scholarly journals Cognitive impairment is differentially associated with depression and anxiety at six-months post-stroke

2020 ◽  
Author(s):  
Owen A Williams ◽  
Nele Demeyere
Keyword(s):  
Cognitive Impairment ◽  
Spatial Attention ◽  
Depressive Symptomatology ◽  
Depression Scale ◽  
Anxiety Symptoms ◽  
Cognitive Domain ◽  
Stroke Severity ◽  
Depression And Anxiety ◽  
Post Stroke ◽  
Post Stroke Depression

Objective: This study investigated the associations between general cognitive impairment and domain specific cognitive impairment with post-stroke depression and anxiety at six-months post-stroke. Methods: Participants were a subset of 437 stroke patients from the OCS-CARE study who were followed up at a 6 months post-stroke assessment. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale sub-scales. General cognitive impairment was assessed using the Montreal Cognitive Assessment and stroke-specific cognitive domain impairments was assessed using the Oxford Cognitive Screen. Multivariable linear regression was used to examine the associations between cognition and depression/anxiety symptoms, controlling for acute stroke severity and ADL impairment, age, sex, education, and co-occurring post-stroke depression/anxiety. Results: Six-month post-stroke depression was associated with six-month impairment on the MoCA (beta [b] =0.96, standard error [SE] =0.31, p=0.006), and all individual domains assessed by the OCS including spatial attention (b=0.67, SE=0.33, p =0.041), executive function (b=1.37, SE=0.47, p=0.004), language processing (b=0.87, SE=0.38, p=0.028), memory (b=0.76, SE=0.37, p=0.040), number processing (b=1.13, SE=0.40, p=0.005), and praxis (b=1.16, SE =0.49, p=0.028). Post-stroke anxiety was associated with impairment on the MoCA (b=1.47, SE=0.42, p=0.001), and spatial attention (b=1.25, SE=0.45, p=0.006), but these associations did not remain significant after controlling for co-occurring post-stroke depression. Conclusion: The different profiles of associations between cognitive impairment and post-stroke depression and anxiety suggest that cognitive impairment is highly related to depressive symptomatology, but associations observed between cognitive impairment and anxiety may actually be the result of co-morbid post stroke depression.

scholarly journals Association of Depression and Anxiety With Cognitive Impairment 6 Months After Stroke

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011748
Author(s):  
Owen A Williams ◽  
Nele Demeyere
Keyword(s):  
Cognitive Impairment ◽  
Acute Stroke ◽  
Spatial Attention ◽  
Anxiety Symptoms ◽  
Cognitive Domain ◽  
Stroke Severity ◽  
Depression And Anxiety ◽  
Post Stroke ◽  
Domain Specific ◽  
Post Stroke Depression

Objective:Investigate the associations between general cognitive impairment and domain specific cognitive impairment with post-stroke depression and anxiety at six-months post-stroke.Methods:Participants were confirmed acute stroke patients from the OCS-CARE study who were recruited on stroke wards in a multi-site study and followed up at a 6 months post-stroke assessment. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale sub-scales, with scores greater than seven indicating possible mood disorders. General cognitive impairment at follow-up was assessed using the Montreal Cognitive Assessment, stroke-specific cognitive domain impairments was assessed using the Oxford Cognitive Screen. Linear regression was used to examine the associations between cognition and depression/anxiety symptoms at 6-months, controlling for acute-stroke severity and ADL-impairment, age, sex, education, and co-occurring post-stroke depression/anxiety.Results:437 participants mean age=69.28 years (S.D.=12.17), 226 male (51.72%), were included in analyses. Six-month post-stroke depression (n=115, 26%) was associated with six-month impairment on the MoCA (beta [b] =0.96, standard error [SE] =0.31, p=0.006), and all individual domains assessed by the OCS: spatial attention (b=0.67, SE=0.33, p =0.041), executive function (b=1.37, SE=0.47, p=0.004), language processing (b=0.87, SE=0.38, p=0.028), memory (b=0.76, SE=0.37, p=0.040), number processing (b=1.13, SE=0.40, p=0.005), praxis (b=1.16, SE =0.49, p=0.028). Post-stroke anxiety (n=133, 30%) was associated with impairment on the MoCA (b=1.47, SE=0.42, p=0.001), and spatial attention (b=1.25, SE=0.45, p=0.006), these associations did not remain significant after controlling for co-occurring post-stroke depression.Conclusion:Domain-general and domain-specific post-stroke cognitive impairment was found to be highly related to depressive symptomatology but not anxiety symptomatology.

