Abstract TP322: Towards better screening for 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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STROKE PATIENTS AND THEIR PARTNER’S PERCEPTIONS OF SURVIVOR FUNCTIONING

Acta Neuropsychologica ◽

10.5604/01.3001.0010.2407 ◽

2017 ◽

Vol 15 (2) ◽

pp. 0-0 ◽

Cited By ~ 1

Author(s):

Chloe Witty ◽

Thomas Heffernan ◽

Leigh Riby

Keyword(s):

Verbal Memory ◽

Digit Span ◽

Qualitative Interviews ◽

Stroke Survivor ◽

Self Report ◽

Stroke Recovery ◽

Step Test ◽

Stroke Survivors ◽

Post Stroke ◽

Significant Difference

[b]Background: [/b]Research into stroke survivors and their partners have shown that the partner frequently rates the stroke survivor as less capable than the survivors rate themselves through self-report questionnaires or qualitative interviews; however, no research to date has used cognitive tasks as a method for in vestigation. This paper aims to investigate if the stroke survivor or the partner rate the stroke survivor as worse across all cognitive domains. [b]Material/ Methods:[/b]This research aimed to observe the incongruence of stroke survivors and their spouse’s perception of survivor functioning by rating their confidence on Picture Memory, Verbal Memory, Digit Span, Luria’s Three Step Test, NART and Raven’s Matrices. Participants, and to compare these score to see if either could predict the actual score. [b]Results: [/b]Showed that neither the stroke survivor nor the partner consistently rated functioning as worse, but there was a significant difference between the dyad. Further, the stroke survivor and the partner’s confidence had no relationship with raw scores. A thematic analysis was also conducted and themes emerged from the data. These were “Confidence,” “Insight into Ability,” and “Post-Stroke Changes.”[b]Conclusions:[/b]These themes were shown to interlink with the scores provided in the qualitative analysis, and implied that low self-efficacy may be crucial in post stroke recovery. Limitations and implications are discussed in full.

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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 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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Psychometric evaluation of a newly developed measure of emotionalism after stroke (TEARS-Q)

Clinical Rehabilitation ◽

10.1177/0269215520981727 ◽

2020 ◽

pp. 026921552098172

Author(s):

Niall M Broomfield ◽

Robert West ◽

Allan House ◽

Theresa Munyombwe ◽

Mark Barber ◽

...

Keyword(s):

Item Response ◽

Psychometric Evaluation ◽

Self Report ◽

Stroke Survivors ◽

Reference Standard ◽

Stroke Units ◽

Post Stroke ◽

Response Variance ◽

Mild Stroke ◽

Functional Outcome Measures

Objective: To evaluate, psychometrically, a new measure of tearful emotionalism following stroke: Testing Emotionalism After Recent Stroke – Questionnaire (TEARS-Q). Setting: Acute stroke units based in nine Scottish hospitals, in the context of a longitudinal cohort study of post-stroke emotionalism. Subjects: A total of 224 clinically diagnosed stroke survivors recruited between October 1st 2015 and September 30th 2018, within 2 weeks of their stroke. Measures: The measure was the self-report questionnaire TEARS-Q, constructed based on post-stroke tearful emotionalism diagnostic criteria: (i) increased tearfulness, (ii) crying comes on suddenly, with no warning (iii) crying not under usual social control and (iv) crying episodes occur at least once weekly. The reference standard was presence/absence of emotionalism on a diagnostic, semi-structured post-stroke emotionalism interview, administered at the same assessment point. Stroke, mood, cognition and functional outcome measures were also completed by the subjects. Results: A total of 97 subjects were female, with a mean age 65.1 years. 205 subjects had sustained ischaemic stroke. 61 subjects were classified as mild stroke. TEARS-Q was internally consistent (Cronbach’s alpha 0.87). TEARS-Q scores readily discriminated the two groups, with a mean difference of −7.18, 95% CI (−8.07 to −6.29). A cut off score of 2 on TEARS-Q correctly identified 53 of the 61 stroke survivors with tearful emotionalism and 140 of the 156 stroke survivors without tearful emotionalism. One factor accounted for 57% of the item response variance, and all eight TEARS-Q items acceptably discriminated underlying emotionalism. Conclusion: TEARS-Q accurately diagnoses tearful emotionalism after stroke.

