scholarly journals Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression

2021 ◽  
Vol 10 (8) ◽  
pp. 1674
Author(s):  
Tissa Wijeratne ◽  
Carmela Sales
Keyword(s):  
Iron Homeostasis ◽  
Calcium Influx ◽  
Brain Regions ◽  
Potassium Efflux ◽  
Post Stroke ◽  
Rehabilitation Outcomes ◽  
Post Stroke Depression ◽  
Neuro Inflammation ◽  
Subcortical Regions

Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions.

scholarly journals Post Stroke Depression to be Expected

2021 ◽  
Author(s):  
Tissa Wijeratne ◽  
Carmela Sales
Keyword(s):  
Functional Ability ◽  
Iron Homeostasis ◽  
Calcium Influx ◽  
Brain Regions ◽  
Potassium Efflux ◽  
Post Stroke ◽  
Rehabilitation Outcomes ◽  
Immune Mediated ◽  
Post Stroke Depression

Ischemic Stroke precedes depression . Post Stroke Depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. This systematic reviews confirmed the post stroke depression as the norm as complex ischemic cascade involve the bioenergetic failure, deranged iron homeostasis ( calcium influx, Na influx, potassium efflux etc) excitotoxicity, acidotoxicity,disruption of the blood brain barrier, cytokine mediated cytotoxicity, reactive oxygen mediated toxicity , activation of cyclooxygenase pathway and generation of toxic products, infiltration of immune mediated cells resulting the cell death and deranged neuronal networks in mood related brain regions. This review focus on the pathobiology of stroke in the context and make the argument that PSD is the norm after a stroke rather than the exception.

scholarly journals Dysfunction of anterior insula in the non- affected hemisphere in patients with post- stroke depression: A resting-state fMRI study

2021 ◽  
Vol 29 ◽  
pp. 35-48
Author(s):  
Eunhee Park ◽  
Jang Woo Park ◽  
Yu-Sun Min ◽  
Yang-Soo Lee ◽  
Byung-Soo Kim ◽  
...  
Keyword(s):  
Resting State ◽  
Resting State Fmri ◽  
Depressive Mood ◽  
Brain Regions ◽  
Anterior Insula ◽  
Post Stroke ◽  
Fmri Study ◽  
Post Stroke Depression ◽  
Healthy Control ◽  
Subcortical Regions

BACKGROUND: Post-stroke depression (PSD) is a consequential neuropsychiatric sequela that occurs after stroke. However, the pathophysiology of PSD are not well understood yet. OBJECTIVE: To explore alterations in functional connectivity (FC) between anterior insula and fronto-cortical and other subcortical regions in the non-affected hemisphere in patients with PSD compared to without PSD and healthy control. METHODS: Resting-state FC was estimated between the anterior insula and cortical and subcortical brain regions in the non-affected hemisphere in 13 patients with PSD, 12 patients without PSD, and 13 healthy controls. The severity of depressive mood was measured by the Beck Depression Inventory (BDI)-II. RESULTS: Patients with PSD showed significant differences in FC scores between the anterior insula and the superior frontal, middle frontal, and orbitofrontal gyrus in the non-affected hemisphere than healthy control or patients without PSD (P< 0.05). In post-hoc, patients with PSD showed higher FC scores between the anterior insula and the superior frontal region than patients without PSD (P< 0.05). Furthermore, alterations in FC of the superior frontal, middle frontal, and orbitofrontal gyrus were positively correlated with depression severity, as measured with the BDI-II (P< 0.001).

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

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.

scholarly journals Association of Functional Outcome and Post Stroke Depression amongAssociation of Functional Outcome and Post Stroke Depression among Stroke Survivor after Three Months Onset: A Preliminary Study

2019 ◽  
Vol 14 (1) ◽  
pp. 31
Author(s):  
Fitria Handayani ◽  
Setyowati Setyowati ◽  
Dwi Pudjonarko ◽  
Dian Ratna Sawitri ◽  
Hastaning Sakti ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Functional Outcome ◽  
Barthel Index ◽  
Rating Scale ◽  
Stroke Survivor ◽  
Nursing Intervention ◽  
Research Committee ◽  
Post Stroke ◽  
Post Stroke Depression

