Post-stroke Depression Patients Research Articles

Abnormal intrinsic functional hubs and connectivity in patients with post-stroke depression.

The present study aimed to investigate the specific alterations of brain networks in patients with post-stroke depression (PSD), and further assist in elucidating the brain mechanisms underlying the PSD which would provide supporting evidence for early diagnosis and interventions for the disease. Resting-state functional magnetic resonace imaging data were acquired from 82 nondepressed stroke patients (Stroke), 39 PSD patients, and 74 healthy controls (HC). Voxel-wise degree centrality (DC) conjoined with seed-based functional connectivity (FC) analyses were performed to investigate the PSD-related connectivity alterations. The relationship between these alterations and depression severity was further examined in PSD patients. Relative to both Stroke and HC groups, (1) PSD showed increased centrality in regions within the default mode network (DMN), including contralesional angular gyrus (ANG), posterior cingulate cortex (PCC), and hippocampus (HIP). DC values in contralesional ANG positively correlated with the Patient Health Questionnaire-9 (PHQ-9) scores in PSD group. (2) PSD exhibited increased connectivity between these three seeds showing altered DC and regions within the DMN: bilateral medial prefrontal cortex and middle temporal gyrus and ipsilesional superior parietal gyrus, and regions outside the DMN: bilateral calcarine, ipsilesional inferior occipital gyrus and contralesional lingual gyrus, while decreased connectivity between contralesional ANG and contralesional supramarginal gyrus. Moreover, these FC alterations could predict PHQ-9 scores in PSD group. These findings highlight that PSD was related with increased functional connectivity strength in some areas within the DMN, which might be attribute to the specific alterations of connectivity between within DMN and outside DMN regions in PSD.

Increased C-Reactive Protein in Patients with Post-Stroke Depression: A Meta-analysis of Cohort Study.

Pathophysiological mechanisms and related biological markers for post-stroke depression (PSD) are unknown. Some studies have noted that C-reactive protein (CRP) is activated in the serum of PSD patients. We aim to quantitatively summarize the concentrations of CRP in PSD patients compared to non-PSD patients. Original studies evaluating the association between CRP and PSD were searched in 4 specific databases from the establishment of the databases to March 2023. RevMan 5.20 and Stata 11.0 statistical software were used for meta-analysis. Publication bias was tested by Egger's test. The CRP level were combined by standardized mean difference (SMD) with 95% confidence interval (CI). A total of 43 relevant literatures were retrieved, while 13 cohort studies were collected. The heterogeneity test result of the level of CRP in patients with PSD vs. non-PSD was (Q = 98.38, P < .001, I2 = 88%). The combined value of the estimated effect was [SMD = 0.34, 95% CI (0.12-0.56); P = .003]. Sensitivity analysis indicated that no study had a remarkable influence on the result of the pooled estimate. Egger's test was used to test the bias and the result was (Egger's test, P = .548), suggesting that there was no publication bias, and the results were credible. We found that different depression evaluation criteria (P = .035) and stroke types (P = .024) were considered as influencing factors for potential sources of heterogeneity. In conclusion, compared to those without depressive symptoms, patients with post-stroke depression have higher concentrations of CRP in the blood.

The factors influencing the occurrence of post-ischemic stroke depression and its relationship with the burden score of cerebral small vessel disease.

This study explored the determinants of post-stroke depression (PSD) in ischemic stroke (AIS) patients and its association with the burden score of cerebral small vessel disease (CSVD). We analyzed 374 AIS patients treated between January 2020 and January 2022. Patients were categorized into 90 with PSD and 284 without PSD, enabling an investigation into PSD risk factors and the CSVD-PSD relationship. There was no significant difference in health factors between PSD and non-PSD patients (p>0.05). However, significant disparities were noted in age, gender, initial Barthel Index (BI), Mini-Mental State Examination (MMSE) score, plasma fibrinogen, homocysteine, red cell distribution width, National Institutes of Health Stroke Scale (NIHSS) score, and CSVD burden score (p<0.05). Regression analysis indicated that these variables were pivotal PSD predictors (OR>1, p<0.05). Surprisingly, a positive correlation with PSD occurrence was found for age, NIHSS score, plasma fibrinogen, homocysteine levels, red cell distribution width, CSVD burden score (r=0.565, 0.615, 0.482, 0.514, 0.572, 0.608, respectively; p<0.05). Meanwhile, the MMSE score and BI index were inversely related to PSD onset (r=-0.604, -0.590; p<0.05). The ROC curve analysis of the combination model based on MMSE, NIHSS and CSVD score revealed an AUC of 0.926 and Youden's index of 0.744. Age, MMSE score, BI index, NIHSS score, plasma fibrinogen concentration, homocysteine level, red blood cell distribution width, and CSVD burden score are all major influencing factors in the occurrence of PSD. The combination model based on MMSE, NIHSS, and CSVD scores presented a valuable approach to predicting PSD.

