Post-Stroke Depression and Its Effect on Functional Outcomes during Inpatient Rehabilitation

Abstract Objective The aim of the study is to observe the effect of post-stroke depression on functional outcomes during inpatient rehabilitation. Patients 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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Acupuncture Treatments for Post-stroke Depression: A Systematic Review and Network Meta-analysis

10.21203/rs.3.rs-951353/v1 ◽

2021 ◽

Author(s):

Lam Wai Ching ◽

Hui Juan Li ◽

Jianwen Guo ◽

Liang Yao ◽

Janita Chau ◽

...

Keyword(s):

Clinical Trials ◽

Randomized Clinical Trials ◽

Rating Scale ◽

Meta Analysis ◽

Cochrane Library ◽

Depression Symptoms ◽

Post Stroke ◽

Significant Difference ◽

Post Stroke Depression ◽

The Impact

Abstract Background: Depression is one of the most common complications after stroke, with a prevalence of 30-33%. Patients with post-stroke depression (PSD) usually experience anxiety, hopelessness, and insomnia, which have a negative impact on their daily activities and post-stroke rehabilitation. In this review, we aimed to explore the impact of acupuncture in alleviating symptoms of PSD and to evaluate the difference in effectiveness between acupuncture combined with pharmacotherapies and various non-pharmacotherapies in order to provide guides and advice for clinical personnel. Methods: Six databases (Cochrane Library, PubMed, EMBASE, China National Knowledge Infrastructure, Wanfang Database, Chongqing VIP Database) and two clinical trials registration platforms were searched from inception to May 2021. Randomized clinical trials (RCTs) comparing needle-based acupuncture with pharmacotherapy, and other non-pharmacotherapy or invalid group were included. Two independent reviewers identified eligible studies. Two reviewers independently abstracted and recorded data into a pre-made form. A Bayesian network meta-analysis (NMA) was conducted to assess and compare different techniques using RStudio 3.6.0. The primary outcome was the change in scores of scales measuring depressive symptoms. The secondary outcomes were changes in serotonin levels and in quality of life. Results: Fifty-nine RCTs were included. The results of this NMA showed that compared with western medicine (WM), acupuncture alone or with repetitive transcranial magnetic stimulation (RTMS), Traditional Chinese medicine (TCM) alone or with WM, were superior for alleviating depression symptoms. Compared to Usual Care, acupuncture alone or plus other therapies could significantly decrease scores of the Hamilton Depression Rating scale. However, there was no significant difference found among acupuncture, WM, TCM with AC plus any of other treatment.Conclusions: The results of this study indicate that acupuncture alone or combined with other therapies appear to be effective in improving depression symptoms of stroke survivors. Moreover, in comparison with WM, acupuncture alone or plus RTMS, TCM, TCM with WM, or WM, were more effective in improving depression symptoms. Also, acupuncture with RTMS seems to be the most effective with the highest probability.

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Depressed Mood after Stroke: Predictive Factors at Six Months Follow-Up

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17249542 ◽

2020 ◽

Vol 17 (24) ◽

pp. 9542

Author(s):

Fidel López-Espuela ◽

Raúl Roncero-Martín ◽

Maria de la Luz Canal-Macías ◽

Jose M. Moran ◽

Vicente Vera ◽

...

Keyword(s):

Rating Scale ◽

Depression Scale ◽

Length Of Hospital Stay ◽

Hamilton Depression Scale ◽

Modified Rankin Scale ◽

Cross Sectional ◽

Post Stroke ◽

Depression Assessment ◽

Degree Of Disability ◽

Post Stroke Depression

We aimed to know the prevalence of post-stroke depression (PSD) in our context, identify the variables that could predict post-stroke depression, by using the Hamilton Depression Rating Scale, occurring within six months after stroke, and identify patients at high risk for PSD. Methods: descriptive, cross-sectional and observational study. We included 173 patients with stroke (transient ischemic attack (TIA) included) and collected sociodemographic and clinical variables. We used the Hamilton Depression Scale (HDS) for depression assessment and Barthel Index and modified Rankin Scale (mRS) for functional assessment. The neurological severity was evaluated by the National Institutes of Health Stroke Scale (NIHSS). Results: 35.5% were women, aged 71.16 (±12.3). Depression was present in 42.2% patients (n = 73) at six months after stroke. The following variables were significantly associated with PSD: diagnosis of previous depression (p = 0.005), the modified Rankin Scale at discharge (p = 0.032) and length of hospital stay (p = 0.012). Conclusion: PSD is highly prevalent after stroke and is associated with the severity, left location of the stroke, and the degree of disability at discharge. Its impact justifies the evaluation and early treatment that still continues to be a challenge today.