<p><span>Background </span></p><p><span>The Post Stroke Depression (PSD) prevalence of stroke survivor after three months onset was ranged from 17% to 37%. Depression led to fatigue, low quality of life, severe morbidity, and mortality.<span>  </span>Functional Outcome influence depression on stroke survivor. <span> </span>However, correlation between functional state level and depression among stroke survivor after three months onset has not been established. </span></p><p><span>Objective</span></p><p><span>This study was aimed to investigate the correlation of executive functional outcome and PSD among stroke survivor after three months onset. </span></p><p><span>Method</span></p><p><span>This study was a correlation study. The participants were 44 stroke ischemic patients after three months onset. Participants were recruited in an outpatient unit. PSD was measured using <span>The GRID-Hamilton Rating Scale for Depression 17 (GRID-HAMD 17) and </span>Functional Outcome was measured using <span>Barthel Index (BI). The reliability of GRID-HAMD 17 was .776. <span> </span>Both instruments were conducted on backward translation in to bahasa. Data was examined using </span>simple linier regression analyses. <span> </span>The ethical approval was obtained from the Ethical Research Committee of the Medical Faculty Diponegoro University and Tugurejo Semarang Hospital. </span></p><p><span>Results</span></p><p><span>The presence of PSD were 56.82. The median of HAMD-GRID-17 was 10.38 ± 7.58, and Barthel Index was 69.56 ± 21.69.<span>  </span>The Barthel Index showed positive correlation with HAMD-GRID-17 (?= -.41 ?=.006). The Functional Outcome determined PSD as much as 16.8 %. </span></p><p><span>Conclusion</span></p><p><span>Moderate association demonstrated the correlation between Functional Outcome and PSD. Nursing intervention should consider these two variables for an optimum quality of life among stroke survivors. </span></p><p> </p>

scholarly journals Post-stroke depression

2014 ◽  
Vol 155 (34) ◽  
pp. 1335-1343 ◽  
Author(s):  
Mónika Schulte-Altedorneburg ◽  
Dániel Bereczki
Keyword(s):  
Cerebrovascular Diseases ◽  
Depressive Illness ◽  
First Year ◽  
Post Stroke ◽  
Treatment And Prevention ◽  
High Incidence ◽  
Negative Effect ◽  
Post Stroke Depression ◽  
High Level

Cerebrovascular diseases are associated with a high incidence of psychiatric disorders. Depressive illness after stroke has been extensively investigated during the last three decades. Post-stroke depression is estimated to occur in 30–35% of the patients during the first year after stroke. Numerous studies have given information on its prevalence, pathogenesis, clinical course, treatment and prevention. Despite the high level of comorbidity, depressive symptoms appear to remain frequently unrecognized and untreated. This has a negative effect on the rehabilitation, quality of live, cognitive function and mortality of stroke patients. Orv. Hetil., 2014, 155(34), 1335–1343.

scholarly journals POST STROKE DEPRESSION AND ANXIETY: PREVALANCE AND CORRELATES

2021 ◽  
pp. 142-147
Author(s):  
NASMI NOUSHAD ◽  
SACHITA S ◽  
SHILPA ANNA VARUGHESE ◽  
SIJIMOL K JOY ◽  
SNEHA JOSE
Keyword(s):  
Clinical Care ◽  
Depression And Anxiety ◽  
Comorbid Conditions ◽  
Stroke Patients ◽  
Post Stroke ◽  
Increased Risk ◽  
Prevalence Of Depression ◽  
Post Stroke Depression ◽  
Collection Form

Objectives: The objective of the study is to evaluate the prevalence of depression and anxiety in post-stroke patients and identify its predictors. Materials and Methods: This study was conducted for a period of 6 months among 81 patients admitted with stroke in SSIMS and RC, Davangere. The information compiled from patient data collection form was assessed for comorbid conditions and type of stroke. Assessment for depression and anxiety was conducted using Hamilton D (HAM-D) and HAM-A scale and information of location of lesion was obtained from patient’s neuroimaging results. Quality of life (QOL) of post-stroke was assessed using stroke and aphasia QOL (SAQOL) questionnaire. Follow-up was conducted for patients who were diagnosed with depression and anxiety within 1 to 3 months. Results: Depression was more prevalent as compared to anxiety in post-stroke patients and was predominant in males and between the ages 61 and 70 years. Hypertension and diabetes were found to be a major comorbid conditions in such patients. Factors contributing to increased risk of depression and anxiety after stroke include age, sex, comorbidities, lesion location, and type of stroke. Post-stroke depression (PSD) and anxiety showed statistically significant association with left-sided lesion. Conclusion: PSD and anxiety are a relatively common complications and can result in poor QOL in stroke patients. Early detection of depression and anxiety symptoms may assist functional recovery and improve QOL in stroke patients. Careful evaluation of PSD and post-stroke anxiety should be integrated into clinical care of stroke patients.

