from discharge to assessment of quality of life was 2.2 ± 1.6 years. In all, 98% of patients had good modified Rankin score at follow-up. SA-SIP 30 did not reveal any functional disability for physical functioning. Seven had impairment for psychosocial domain despite having good modified Rankin scores. Thirty patients had depression. Patients with higher mRS at discharge had increased presence of depression. Quality-of-life scores did not correlate with presence of seizure, headache, infarction and sinuses involved. Conclusion: This is the first Indian study demonstrating depression in patients with CVST and use of SA-SIP to assess quality of life in them. Occurrence of depression in CVST is as high as in arterial strokes.
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Affiliation(s)
- Aralikatte O Saroja
- Department of Neurology, Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi, Karnataka, India
| | - Ninad N Thorat
- Department of Neurology, Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi, Karnataka, India
| | - Karkal R Naik
- Department of Neurology, Jawaharlal Nehru Medical College, Nehru Nagar, Belagavi, Karnataka, India
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17
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Corallo F, Scarfì C, Arcadi FA, Formica C, Di Cara M, Palmeri R, Romeo L, Lo Buono V, Bramanti P, Marino S, De Cola MC. Role of functional pharmacological therapy in post-stroke depression: a narrative review. J Int Med Res 2020; 48:300060520950557. [PMID: 33081542 PMCID: PMC7588775 DOI: 10.1177/0300060520950557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective We conducted a narrative review to investigate whether antidepressant therapy, including the use of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) or the use of supportive drugs (i.e., citicoline or choline alfoscerate) as a substitute for antidepressant therapy, reduces depression in patients with cerebrovascular diseases. Methods A systematic search of the PubMed and Web of Science databases was performed, including review articles and other studies to identify additional citations. Only 4 of 1566 publications met the inclusion/exclusion criteria and were selected. Results Studies showed that post-stroke depression (PSD) could be treated with antidepressant therapy, as well as supportive drugs such as citicoline or choline alfoscerate, which may have antidepressant effects. Conclusions The findings support the efficacy of citicoline as a treatment for depression. Studies aimed to discover the characteristics of these psychostimulants in relation to PSD treatment should be performed.
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Affiliation(s)
- Francesco Corallo
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Chiara Scarfì
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | | | - Caterina Formica
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Marcella Di Cara
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Rosanna Palmeri
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Laura Romeo
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Viviana Lo Buono
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Placido Bramanti
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
| | - Silvia Marino
- IRCCS Centro Neurolesi "Bonino Pulejo" - S.S. 113 C.da Casazza, Messina, Italy
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18
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Ahmed T, Kumar R, Bahurupi Y. Factors Affecting Quality of Life among Post-Stroke Patients in the Sub-Himalayan Region. J Neurosci Rural Pract 2020; 11:616-622. [PMID: 33144800 PMCID: PMC7595802 DOI: 10.1055/s-0040-1716927] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
Stroke is one of the most debilitating conditions contributing to significant disability and death globally. Identifying risk factors for quality of life (QoL) will enable to improve home-based rehabilitation in post-stroke phase.
Objective
This study was aimed to identify the risk factors of QoL in stroke patients in the sub-Himalayan region.
Materials and Methods
A cross-sectional hospital-based study assessed the QoL among stroke patients within a week after the onset of acute stroke and then re-evaluated at 3 months. World Health Organization QoL-BREF, Beck Depression Inventory, the Barthel Index, and Montreal Cognitive Assessment (MOCA) were used to seek data on QoL, depression, cognitive, and functional dependence status, respectively. Appropriate statistics were used to compute the results.
Results
In total, 129 stroke patients recruited, out of which 102 returned to a 3-month follow-up. QoL, MOCA, disability index, and depression score were compared using Wilcoxon Singed-rank test. In multivariate analysis, depression and disability together predicted 60% of the variance for physical QoL (
p
< 0.0001). Similarly, poststroke depression and disability together predicted 61% of the variance for psychological QoL (
p
< 0.0001) in stroke patients.
Conclusion
Findings indicated that depression and disability are leading risk factors of QoL in stroke patients. Early identification of poststroke depression and functional dependence status is, therefore, essential to devise screening procedure and to develop targeted intervention to improve rehabilitation outcomes.
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Affiliation(s)
- Tarannum Ahmed
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Rajesh Kumar
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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19
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Astuti P, Kusnanto K, Dwi Novitasari F. Depression and functional disability in stroke patients. J Public Health Res 2020; 9:1835. [PMID: 32728574 PMCID: PMC7376455 DOI: 10.4081/jphr.2020.1835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background: Stroke patients often suffer from depression, a mental disorder that worsens their condition and slows down the recovery process. Depression is the leading cause of functional disability due to inability to cope with daily stressors and to function independently in their activities. The purpose of this study is to analyze the relationship between depression and functional disability levels in post-stroke patients. Design and Methods: This is an analytic observational research with a cross-sectional approach. The population in exam consisted of all 4-12 week post-stroke patient in the hospital (about 139 patients). The study focused on 104 respondents, who were selected using simple random sampling techniques. Results: The results show that 62.5% stroke patients suffered mild depressive episodes after the stroke while 58.7% experienced mild disabilities. Analysis results using the Pearson Product Moment Test obtained P=0,000. This shows there is a relationship between the level of depression and the degree of functional disability in post-stroke patients. Conclusions: It can be concluded that there is a significant relationship between the levels of post-stroke depression and the functional disability. Families are expected to provide a safe, supportive, and comfortable environment to lessen the level of depression.
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Affiliation(s)
- Puji Astuti
- Doctoral Program of Public Health, Faculty of Public Health.,Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Indonesia
| | - Kusnanto Kusnanto
- Faculty of Nursing and Midwifery, Universitas Nahdlatul Ulama Surabaya, Indonesia
| | - Ferra Dwi Novitasari
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya
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20
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Kumar R, Kataria N, Kumar N, Kumar M, Bahurupi Y. Poststroke depression among stroke survivors in Sub-Himalayan region. J Family Med Prim Care 2020; 9:3508-3513. [PMID: 33102322 PMCID: PMC7567203 DOI: 10.4103/jfmpc.jfmpc_444_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Stroke is a leading cause of long-term disability and loss of productive life in developing countries, including India. Ischemic stroke accounts for 85% of all types of stroke with a prevalence of 5%-15% among acute stroke incidents. The prevalence of poststroke depression among acute stroke survivors is varied from 5 to 54%. The study focused on depression among stroke survivors who actively involved in a home-based rehabilitation. MATERIALS AND METHODS A descriptive cross-sectional survey was conducted by enrolling 138 stroke survivors consecutively at tertiary care public hospital, North India. A sociodemographic and clinical profile sheet was used to seek information on personal and clinical variables. Information on disability, depression, performance in the activity of daily living, and degree of stroke severity was ascertained by using the Modified Rankin Scale (MRS), Physical Health Questionnaire (PHQ-9), Barthel Index, and National Institutes of Health Stroke (NIHSS). After binary logistic regression model, a multivariate logistic regression was applied to detect the independent predictor of depression. RESULTS Over 86% (119) of the stroke survivors had no symptoms of depression, and only 14% (19) were reported to have symptoms of depression. Poststroke depression found significant association with disability (P = 0.029) and functional independence (P = 0.0001). A significant difference was observed in the gender (P = 0.018), types of stroke (P = 0.0001), and location of lesion (P = 0.0001) with depression. Binary logistic regression model shows that disability (MRS) status of stroke survivor (P < 0.0001; 95% CI 1.998-2.638) and functional independence (BI) (P < 0.0001; 95% CI -0.034-0.020) are same as independent predictors for depression. CONCLUSION Clinician should use the community reintegration, referral, and mandatory screening of the stroke survivors at follow-up visit to rule out the probability of occurrence of poststroke depression.
