Lacunar stroke, deep white matter disease and depression: a meta-analysis

2014 ◽  
Vol 26 (7) ◽  
pp. 1101-1109 ◽  
Author(s):  
Peter Egeto ◽  
Corinne E. Fischer ◽  
Zahinoor Ismail ◽  
Eric E. Smith ◽  
Tom A. Schweizer
Keyword(s):  
Depressive Symptoms ◽  
White Matter ◽  
Meta Analysis ◽  
Cerebrovascular Diseases ◽  
White Matter Disease ◽  
Lacunar Stroke ◽  
Stroke Patients ◽  
Deep White Matter ◽  
Depression Prevalence ◽  
Prevalence Of Depression

ABSTRACTBackground:Lacunar stroke is a small (<2 cm) infarction that accounts for approximately 20% of all strokes. While a third of all stroke patients experience depressive symptoms, the prevalence of depression in the lacunar stroke patient population is unclear. This meta-analysis aimed to synthesize the evidence on the effect of lacunar stroke and deep white matter disease on depressive symptoms.Methods:A systematic search of electronic databases was conducted, resulting in the inclusion of 12 studies. Analyses were performed on the effects of lacunar stroke, volume and location of lacunes on depression prevalence, and the effect on depression severity. The effects estimates were calculated in random-effects models.Results:None of the analyses produced statistically significant results. Lacunar stroke patients had a non-significantly higher prevalence of depression compared to patients with non-lacunar cerebrovascular diseases (OR = 1.46, 95% CI: 0.88–2.43, p = 0.15). Neither thalamic (OR = 1.37 (0.85–2.20), p = 0.19), deep white matter (RR = 1.16 (0.85–1.57), p = 0.35), multiple lacunes (OR = 1.34 (0.81–2.22), p = 0.25), or the volume of lacunes (MD = −4.71 (−351.59–342.18), p = 0.98) had an effect on depression prevalence. Lastly, lacunar stroke did not influence depressive symptom severity (MD = 0.96 (−1.57–3.48), p = 0.46).Conclusions:The pooled group of patients with lacunar stroke and deep white matter disease appear to have a similar prevalence of depression compared to those with other types of cerebrovascular diseases. However, the small number of studies, heterogeneous comparison groups, and high statistical heterogeneity between studies posed an obstacle to the meta-analysis. To determine appropriate screening and treatment approaches, future research will need to separate lacunar stroke and deep white matter disease patients, and include larger sample sizes and healthy control groups to determine their distinct contributions to depression.

scholarly journals Association between Perivascular Spaces and Progression of White Matter Hyperintensities in Lacunar Stroke Patients

PLoS ONE ◽  
2015 ◽  
Vol 10 (9) ◽  
pp. e0137323 ◽  
Author(s):  
Caroline M. J. Loos ◽  
Pim Klarenbeek ◽  
Robert J. van Oostenbrugge ◽  
Julie Staals
Keyword(s):  
White Matter ◽  
White Matter Hyperintensities ◽  
Perivascular Spaces ◽  
Lacunar Stroke ◽  
Stroke Patients

scholarly journals Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e017173 ◽  
Author(s):  
Jinghui Wang ◽  
Xiaohang Wu ◽  
Weiyi Lai ◽  
Erping Long ◽  
Xiayin Zhang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Meta Analysis ◽  
Significant Proportion ◽  
Depression Scale ◽  
Developed Countries ◽  
Self Report ◽  
Cochrane Library ◽  
Significant Heterogeneity ◽  
Prevalence Of Depression

ObjectivesDepression and depressive symptoms are common mental disorders that have a considerable effect on patients’ health-related quality of life and satisfaction with medical care, but the prevalence of these conditions varies substantially between published studies. The aim of this study is to conduct a systematic review and meta-analysis to provide a precise estimate of the prevalence of depression or depressive symptoms among outpatients in different clinical specialties.DesignSystematic review and meta-analysis.Data sources and eligibility criteriaThe PubMed and PsycINFO, EMBASE and Cochrane Library databases were searched to identify observational studies that contained information on the prevalence of depression and depressive symptoms in outpatients. All studies included were published before January 2016. Data characteristics were extracted independently by two investigators. The point prevalence of depression or depressive symptoms was measured using validated self-report questionnaires or structured interviews. Assessments were pooled using a random-effects model. Differences in study-level characteristics were estimated by meta-regression analysis. Heterogeneity was assessed using standard χ2tests and the I2statistic. The study protocol has been registered with PROSPERO under number CRD42017054738.ResultsEighty-three cross-sectional studies involving 41 344 individuals were included in this study. The overall pooled prevalence of depression or depressive symptoms was 27.0% (10 943/41 344 individuals; 95% CI 24.0% to 29.0%), with significant heterogeneity between studies (p<0.0001, τ2=0.3742, I2=96.7%). Notably, a significantly higher prevalence of depression and depressive symptoms was observed in outpatients than in the healthy controls (OR 3.16, 95% CI 2.66 to 3.76, I2=72.0%, χ2=25.33). The highest depression/depressive symptom prevalence estimates occurred in studies of outpatients from otolaryngology clinics (53.0%), followed by dermatology clinics (39.0%) and neurology clinics (35.0%). Subgroup analyses showed that the prevalence of depression and depressive symptoms in different specialties varied from 17.0% to 53.0%. The prevalence of depression and depressive symptoms was higher among outpatients in developing countries than in outpatients from developed countries. Moreover, the prevalence of depression and depressive symptoms in outpatients slightly decreased from 1996 to 2010. Regarding screening instruments, the Beck Depression Inventory led to a higher estimate of the prevalence of depression and depressive symptoms (1316/4702, 36.0%, 95% CI 29.0% to 44.0%, I2=94.8%) than the Hospital Anxiety and Depression Scale (1003/2025, 22.0%, 95% CI 12.0% to 35.0%, I2=96.6%).ConclusionOur study provides evidence that a significant proportion of outpatients experience depression or depressive symptoms, highlighting the importance of developing effective management strategies for the early identification and treatment of these conditions among outpatients in clinical practice. The substantial heterogeneity between studies was not fully explained by the variables examined.