Abstract WMP98: Post-Stroke Depression Predictors Among Intracerebral Hemorrhage Survivors

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Radhika Avadhani ◽  
Richard E Thompson ◽  
Nichol McBee ◽  
Noeleen Ostapkovich ◽  
Lourdes Carhuapoma ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Intracerebral Hemorrhage ◽  
Functional Recovery ◽  
Right Hemisphere ◽  
Depression Scale ◽  
Multivariable Logistic Regression Analysis ◽  
Clinical Predictors ◽  
Post Stroke ◽  
Patient Disposition ◽  
Post Stroke Depression

Introduction: Post-stroke depression (PSD) in ischemic stroke is well-documented in the literature, but much less in intracerebral hemorrhage (ICH). We aimed to evaluate the clinical predictors of PSD in a cohort of ICH patients. Methods: 499 randomized ICH subjects in MISTIE-III trial were followed for 1 year. Center for Epidemiologic Studies Depression Scale (CES-D) was assessed at 180 days (D180) post-ICH. A score of CES-D ≥16 were considered depressed. 300 out of 379 survivors responded. Multivariable logistic regression analysis was performed to identify independent predictors of depression at D180 with adjustment for baseline demographic characteristics, ICH hemisphere and severity, and functional recovery, cognition status and patient disposition at day 30 (Model 1) and day 180 (Model 2). Good functional outcome was defined as modified Rankin Scale (mRS) 0-3 vs. 4-5 (poor mRS), cognitive impairment status was defined as screening Mini-Mental State Examination (MMSE) < 24 and good patient disposition was defined as patient location at home. Prior use of antidepressants was too small to consider. Results: Using CES-D, 106/300 subjects (35%) were considered depressed at day 180. Both models found that female gender, Hispanic ethnicity, and right hemisphere ICH location were statistically significant predictors of PSD. Poor mRS at D180 was statistically significant D180. Early (D30), but not late cognitive impairment was also significant. Conclusion: Almost 4 out of 10 ICH survivors displayed significant depression as defined by CES-D. Race/ethnicity, gender, ICH hemisphere, and poor functional recovery appear to influence post-stroke depression, while later cognitive impairment, volumetric, age, and later home location were less important.

Depression and Anxiety Across the First Year After Ischemic Stroke: Findings from a Population-Based New Zealand ARCOS-IV Study

2017 ◽  
Vol 18 (3) ◽  
pp. 265-276 ◽  
Author(s):  
Suzanne Barker-Collo ◽  
Rita Krishnamurthi ◽  
Emma Witt ◽  
Alice Theadom ◽  
Nicola Starkey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Depression Scale ◽  
Population Level ◽  
Population Based ◽  
Anxiety Symptoms ◽  
Depression Symptoms ◽  
First Year ◽  
Depression And Anxiety ◽  
Population Based Study ◽  
Post Stroke

Background: Depression and anxiety are the two most frequently studied emotional outcomes of stroke. However, few previous studies have been carried out at a population level or beyond 6 months post stroke. The aim of this study was to describe depression and anxiety across the first year following incident ischemic stroke (IS), and identify predictive factors in a population-based study.Method: The Hospital Anxiety Depression Scale (HADS) was administered at baseline (within 2 weeks of onset), and again at 1-month, 6-months and 12-months after IS in a sample (N = 365) drawn from a population-based study.Results: Over 75% of those assessed experienced depression or anxiety symptoms below cut-offs for probable disorder across the year post stroke. Moderate to severe symptoms for anxiety were approximately twice as likely (range 4.1%–10.6%) as compared to depression (range 2.5%–5.0%) at each assessment. The greatest improvement in anxiety occurred within the first month post stroke. In contrast, the greatest reduction in depression occurred between 1- to 6-months post stroke.Conclusions: Anxiety symptoms in the moderate to severe range were twice as common as depression, and improved over the first month post stroke, whilst depression symptoms persisted for up to 6 months, indicating a need to target these two issues at different points in the recovery process.

scholarly journals Effects of Glycemic Gap on Post-Stroke Cognitive Impairment in Acute Ischemic Stroke Patients

2021 ◽  
Vol 11 (5) ◽  
pp. 612
Author(s):  
Minwoo Lee ◽  
Jae-Sung Lim ◽  
Yerim Kim ◽  
Ju Hun Lee ◽  
Chul-Ho Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Acute Ischemic Stroke ◽  
Sex Education ◽  
Cognitive Domain ◽  
P Value ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Stroke Treatment ◽  
Post Stroke

