Association among depression, cognitive impairment and executive dysfunction after stroke.

Luisa Terroni,Renério Fráguas,Valeri D Guajardo,Mara Cristina S De Lucia,Adriana B Conforto,Carla C Adda,Matildes F.M Sobreiro

doi:10.1590/s1980-57642012dn06030007

Luisa Terroni, Renério Fráguas + Show 5 more

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https://doi.org/10.1590/s1980-57642012dn06030007

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Journal: Dementia & neuropsychologia	Publication Date: Sep 1, 2012
Citations: 42	License type: cc-by

Affiliation: Universidade de São Paulo

Abstract

The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated.ObjectiveTo review the relationship between post-stroke depression and cognitive impairment.MethodsWe 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.ResultsSix 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.ConclusionExecutive 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.

Highlights

Depression is the most common psychiatric complication of stroke with significant prevalence and incidence rates
The reasons behind the decision to include them were: [1] the study performed by Bolla-Wilson et al.[30] was the first to use neuropsychological tests to assess cognitive function; [2] the studies of Pohjasvaara et al.[27] and Vataja et al.[31] included partially the same cohort of patients but given the different aims and methods employed by the two studies they were both included
Executive function impairment has been associated with depression after stroke and some authors have considered the existence of depression-dysexecutive syndrome within three to four months of stroke.[27,31]

Summary

Introduction

Depression is the most common psychiatric complication of stroke with significant prevalence and incidence rates. The reported prevalence of major depression within three months after stroke ranges from 22% to 31%.1-5. PSD, or even depressive symptoms after stroke, have been associated with increased mortality, greater impairment in physical functioning and language, longer hospitalization, reduced quality of life and cognitive impairments.[12,13,14] Studies have supported that PSD has underlying biological and psychosocial etiologic factors such as cognitive impairment, female sex, hypercortisolism, poor social network, living alone and previous depression.[2,6,9,15,16,17]

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