scholarly journals Plasma tPA-Activity and Progression of Cerebral White Matter Hyperintensities in Lacunar Stroke Patients

PLoS ONE ◽  
2016 ◽  
Vol 11 (3) ◽  
pp. e0150740 ◽  
Author(s):  
Ellen C. van Overbeek ◽  
Julie Staals ◽  
Iris L. H. Knottnerus ◽  
Hugo ten Cate ◽  
Robert J. van Oostenbrugge
Keyword(s):  
White Matter ◽  
White Matter Hyperintensities ◽  
Cerebral White Matter ◽  
Lacunar Stroke ◽  
Stroke Patients

Relationships between the neighborhood environment and depression in older adults: a systematic review and meta-analysis

2017 ◽  
Vol 30 (8) ◽  
pp. 1153-1176 ◽  
Author(s):  
Anthony Barnett ◽  
Casper J. P. Zhang ◽  
Janice M. Johnston ◽  
Ester Cerin
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Collective Efficacy ◽  
Economic Status ◽  
Meta Analysis ◽  
Neighborhood Environment ◽  
Public Health Issue ◽  
Environmental Correlates ◽  
Prevalence Of Depression ◽  
Physical Attributes

ABSTRACTBackground:While depression is a growing public health issue, the percentage of individuals with depression receiving treatment is low. Physical and social attributes of the neighborhood may influence the level of depressive symptoms and the prevalence of depression in older adults.Methods:This review systematically examined the literature on neighborhood environmental correlates of depression in older adults. Findings were analyzed according to three depression outcomes: depressive symptoms, possible depression, and clinical depression. Based on their description in the article, environmental variables were assigned to one of 25 categories. The strength of evidence was statistically quantified using a meta-analytical approach with articles weighted for sample size and study quality. Findings were summarized by the number of positive, negative, and statistically non-significant associations by each combination of environmental attribute – depression outcome and by combining all depression outcomes.Results:Seventy-three articles met the selection criteria. For all depression outcomes combined, 12 of the 25 environmental attribute categories were considered to be sufficiently studied. Three of these, neighborhood socio-economic status, collective efficacy, and personal/crime-related safety were negatively associated with all depression outcomes combined. Moderating effects on associations were sparsely investigated, with 52 articles not examining any. Attributes of the physical neighborhood environment have been understudied.Conclusion:This review provides support for the potential influence of some neighborhood attributes on population levels of depression. However, further research is needed to adequately examine physical attributes associated with depression and moderators of both social and physical neighborhood environment attribute – depression outcome associations.

scholarly journals Kidney Function and White Matter Disease in Young Stroke Patients

Stroke ◽  
2012 ◽  
Vol 43 (9) ◽  
pp. 2382-2388 ◽  
Author(s):  
Robert Steinicke ◽  
Beate Gaertner ◽  
Ulrike Grittner ◽  
Wolf Schmidt ◽  
Martin Dichgans ◽  
...  
Keyword(s):  
White Matter ◽  
Kidney Function ◽  
White Matter Disease ◽  
Stroke Patients ◽  
Young Stroke

Relationship between periventricular and deep white matter lesions and depressive symptoms in older people. The LADIS Study

2006 ◽  
Vol 21 (10) ◽  
pp. 983-989 ◽  
Author(s):  
Mani S Krishnan ◽  
John T O'Brien ◽  
Michael J Firbank ◽  
Leonardo Pantoni ◽  
Giovanna Carlucci ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
White Matter ◽  
Older People ◽  
White Matter Lesions ◽  
Deep White Matter

Abstract WP424: Efficacy Of Antiplatelet Therapy For Secondary Stroke Prevention Following Lacunar Stroke: A Meta-analysis And Pooled Analysis Of Randomized Controlled Trials

