Abstract
BackgroundApathy and depression are important neuropsychiatric disorders that can occur after a stroke but the etiology and risk factors are not well understood. The purpose of this study was to identify risk factors for apathy and depression following a stroke.MethodsPatients with an acute stroke who met the inclusion criteria were recruited from our hospital, and general information was recorded from patient charts. The Apathy Evaluation Scale, Clinician Version (AES-C) was used to evaluate these patients within 2 weeks after the stroke. The Montreal Cognitive Assessment (MoCA), mini-mental state examination (MMSE), Hamilton Depression Scale (HAMD), Mattis Dementia Rating Scale Initiation/Perseveration subset (MDRS I/P), Frontal Assessment Battery (FAB) and Stroop Color-Word Association Test were employed to evaluate emotion, cognitive function and executive function. The patients were divided into two groups: the apathy group and the non-apathy group. We also divided the patients into two groups based on whether or not they had post-stroke depression. The clinical characteristics and scores on the MoCA, MMSE, HAMD and MDRS I/P were compared between the apathy and non-apathy groups as well as between patients with and without depression. Logistic regression analysis was performed to identify risk factors for apathy and depression following a stroke.ResultsA total of 75 patients with acute stroke were recruited. Of these, 25 (33.3%) developed apathy and 12 (16%) developed depression. Multivariate logistic regression analysis indicated that a history of cerebrovascular disease (OR: 6.45, 95% CI: 1.48-28.05, P = 0.013), low HbA1c (OR: 0.31, 95% CI: 0.12-0.81, P = 0.017) and a low MDRS I/P score (OR: 0.84, 95% CI: 0.74, 0.96, P = 0.010) were risk factors for post-stroke apathy. Additionally, multivariate logistic regression indicated that a low MDRS I/P (OR: 0.85, 95% CI: 0.75, 0.97, P = 0.015) was associated with post-stroke depression.ConclusionsThree risk factors for post-stroke apathy were identified as a history of cerebrovascular disease, low HbA1c and lower MDRS I/P scores. A low MDRS I/P score was also identified as a risk factor for post-stroke depression. These results may be useful to clinicians in recognizing and treating apathy and depression in patients after a stroke.
Highlights
Apathy and depression are important neuropsychiatric disorders that can occur after a stroke but the etiology and risk factors are not well understood
The results of multivariate logistic regression indicated that a low MDRS I/P
A low MDRS I/P score was identified as a predictor of post-stroke depression
Summary
Apathy and depression are important neuropsychiatric disorders that can occur after a stroke but the etiology and risk factors are not well understood. The purpose of this study was to identify risk factors for apathy and depression following a stroke. Apathy and depression are important neuropsychiatric symptoms that can occur after a stroke and may be the core symptoms in some stroke patients [1,2]. It has been reported that in the acute phase of a stroke, 15.2-71% of patients demonstrate apathy [3]. It is important to identify stroke patients who are apathetic and to make the distinction between apathy and depression for several reasons: apathy increases the burden on caregivers, apathetic patients have been found to require longer hospitalizations and patients with apathy tend to participate less in rehabilitation [4].
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