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Magnitude and determinants of depression in acute stroke patients admitted in a rural tertiary care hospital

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.153228 ◽

2015 ◽

Vol 6 (02) ◽

pp. 202-207 ◽

Cited By ~ 5

Author(s):

Amrish Saxena ◽

Ajitabh Suman

Keyword(s):

Acute Stroke ◽

Rating Scale ◽

Tertiary Care Hospital ◽

Economic Status ◽

Tertiary Care ◽

Care Hospital ◽

Stroke Patients ◽

Post Stroke ◽

Socio Economic Status ◽

Post Stroke Depression

ABSTRACT Objectives: Depression is one of the most frequent neuropsychiatric disturbances after a cerebrovascular stroke. The frequency of depression in stroke patients has varied widely in different populations. Post stroke depression is an important factor limiting recovery and rehabilitation in acute stroke patients. Settings and Design: A cross-sectional hospital-based study was performed in acute stroke patients admitted in the department of Medicine of a rural teaching tertiary care hospital in central India. Materials and Methods: In all consecutive acute stroke inpatients, the intensity of depression was assessed by a trained person through a questionnaire, Montgomery-Asberg Depression Rating Scale (MADRS), who is blind of the diagnosis and investigations of the patient. Another study person collected the data including demographics, co-morbid diseases or risk factors. Radiological imaging data was noted from the CT/MRI head reports of stroke patients. Results: Of the total 107 stroke patients, 60 (56%) were males and 47 (44%) were females. Sixty-one (57%) of the 107 stroke patients had depression. Of the 107 stroke patients, 35 (33%) had mild depression, 22 (20%) had moderate depression and 4 (4%) had severe depression. The age, gender, education status and co-morbidities of the stroke patient were not associated with depression. The association of socio-economic status and left-sided lesions with depression was found to be statistically significant (P < 0.05). Type and location of the lesion were not associated with depression. Conclusion: Post-stroke depression was present in more than half of the stroke patients and was related to socio-economic status and left-sided hemisphere lesions.

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Effect of Nursing Care Strategy on Functional Outcomes among Patients after First Time Stroke

Evidence-Based Nursing Research ◽

10.47104/ebnrojs3.v1i2.69 ◽

2019 ◽

Vol 1 (2) ◽

pp. 13

Author(s):

Marwa M. Ali ◽

Rasha F. Mohamed ◽

Amina A. Mahmoud

Keyword(s):

Nursing Care ◽

Functional Outcomes ◽

Intervention Group ◽

Depression Scale ◽

Knowledge Score ◽

University Hospital ◽

Control Group ◽

Significant Difference ◽

Functional Disabilities ◽

First Time

Context: Strokes are life-changing events not merely affect a person physically but also emotionally as it may result in physical disabilities, which lead to functional disabilities as difficulties carrying out daily activities as working, walking, talking, eating, bathing, with loss of energy in addition to depressive status as a result of functional disabilities. Daily nursing care strategies are essential to stroke management. Since, it can overcome spasticity and hemiplegia through sustained stretching by various positioning, repetitive performance of a specific movement, and teaching patient to use and adapt the affected limb during functional activities. Aim: The aim of this study is to evaluate the effect of nursing care strategy on functional outcomes among patients after the first-time stroke. Methods: A quasi-experimental design used to conduct the current study in neurology department to be followed through neurology outpatient clinic at Benha University Hospital. During the period from the beginning of February 2018 till the beginning of January 2019.Subjects: Purposive sample of 171 patients to be at the end of study period (Intervention group 72 & control group 69), recruited according to the study formula based on the total number admitted to the study settings during 2017. Tools: Two tools utilized for data collection, (1)Structured interviewing questionnaire for patients, (II)Functional outcomes scales, involving: Modified Ashworth scale, Modified Barthel index, as well as the Center for Epidemiologic Studies Depression Scale (CES-D Scale). Results: Showed that there was highly statistically significant difference in term of increased knowledge score among the intervention group compared to controls, as well as a significantly lower degree of spasticity, a higher level of independence in performing activity of daily living (ADL), besides, lower depression score among intervention group compared to controls. It also showed a significant correlation between the degree of spasticity with both of independence in performing ADL and degree of depression among intervention group after nursing care strategy implementation. Conclusion: The nursing care strategy was effective in improving patients’ knowledge as well as the functional outcomes among intervention group revealing a significant correlation between the degree of spasticity with both independence in performing ADL and degree of depression. The study suggested continuous education and training program planned and offered regularly to stroke patients in the neurology and rehabilitation unit. Also recommended written, a simple booklet about stroke and its management should be provided & be available for patients and their families (relatives).

