Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors

Anna Carnes-Vendrell,Francisco Purroy,Josep Pifarré,Jessica Molina-Seguin,Joan Deus

doi:10.1038/s41598-019-52721-5

Abstract

Few previous studies have focused on affective impairment after transient ischemic attack (TIA) and/or minor stroke. The aim was to establish the prevalence, evolution and predictors of post-stroke depression (PSD) and post-stroke apathy (PSA) over a 12-month follow-up period. We prospectively included TIA and minor stroke patients (NIHSS ≤4) who had undergone magnetic resonance imaging <7 days. PSD was diagnosed according to DSM-5 criteria and PSA was defined based on an Apathy Evaluation Scale (AES-C) score of ≥37. Clinical and neuroimaging variables (presence and patterns of lesion, cerebral bleeds and white matter disease) were analysed in order to find potential predictors for PSD and PSA. Follow-up was performed at 10 days and after 2, 6, 9 and 12 months. 82 patients were included (mean 66.4 [standard deviation11.0] years) of whom 70 completed the follow-up. At 10 days, 36 (43.9%) and 28 (34.1%) patients respectively were diagnosed with PSD and PSA. At 12 months, 25 of 70 (35.7%) patients still had PSA, but only 6 of 70 (8.6%) had PSD. Beck Depression Inventory-II score, mini mental state examination (MMSE) and a previous history of depression or anxiety were predictors for PSD. While MMSE score, The Montgomery Asberg Depression Rating Scale and having previously suffered a stroke were also risk factors for PSA. Acute basal ganglia lesion and periventricular leukoaraiosis were associated with PSA while deep leukorariosis with PSD. Despite the presence of few or only transient symptoms, PSD and PSA frequent appear early after TIA and minor stroke. Unlike PSD, apathy tends to persist during follow-up.

Highlights

Apathy and depression may appear together, and the former may be a symptom or expression of the latter, it has been shown that apathy can occur as an independent symptom of depression[7]
Of the 82 patients, 42 suffered a minor stroke and 40 suffered a transient ischemic attack (TIA). 48 of the 130 eligible patients declined to participate in the study, mainly because they refused to go to the hospital to do the visits
There were no significant differences between the sociodemographic characteristics of the patients who participated in the study and those who did not. 12 patients dropped out, basically for the same reasons as previous stated, during the first or second follow-up visit stage

Summary

Introduction

Apathy and depression may appear together, and the former may be a symptom or expression of the latter, it has been shown that apathy can occur as an independent symptom of depression[7]. It has been shown that PSA is consistently associated with a worse level of functional recovery, poorer overall health and poorer quality of life[9,11,12]. In both cases, a number of predictors have been described. Biomedical Research Institute of Lleida (IRBLleida) Universitat de Lleida, Lleida, Spain. Diffusion-weighted imaging could detect signs of acute ischemia in 30% of TIA patients. Besides their transient symptoms, these lesions could increase the risk of cognitive and affective impairment. Our aim was to determine the prevalence, predictors and evolution of symptoms of post-stroke depression and post-stroke apathy in TIA and minor stroke patients during the first post-stroke year

Objectives

Methods

Results

Conclusion