Background: Post-stroke hyperglycemia is a frequent finding in acute ischemic stroke patients and is associated with poor functional and cognitive outcomes. However, it is unclear as to whether the glycemic gap between the admission glucose and HbA1c-derived estimated average glucose (eAG) is associated with post-stroke cognitive impairment (PSCI). Methods: We enrolled acute ischemic stroke patients whose cognitive functions were evaluated three months after a stroke using the Korean version of the vascular cognitive impairment harmonization standards neuropsychological protocol (K-VCIHS-NP). The development of PSCI was defined as having z-scores of less than −2 standard deviations in at least one cognitive domain. The participants were categorized into three groups according to the glycemic gap status: non-elevated (initial glucose − eAG ≤ 0 mg/dL), mildly elevated (0 mg/dL < initial glucose − eAG < 50 mg/dL), and severely elevated (50 mg/dL ≤ initial glucose − eAG). Results: A total of 301 patients were enrolled. The mean age was 63.1 years, and the median National Institute of Health Stroke Scale (NIHSS) score was two (IQR: 1–4). In total, 65 patients (21.6%) developed PSCI. In multiple logistic regression analyses, the severely elevated glycemic gap was a significant predictor for PSCI after adjusting for age, sex, education level, initial stroke severity, Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and left hemispheric lesion (aOR: 3.65, p-value = 0.001). Patients in the severely elevated glycemic gap group showed significantly worse performance in the frontal and memory domains. Conclusions: In conclusion, our study demonstrated that an elevated glycemic gap was significantly associated with PSCI three months after a stroke, with preferential involvement of frontal and memory domain dysfunctions.

Red Blood Cell Indices in Relation to Post-stroke Psychiatric Disorders: A Longitudinal Study in a Follow-up Stroke Clinic

2020 ◽  
Vol 17 (3) ◽  
pp. 218-223
Author(s):  
Haichao Wang ◽  
Li Gong ◽  
Xiaomei Xia ◽  
Qiong Dong ◽  
Aiping Jin ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Blood Cell ◽  
Cox Regression ◽  
Depression And Anxiety ◽  
Cox Regression Analysis ◽  
Post Stroke ◽  
Rbc Indices ◽  
Post Stroke Depression

Background: Depression and anxiety after stroke are common conditions that are likely to be neglected. Abnormal red blood cell (RBC) indices may be associated with neuropsychiatric disorders. However, the association of RBC indices with post-stroke depression (PSD) and poststroke anxiety (PSA) has not been sufficiently investigated. Methods: We aimed to investigate the trajectory of post-stroke depression and anxiety in our follow- up stroke clinic at 1, 3, and 6 months, and the association of RBC indices with these. One hundred and sixty-two patients with a new diagnosis of ischemic stroke were followed up at 1, 3, and 6 months, and underwent Patient Health Questionnaire-9 (PHQ-9) and the general anxiety disorder 7-item (GAD-7) questionnaire for evaluation of depression and anxiety, respectively. First, we used Kaplan-Meier analysis to investigate the accumulated incidences of post-stroke depression and post-stroke anxiety. Next, to explore the association of RBC indices with psychiatric disorders after an ischemic stroke attack, we adjusted for demographic and vascular risk factors using multivariate Cox regression analysis. Results: Of the 162 patients with new-onset of ischemic stroke, we found the accumulated incidence rates of PSD (1.2%, 17.9%, and 35.8%) and PSA (1.2%, 13.6%, and 15.4%) at 1, 3, and 6 months, respectively. The incident PSD and PSA increased 3 months after a stroke attack. Multivariate Cox regression analysis indicated independent positive associations between PSD risk and higher mean corpuscular volume (MCV) (OR=1.42, 95% CI=1.16-1.76), older age (OR=2.63, 95% CI=1.16-5.93), and a negative relationship between male sex (OR=0.95, 95% CI=0.91-0.99) and PSA. Conclusion: The risks of PSD and PSA increased substantially 3 months beyond stroke onset. Of the RBC indices, higher MCV, showed an independent positive association with PSD.

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

2021 ◽  
Author(s):  
Gurumayum Sonachand Sharma ◽  
Anupam Gupta ◽  
Meeka Khanna ◽  
Naveen Bangarpet Prakash
Keyword(s):  
Outcome Measures ◽  
Functional Outcomes ◽  
Rating Scale ◽  
Tertiary Care ◽  
Depression Scale ◽  
Inpatient Rehabilitation ◽  
University Hospital ◽  
Post Stroke ◽  
Significant Difference ◽  
Post Stroke Depression

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.