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The Usefulness of Functional Near-Infrared Spectroscopy for the Assessment of Post-Stroke Depression

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.680847 ◽

2021 ◽

Vol 15 ◽

Author(s):

Masahiko Koyanagi ◽

Mai Yamada ◽

Toshio Higashi ◽

Wataru Mitsunaga ◽

Takefumi Moriuchi ◽

...

Keyword(s):

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Rating Scale ◽

Evaluation Tool ◽

Functional Near Infrared Spectroscopy ◽

Post Stroke ◽

Depressed Group ◽

Significant Difference ◽

Post Stroke Depression

Background: Post-stroke depression (PSD) is the most common mood disorder following stroke and is also the main factor that limits the recovery and rehabilitation of patients with stroke. The prevalence of PSD is ~30%. Since there is no gold standard for the diagnosis and evaluation of PSD, it is important to raise awareness of PSD and to establish methods for its evaluation, early diagnosis, and treatment. In the field of psychiatry, functional near-infrared spectroscopy (fNIRS) has been used as a diagnostic tool for the measurement of oxygenated hemoglobin (oxy-Hb). This study aimed to assess whether fNIRS could be applied in the diagnosis and evaluation of PSD.Methods: We recruited 45 patients with stroke, who were admitted to Nagasaki Kita Hospital between May 2015 and April 2019. The 17-item Hamilton Rating Scale for Depression (HAMD17), which is considered to be a useful screening and evaluation tool for PSD, was used for the assessment of patients after stroke; moreover, oxy-Hb was measured in the pre-frontal cortex. The subjects were divided into two groups: the depressed group (n = 13) and the non-depressed group (n = 32). We evaluated the correlation between the oxy-Hb integral values and HAMD17 scores.Results: We investigated the relationship between the oxy-Hb integral values and HAMD17 total scores, and found a negative correlation between them (ρ = −0.331, P < 0.005). There was a significant difference in the oxy-Hb integral values during the activation task period between the depressed and non-depressed groups (3.16 ± 2.7 and 1.71 ± 2.4, respectively; P = 0.040). The results indicated that the patients of the depressed group showed lower oxy-Hb integral values and lower activation in the frontal lobe in comparison with the patients of the non-depressed group.Conclusion: The present study highlights that the measurement of oxy-Hb by using fNIRS is a useful methodology for the diagnosis of PSD in patients after stroke.

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Symptoms of post-stroke depression

Trakia Journal of Sciences ◽

10.15547/tjs.2019.03.009 ◽

2019 ◽

Vol 17 (3) ◽

pp. 235-242

Author(s):

D. Komsiyska

Keyword(s):

Acute Phase ◽

Depressive Disorders ◽

Rating Scale ◽

Somatic Complaints ◽

University Hospital ◽

Stroke Patients ◽

High Occurrence ◽

Post Stroke ◽

Post Stroke Depression ◽

The University

The purpose of this manuscript is to present our research on post-stroke depression and compare them to previous observations. Depression is a very common among disorders found in stroke patients, thus there is а high necessity in its research. We have used a contingent of 93 patients in the acute phase after stroke, which were treated at the Neurological Clinic to the University Hospital "Prof. Dr. Stoyan Kirkovich" in Stara Zagora for the period 2015 – 2016. We tested them with The Hamilton Depression Rating Scale (HAM-D-17) and analyzed the results with Statistica, version 10 (StatSoft, Inc.). We found high occurrence of depression in stroke patients. We tested for its severity and for its different symptoms in order to compare them to other studies and discover which are most common in post-stroke depression. As a conclusion, we summarize our results that among our contingent there are predominantly mild and moderate depressive disorders with reduced mood, sadness, increased psychic and somatic anxiety, insomnia, somatic complaints and superfluous hypochondriac thoughts.