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Affiliation(s)
- Rajesh Kumar
- Assistant Professor, College of Nursing, Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Neetu Kataria
- PhD Scholar, College of Nursing, Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Niraj Kumar
- Additional Professor, Department of Neurology, Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Mritunjai Kumar
- Assistant Professor, Department of Neurology, Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Yogesh Bahurupi
- Assistant Professor, Department of Community and Family Medicine, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Almhdawi KA, Alazrai A, Kanaan S, Shyyab AA, Oteir AO, Mansour ZM, Jaber H. Post-stroke depression, anxiety, and stress symptoms and their associated factors: A cross-sectional study. Neuropsychol Rehabil 2020; 31:1091-1104. [PMID: 32419606 DOI: 10.1080/09602011.2020.1760893] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Individuals post-stroke are subject to increased levels of mental health symptoms. This is a cross-sectional study explored levels of depression, anxiety, and stress symptoms and identified their predictors among Jordanian individuals with stroke. Outcome measures included Depression Anxiety Stress Scale, Fugl-Meyer assessment, goniometry, hand-held dynamometry, nine-hole peg test, Ashworth scale, Motor Activity Log, ten-meter walk test, and 12-item Short-Form health survey (SF-12). Descriptive analyses were used to describe prevalence of mental health symptoms and multiple variable linear regression models were used to identify their predictors. A total of 153 individuals participated in the study. Proportions of participants with mental health symptoms were 74.5% for depression, 52.9% for anxiety, and 68% for stress. Significant predictors of post-stroke mental health symptoms were SF-12 Mental Composite Score and grip strength for depression, anxiety, and stress. Depression and stress symptoms were significantly associated with discontinuation of rehabilitation services. Furthermore, self-reports of fewer sleep hours was significantly associated with anxiety and stress. Finally, Gender and self-reported physical diseases other than stroke were significantly associated with depression symptoms. We conclude that high proportions of Jordanian individuals' post-stroke have suffered mental health symptoms. Future studies are required to design effective interventions to improve post-stroke mental health.
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Affiliation(s)
- Khader A Almhdawi
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Alza Alazrai
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Saddam Kanaan
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Awni A Shyyab
- Division of Neurology, King Hussein Centre, Amman, Jordan
| | - Alaa O Oteir
- Department of Allied Health Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Zaid Modhi Mansour
- Department of Physical and Occupational Therapy, Hashemite University, Zarqa, Jordan
| | - Hanan Jaber
- Department of Rehabilitation Sciences, Jordan University of Science and Technology, Irbid, Jordan
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Maier M, Ballester BR, Leiva Bañuelos N, Duarte Oller E, Verschure PFMJ. Adaptive conjunctive cognitive training (ACCT) in virtual reality for chronic stroke patients: a randomized controlled pilot trial. J Neuroeng Rehabil 2020; 17:42. [PMID: 32143674 PMCID: PMC7059385 DOI: 10.1186/s12984-020-0652-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/28/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current evidence for the effectiveness of post-stroke cognitive rehabilitation is weak, possibly due to two reasons. First, patients typically express cognitive deficits in several domains. Therapies focusing on specific cognitive deficits might not address their interrelated neurological nature. Second, co-occurring psychological problems are often neglected or not diagnosed, although post-stroke depression is common and related to cognitive deficits. This pilot trial aims to test a rehabilitation program in virtual reality that trains various cognitive domains in conjunction, by adapting to the patient's disability and while investigating the influence of comorbidities. METHODS Thirty community-dwelling stroke patients at the chronic stage and suffering from cognitive impairment performed 30 min of daily training for 6 weeks. The experimental group followed, so called, adaptive conjunctive cognitive training (ACCT) using RGS, whereas the control group solved standard cognitive tasks at home for an equivalent amount of time. A comprehensive test battery covering executive function, spatial awareness, attention, and memory as well as independence, depression, and motor impairment was applied at baseline, at 6 weeks and 18-weeks follow-up. RESULTS At baseline, 75% of our sample had an impairment in more than one cognitive domain. The experimental group showed improvements in attention ([Formula: see text] (2) = 9.57, p < .01), spatial awareness ([Formula: see text] (2) = 11.23, p < .01) and generalized cognitive functioning ([Formula: see text] (2) = 15.5, p < .001). No significant change was seen in the executive function and memory domain. For the control group, no significant change over time was found. Further, they worsened in their depression level after treatment (T = 45, r = .72, p < .01) but returned to baseline at follow-up. The experimental group displayed a lower level of depression than the control group after treatment (Ws = 81.5, z = - 2.76, r = - .60, p < .01) and (Ws = 92, z = - 2.03, r = - .44, p < .05). CONCLUSIONS ACCT positively influences attention and spatial awareness, as well as depressive mood in chronic stroke patients. TRIAL REGISTRATION The trial was registered prospectively at ClinicalTrials.gov (NCT02816008) on June 21, 2016.
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Affiliation(s)
- Martina Maier
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Av. d'Eduard Maristany 10-14, 08930, Barcelona, Spain
| | - Belén Rubio Ballester
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Av. d'Eduard Maristany 10-14, 08930, Barcelona, Spain
| | - Nuria Leiva Bañuelos
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Physical Medicine and Rehabilitation Department Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), Barcelona, Spain
| | - Esther Duarte Oller
- Rehabilitation Research Group, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Physical Medicine and Rehabilitation Department Parc de Salut Mar (Hospital del Mar, Hospital de l'Esperança), Barcelona, Spain
| | - Paul F M J Verschure
- Laboratory of Synthetic, Perceptive, Emotive and Cognitive Systems (SPECS), Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology, Av. d'Eduard Maristany 10-14, 08930, Barcelona, Spain.
- Institució Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain.
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Depression Characterization and Race Among Stroke Survivors Receiving Inpatient Rehabilitation. Am J Phys Med Rehabil 2019; 98:325-330. [PMID: 30211718 DOI: 10.1097/phm.0000000000001037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Race and ethnicity play a significant role in poststroke outcomes. This brief report describes the presence of depression among stroke survivors who received inpatient rehabilitation and whether depression differs by race. Data from eRehabData and electronic medical records were analyzed for patients who received rehabilitation after an acute ischemic or hemorrhagic stroke. Of 1501 stroke patients, 61.3% were white, 33.9% were African American, and 4.8% were of other race/ethnic backgrounds. By retrospective clinical review, depression was documented for 29.7% of stroke patients. Premorbid versus new onset of poststroke depression was documented for 13.4% and 21.6% of whites, 7.5% and 11.5% of African American, and 0% and 16.7% of patients of other race/ethnic groups. Compared with whites, African American and people of other races had a lower odds of poststroke depression (African American adjusted odds ratio = 0.52, 95% confidence interval = 0.41-0.68; other races odds ratio = 0.37, 95% confidence interval = 0.19-0.71), after adjusting for all other significant risk factors identified in the bivariate analysis (sex, hyperlipidemia, cognitive deficit, neglect). Depression was documented for one in three stroke survivors who received inpatient rehabilitation and highest among whites especially for prestroke depression. Addressing depression in rehabilitation care needs to consider individual patient characteristics and prestroke health status.