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Ashkan Shoamanesh ◽  
Chun Shing Kwok ◽  
Phyo K Myint ◽  
Yoon K Loke ◽  
Hannah Copley ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Antiplatelet Agents ◽  
Pooled Analysis ◽  
Cochrane Library ◽  
Lacunar Stroke ◽  
Stroke Patients

INTRODUCTION: The predominant underlying mechanism of lacunar stroke differs from that of other ischemic stroke subtypes. Accordingly, so may the ideal stroke prevention regimen. We aimed to evaluate the efficacy of different antiplatelet agents in lacunar stroke patients. Method: We searched MEDLINE, EMBASE and the Cochrane library for RCTs that evaluated antiplatelet therapy in patients with ischemic stroke. Trials which provided stroke recurrence rates in patients presenting with lacunar stroke, or where the data was obtainable from manuscript authors were included. In addition, we included the novel SPS3 trial’s antiplatelet arm data presented at the 2011 ISC. We performed pooled analysis to assess the crude frequency of recurrent stroke and a random effects meta-analysis. Results: Lacunar stroke data was available for 12 trials encompassing 35, 218 participants (mean age 65, 65% male). The pooled crude recurrent stroke rate was least for cilostazol monotherapy (6.2%), followed by ASA monotherapy (7.4%), clopidogrel monotherapy (8.6%), ASA/dipyridamole (8.6%) and greatest for ASA/clopidogrel therapy (9.1%). Rate ratios of lacunar stroke patients suggest no significant efficacy advantage for ASA [ASA vs placebo (RR 0.72, 95% CI 0.34-1.50; p=0.38)], ASA/clopidogrel [ASA/clopidogrel vs ASA (RR 0.80, 95% CI 0.62-1.03; p=0.08), ASA/clopidogrel vs clopidogrel (RR 0.95, 95% CI 0.79-1.15; p=0.63)], sarpogrelate [sarpogrelate vs ASA (RR 1.31, 95% CI 0.84-2.04; p=0.23)] and ASA/dipyridamole [ASA/dipyridamole vs ASA (RR 0.90, 95% CI 0.70-1.16; p=0.042)] for recurrent stroke. The results from Japanese trials evaluating the efficacy of cilostazol found that it is significantly better than both placebo (RR 0.51, 95% CI 0.30-0.85; p=0.01) and ASA (RR 0.70, 95% CI 0.51-0.96; p=0.03) in the secondary prevention of stroke. Conclusions: There seems to be no significant advantage among the various antiplatelet agents studied in lacunar stroke patients apart for cilostazol. However, this requires confirmation within large randomized trials outside of Japanese populations.

scholarly journals 344 The Relationship between Late Life Depressive Symptoms and Cerebral White Matter Disease is Modified by Systemic and Orthostatic Blood Pressure

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Robert Briggs ◽  
Anne Buckley ◽  
Silvin Knight ◽  
Jim Meaney ◽  
Sean Kennelly ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Depressive Symptoms ◽  
White Matter ◽  
Brain Mri ◽  
Depression Scale ◽  
Late Life ◽  
Community Dwelling ◽  
Cerebral White Matter ◽  
White Matter Disease ◽  
The Relationship

Abstract Background Cerebral white matter hyperintensity (WMH) burden is a key biological risk factor underpinning late life depression (LLD) and cerebral hypoperfusion has been identified as an important cause of WMH. The aim of this study therefore is to clarify if orthostatic hypotension (OH) and lower systemic blood pressure (BP), both of which cause reduced cerebral blood flow, modify the relationship between depression and cerebral white matter disease in a cohort of community-dwelling older people aged ≥70 years. Methods This study uses data from wave 3 of TILDA. Participants were included if they were aged ≥70 years and had undergone assessment for depressive symptoms, brain MRI and cardiovascular measures. Depressive symptoms were measured using the 8-item Centre for Epidemiological Studies Depression Scale. Scheltens Score was used by a trained radiologist to calculate overall WMH burden. Orthostatic BP was measured by active stand. OH was defined as a drop in Systolic BP≥20 mmHg or drop in diastolic BP≥10 mmHg at 30, 60 or 90 seconds post standing. Results Participants with depressive symptoms (8%, 16/202) had a significantly higher burden of WMH measured by Scheltens Score (14.6 (95% CI:11.0–18.2) vs. 11.0 (95% CI:10.1–11.8); p=0.0211). Two-way interaction models demonstrated that the association between depressive symptoms and WMH burden is significant only in those with co-existing OH. Similarly, the two-way interaction between depressive symptoms and systolic BP shows that this association remains statistically significant only in those with both depressive symptoms and lower BP, i.e. <130 mm Hg. Conclusion This study demonstrates that depressive symptoms are associated with cerebral WMH in a cohort of community-dwelling people aged ≥70 years but this relationship is modified by co-existing OH or lower BP. Identifying the processes that lead to WMH accumulation and progression in depression is crucial in order to inform strategies aimed at preventing and ameliorating LLD.

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