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Factors Associated with Post-Stroke Depression in Chinese Stroke Survivors

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2021.106076 ◽

2021 ◽

Vol 30 (11) ◽

pp. 106076

Author(s):

Janita P C Chau ◽

Suzanne H S Lo ◽

Jie Zhao ◽

Kai Chow Choi ◽

Simon K Y Lam ◽

...

Keyword(s):

Stroke Survivors ◽

Factors Associated ◽

Post Stroke ◽

Post Stroke Depression

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LACK OF EMPHASIS ON PSYCHOLOGICAL REHABILITATION FOR STROKE PATIENTS

Pakistan Journal of Rehabilitation ◽

10.36283/pjr.zu.1.1/009 ◽

2012 ◽

Vol 1 (1) ◽

pp. 2

Author(s):

Samina Masood Haider

Keyword(s):

Emotional Difficulties ◽

Stroke Survivors ◽

Stroke Patients ◽

Post Stroke ◽

Post Stroke Depression ◽

The Many ◽

Over Time

It has been observed that most of the patients are not aware of the dilapidating affects of post stroke depression on their recovery, survival and a return to normal activities of life. The lack of emphasis on psychological rehabilitation for stroke patients is a source of concern for me and I would like to bring to your attention about the facts regarding the implications of proper psychological rehabilitation is not undertaken. Stroke survivors report a range of emotional difficulties, most common being fear, anxiety, frustration, anger, sadness and a sense of grief for their physical and mental losses. Usually these feelings may fade over time however, some patients may struggle with adjusting to the many changes following stroke. When this happens these feelings can develop into depression. It is estimated that approximately one-third of stroke1 survivors develop post-stroke depression (PSD)

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Association among depression, cognitive impairment and executive dysfunction after stroke

Dementia & Neuropsychologia ◽

10.1590/s1980-57642012dn06030007 ◽

2012 ◽

Vol 6 (3) ◽

pp. 152-157 ◽

Cited By ~ 13

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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Prevalence of pre-stroke depression and its association with post-stroke depression: a systematic review and meta-analysis

Psychological Medicine ◽

10.1017/s0033291718002003 ◽

2018 ◽

Vol 49 (4) ◽

pp. 685-696 ◽

Cited By ~ 7

Author(s):

Martin Taylor-Rowan ◽

Oyiza Momoh ◽

Luis Ayerbe ◽

Jonathan J. Evans ◽

David J. Stott ◽

...

Keyword(s):

Systematic Review ◽

Publication Bias ◽

Meta Analysis ◽

Assessment Method ◽

Self Report ◽

Funnel Plot ◽

Strength Of Evidence ◽

Post Stroke ◽

Depression Assessment ◽

Post Stroke Depression

AbstractBackgroundDepression is a common post-stroke complication. Pre-stroke depression may be an important contributor, however the epidemiology of pre-stroke depression is poorly understood. Using systematic review and meta-analysis, we described the prevalence of pre-stroke depression and its association with post-stroke depression.MethodsWe searched multiple cross-disciplinary databases from inception to July 2017 and extracted data on the prevalence of pre-stroke depression and its association with post-stroke depression. We assessed the risk of bias (RoB) using validated tools. We described summary estimates of prevalence and summary odds ratio (OR) for association with post-stroke depression, using random-effects models. We performed subgroup analysis describing the effect of depression assessment method. We used a funnel plot to describe potential publication bias. The strength of evidence presented in this review was summarised via ‘GRADE’.ResultsOf 11 884 studies identified, 29 were included (total participantsn= 164 993). Pre-stroke depression pooled prevalence was 11.6% [95% confidence interval (CI) 9.2–14.7]; range: 0.4–24% (I295.8). Prevalence of pre-stroke depression varied by assessment method (p= 0.02) with clinical interview suggesting greater pre-stroke depression prevalence (~17%) than case-note review (9%) or self-report (11%). Pre-stroke depression was associated with increased odds of post-stroke depression; summary OR 3.0 (95% CI 2.3–4.0). All studies were judged to be at RoB: 59% of included studies had an uncertain RoB in stroke assessment; 83% had high or uncertain RoB for pre-stroke depression assessment. Funnel plot indicated no risk of publication bias. The strength of evidence based on GRADE was ‘very low’.ConclusionsOne in six stroke patients have had pre-stroke depression. Reported rates may be routinely underestimated due to limitations around assessment. Pre-stroke depression significantly increases odds of post-stroke depression.Protocol identifierPROSPERO identifier: CRD42017065544

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