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Mohammed GF, Azab HM, Sayed MAE, Elnady HM, Youssif H, Mahmoud OAA. Risk factors for post-stroke depression in Sohag University Hospital. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0057-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Garrett-Jones EC, Anakor EA, Mamin FA, Fatema UK, Das SK. The long-term challenges faced by stroke survivors and their caregivers following a stroke in Bangladesh: a qualitative study. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
BACKGROUND Post stroke depression adversely affects long term outcome of stroke and increases mortality risk. Few studies have looked into the comprehensive picture of post stroke depression in past. AIM The current study aimed to look into the phenomenology, characteristic features and various correlates of post stroke depression. METHOD 142 consecutive stroke patients aged 60 years or above, fulfilling the inclusion criteria were assessed. Sociodemographic and clinical data were gathered using a specially designed pro-forma. Depression, apathy and psychosis were assessed by Post stroke depression rating scale, Apathy Evaluation Scale, and Brief Psychiatric Rating Scale respectively. Groups (with or without major depression) were compared using Mann-Whitney U, chi square or Fisher's exact test. One way ANOVA was conducted to see the relations of lesion location and laterality with various clinical parameters. Kaplan-Meier survival analysis was done to see the time to develop depression. The effect sizes were reported as r and partial eta squared. RESULTS Guilt was significantly higher (p<.05) with lesions in parietal lobe and remaining of middle cerebral artery territory. Catastrophic reaction (p<.05) and emotional dyscontrol (p<.05) were higher for diffuse lesions, periventricular lesions and lesions in frontal/occipital lobe. BPRS score, but not apathy, had a significant positive correlation with depression (Pearson's r=.692). Mean time to develop depression after stroke was 28.34 (95% CI 22.37 to 34.31) months. CONCLUSIONS Post stroke depression consists of various clinically important sub-components whose occurrence varies with different lesion locations. Post stroke depression is discriminable from apathy but is related to psychosis.
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Affiliation(s)
- Amlan Kusum Jana
- Department of Psychiatry, KPC Medical College and Hospital, Kolkata, West Bengal, India
| | - Suddhendu Chakraborty
- Department of Psychiatry, Bongaon J R Dhar Sub Divisional Hospital, Bongaon, West Bengal, India
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Efficacy and safety of Sihogayonggolmoryeo-tang (Saikokaryukotsuboreito, Chai-Hu-Jia-Long-Gu-Mu-Li-Tang) for post-stroke depression: A systematic review and meta-analysis. Sci Rep 2019; 9:14536. [PMID: 31601868 PMCID: PMC6787092 DOI: 10.1038/s41598-019-51055-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 09/24/2019] [Indexed: 12/14/2022] Open
Abstract
This systematic review and meta-analysis aimed to analyze the efficacy and safety of Sihogayonggolmoryeo-tang (SGYMT), a classical herbal medicine consisting of 11 herbs, for treatment of post-stroke depression (PSD). Thirteen databases were comprehensively searched from their inception dates until July 2019. Only randomized controlled trials (RCTs) using SGYMT as a monotherapy or adjunctive therapy for PSD patients were included. Where appropriate data were available, meta-analysis was performed and presented as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CIs). We assessed the quality of RCTs using the Cochrane risk of bias tool and the Jadad scale. The quality of evidence for each main outcome was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Twenty-one RCTs with 1,644 participants were included. In the comparison between the SGYMT and antidepressants groups, the SGYMT group scored significantly lower on both the Hamilton Depression Scale (HAMD) (8 studies; MD −2.08, 95% CI −2.62 to −1.53, I2 = 34%) and the National Institutes of Health Stroke Scale (NIHSS) (2 studies; MD −0.84, 95% CI −1.40 to −0.29, I2 = 19%), and significantly higher on the Barthel index (3 studies; MD 4.30, 95% CI 2.04 to 6.57, I2 = 66%). Moreover, the SGYMT group was associated with significantly fewer adverse events (6 studies; RR 0.13, 95% CI 0.05 to 0.37, I2 = 0%) than the antidepressants group. In the subgroup analysis, SGYMT treatment consistently reduced HAMD scores within the first 8 weeks of treatment, but thereafter this difference between groups disappeared. Comparisons between SGYMT combined with antidepressants, and antidepressants alone, showed significantly lower scores in the combination group for both HAMD (7 studies; MD = −6.72, 95% CI = −11.42 to −2.01, I2 = 98%) and NIHSS scores (4 studies; MD −3.03, 95% CI −3.60 to −2.45, I2 = 87%). In the subgroup analysis, the reductions of HAMD scores in the SGYMT combined with antidepressants group were consistent within 4 weeks of treatment, but disappeared thereafter. The quality of RCTs was generally low and the quality of evidence evaluated by the GRADE approach was rated mostly “Very low” to “Moderate.” The main causes of low quality ratings were the high risk of bias and imprecision of results. Current evidence suggests that SGYMT, used either as a monotherapy or an adjuvant therapy to antidepressants, might have potential benefits for the treatment of PSD, including short-term reduction of depressive symptoms, improvement of neurological symptoms, and few adverse events. However, since the methodological quality of the included studies was generally low and there were no large placebo trials to ensure reliability, it remains difficult to draw definitive conclusions on this topic. Further well-designed RCTs addressing these shortcomings are needed to confirm our results.
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Zhang E, Liao P. Brain‐derived neurotrophic factor and post‐stroke depression. J Neurosci Res 2019; 98:537-548. [DOI: 10.1002/jnr.24510] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/21/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Eric Zhang
- Western University of Health Sciences Pomona CA
| | - Ping Liao
- Calcium Signalling Laboratory National Neuroscience Institute Singapore
- Duke‐NUS Medical School Singapore
- Health and Social Sciences Singapore Institute of Technology Singapore
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Ding X, Yang Q, Su L, Huang X, Zhou Z. Correlation Between C3435T Locus of ABCB1 Gene and Poststroke Depression in China. DNA Cell Biol 2019; 38:808-813. [PMID: 31335167 DOI: 10.1089/dna.2018.4565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Xianhui Ding
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Qian Yang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Liwei Su
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Xianjun Huang
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, P.R. China
| | - Zhiming Zhou
- Department of Neurology, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui Province, P.R. China
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Akhoundzadeh K, Vakili A. Occurrence of priapism after transient right MCAO in Swiss albino mice. Somatosens Mot Res 2019; 36:151-155. [DOI: 10.1080/08990220.2019.1632182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kobra Akhoundzadeh
- Faculty of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran
- Physiology Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Abedin Vakili
- Physiology Research Center, Semnan University of Medical Sciences, Semnan, Iran
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Pucciarelli G, Ausili D, Rebora P, Arisido MW, Simeone S, Alvaro R, Vellone E. Formal and informal care after stroke: A longitudinal analysis of survivors’ post rehabilitation hospital discharge. J Adv Nurs 2019; 75:2495-2505. [DOI: 10.1111/jan.13998] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/03/2019] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Gianluca Pucciarelli
- Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy
| | - Davide Ausili
- Department of Medicine and Surgery University of Milano‐Bicocca Milan Italy
| | - Paola Rebora
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery University of Milano‐Bicocca Milan Italy
| | - Maeregu W. Arisido
- Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery University of Milano‐Bicocca Milan Italy
| | - Silvio Simeone
- Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention University of Rome Tor Vergata Rome Italy
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Bai ZF, Wang LY. Efficacy of sertraline for post-stroke depression: A systematic review protocol of randomized controlled trial. Medicine (Baltimore) 2019; 98:e15299. [PMID: 31008979 PMCID: PMC6494403 DOI: 10.1097/md.0000000000015299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Depression is a prevalent disorder for patients with stroke. Clinical researches indicate that sertraline is utilized to treat post-stroke depression (PSD) effectively. However, no systematic review has investigated this issue yet presently. Thus, this study aims to systematically assess the efficacy and safety of sertraline for patients with PSD. METHODS Literature sources will be divided into 2 sections: electronic sources and manual sources. We will search electronic literature sources as follows: EMBASE, MEDICINE, Web of Science, Cochrane Library, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure from their inceptions to the February 28, 2019. Manual sources include dissertations, ongoing trials, and conference abstracts. Two reviewers will select the literatures, extract and collect data information, and evaluate the risk of bias independently. Statistical analysis will be carried out by using RevMan 5.3 software. RESULTS Primary outcome is depression. It can be measured by Hamilton depression scale, Beck Depression Inventory, or any other scales. Secondary outcome are anxiety (as assessed by Hamilton anxiety scale, or other tools) response rate, activities of daily living (as measured by Barthel Index, or other scales), quality of life (as measured by 36-Item Short Form Health Survey), and safety. CONCLUSIONS The results of this systematic review may summarize the up-to-date evidence on the efficacy and safety of sertraline for patients with PSD. ETHICS AND DISSEMINATION This systematic review will not need any ethical approval, because it will not analyze any individual patient data. The findings of this study are expected to disseminate at peer-reviewed journals.