Transcutaneous auricular vagus nerve stimulation for post-stroke depression: A double-blind, randomized, placebo-controlled trial

BackgroundIt is a well-established fact that post-stroke depression (PSD) is a prevalent condition that affects a significant proportion of individuals who have suffered a stroke. Hence, our research endeavors to explore the safety, efficacy and the potential molecular mechanism of transcutaneous auricular vagus nerve stimulation (ta-VNS) for the treatment of depression in PSD patients by conducting a double-blind, sham-controlled, randomized trial. MethodsPatients who had experienced strokes and exhibited depressive symptoms, with a Hamilton Depression Scale (HAMD-17) score of ≥8 and met the DSM-IV criteria, were diagnosed with PSD. A volunteer sample of participants (N = 80) were randomly divided into either the ta-VNS group (which received ta-VNS in addition to conventional treatment) or the control group (which received conventional treatment only), in a 1:1 ratio. The effectiveness of the interventions was evaluated using the 17-item Hamilton Rating Scale for Depression (HAMD-17), Zung Self-Rating Depression Scale (SDS), and Barthel Index (BI) scores. Furthermore, Plasma BDNF, CREB1, and 5-HT levels were measured before and after treatment. ResultsThe concomitant application of ta-VNS demonstrated a remarkable reduction in HAMD-17 and SDS scores, leading to noteworthy enhancements in patients' daily functioning, as evidenced by improved activities of daily living, at all assessed time points, in contrast to the control group (p < 0.0001). Notably, the ta-VNS group exhibited superior effects in modulating the measured neurotrophic biomarkers when compared to the control group (p < 0.05). ConclusionsThe synergistic approach of combining ta-VNS with conventional treatment has demonstrated remarkable efficacy and tolerability in managing depression following a stroke.

Paroxetine Effect on Nerve Growth Factor, Human Neurotrophin-4, Brain-Derived Neurotrophic Factor Levels in Post-stroke Depression.

The aim of this study is to explore paroxetine's effect on nerve growth factor (NGF), human neurotrophin-4 (NT-4), and brain-derived neurotrophic factor (BDNF) levels in post-stroke depression. Ninety-two post-stroke depression patients from April 2021 to April 2023 in our hospital were selected and numbered 1 to 92 after enrollment. Forty-six patients with odd number and 46 patients with even number were, respectively, included in the control and observation group. In addition to basic treatment, control group was treated with flupentixol melitracen tablets orally, and observation group received paroxetine hydrochloride orally. The levels of NGF, NT-4, BDNF, 5-hydroxytryptamine (5-HT), homocysteine (Hcy), noradrenaline (NE), Hamilton Depression Scale (HAMD) changes of National Institute of Health Stroke Scale (NIHSS). NGF, NT-4, and BDNF levels were compared between groups at T0, T1, and T2 levels were higher, and the levels at T2 were higher than those at T1, and observation group levels were higher (P < 0.05); NGF, NT-4, and BDNF levels were compared among groups, time, and interaction. 5-HT, Hcy, and NE levels at T0 were compared between groups; 5-HT and NE levels at T1 and T2 were higher than those at T0, the levels at T2 were higher than those at T1, and observation group levels were higher (P < 0.05); Hcy level at T1 and T2 was lower, its level at T2 was lower than those at T1, and observation group levels were lower (P < 0.05); 5-HT, Hcy, and NE levels were compared among groups, time, and interaction (P < 0.05). HAMD and NIHSS at T0 were compared; T1 and T2 were lower than T0, T2 was lower than T1, and observation group was lower (P < 0.05); HAMD and NIHSS were compared among groups, time, and interaction (P < 0.05). For post-stroke depression, paroxetine treatment can effectively improve NGF, NT-4, BDNF, 5-HT, Hcy, and NE levels and effectively reduce the degree of neurological damage and depression, which has high clinical application value.

