Ischemic stroke and depression

Abstract

P219 Objective: To investigate the frequency and clinical determinants of depression after ischemic stroke. Methods: We administered the Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH-D) and neurological, neuropsychological, and functional assessments to 421 patients (age = 71.5 ± 8.0 years) three months after ischemic stroke and 249 stroke-free control subjects. We required a SIGH-D total score > 11 for the identification of clinically significant depression. Results: We identified clinically significant depression in 47 of the 421 patients (11.2%) and 13 of the 249 control subjects (5.2%), yielding an unadjusted odds ratio (OR) of 2.3 (95% confidence interval, 1.2 to 4.3) for depression associated with stroke. Logistic regression suggested that depression was independently associated with dementia (OR, 3.2), a major hemispheral stroke syndrome (OR, 1.7), infarcts in the anterior and posterior cerebral artery territories vs. infarcts in other vascular territories (OR, 1.6), and female sex (OR, 1.7). When present, depression tended to be mild and typically remitted in follow-up examinations. Somatic SIGH-D items but not depressed mood best distinguished stroke patients from control subjects and demented from nondemented stroke patients. Conclusions: Depression was less frequent, less severe, and less persistent in our stroke cohort than previously reported, possibly due to the underrepresentation of patients with a premorbid history of affective illness. It was associated with more severe stroke, particularly in vascular territories that supply limbic structures, and it was more frequent among patients with dementia and women. Somatic symptoms but not depressed mood best distinguished stroke patients from control subjects and demented from nondemented stroke patients, however, suggesting that stroke is more likely to be associated with a “pseudo-depression of dementia” than a “pseudo-dementia of depression.”