First evidence of protective effects on stroke recovery and post-stroke depression induced by sortilin-derived peptides

Introduction: The etiology of post-stroke depression (PSD) is still not fully understood. It is well known that leukoaraiosis is associated with cognitive decline and depression, but currently unclear if lacunar strokes, thought to be caused by small vessel disease, have higher rates of PSD. A better understanding of PSD etiology can lead to improved treatment of PSD and subsequently better stroke recovery. Methodology: Out of 159 patients that were successfully contacted via phone within 3 months of discharge, there were 22 identified as having an acute stroke or TIA and scored ≥ 2 on the Patient Health Questionnaire (PHQ) assessment. MRI brain was reviewed for stroke size, location, periventricular and deep white matter fazekas score, number of microbleeds, and chronic lacunar strokes. Admission and discharge National Institutes of Health (NIH) stroke scale and stroke etiology were also recorded. Results: There was a significantly positive correlation between NIH score at admission and PHQ2 score (r = 0.184, p =0.044), demonstrating that patients with NIH ≥ 6 are 4.6 times more likely to develop PSD than a patient with NIH < 6 (Odds ratio (OR) = 4.6, CI [1.284-16.591]). There was no significant difference between PSD incidence in stroke size or location. Although not statistically significant, there was a suggestion of more PSD seen in cortical, cardioembolic, and cryptogenic strokes as well as fazekas score ≥ 2 and old lacunar infarcts. The table summarizes characteristics of the 7 TIA and 15 stroke patients suffering from PSD with PHQ ≥ 2: Conclusion: Initial NIH significantly predicted PSD irrespective of leukoaraiosis. This study was limited by the small sample size which could be due to under-diagnosis of PSD. In conclusion, admission NIH is associated with higher rates of PSD, but the underlying etiology is likely multifactorial given the suggestion of higher rates of PSD with higher fazekas score, and cortical, cardioembolic, and cryptogenic strokes.

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Statins, vascular risk factors and stroke prevention

NATIONAL JOURNAL OF NEUROLOGY ◽

10.28942/nnj.v1i2.227 ◽

2019 ◽

pp. 17-25

Author(s):

Petya Pencheva Mineva

Keyword(s):

Stroke Recovery ◽

Primary And Secondary Prevention ◽

First Line ◽

Asymptomatic Carotid ◽

Neuroprotective Effects ◽

Post Stroke ◽

First Line Therapy ◽

Risk Patients ◽

Post Stroke Depression ◽

New Hypothesis

The most widely prescribed drugs as a first-line therapy for dyslipidemia (DL) are 3-hydroxy-3-methylglutaryl-CoA inhibitors, also known as “statins”. They manifest direct and indirect neuroprotective effects, and also rapid vasoprotection, which occur independently of their cholesterol decreasing activity. Their unique properties have given to statins a place in contemporary therapy guidelines for treatment of the vascular RFs such as DL, arterial hypertension, coronary heart disease (CHD), diabetes mellitus and asymptomatic carotid stenosis in high risk patients. They are recommended for ischemic stroke (IS) primary and secondary prevention and prescribed for long periods. Statin vasoprotective and neuroprotective activities, which manifest immediately after administration, have raised discussion about their beneficial effect in acute IS, and in post-stroke recovery. The withdrawal of statin therapy worsens prognosis and increases mortality rate. There is evidence that oxidative stress and inflammation play role in depression and statin use decreases risk of depressive symptoms in CHD patients. Further well designed randomized studies are needed to investigate the efficacy and safety of statins in acute IS. A challenge for a new study on statins is clarifying whether they possess favorable effects on post-stroke depression in light of the new hypothesis of depression pathogenesis.

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Post-stroke Depression in the Very Elderly Rate and Predictive Factors

10.21203/rs.3.rs-51169/v1 ◽

2020 ◽

Author(s):

Elias Smadja ◽

Nicolas Chausson ◽

Manvel Aghasaryan ◽

Olga Lainé ◽

Sofiane Saddedine ◽

...

