Abstract
Background: Anxiety is prevalent after a stroke. The pathophysiological mechanisms underlying the development of poststroke anxiety (PSA) remain unclear. The aim of this study was to investigate the clinical and neuroimaging risk factors for development of PSA and examine the effects of PSA on activities of daily living (ADL) and quality of life (QOL) in Chinese patients with ischemic stroke. Methods: Two hundred nineteen patients with acute ischemic stroke were recruited to the study. A series of comprehensive assessments, including Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale (HDRS), Lawton ADL Scale, and the Stroke-Specific Quality of Life (SSQOL) Scale, were conducted in the acute stage and 3 months after stroke. Magnetic resonance imaging assessment focused on evaluation of infarctions, white matter lesions, and brain atrophy. Results: In the acute stage and 3 months after stroke, 34 (16%) and 33 (15%) patients had PSA, respectively. Multiple logistic regression analysis indicated that HDRS (OR = 1.269, 95% CI = 1.182–1.364, P < 0.001) and acute infarcts in cerebral hemispheric white matter (CHWM; OR = 2.902, 95% CI = 1.052–8.007, P = 0.040) were significant correlates of PSA in the acute stage of stroke. Three months after stroke, these correlates remained significant predictors, along with male sex. Multiple linear regressions showed that age, NIHSS, HARS, and HDRS in the acute stage were significant predictors for both ADL and SSQOL at 3 months after stroke. Conclusion: Depressive symptoms are the major correlates of PSA while more severe PSA is associated with poorer ADL and health-related QOL. Acute lesions involving CHWM may correlate with PSA in ischemic stroke patients with mild-to-moderate neurologic deficits, supporting a lesion-location hypothesis in PSA.
Highlights
Anxiety is prevalent after stroke and occurs in about one-quarter of stroke survivors [1, 2]
No magnetic resonance imaging (MRI) variables were significantly different between the two groups, patients with Poststroke anxiety (PSA) trended toward more Cerebral hemispheric white matter (CHWM) infarcts in both the acute stage and 3 months after stroke (P = 0.075 and P = 0.071, respectively; Table 2)
Multiple linear regressions showed that age, NIHSS, Hamilton Anxiety Rating Scale (HARS), and Hamilton Depression Rating Scale (HDRS) in the acute stage were significant predictors for both activities of daily living (ADL) and Stroke-Specific Quality of Life (SSQOL) at 3 months after stroke (Table 5)
Summary
Anxiety is prevalent after stroke and occurs in about one-quarter of stroke survivors [1, 2]. Studying the neuroimaging correlates of PSA may be helpful in understanding the pathophysiology of PSA. The lesion-location hypothesis of PSA might be presumed as the infarction may damage brain structures involved in anxiety. A large-scale MRI study involving 239 stroke patients was performed, but no association was found between brain lesion location and PSA [18]. The underlying pathophysiological mechanisms of development of PSA remain unclear. The pathophysiological mechanisms underlying the development of poststroke anxiety (PSA) remain unclear. The aim of this study was to investigate the clinical and neuroimaging risk factors for development of PSA and examine the effects of PSA on activities of daily living (ADL) and quality of life (QOL) in Chinese patients with ischemic stroke
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