Abstract
BackgroundPost-stroke depressive symptoms (DS) can be chronic or transient, occurring shortly or long after stroke and lasting only few months. It remains unclear if the prognosis differs between patients with DS in the acute phase of stroke and those who develop DS several months later. We aimed to determine whether outcomes vary among patients with different trajectories of post-stroke depressive symptoms.MethodsOf 698 enrolled patients with ischemic stroke, we included 335 participants (median age: 68, 48% female) who were assessed for DS both 8 days and 3 months post-stroke. We divided patients into 4 groups: without greater DS (Group 1), only earlier DS (Group 2), only later DS (Group 3), and persistent DS (Group 4). Logistic regression was used to determine the association between DS and 3- and 12-month functional outcome.ResultsGroup 2 was predominantly female and had the highest rate of previous stroke or transient ischemic attack. Group 3 was more likely to suffer from delirium and more severe stroke. Group 4 had the highest frequency of vascular risk factors, pre-morbid psychiatric symptoms, and cognitive decline. In multivariate analysis, Group 3, but not Groups 2 and 4, had an increased risk of poor 3- and 12-month functional outcome (adjusted OR 2.59, 95% CI 1.64–4.07, P < 0.01 and OR 3.97, 95% CI 2.32–6.76, P < 0.01, respectively) compared with Group 1.ConclusionsDifferent trajectories of post-stroke DS are related to different outcomes. Patients who only have later DS also have the worst prognosis.
Highlights
Longitudinal studies that examined the natural history of post-stroke depression demonstrated a dynamic course of depressive symptoms, with new cases and recovery from depression occurring over time (Ayerbe et al 2013)
Of 750 patients who participated in the PROPOLIS study, 698 patients had an ischemic stroke or transient ischemic attack (TIA)
The predictors of 3-month poor functional outcome were: age, National Institute of Health Stroke Scale (NIHSS) score on admission, pre-stroke cognitive decline, Neuropsychiatric Inventory (NPI) score, and delirium
Summary
The prevalence of depression after stroke is about 30% and remains stable up to 10 years, with a cumulative incidence of 39–52% within 5 years after stroke (Ayerbe et al 2013; Hackett and Pickles 2014).Post-stroke depression is associated with worse functional outcome (Ayerbe et al 2013; Kutlubaev and Hackett 2014), increased mortality (Bartoli et al 2013), a higher risk of recurrent stroke (Sibolt et al 2013) and lower quality of life (Ayerbe et al 2013).Longitudinal studies that examined the natural history of post-stroke depression demonstrated a dynamic course of depressive symptoms, with new cases and recovery from depression occurring over time (Ayerbe et al 2013). Post-stroke depressive symptoms could be transient, occurring early or late after stroke onset and lasting only few months, or chronic. We aimed to determine whether outcomes (3- and 12-month functional outcome, and 12-month case fatality) vary among patients with different trajectories of post-stroke depressive symptoms. Post-stroke depressive symptoms (DS) can be chronic or transient, occurring shortly or long after stroke and lasting only few months. It remains unclear if the prognosis differs between patients with DS in the acute phase of stroke and those who develop DS several months later. We aimed to determine whether outcomes vary among patients with different trajectories of post-stroke depressive symptoms. Patients who only have later DS have the worst prognosis
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