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Affiliation(s)
- Zheng-fa Bai
- Department of Orthopedics, The Fourth People's Hospital of Shaanxi, Xi’an
| | - Liu-yi Wang
- Second Ward of Neurology Department, Cardiovascular and Cerebrovascular Specialist Section of Yan’an University Affiliated Hospital, Yan’an, China
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Liang ZH, Jia YB, Wang ML, Li ZR, Li M, Yun YL, Zhu RX. Efficacy of ginkgo biloba extract as augmentation of venlafaxine in treating post-stroke depression. Neuropsychiatr Dis Treat 2019; 15:2551-2557. [PMID: 31564880 PMCID: PMC6731991 DOI: 10.2147/ndt.s215191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/15/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Post-stroke depression (PSD) is one of the most common psychiatric diseases afflicting stroke survivors. This study was conducted to assess the efficacy of ginkgo biloba extract as augmentation of venlafaxine in treating PSD. METHODS The included PSD patients were randomly assigned into the experiment group (receiving ginkgo biloba extract plus venlafaxine) and control group (receiving venlafaxine alone). The treatment was continued for eight weeks. The Hamilton Depression Rating Scale (HDRS) and the Self-rating Depression Scale (SDS) were used to assess the depressive symptoms. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the neurological defect, and the Activities of Daily Living (ADL) was used to assess recovery of abilities of patients after stroke. Meanwhile, the levels of serum 5-hydroxytryptamine (5-HT) and brain-derived neurotrophic factor (BDNF) were measured before and after treatment. The dose of venlafaxine used and adverse events were also recorded. RESULTS Each group had 40 PSD patients. After treatment, the depressive symptoms, neurological defect and living function were significantly improved in both groups. But the patients receiving ginkgo biloba extract plus venlafaxine had the significantly lower average HDRS score (p=0.0008), SDS score (p<0.00001), NIHSS score (p=0.00001), and higher average ADL score (p=0.0005). Meanwhile, compared to the control group, patients in the experiment group had the significantly higher 5-HT (p<0.00001) level and BDNF level (p<0.00001), needed lower dose of venlafaxine (p=0.007), and experienced fewer adverse events. CONCLUSION These results demonstrated that the ginkgo biloba extract was a good augmentation of venlafaxine in treating PSD and should be further investigated.
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Affiliation(s)
- Zi-Hong Liang
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Yan-Bo Jia
- Department of Orthopaedics, The Second Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia, People's Republic of China
| | - Mei-Ling Wang
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Zi-Ru Li
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Min Li
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Yong-Li Yun
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
| | - Run-Xiu Zhu
- Department of Neurology, Inner Mongolia Autonomous Region People's Hospital, Huhhot, Inner Mongolia, People's Republic of China
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Kwon CY, Lee B, Chung SY, Kim JW, Shin A, Choi YY, Yun Y, Leem J. Herbal medicine Sihogayonggolmoryeo-tang or Chai-Hu-Jia-Long-Gu-Mu-Li-Tang for the treatment of post-stroke depression: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e12384. [PMID: 30235703 PMCID: PMC6160176 DOI: 10.1097/md.0000000000012384] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION This systematic review protocol describes the methods that will be used to evaluate the efficacy and safety of herbal medicine Sihogayonggolmoryeo-tang (SGYMT) or Chai-Hu-Jia-Long-Gu-Mu-Li-Tang for the treatment of post-stroke depression. METHODS AND ANALYSIS The following electronic databases will be searched up to July 2018 without language or publication status restrictions: MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Allied and Complementary Medicine Database (AMED), Cumulative Index to Nursing, and Allied Health Literature (CINAHL), and PsycARTICLES. We will also search Korean and Chinese databases. Any clinical randomized controlled trials related to SGYMT treatment for post-stroke depression will be included. Changes in the degree of depression and adverse events will be assessed as primary outcomes. The total effective rate and changes in neurological function, activities of daily living, and quality of life will be evaluated as secondary outcomes. Study selection, data extraction, assessment of study quality, and evaluation of the quality of evidence for the main findings will be performed independently by 2 researchers. The data synthesis and analysis will be performed using RevMan version 5.3. The results will be expressed as a risk ratio for dichotomous data and as the mean difference or standardized mean difference for continuous data. Data will be synthesized by either a fixed-effects or random-effects model according to a heterogeneity test or the number of studies included in the meta-analysis. The methodological quality of the included studies will be evaluated using the Cochrane Collaboration's risk of bias tool. The quality of evidence for each main outcome will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. ETHICS AND DISSEMINATION Ethical approval is not required because individual patient data are not included. The findings of this systematic review will be disseminated through a peer-reviewed publication or conference presentations. PROSPERO REGISTRATION NUMBER CRD42018102939.
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Affiliation(s)
- Chan-Young Kwon
- Chung-Yeon Medical Institute, Gwangju
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University
| | - Boram Lee
- Department of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong
| | - Sun-Yong Chung
- Department of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong
| | - Jong Woo Kim
- Department of Korean Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong
| | | | - Ye-yong Choi
- Chung-Yeon Medical Institute, Gwangju
- Research and Development Institute, CY Pharma Co
| | - Younghee Yun
- Chung-Yeon Medical Institute, Gwangju
- Research and Development Institute, CY Pharma Co
| | - Jungtae Leem
- Chung-Yeon Medical Institute, Gwangju
- Dongshin Korean Medicine Hospital, Seoul, Republic of Korea
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Vojtikiv-Samoilovska D, Arsovska A. Socio-Demographic Characteristics of the Patients with a Post Stroke Depression from the Municipality of Tetovo, Republic of Macedonia. Open Access Maced J Med Sci 2018; 6:782-785. [PMID: 29875846 PMCID: PMC5985879 DOI: 10.3889/oamjms.2018.201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/23/2018] [Accepted: 04/25/2018] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND: Although post-stroke depression (PSD) is the most common neuro-psychiatric consequence after a stroke there is still some obscurity regarding its aetiology and risk factors, which complicates its management. A better knowledge of the predictors will enable better prevention and treatment. AIM: The aim of this work was the identification of the risk factors for PSD, typical for the Macedonian population, which will help in early prediction, timely diagnosis and treatment of the disease. MATERIALS AND METHODS: We carried out a prospective study at the Clinical Hospital in Tetovo, the Republic of Macedonia to determine the prevalence of PSD and to analyse the socio-demographic characteristics as possible risk factors in 100 patients on discharge and after 5 months. The depression symptoms were quantified using the Hamilton Depression Ranking Scale (HAM-d) and the Geriatric Depression Scale (GDS). RESULTS: The average age of the patients with PSD on the first examination is 65.0 ± 8.3, whereas on the second examination is 64.5 ± 9.2. According to the Mann-Whitney U test, the difference between the average ages on both examinations is statistically insignificant for p > 0.05. On both examinations, the statistically significant dependence of p > 0.05 between PSD and the occupational status and PSD and education is not recorded. On both examinations, the PSD in male patients was 78.0% and 62.7%, while in female patients it was 85.4% and 68.3% not recording the statistically significant dependence of p < 0.05 between PSD and the gender. CONCLUSION: The socio-demographic characteristics of the patients with PSD cannot be considered as predictors of the disease.