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Abstract T P121: A Comparative Study of Duloxetine and Paroxetine in Japanese Patients With Post-Stroke Depression

Stroke ◽

10.1161/str.45.suppl_1.tp121 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Shuji Matsumoto ◽

Megumi Shimodozono

Keyword(s):

Rating Scale ◽

Standard Dose ◽

Japanese Patients ◽

Fixed Dose ◽

Controlled Study ◽

Double Blind ◽

Post Stroke ◽

Significant Difference ◽

Post Stroke Depression ◽

Pain Symptoms

Background and methods: Patients with stroke may suffer from post-stroke depression and concomitant pain symptoms. A double-blind, parallel-group, controlled study was performed to investigate if duloxetine was superior to paroxetine in terms of improvement in symptoms of depression and pain in Japanese patients with post-stroke depression in a fixed-dose design. The efficacy and safety of duloxetine 60 mg/day were also assessed in comparison with those at the standard dose of 40 mg/day. Results: Changes in 17-item Hamilton depression rating scale (HAM-D) total score (mean ± standard deviation) for group D1 (duloxetine 40 mg/day), group M2 (duloxetine 60 mg/day), and group PX (paroxetine 20 mg/day) were –14.9 ± 5.6, –15.6 ± 6.4, and –11.4 ± 6.2, respectively, and the estimated differences in total score for group PX (Dunnett’s 95% simultaneous confidence interval) were 3.8 (3.2 to 4.4) for group D1 and 4.2 (3.6 to 4.8) for group D2. The superiority of groups M1 and M2 to group PX was thus confirmed, because the upper confidence limit of differences between groups D1 and PX and between groups D2 and PX was more than 3.2. The groups M1 and M2 presented a reduction in the pain, which was not observed in the group PX. The incidence of treatment-related adverse events was 21% for group D1, 28% for group D2, and 30% for group PX, indicating no significant difference between the three groups. Conclusion: These results demonstrate that duloxetine 40 mg/day and 60 mg/day is superior to paroxetine in terms of efficacy on post-stroke depression and central pain.

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Donepezil for mild cognitive impairment in Parkinson’s disease

Scientific Reports ◽

10.1038/s41598-021-84243-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Kyoungwon Baik ◽

Seon Myeong Kim ◽

Jin Ho Jung ◽

Yang Hyun Lee ◽

Seok Jong Chung ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Treatment Group ◽

Outcome Measures ◽

Rating Scale ◽

Secondary Outcome ◽

Control Group ◽

Significant Difference

AbstractWe investigated the efficacy of donepezil for mild cognitive impairment in Parkinson’s disease (PD-MCI). This was a prospective, non-randomized, open-label, two-arm study. Eighty PD-MCI patients were assigned to either a treatment or control group. The treatment group received donepezil for 48 weeks. The primary outcome measures were the Korean version of Mini-Mental State Exam and Montreal Cognitive Assessment scores. Secondary outcome measures were the Clinical Dementia Rating, Unified Parkinson’s Disease Rating Scale part III, Clinical Global Impression scores. Progression of dementia was assessed at 48-week. Comprehensive neuropsychological tests and electroencephalography (EEG) were performed at baseline and after 48 weeks. The spectral power ratio of the theta to beta2 band (TB2R) in the electroencephalogram was analyzed. There was no significant difference in the primary and secondary outcome measures between the two groups. However, the treatment group showed a significant decrease in TB2R at bilateral frontotemporoparietal channels compared to the control group. Although we could not demonstrate improvements in the cognitive functions, donepezil treatment had a modulatory effect on the EEG in PD-MCI patients. EEG might be a sensitive biomarker for detecting changes in PD-MCI after donepezil treatment.

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Influence of Physical Activity and Socio-Economic Status on Depression and Anxiety Symptoms in Patients after Stroke

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18158058 ◽

2021 ◽

Vol 18 (15) ◽

pp. 8058

Author(s):

Małgorzata Paprocka-Borowicz ◽

Mona Wiatr ◽

Maria Ciałowicz ◽

Wojciech Borowicz ◽

Agnieszka Kaczmarek ◽

...