Keyword(s):

Rating Scale ◽

Stroke Recovery ◽

Stroke Survivors ◽

Stroke Patients ◽

Very Elderly ◽

Stroke Incidence ◽

Post Stroke ◽

Post Stroke Depression ◽

Acute Stroke Unit ◽

Potential Factors

Abstract Background: Post-stroke depression (PSD) affects 25–32% stroke survivors. PSD is quality-of-life altering and negatively impacts stroke recovery and mortality. Stroke incidence increases exponentially with age, especially >65 years, but no studies have yet specifically evaluated PSD in older stroke survivors. Because the very elderly are more prone to developing depression, we hypothesized a relatively high PSD rate for them. Methods: Consecutive stroke patients ≥75 years old, admitted to an acute stroke unit, were screened for depression with the Montgomery-Åsberg Depression Rating Scale or Aphasic Depression Rating Scale for aphasic patients, ≥15 days to 1-year post-stroke. Potential factors predictive of PSD were assessed. Results: Among 441 consecutive stroke patients, only 78 (17%) patients were evaluated because of high mortality and exclusion criteria. Among them, 44.8% (35/78) developed PSD: 22/78 (28.2%) mild and 11/78 (14.1%) moderate. Multivariate analysis retained only ≥1 mRS-point gain as being independently associated with PSD (OR, 6.2 (95% CI, 1.3–29.2), P=0.020). Conclusion: Our results confirmed the expected high PSD rate in patients ≥75 years, and suggest that PSD should be sought systematically or prophylactic antidepressants prescribed >15 days post-stroke for patients with ≥1 mRS-point gain.

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Abstract TP322: Towards better screening for Post Stroke Depression

Stroke ◽

10.1161/str.44.suppl_1.atp322 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Alyssa J Herzig ◽

Nancy Mayo ◽

Syd Miller

Keyword(s):

Length Of Hospital Stay ◽

Critical Factor ◽

Self Report ◽

Screening Tools ◽

Stroke Recovery ◽

Stroke Survivors ◽

Post Stroke ◽

Rehabilitation Outcomes ◽

C Statistic ◽

Post Stroke Depression

Post stroke depression (PSD), occurring in 33% of stroke survivors, is considered the most critical obstacle to rehabilitation after stroke. PSD is consistently linked with increased length of hospital stay, motivation to undergo rehabilitation, poorer rehabilitation outcomes, decreased engagement in recreational and social pursuits, decreased quality of life, and mortality. Although addressing PSD should be considered a critical factor in stroke recovery, the condition remains largely under-diagnosed. A challenge to diagnosis of PSD is a lack of appropriate screening tools. Existing screening tools were not designed for stroke populations or are too time consuming and complex to be utilized routinely. The goal of the present study was to identify a quick, two item screening tool for PSD that requires no training or scoring. Specifically, we examined what brief combination of dichotomized self-report questions can be used as indicators for a DSM-IV-TR classification of depression in stroke survivors In this prospective natural history study, a consecutive sample of 121 stroke survivors completed comprehensive interviews at 10 days post stroke. Contender questions assessing mood, cognition, physical functioning, social support, and relationship profiles were selected based on previous findings. At 10 days, 7 of 121 participants were classified as depressed in accordance with the SCID-I, the gold standard diagnostic tool for clinical depression. Results of logistic regression indicated that patients who met threshold on two MHI item, are you a happy person and have you been so down in the dumps, were 25 times more likely to be depressed than patients who did not (C Statistic > 0.90). As well, these brief questions better predicted PSD at 10 days than did the total MHI score. In the present paper, screening models are considered with regard to practical and theoretical issues in the assessment of PSD. The present study indicates that quick and simple screening tools designed for PSD can be used to select patients for diagnostic assessments and facilitate timely diagnoses of PSD. The present study contributes to our understanding of the clinical presentation of depression in the context of stroke and to our goal of facilitating recovery from stroke.

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COGNITIVE BEHAVIOURAL THERAPY TO REDUCE DEPRESSION IN POST STROKE PATIENTS: A SCOPING REVIEW

Nurse and Health: Jurnal Keperawatan ◽

10.36720/nhjk.v10i1.234 ◽

2021 ◽

Vol 10 (1) ◽

pp. 116-125

Author(s):

Dwi Puji Susanti ◽

Niken Safitri Dyan Kusumaningrum ◽

Fitria Handayani

Keyword(s):