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Affiliation(s)
| | - Anita Arsovska
- Clinic of Neurology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Yeo SH, Lim ZJI, Mao J, Yau WP. Effects of Central Nervous System Drugs on Recovery After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Drug Investig 2018; 37:901-928. [PMID: 28756557 DOI: 10.1007/s40261-017-0558-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Pilot trials have suggested that pharmacotherapy may aid stroke recovery. The aim of this study was to systematically review the effects of antidepressants, anti-Alzheimer drugs, anti-Parkinson drugs, central nervous system (CNS) stimulants and piracetam on gross motor function, cognition, disability, dependency and quality of life (QOL) after stroke. METHODS PubMed, EMBASE and the Cochrane Central Register of Controlled Trials databases were searched, and 44 randomized controlled trials that compared outcomes of interest between drug treatment and placebo or no treatment were included. For each study, standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval (CI) were calculated. Meta-analyses were conducted to pool results using either the fixed-effects or random-effects model. RESULTS Selective serotonin reuptake inhibitors (SSRIs) improved gross motor function (SMD 0.54, 95% CI 0.22-0.85; three studies), disability (SMD 0.49, 95% CI 0.32-0.66; 14 studies) and QOL (MD 6.46, 95% CI 4.71-8.22; two studies), but there was insufficient evidence for their use in enhancing global cognition (SMD 0.23, 95% CI -0.01 to 0.46; five studies) and dependency (risk ratio 0.81, 95% CI 0.68-0.97; one fluoxetine study). In particular, gross motor function was improved by fluoxetine (SMD 0.64, 95% CI 0.31-0.98; two studies), while disability was improved by paroxetine (SMD 1.05, 95% CI 0.63-1.46; two studies), citalopram (SMD 0.51, 95% CI 0.08-0.93; two studies) and fluoxetine (SMD 0.41, 95% CI 0.22-0.60; nine studies). There is insufficient evidence for the use of anti-Alzheimer drugs, anti-Parkinson drugs, CNS stimulants and piracetam to promote stroke recovery. CONCLUSIONS Administration of SSRIs may improve gross motor function, reduce disability and enhance QOL for patients recovering from stroke.
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Affiliation(s)
- See-Hwee Yeo
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Zheng-Jie Ian Lim
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Jia Mao
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Wai-Ping Yau
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore.
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Vojtikiv-Samoilovska D, Arsovska A. Prevalence and Predictors of Depression after Stroke - Results from a Prospective Study. Open Access Maced J Med Sci 2018; 6:824-828. [PMID: 29875853 PMCID: PMC5985895 DOI: 10.3889/oamjms.2018.182] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/23/2018] [Accepted: 03/24/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND: A depression following a stroke (Post Stoke Depression-PSD) is the most common complication of a stroke that has a negative effect on the result after the stroke. A better definition of the risk factors of the disease will provide for better prediction and treatment. AIM: To research identification of the risk factors for PSD, typical for the Macedonian population, which will help in early prediction, timely diagnosis and treatment of the disease? MATERIAL AND METHODS: We carried out a prospective study in order to determine the prevalence and the risk factors of PSD in 100 patients treated at the hospital in Tetovo. The severity, localisation and the functional outcome of the stroke have been examined as potential risk factors for discharge and after 5 months. The symptoms of depression were quantified using the Hamilton Depression Rating Scale (HAM-d). RESULTS: On discharge, 81% of the patients were diagnosed with PSD, and 67% had PSD after 5 months. A statistically significant codependence of p < 0.05 was registered between PSD and the level of functional dependence for activities of daily living (ADL); PSD and the severity of the stroke; and PSD and the level of disability on both examinations. In most patients with PSD, an ischemic stroke in the right middle cerebral artery has been diagnosed; the percentage difference between the other localisations is statistically significant (p = 0.0436; p = 0.0002). CONCLUSION: There is an increased risk of PSD for immobile patients, those incapable of activities of daily living (ADL), with ischemic stroke in the right middle cerebral artery. A PSD screening and additional studies for better prediction are required.
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Affiliation(s)
| | - Anita Arsovska
- University Clinic of Neurology, Faculty of Medicine, Ss Cyril and Methodius University of Skopje, Skopje, Republic of Macedonia
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Oni OD, Olagunju AT, Olisah VO, Aina OF, Ojini FI. Post-stroke depression: Prevalence, associated factors and impact on quality of life among outpatients in a Nigerian hospital. S Afr J Psychiatr 2018; 24:1058. [PMID: 30263206 PMCID: PMC6138133 DOI: 10.4102/sajpsychiatry.v24i0.1058] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 11/07/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate the prevalence of post-stroke depression (PSD), its associated factors and impact on quality of life (QoL) among outpatients in a Nigerian hospital. METHODS This cross-sectional study was carried out among 140 adults made up of 70 stroke survivors and matched controls with stable hypertension. Participants were administered questionnaires to profile their socio-demographic and clinical characteristics. Subsequently, they were assessed with the modified mini-mental state examination (MMSE), modified Rankin Scale (mRS), schedule for clinical assessment in neuropsychiatry (SCAN) and World Health Organization Quality of Life-BREF (WHOQoL-BREF). RESULTS The mean ages (± s.d.) of stroke survivors and controls were 57.43 (± 9.67) years and 57.33 (± 9.33) years, respectively. Majority of stroke survivors (n = 55 [78.6%]) had infarctive stroke, and 37 (52.9%) had right hemispheric lesion. Sixteen (22.9%) stroke survivors had PSD, with moderate to severe depression (F32.1) being the most prevalent, while none of the controls was clinically depressed. PSD correlated positively with monthly health bill above 10 000 naira ($61), significant post-stroke disability and poorer scores on all QoL domains (p < 0.05). CONCLUSION Depression was 20-fold prevalent in stroke survivors compared to controls with stable hypertension, and sevenfold the life-time prevalence reported among adult general population in Nigeria. Furthermore, increased health care bills per month, significant post-stroke disability and poorer QoL indicated survivors more likely to have depression. Findings in this study support the need to pay closer attention to psychosocial needs of stroke survivors to improve well-being. Future longitudinal study on psychosocial burden of stroke is warranted.
