Abstract
Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions.
Highlights
Stroke is one of the leading causes of death and disability globally
We explored the relationship between stroke, inflammation and depression, based on systematic review as described below
Serum IL-18 on day 7 after admission may predict the risk of post-stroke depression both at the acute stage of stroke and at 6 months post-stroke
Summary
Stroke is one of the leading causes of death and disability globally. There are 16 million strokes annually, with 6 million deaths and another 5.5 million left with significant disability with enormous health, social and economic impact worldwide [1]. Depression is responsible for heavy global societal burden with more than 258 million people worldwide with rising rates globally [5,6,7,8]. Both stroke and depression have been associated with increased inflammatory activation of the immune system causing negative health impacts in both conditions. Articles in English, involving human subjects and published between 2005 and 2020 were considered (several key pre-2005 publications from first author’s personal collection were considered). The following databases were searched with the following keywords: stroke; depression; inflammation and neuroanatomy. Publications were reviewed in terms of the sample size, design and reliability of data collection
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