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

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.

scholarly journals Association between self-care agency and depression and anxiety in patients with diabetic retinopathy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bo Zhang ◽  
Qin Wang ◽  
Xuancan Zhang ◽  
Li Jiang ◽  
Lezhi Li ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
Rural Areas ◽  
Self Care ◽  
Depression Scale ◽  
Anxiety Symptoms ◽  
Depression And Anxiety ◽  
Clinical Factors ◽  
Cross Sectional ◽  
History Of ◽  
Care Agency

Abstract Background This study aimed at investigating: 1) the relationship between self-care agency and depression and anxiety; 2) the sociodemographic and clinical factors associated with depression and anxiety in patients with diabetic retinopathy (DR) in China. Methods A cross-sectional study was conducted. One-hundred and five patients with DR were recruited. Self-care agency was assessed by the exercise of self-care agency (ESCA) scale. Depression and anxiety were assessed by the hospital anxiety and depression scale (HADS-D and HADS-A). Pearson or Spearman correlations were performed to assess the association between self-care agency and depression and anxiety. Stepwise multivariate linear regression analyses were conducted to assess the contribution of the sociodemographic and clinical factors to depression and anxiety. Results Thirty-six (34.3%) and 43 (41.1%) patients exhibited depressive and anxiety symptoms, respectively. Only 24 (22.9%) patients showed a high self-care agency. The ESCA total and subscale scores were negatively correlated depressive symptoms (P < 0.05). Self-care skills were negatively correlated with anxiety symptoms (P < 0.05). ESCA total score, rural residence, history of hypertension and visual acuity were associated with depression; self-care skills and diastolic blood pressure were associated with anxiety. Conclusions Self-care agency negatively correlates with depression and anxiety in patients with DR. Special attention should be paid to patients living in rural areas and/or those having a history of hypertension when assessing depression and anxiety in patients with DR. Future studies are needed to clarify the causal relationship between self-care agency and depression and anxiety.

scholarly journals Morphological and Metabolic Alteration of Cerebellum in Patients with Post-Stroke Depression

2016 ◽  
Vol 40 (3-4) ◽  
pp. 420-430 ◽  
Author(s):  
Ling Zhang ◽  
Rubo Sui ◽  
Lei Zhang ◽  
Zhuang Zhang
Keyword(s):  
Magnetic Resonance ◽  
Depression Scale ◽  
Resonance Spectroscopy ◽  
Hamilton Depression Scale ◽  
Stroke Patients ◽  
1H Mrs ◽  
Post Stroke ◽  
Cont Group ◽  
Post Stroke Depression ◽  
Norm Group

Background: To study morphological and metabolic changes of cerebellum with multimodality magnetic resonance imaging (MRI) and proton magnetic resonance spectroscopy (1H-MRS), respective, to explore correlation between cerebellum alteration and severity of depression in patients with post-stroke depression. Methods: 60 subjects, including 40 stroke patients and 20 healthy volunteers were enrolled. Depression of stroke patients was tested by Self-rating Depression Scale (SDS) and Hamilton Depression Scale (HAMD), based on which stroke-patients were grouped into post-stroke depression (PSD group) and without post-stroke depression (CONT group). Results: Volume of cerebellum decreased in PSD group and CONT group compared with healthy volunteer (NORM) group. White matter of cerebellum in PSD group and CONT group was disrupted; such disruption was significantly in PSD group. In addition, there was correlation between cerebellum volume and FA and HDRS scores (P<00.01). The Cho/Cr and Cho/NAA ratios in cerebellum contralateral to stroke lesion in PSD were higher than those in NORM group (P<0.05). Cho/Cr and Cho/NAA ratios in contralateral cerebellum and ratio difference of Cho/Cr in bilateral cerebellum were positively correlated with HAMD scales (P<0.05). Conclusion: Morphologic and metabolic alterations are evident in patients with post-stroke depression, indicating possible involvement of cerebellum in post-stroke-depression occurrence.

scholarly journals Association among depression, cognitive impairment and executive dysfunction after stroke

2012 ◽  
Vol 6 (3) ◽  
pp. 152-157 ◽  
Author(s):  
Luisa Terroni ◽  
Matildes F.M. Sobreiro ◽  
Adriana B. Conforto ◽  
Carla C. Adda ◽  
Valeri D. Guajardo ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Neuropsychological Tests ◽  
Executive Dysfunction ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Adequate Treatment ◽  
Post Stroke ◽  
Quantitative Studies ◽  
Post Stroke Depression ◽  
The Relationship

ABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.

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