Cerebral Small Vessel Disease Burden Is Associated With Poststroke Depressive Symptoms: A 15-Month Prospective Study.

Yan Liang,Vincent Chung-Tong Mok,Yang-Kun Chen,De-Feng Wang,Wai-Kwong Tang,Gabor S Ungvari,Winnie Chiu-Wing Chu,Hee-Ju Kang

doi:10.3389/fnagi.2018.00046

Abstract

Objective: All types of cerebral small vessel disease (SVD) markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds, and perivascular spaces were found to be associated with poststroke depressive symptoms (PDS). This study explored whether the combination of the four markers constituting an overall SVD burden was associated with PDS.Methods: A cohort of 563 patients with acute ischemic stroke were followed over a 15-month period after the index stroke. A score of ≥7 on the 15-item Geriatric Depression Scale was defined as clinically significant PDS. Scores of the four SVD markers ascertained on magnetic resonance imaging were summed up to represent total SVD burden. The association between SVD burden and PDS was assessed with generalized estimating equation models.Results: The study sample had a mean age of 67.0 ± 10.2 years and mild-moderate stroke [National Institutes of Health Stroke Scale score: 3, interquartile, 1–5]. PDS were found in 18.3%, 11.6%, and 12.3% of the sample at 3, 9, and 15 months after stroke, respectively. After adjusting for demographic characteristics, vascular risk factors, social support, stroke severity, physical and cognitive functions, and size and locations of stroke, the SVD burden was associated with an increased risk of PDS [odds ratio = 1.30; 95% confidence interval = 1.07–1.58; p = 0.010]. Other significant predictors of PDS were time of assessment, female sex, smoking, number of acute infarcts, functional independence, and social support.Conclusion: SVD burden was associated with PDS examined over a 15-month follow-up in patients with mild to moderate acute ischemic stroke.

Highlights

Poststroke depression (PSD) is associated with higher risk of mortality, disability, and poor quality of life (Towfighi et al, 2017)
After adjusting for demographic characteristics, vascular risk factors, social support, stroke severity, physical and cognitive functions, and size and locations of stroke, the small vessel disease (SVD) burden was associated with an increased risk of poststroke depressive symptoms (PDS) [odds ratio = 1.30; 95% confidence interval = 1.07–1.58; p = 0.010]
SVD burden was associated with PDS examined over a 15-month follow-up in patients with mild to moderate acute ischemic stroke

Summary

Introduction

Poststroke depression (PSD) is associated with higher risk of mortality, disability, and poor quality of life (Towfighi et al, 2017). Cerebral small vessel disease (SVD) is a composite term for a variety of chronic cerebral microvascular lesions resulting from aging, vascular risk factors or unknown etiologies (Wardlaw et al, 2013). A “SVD score” that includes the above four MRI markers was recently proposed to quantify the global damage to the small vessels of the brain caused by SVD (Staals et al, 2014). The SVD burden is associated with cognitive decline in hypertension (Uiterwijk et al, 2016), poststroke disability (Arba et al, 2017a), recurrence of stroke (Lau et al, 2017), poor quality of life of stroke survivors (Liang et al, 2017), and depression after lacunar stroke (Zhang X. et al, 2017)

Methods

Results

Discussion

Conclusion