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Affiliation(s)
- Osunwale D Oni
- Department of Psychiatry, Lagos University Teaching Hospital, Nigeria
| | - Andrew T Olagunju
- Department of Psychiatry, Lagos University Teaching Hospital, Nigeria
- Department of Psychiatry, College of Medicine, University of Lagos, Nigeria
| | - Victor O Olisah
- Department of Psychiatry, Ahmadu Bello University Teaching Hospital, Nigeria
| | - Olatunji F Aina
- Department of Psychiatry, Lagos University Teaching Hospital, Nigeria
- Department of Psychiatry, College of Medicine, University of Lagos, Nigeria
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Badrin S, Mohamad N, Yunus NA, Zulkifli MM. A Brief Psychotic Episode with Depressive Symptoms in Silent Right Frontal Lobe Infarct. Korean J Fam Med 2017; 38:380-382. [PMID: 29209479 PMCID: PMC5711658 DOI: 10.4082/kjfm.2017.38.6.380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 06/14/2017] [Accepted: 07/12/2017] [Indexed: 11/16/2022] Open
Abstract
Psychiatric symptoms may be related to a silent cerebral infarct, a phenomenon that has been described previously in literature. Acute psychosis or other neuropsychiatric symptoms including depression may present in stroke patients and patients with lesions either within the prefrontal or occipital cortices, or in subcortical areas such as the basal ganglia, thalamus, mid-brain, and brainstem. Psychosis in clinical stroke or in silent cerebral infarction is uncommon and not well documented in the literature. Neurological deficits are the most common presentation in stroke, and nearly a third of patients that suffer a stroke may experience psychological disorders such as depression and anxiety, related to physical disability. The present case report describes an elderly female patient who presented with hallucinations and depressive symptoms, and was discovered to have a recent right frontal brain infarction, without other significant neurological deficits.
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Affiliation(s)
- Salziyan Badrin
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Noraini Mohamad
- School of Dental Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Nor Akma Yunus
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Maryam Mohd Zulkifli
- Department of Family Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kelantan, Malaysia
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Li J, Oakley LD, Li Y, Luo Y. Development and initial validation of a clinical measure to assess early symptoms of post‐stroke depression in the acute stroke patient. J Clin Nurs 2017; 27:784-794. [PMID: 28981176 DOI: 10.1111/jocn.14099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Jufang Li
- School of Nursing Wenzhou Medical University Wenzhou Zhejiang China
| | | | - Yun Li
- The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang China
| | - Yong Luo
- The First Affiliated Hospital of Chongqing Medical University Chongqing China
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Tocci G, Presta V. Increased arterial stiffness and haemorrhagic transformation in ischaemic stroke after thrombolysis: A new marker of risk for cerebrovascular events and complications. Int J Cardiol 2017; 243:471-472. [DOI: 10.1016/j.ijcard.2017.04.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 04/19/2017] [Indexed: 11/24/2022]
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Geng LY, Qian FY, Qian JF, Zhang ZJ. The combination of plasma glutamate and physical impairment after acute stroke as a potential indicator for the early-onset post-stroke depression. J Psychosom Res 2017; 96:35-41. [PMID: 28545791 DOI: 10.1016/j.jpsychores.2017.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 12/21/2016] [Accepted: 01/07/2017] [Indexed: 12/11/2022]
Abstract
OBJECTS The present study aimed to investigate the relationship of plasma glutamate levels with the early-onset of post-stroke depression (PSD) and to further explore the prognostic value of plasma glutamate combined with clinical characteristics for the early-onset PSD in the acute ischemic stroke patients. METHODS Seventy-four patients who admitted to the hospital within 24h of acute ischemic stroke were consecutively recruited and followed up for 2weeks. The Beck Depression Inventory (BDI) and 17-item Hamilton Depression Rating Scale (HAMD-17) were used to screen for depressive symptoms 14days after stroke. Diagnoses of depression were made in accordance with DSM-IV. Plasma glutamate levels were determined by High Performance Liquid Chromatography (HPLC) on days 1 and 14 after stroke for all patients. RESULTS Plasma glutamate levels were significantly lower in PSD patients than those of non-PSD patients on day 1 after stroke. ROC curve analyses revealed an AUC (area under the ROC curve) of 0.724 (95% CI: 0.584-0.863, p=0.004) and of 0.669 (95% CI: 0.523-0.814, p=0.030) for National Institute of Health Stroke Scale (NIHSS) scores and plasma glutamate levels on day 1 respectively. Combined ROC analyses using the two factors revealed the highest AUC of 0.804 (95% CI: 0.685-0.922, P<0.0001). CONCLUSIONS These results indicated an association between the early-onset PSD and a low plasma glutamate level following acute ischemic stroke. The combination of reduced plasma glutamate levels and physical impairment (determined by NIHSS) 1day after acute ischemic stroke was a potential diagnostic indicator for early-onset PSD.
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Affiliation(s)
- Lei-Yu Geng
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
| | - Fang-Yuan Qian
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
| | - Jun-Feng Qian
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
| | - Zhi-Jun Zhang
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.
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Yue Y, Liu R, Cao Y, Wu Y, Zhang S, Li H, Zhu J, Jiang W, Wu A, Yuan Y. New opinion on the subtypes of poststroke depression in Chinese stroke survivors. Neuropsychiatr Dis Treat 2017; 13:707-713. [PMID: 28293112 PMCID: PMC5345901 DOI: 10.2147/ndt.s128429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AIM Poststroke depression (PSD) is the most common complication of stroke. However, some stroke survivors with depression cannot meet the diagnostic criteria of PSD. The aim of this study was to propose the new conception of stroke patients with depression and then make them to receive reasonable diagnosis and treatment. METHODS We first put forward the opinion that the general PSD should consist of PSD disorder (PSDD) and PSD symptoms (PSDS) according to the Diagnostic and Statistical Manual of Mental Disorder - Fifth Edition (DSM-5) and ZhongDa diagnostic criteria - first edition (ZD-1), respectively. The ZD-1 was established based on the suggestions of 65 Chinese chief doctors considering that the symptoms of PSDS might be different from those of PSDD and the duration of DSM-5 was too strict. Then, 166 stroke inpatients were recruited, and the study was conducted using the diagnosis and classification of PSD to verify the new concept. RESULTS A total of 24 (14.46%) and 80 (48.19%) stroke patients were diagnosed with PSDD and PSDS, respectively, according to individual diagnosis criteria. Moreover, patients meeting the diagnostic criteria of PSDD should satisfy the criteria of PSDS first. The distribution frequencies of depressive symptoms were different, which suggested that there might be discrepant depressive symptoms between PSDS and PSDD. CONCLUSION The present study proposes new opinion about the classification and diagnosis of depression in stroke survivors. The definition and criteria of PSDS are beneficial to explore phenomenological consistency and provide useful information for early recognition and appropriate interventions.