Cognitive Behavioral Therapy ◽

Scoping Review ◽

Behavioral Therapy ◽

Recovery Process ◽

Psychosocial Interventions ◽

Cognitive Behavioral ◽

Stroke Recovery ◽

Stroke Patients ◽

Post Stroke ◽

Post Stroke Depression

Background: Post-stroke depression is one of the psychological disorders that is often experienced by post-stroke patients. Depression is more than just sadness. People with post-stroke depression will experience a lack of interest and pleasure in daily activities, weight loss or excessive sleep, lack of energy, inability to concentrate, feelings of worthlessness or guilt and recurring thoughts of death or suicide. Based on several types of post-stroke depression management, psychosocial interventions have been shown to reduce the likelihood of developing post-stroke depression. One of the interventions to reduce post-stroke depression is cognitive behavioral therapy. Objective: This scoping review aims to identify the effectiveness of cognitive behavioral therapy to reduce depression in post-stroke patients. Design: This study used a scoping review through a review of articles on cognitive behavioral therapy that has been used to reduce depression in post-stroke patients. Data Sources: Search for articles accessed through a database, including: CINAHL, MEDLINE, Academic search ultimate, PubMed, and google scholar with a range of search years 2011-2020. Review Methods: Quality appraisal assessment for each selected study was conducted using the Preferred Reporting Items for scoping review (PRISMA) method. Results: The results of this literature review show that cognitive behavioral therapy to reduce depression in post-stroke patients can change thoughts, feelings and behaviors to influence each other. The relationship between thoughts, feelings and behavior greatly influences respondents in dealing with post-stroke conditions with a positive way of thinking so that it will accelerate or help the post-stroke recovery process. The way to implement cognitive behavioral therapy is to be given as many as 12 sessions in 25-35 minutes each session. Cognitive behavioral therapy can be done in a hospital and has a significant post-stroke depression rate with p <0.01. Conclusion: Cognitive behavioral therapy can be given as an intervention to reduce depression in post-stroke patients including cognitive behavioral therapy, duration of cognitive behavioral therapy and sessions in cognitive behavioral therapy. Keywords: Cognitive behavioral therapy, post stroke depression.

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Abstract T MP14: The Critical Role of Macrophage Migration Inhibitory Factor on Post-Stroke Recovery

Stroke ◽

10.1161/str.46.suppl_1.tmp14 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Venugopal R Venna ◽

Sharon E Benashski ◽

Rajkumar Verma ◽

Yan Xu ◽

Lori Capozzi ◽

...

Keyword(s):

Migration Inhibitory Factor ◽

Macrophage Migration Inhibitory Factor ◽

Critical Role ◽

Inhibitory Factor ◽

Stroke Recovery ◽

Stroke Survivors ◽

Macrophage Migration ◽

Post Stroke ◽

Poor Recovery ◽

Post Stroke Depression

Objective: One-third of stroke survivors are affected by post-stroke depression. Evidence from epidemiological and clinical studies demonstrates that depression either before or after stroke is associated with poor recovery and high mortality. Recently it was found that loss of macrophage migration inhibitory factor (MIF) is associated with depressive behavior and impaired neurogenesis. Therefore, here we tested the hypothesis that MIF plays a role in stroke recovery and that chronic MIF inhibition contributes to post-depressive phenotypes and poor stroke outcomes. Methods: C57BL/6 male mice (20-25g; Charles River), were subjected to a 60min right middle cerebral artery occlusion (MCAO) and randomly assigned to vehicle or MIF antagonist, ISO-1 (7mg/kg/day intraperitoneal) treatment. Infarcts quantified with TTC. Recovery was investigated using neurological deficit scores (NDS), corner test, the forced swim test (FST) and the tail suspension test (TST). MIF levels were assessed by ELISA and western-blot (n=4/grp). Further, the effects of MIF loss were tested using knockout (KO) mice. Data are expressed as mean±sem. P value < .05 was set for statistical significance. Results: Post-stroke chronic ISO-1 treatment significantly increased immobility in TST at 14d (126±8 vs 83±6s; p<.05), delayed stroke recovery in the corner test (p<.05) and NDS (p<.05) compared to vehicle group. These detrimental effects were observed in parallel to reduced plasma MIF levels (p<.05). Stroke alone did not affect mobility in FST compared to sham (p>.05). Infarct size was similar in ISO-1 and vehicle groups (48±3.2% versus 46±2.8%; p>.05). When subjected MIF KO mice to stroke, similar pattern of delayed post-stroke recovery is observed suggesting that MIF plays a critical role in pre- or post-stroke depression and recovery. Conclusions: MIF KO mice had a depressive phenotype at baseline, and poor recovery after stroke compared to WT. Post-stroke MIF inhibition led to the development of a post-stroke depressive phenotype and also led to poorer recovery. These effects are independent of stroke volume. These findings suggest that targeting MIF might be a novel therapeutic strategy to treat post-stroke depression and to enhance recovery in stroke survivors.