Abstract NS8: Prevalence and Relating Factors of Sleep Disturbances at 3 Months Post Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Smi Choi-Kwon ◽  
Minhee Suh ◽  
Jong S. Kim
Keyword(s):  
Social Support ◽  
Sleep Disturbances ◽  
Poor Quality ◽  
Adverse Outcomes ◽  
Motor Dysfunction ◽  
Night Time ◽  
Post Stroke ◽  
Post Stroke Depression ◽  
Nighttime Sleep

Background: Post-stroke sleep disturbances (PSSD) are common and associated with various adverse outcomes. However, PSSD in the subacute stages of stroke have been scarcely studied. We aimed to evaluate the characteristics of and the factors related to PSSDs in stroke patients 3 months post-stroke. Methods: A total of 199 patients were evaluated for PSSD at 3 months after stroke. The quality of nighttime sleep and excessive daytime sleepiness (EDS) were assessed using the Verran Snyder-Halpern sleep scale and Epworth Sleepiness Scale, respectively. Presence of motor dysfunction and post-stroke pain, post-stroke depression, fatigue, and social support were evaluated. Results: Eighty eight patients (44.2%) had poor quality of night time sleep. Twenty eight patients (14.4%) reported EDS. Poor quality of sleep was independently associated with depression (p = 0.044) and EDS (p = 0.041) whereas fatigue (p = 0.000) and poor nighttime sleep (p = 0.045) were independently associated with EDS. Post-stroke pain and social support showed no association with PSSD. Conclusions: We found that PSSD 3 month post-stroke is common. Although causality remained to be determined, depression and nighttime sleep disturbances were related, whereas fatigue and nighttime sleep disturbances were related to EDS.

scholarly journals 277 Frailty and Early Supported Discharge (ESD) Post-Stroke: Are Frail Patients Referred to ESD and is Frailty Associated with Rehabilitation Outcomes?

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii1-iii16
Author(s):  
Marie Condon ◽  
Louise O'Regan ◽  
Lucy Pope ◽  
Anne Barrett
Keyword(s):  
Quality Of Life ◽  
Occupational Therapy ◽  
Functional Independence ◽  
Stroke Survivors ◽  
Post Stroke ◽  
Rehabilitation Outcomes ◽  
Frail Patients ◽  
Early Supported Discharge ◽  
Therapy Sessions

Abstract Background Frailty presents in one in four stroke survivors and can be a determinant of recovery post-stroke. Healthcare services provided at home, instead of in hospitals, results in improved outcomes for frail patients. Early supported discharge (ESD) provides multidisciplinary rehabilitation at home post-stroke. It is unknown if frail stroke survivors receive ESD and if they benefit from it. The objectives were to evaluate the prevalence of pre-stroke frailty among ESD patients and examine if frailty is associated with rehabilitation outcomes. Methods Consecutive patients in the ESD programme were assessed for pre-stroke frailty using the Clinical Frailty Scale (CFS) from November 2018 to April 2019. Baseline characteristics and programme outcomes were recorded, including admission and discharge scores on the Functional Independence Measure and Functional Assessment Measure (FIM+FAM) and the Stroke Aphasia Quality of Life-39 measure (SAQOL-39). The duration of ESD rehabilitation and number of therapy sessions provided were also recorded. Distributions using Pearson’s Chi Squared test and associations using the Mann–Whitney U test were calculated. Results Results from 23 patients were analysed, median age 75±14.8 years, 82.6% male. The prevalence of frailty (CFS >5) was 4.3% (1/23) and pre-frailty (CFS=4) was 26.1% (6/23). Patients who were frail or pre-frail (CFS>4) were less likely to receive speech and language therapy (SLT) (z=-2.201; p=0.03) and have a lower SAQOL-39 on discharge (z=-2.294; p=0.02). No significant differences were noted in the FIM+FAM or the number of physiotherapy and occupational therapy sessions provided. Conclusion Frail patients are not routinely referred for ESD post-stroke. Patients who are pre-frail or frail make similar improvements with ESD compared to non-frail patient in functional independence but not quality of life. Comparable levels of physiotherapy and occupational therapy are provided but frail patients require less SLT. Further research is needed to ascertain if frail patients are appropriate for ESD.

Sign in / Sign up

Export Citation Format

Share Document