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Affiliation(s)
- Yingying Yue
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing; Institute of Psychosomatics, Medical school of Southeast university, Nanjing
| | - Rui Liu
- School of Information Science and Engineering, Southeast University, Nanjing
| | - Yin Cao
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou
| | - Yanfeng Wu
- Department of Neurology, The Second Affiliated Hospital of Nanjing Medical University
| | - Shining Zhang
- Department of Psychiatry, Nanjing Brain Hospital of Nanjing Medical University, Nanjing
| | - Huajie Li
- Department of Neurology, Changzhou First People's Hospital, Changzhou
| | - Jijun Zhu
- Department of Neurology, Yancheng Third People's Hospital, Yancheng
| | - Wenhao Jiang
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing; Institute of Psychosomatics, Medical school of Southeast university, Nanjing
| | - Aiqin Wu
- Department of Psychosomatics, The Affiliated First Hospital of Suzhou University, Suzhou, People's Republic of China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, ZhongDa Hospital, School of Medicine, Southeast University, Nanjing; Institute of Psychosomatics, Medical school of Southeast university, Nanjing
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Khalid W, Rozi S, Ali TS, Azam I, Mullen MT, Illyas S, Un-Nisa Q, Soomro N, Kamal AK. Quality of life after stroke in Pakistan. BMC Neurol 2016; 16:250. [PMID: 27912744 PMCID: PMC5135839 DOI: 10.1186/s12883-016-0774-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
Abstract
Background There is very little information about the quality of life (QOL) of stroke survivors in LMIC countries with underdeveloped non communicable health infrastructures, who bear two thirds of the global stroke burden. Methodology We used a sequential mix methods approach. First, a quantitative analytical cross-sectional study was conducted on 700 participants, who constituted 350 stroke survivor and their caregiver dyads. QOL of stroke survivor was assessed via Stroke Specific Quality of Life Scale (SSQOLS) whereas QOL of caregivers was assessed through RAND-36. In addition; we assessed complications, psychosocial and functional disability of stroke survivors. Following this quantitative survey, caregivers were qualitatively interviewed to uncover contextually relevant themes that would evade quantitative surveys. Multiple linear regression technique was applied to report adjusted β-coefficients with 95% C.I. Results The QOL study was conducted from January 2014 till June 2014, in two large private and public centers. At each center, 175 dyads were interviewed to ensure representativeness. Median age of stroke survivors was 59(17) years, 68% were male, 60% reported depression and 70% suffered post-stroke complications. The mean SSQOLS score was 164.18 ± 32.30. In the final model severe functional disability [adjβ -33.77(-52.44, -15.22)], depression [adjβ-23.74(-30.61,-16.82)], hospital admissions [adjβ-5.51(-9.23,-1.92)] and severe neurologic pain [adjβ -12.41(-20.10,-4.77)] negatively impacted QOL of stroke survivors (P < 0.01). For caregivers, mean age was 39.18 ± 13.44 years, 51% were female and 34% reported high stress levels. Complementary qualitative study revealed that primary caregivers were depressed, frustrated, isolated and also disappointed by health services. Conclusion The QOL of Stroke survivors as reported by SSQOLS score was better than compared to those reported from other LMIC settings. However, Qualitative triangulation revealed that younger caregivers felt isolated, depressed, overwhelmed and were providing care at great personal cost. There is a need to develop cost effective holistic home support interventions to improve lives of the survivor dyad as a unit. Trial registration NCT02351778 (Registered as Observational Study). Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0774-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wardah Khalid
- Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan
| | - Shafquat Rozi
- Department of Community Health Sciences, Epidemiology & Biostatistics, Director Clinical Research Track (CRT), Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery (SONAM), Karachi, Pakistan.,Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Michael T Mullen
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Saleem Illyas
- Development Centre DOW University of Health Sciences, Karachi, Pakistan
| | - Qamar Un-Nisa
- Department of Neurology, DOW University of Health Sciences, Karachi, Pakistan.,Department of Medicine, Lecturer, Section of Neurology, Aga Khan University, Karachi, Pakistan
| | - Nabila Soomro
- Institute of Physical Medicine and Rehabilitation, DOW University of Health Sciences, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center and the National Institute of Neurologic Disorders and Stroke, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan. .,Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Kim M, Oh GJ, Lee YH. Association between Stroke Status and Depression in a Community Setting: The 2014 Korea National Health and Nutrition Examination Survey. J Clin Neurol 2016; 13:55-61. [PMID: 27868400 PMCID: PMC5242161 DOI: 10.3988/jcn.2017.13.1.55] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 08/11/2016] [Accepted: 08/11/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Previous studies have examined the risk factors for depression in stroke patients, but little information is available on the relationship between stroke status and depression in the community-dwelling general population. We evaluated the association between stroke status and depression using representative nationwide data. METHODS In total, 3,487 subjects (aged ≥40 years) who participated in version VI-2 of the sixth Korea National Health and Nutrition Examination Survey (KNHANES) performed in 2014 were included. We compared the prevalence of depression in 120 community-dwelling stroke patients and 3,367 nonstroke controls using the nine-item Patient Health Questionnaire (PHQ-9). RESULTS The prevalence of depression (PHQ-9 score ≥10) was 16.7% in stroke patients and 6.4% in controls. In the unadjusted model, depression was more common in stroke patients than in nonstroke controls [odds ratio (OR), 2.95; 95% confidence interval (CI), 1.79-4.86]. After adjusting for demographic characteristics, socioeconomic status, health-related behaviors, and comorbidities, stroke diagnosis was a significant risk factor for depression (OR, 1.85; 95% CI, 1.06-3.24). Specifically, a diagnosis of stroke in patients aged <60 years (OR, 3.82; 95% CI, 1.81-8.09) and the presence of stroke complications (OR, 2.77; 95% CI, 1.25-6.13) remained significant risk factors for depression even after adjusting for potential confounders. CONCLUSIONS In a community setting, poststroke survivors had a higher prevalence of depression, and stroke was an independent risk factor for depression. Public psychosocial interventions are needed to improve the mental health care of community-dwelling stroke survivors.
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Affiliation(s)
- Mina Kim
- Department of Nursing, Graduate School, Chonnam National University, Gwangju, Korea.,Department of Counseling Psychology, Graduate School of Dongshin University, Naju, Korea
| | - Gyung Jae Oh
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea.,Regional Cardiocerebrovascular Center, Wonkwang University Hospital, Iksan, Korea
| | - Young Hoon Lee
- 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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Charfi N, Trabelsi S, Turki M, Mâalej Bouali M, Zouari L, Dammak M, Ben Thabet J, Mhiri C, Mâalej M. [Impact of physical disability and concomitant emotional disturbances on post-stroke quality of life]. Encephale 2016; 43:429-434. [PMID: 27663046 DOI: 10.1016/j.encep.2016.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The physical and/or psycho-cognitive changes after stroke may lead to a decline in the quality of life (QOL) of patients. The aims of our study were to evaluate the QOL of stroke survivors and to investigate its relationships with the physical disability degree and the emotional disorders (anxiety and depression). METHODS We conducted a cross-sectional study, which included 147 patients, followed for stroke that had occurred over the past year, in the outpatient neurology department at the university hospital Habib Bourguiba of Sfax (Tunisia). For each patient, we collected socio-demographic characteristics and clinical and therapeutic data. The quality of life of our patients was assessed using the SF-36 scale. The HAD scale was used to screen for anxiety and depression, whereas the modified Rankin scale was used to measure the degree of disability. RESULTS The average age of our patients was 60.58 years. The overall mean score of the SF-36 ranged from 20.81 to 89.81 with an average of 55.27. Impaired QOL was found in 68% of patients. The study of the dimensional average scores revealed that only two dimensions of the SF-36 were not altered: physical pain and life and relationship with others. The physical component was slightly more altered than the mental component (41.4 and 42.9 respectively). A minimal disability was found in 32% of patients, while a moderate and severe disability was found in 19% and 21.1% of patients. Anxiety was detected in 55.1% of patients and depression in 67.3% of them. Impaired mental component QOL was significantly correlated with the presence of anxiety (P=0.008) and depression (P<<0.05). The severe degree of disability had a significant negative impact on all areas of QOL except that of life and relationships with others. CONCLUSION It appears from our study that among the important effects of stroke is the constant deterioration of QOL in its various dimensions. The occurrence of emotional disturbances such as anxiety and depression and the degree of physical disability seem to be predictors of QOL impairment. Therefore, special attention should be given to such patients at higher risk of decline in their QOL.