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Problems of post-hospital rehabilitation of patients suffering from post-stroke depression

Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery) ◽

10.33920/med-01-2009-03 ◽

2020 ◽

pp. 31-37

Author(s):

M. A. Privalova ◽

L. A. Karasaeva ◽

G. A. Alekseev ◽

A. A. Okhotnikova

Keyword(s):

Cerebrovascular Accident ◽

Recovery Period ◽

Main Group ◽

Stroke Recovery ◽

Control Group ◽

Antidepressant Medications ◽

Post Stroke ◽

Acute Cerebrovascular Accident ◽

Post Stroke Depression ◽

Hospital Rehabilitation

The article covers the issues of organization of rehabilitation at the post-hospital stage for patients who have suffered an acute cerebrovascular accident. According to statistics, almost half of patients who have suffered an acute cerebrovascular accident have a risk of a repeated stroke in the next five years of life against the background of manifestations of post-stroke depression. It is established that in these cases, one of the causes of repeated cerebrovascular accidents is the failure of patients to take prescribed antidepressant medications. The article analyzes two groups of patients who were observed in dynamics up to 6–12 months after the rehabilitation treatment in the Department of Neurology of the hospital. The main group included the patients with diagnosed post-stroke depression. The control group included patients without signs of clinically apparent depression. As a result of a retrospective study, it was found that 85,7 % of patients in the main group who had a repeated stroke did not adhere to the regime for taking antidepressant medications. Among the patients who continue to take antidepressants, there have not been repeated cases of cerebral circulatory disorders. Therefore, timely detection and correction of post-stroke depression in the early stroke recovery period and maintaining the principle of continuity at the post-hospital stage of rehabilitation contributes not only to the recovery of neurological deficit, but also reduces the risk of developing repeated disorders of cerebral circulation.

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Early Symptom Measurement of Post‐Stroke Depression

PsycTESTS Dataset ◽

10.1037/t72564-000 ◽

2016 ◽

Author(s):

Jufang Li ◽

Linda Denise Oakley ◽

Roger L. Brown ◽

Yun Li ◽

Maiyun Ye ◽

...

Keyword(s):

Early Symptom ◽

Post Stroke ◽

Post Stroke Depression ◽

Symptom Measurement

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Early Symptom Measurement of Post‐Stroke Depression--Short Version

PsycTESTS Dataset ◽

10.1037/t72531-000 ◽

2019 ◽

Author(s):

Jufang Li ◽

Yun Li ◽

Ping Li ◽

Maiyun Ye

Keyword(s):

Short Version ◽

Early Symptom ◽

Post Stroke ◽

Post Stroke Depression ◽

Symptom Measurement

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Therapy of post-stroke depression – a systematic review

Die Psychiatrie ◽

10.1055/s-0038-1670863 ◽

2013 ◽

Vol 10 (02) ◽

pp. 108-129 ◽

Cited By ~ 1

Author(s):

W. Gaebel ◽

W. Wannagat ◽

J. Zielasek

Keyword(s):

Systematic Review ◽

Large Scale ◽

Repetitive Transcranial Magnetic Stimulation ◽

Placebo Control ◽

Post Stroke ◽

Pharmacological Studies ◽

Post Stroke Depression ◽

Control Procedures ◽

Antidepressant Pharmacotherapy

SummaryWe performed a systematic review of randomized placebo-controlled pharmacological and non-pharmacological trials for the therapy and prevention of post-stroke depression that have been published between 1980 and 2011. We initially identified 2 260 records of which 28 studies were finally included into this review. A meta-analytic approach was hampered by considerable differences regarding the kinds of therapeutic regimens and the study durations. Modest effects favoring treatment of post-stroke depression could be found for pharmacological treatment as well as repetitive transcranial magnetic stimulation. For the prevention of post-stroke depression, antidepressant pharmacotherapy showed promising results. However, large-scale studies with better standardized study populations, optimized placebo control procedures in non-pharmacological studies, and replication in larger follow-up studies are still necessary to find the optimal therapeutic regimens to prevent and treat post-stroke depression.

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