Keyword(s):

Physical Activity ◽

Physical Therapy ◽

Economic Status ◽

Depression Scale ◽

Post Stroke ◽

Positive Effects ◽

Socio Economic Status ◽

Treatment Of Depression ◽

Post Stroke Depression ◽

The Impact

Stroke is a high-risk factor for depression. Neurological rehabilitation is greatly difficult and often does not include treatment of depression. The post-stroke depression plays an important role in the progress of treatment, health, and the life of the patient. The appropriate treatment of depression could improve the quality of life of the patient and their family. The study aimed to evaluate the impact of physical activity and socio-economic status of the patient on the effectiveness of recovery from depression and the severity of the symptoms of depression. The study was conducted with 40 patients after stroke aged 42–82 years, and included 10 women and 30 men who were hospitalized for two weeks. The severity of depression/anxiety (D/A) symptoms were evaluated two times; at admission and after two weeks of physical therapy. The hospital anxiety and depression scale (HADS) questionnaire was used for this purpose. Socio-economic status was evaluated by several simple questions. It was revealed that physical therapy has a positive influence on mental state. The severity of D/A symptoms after stroke is related to the financial status of the patients (2 = 11.198, p = 0.024). The state of health (2 = 20.57, p = 0.022) and physical fitness (2 = 12.95, p = 0.044) changed the severity of symptoms of anxiety and depressive disorders. The kinesiotherapy in the group of patients with post-stroke depression had positive effects; however, economic and health conditions may influence the prognosis of the disease.

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Acupuncture for post-stroke depression: a systematic review and meta-analysis

BMC Complementary Medicine and Therapies ◽

10.1186/s12906-021-03277-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ran Liu ◽

Kun Zhang ◽

Qiu-yu Tong ◽

Guang-wei Cui ◽

Wen Ma ◽

...

Keyword(s):

Adverse Events ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Quality Of Evidence ◽

Post Stroke ◽

Assessment Development ◽

Significant Difference ◽

Post Stroke Depression ◽

Meta Analyses

Abstract Background Acupuncture for post-stroke depression (PSD) has been evolving, but uncertainty remains. To assess the existing evidence from randomized clinical trials (RCTs) of acupuncture for PSD, we sought to draw conclusions by synthesizing RCTs. Methods An exhaustive literature search was conducted in seven electronic databases from their inception dates to April 19, 2020, to identify systematic reviews (SRs) and meta-analyses (MAs) on this topic. The primary RCTs included in the SRs/MAs were identified. We also conducted a supplementary search for RCTs published from January 1, 2015, to May 12, 2020. Two reviewers extracted data separately and pooled data using RevMan 5.3 software. The quality of evidence was critically appraised with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system. Results A total of 17 RCTs involving 1402 patients were included. Meta-analysis showed that participants who received a combination of acupuncture and conventional treatments exhibited significantly lower scores on the HAM-D17, HAM-D24 and HAM-D (MD, − 5.08 [95% CI, − 6.48 to − 3.67], I2 = 0%), (MD, − 9.72 [95% CI, − 14.54 to − 4.91], I2 = 65%) and (MD, − 2.72 [95% CI, − 3.61 to − 1.82], respectively) than those who received conventional treatment. However, there was no significant difference in acupuncture versus antidepressants in terms of the 17-item, 24-item and HAM-D scales (MD, − 0.43 [95% CI, − 1.61 to 0.75], I2 = 51%), (MD, − 3.09 [95% CI, − 10.81 to 4.63], I2 = 90%) and (MD, − 1.55 [95% CI, − 4.36 to 1.26], I2 = 95%, respectively). For adverse events, acupuncture was associated with fewer adverse events than antidepressants (RR, 0.16 [95% CI, 0.07 to 0.39], I2 = 35%), but there was no significant difference in the occurrence of adverse events between the combination of acupuncture and conventional treatments versus conventional treatments (RR, 0.63 [95% CI, 0.21 to 1.83], I2 = 38%). The quality of evidence was low to very low due to the substantial heterogeneity among the included studies. Conclusions The current review indicates that acupuncture has greater effect on PSD and better safety profile than antidepressants, but high-quality evidence evaluating acupuncture for PSD is still needed.

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