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Affiliation(s)
- N Charfi
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie.
| | - S Trabelsi
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | - M Turki
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | | | - L Zouari
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | - M Dammak
- Service de neurologie, CHU Habib Bourguiba, Sfax, Tunisie
| | - J Ben Thabet
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
| | - C Mhiri
- Service de neurologie, CHU Habib Bourguiba, Sfax, Tunisie
| | - M Mâalej
- Service de psychiatrie C, CHU Hédi Chaker, Sfax, Tunisie
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Xiao J, Zhang J, Sun D, Wang L, Yu L, Wu H, Wang D, Qiu X. Discriminating poststroke depression from stroke by nuclear magnetic resonance spectroscopy-based metabonomic analysis. Neuropsychiatr Dis Treat 2016; 12:1919-25. [PMID: 27536114 PMCID: PMC4977099 DOI: 10.2147/ndt.s110613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Poststroke depression (PSD), the most common psychiatric disease that stroke survivors face, is estimated to affect ~30% of poststroke patients. However, there are still no objective methods to diagnose PSD. In this study, to explore the differential metabolites in the urine of PSD subjects and to identify a potential biomarker panel for PSD diagnosis, the nuclear magnetic resonance-based metabonomic method was applied. Ten differential metabolites responsible for discriminating PSD subjects from healthy control (HC) and stroke subjects were found, and five of these metabolites were identified as potential biomarkers (lactate, α-hydroxybutyrate, phenylalanine, formate, and arabinitol). The panel consisting of these five metabolites provided excellent performance in discriminating PSD subjects from HC and stroke subjects, achieving an area under the receiver operating characteristic curve of 0.946 in the training set (43 HC, 45 stroke, and 62 PSD subjects). Moreover, this panel could classify the blinded samples from the test set (31 HC, 33 stroke, and 32 PSD subjects) with an area under the curve of 0.946. These results laid a foundation for the future development of urine-based objective methods for PSD diagnosis and investigation of PSD pathogenesis.
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Affiliation(s)
- Jianqi Xiao
- Department of Neurosurgery, The First Hospital of Qiqihar City, Qiqihar
| | - Jie Zhang
- Department of Internal Medicine, Central Hospital of Jiamusi City, Jiamusi
| | - Dan Sun
- Department of Geriatrics, General Hospital of Daqing Oil Field, Daqing
| | | | - Lijun Yu
- Department of Neurology, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang, People’s Republic of China
| | - Hongjing Wu
- Department of Neurology, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang, People’s Republic of China
| | - Dan Wang
- Department of Neurology, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang, People’s Republic of China
| | - Xuerong Qiu
- Department of Neurology, The First Hospital of Qiqihar City, Qiqihar, Heilongjiang, People’s Republic of China
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Boyne P, Reisman D, Brian M, Barney B, Franke A, Carl D, Khoury J, Dunning K. Ventilatory threshold may be a more specific measure of aerobic capacity than peak oxygen consumption rate in persons with stroke. Top Stroke Rehabil 2016; 24:149-157. [PMID: 27454553 DOI: 10.1080/10749357.2016.1209831] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND After stroke, aerobic deconditioning can have a profound impact on daily activities. This is usually measured by the peak oxygen consumption rate achieved during exercise testing (VO2-peak). However, VO2-peak may be distorted by motor function. The oxygen uptake efficiency slope (OUES) and VO2 at the ventilatory threshold (VO2-VT) could more specifically assess aerobic capacity after stroke, but this has not been tested. OBJECTIVES To assess the differential influence of motor function on three measures of aerobic capacity (VO2-peak, OUES, and VO2-VT) and to evaluate the inter-rater reliability of VO2-VT determination post-stroke. METHODS Among 59 persons with chronic stroke, cross-sectional correlations with motor function (comfortable gait speed [CGS] and lower extremity Fugl-Meyer [LEFM]) were compared between the different aerobic capacity measures, after adjustment for covariates, in order to isolate any distorting effect of motor function. Reliability of VO2-VT determination between three raters was assessed with intra-class correlation (ICC). RESULTS CGS was moderately correlated with VO2-peak (r = 0.52, p < 0.0001) and weakly correlated with OUES (r = 0.41, p = 0.002) and VO2-VT (r = 0.37, p = 0.01). LEFM was weakly correlated with VO2-peak (r = 0.26, p = 0.055) and very weakly correlated with OUES (r = 0.19, p = 0.17) and VO2-VT (r = 0.14, p = 0.31). Compared to VO2-peak, VO2-VT was significantly less correlated with CGS (r difference = -0.16, p = 0.02). Inter-rater reliability of VO2-VT determination was high (ICC: 0.93, 95% CI: 0.89-0.96). CONCLUSIONS Motor dysfunction appears to artificially lower measured aerobic capacity. VO2-VT seemed to be less distorted than VO2-peak and had good inter-rater reliability, so it may provide more specific assessment of aerobic capacity post-stroke.
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Affiliation(s)
- Pierce Boyne
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA.,b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA
| | - Darcy Reisman
- c Department of Physical Therapy , College of Health Sciences, University of Delaware , Newark , DE , USA
| | - Michael Brian
- c Department of Physical Therapy , College of Health Sciences, University of Delaware , Newark , DE , USA
| | - Brian Barney
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Ava Franke
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Daniel Carl
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA
| | - Jane Khoury
- b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA.,d Division of Biostatistics and Epidemiology , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA
| | - Kari Dunning
- a Department of Rehabilitation Sciences , College of Allied Health Sciences, University of Cincinnati , Cincinnati , OH , USA.,b Department of Environmental Health , College of Medicine, University of Cincinnati , Cincinnati , OH , USA
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Li CM, Lee HY, Hsieh SH, Wang TG, Wang HP, Chen JJJ. Development of Innovative Feedback Device for Swallowing Therapy. J Med Biol Eng 2016. [DOI: 10.1007/s40846-016-0146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Oliveira CRD, Pagliarin KC, Calvette LDF, Gindri G, Argimon IIDL, Fonseca RP. Depressive signs and cognitive performance in patients with a right hemisphere stroke. Codas 2016; 27:452-7. [PMID: 26648216 DOI: 10.1590/2317-1782/20152015005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/31/2015] [Indexed: 11/22/2022] Open
Abstract
PURPOSE This study investigated the influence of suggestive signs of depression (SSD) in right-hemisphere brain-damaged (RHD) patients following a stroke on their cognitive performance measured by a brief neuropsychological assessment battery. METHODS Forty-two adults with RHD after a single episode of stroke and 84 matched controls participated in this study. They were assessed by means of the Geriatric Depression Scale and by Brief Neuropsychological Assessment Battery NEUPSILIN. RESULTS Almost half of the patients showed SSD. The RHD group with SSD (RHD+) showed poorer performance in at least one task among all evaluated cognitive domains (concentrated attention, visual perception, working memory, episodic verbal memory and semantic memory, auditory and written language, constructional praxia and verbal fluency). CONCLUSION The association of depression and RHD seems to enhance the occurrence and the severity of cognitive déficits. A brief neuropsychological assessment can be useful to identify cognitive impairment caused by this neuropsychiatric disorder.
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Affiliation(s)
| | | | | | - Gigiane Gindri
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Rochele Paz Fonseca
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, RS, Brazil
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