Alteration of gut microbiota in post-stroke depression patients with Helicobacter pylori infection

Background: Several studies have identified an association between the gut microbiome and post-stroke depression(PSD), and Helicobacter pylori(H. pylori) infection cause significant alterations in the composition of the gastrointestinal microbiome. However, evidence regarding the role of the H. pylori infection in promoting PSD is still lacking. Here, we conducted a retrospective study to explore risk factors associated with PSD.Methods: Patients with cerebral infarction were consecutively enrolled from December 2021 to October 2022. The diagnosis of PSD is based on the DSM-V criteria, and the Hamilton Depression Rating Scale(HAMD) was used to identify patients with PSD. White matter lesions were evaluated using magnetic resonance imaging(MRI) and H. pylori infection was detected by 13C-urea breath test. Further, 16S rRNA gene sequencing was used to evaluate the changes in gut microbiota composition of fecal samples from PSD patients. The concentration of short-chain fatty acids(SCFAs) was determined by gas chromatography–mass spectrometry(GC–MS).Results: Multivariate regression analysis showed that deep white matter lesions(DWMLs) [odds ratio(OR) 3.382, 95% confidence interval(CI) 1.756–6.512; P = 0.001] and H. pylori infection(OR 2.186, 95% CI 1.149–4.159; P = 0.017) were the independent risk factors for PSD. Patients with H. pylori infection had more severe depressive symptoms than patients without infection. Intestinal microbiota was significantly different between H. pylori-positive PSD[H. pylori(+)] patients and H. pylori-negative PSD[H. pylori (−)] patients. Fecal SCFAs concentrations were significantly reduced in the H. pylori(+) group compared to the negative ones.Conclusion: DWMLs and H. pylori infection may play important roles in the development of PSD. H. pylori infection is likely to be involved in the pathogenesis of PSD by altering the intestinal flora.

Study on the Efficacy of Shugan Jieyu Capsules Combined with Trazodone in Patients with PostStroke Depression and Insomnia

Objective: To analyze the effectiveness of applying ShuGan JieYu Capsules (SGJYC) combined with trazodone in patients with post-stroke depression (PSD) with insomnia. Methods: 60 cases of PSD with insomnia patients admitted to the hospital from May 2022 to May 2023 were selected and randomly divided into a reference group (trazodone) and a research group (SGJYC combined with trazodone) of 30 cases each. Statistics were analyzed using the Hamilton Depression Rating Scale (HAM-D), Pittsburgh Sleep Quality Index (PSQI), and Activities of Daily Living (ADL) scale before treatment and 4, 8, and 12 weeks after treatment. Results: Before treatment, The results of HAM-D, PSQI, and ADL scale studies in the two groups before treatment were not statistically significant (P &gt; 0.05); 4, 8, and 12 weeks after treatment, the results of HAM-D and PSQI studies in the research group were lower than that of the reference group, and the results of ADL scale studies were higher than that of the reference group. There was a significant difference between the groups (P &lt; 0.05). The total adverse reaction rate of the research group was lower than that of the reference group, and there was a significant difference between the groups (P &lt; 0.05). Conclusion: The combination of SGJYC and trazodone reduced depression in post-stroke patients, corrected insomnia, improved sleep quality, was safe, and had a low rate of adverse reactions.

Abstract TP239: Vitamin D and Post-Stroke Depression: A Systematic Review and Meta-Analysis

Objective: Low vitamin D levels have often been associated with depression as well as worsen stroke outcomes. With post-stroke depression (PSD) being an important factor contributing to poor recovery and rehabilitation and thereby poor functional outcomes, this study was undertaken to explore the role of vitamin D deficiency in PSD and their correlation with stroke prognosis and outcomes. Methods: A systematic search of eligible studies from PubMed, MEDLINE, Cochrane CENTRAL, and Google Scholar were identified. Selected studies were those that met the inclusion criteria. Statistical analysis was conducted using Review Manager 5.4.1. A random-effects model was used to pool the data when heterogeneity was seen and so,results were reported in the standard mean differences within their corresponding 95% confidence interval. Results: Our analysis showed statistically significant clinical depression in the Vitamin D deficient group on the BDIII (SMD= 6.90 [3.32, 10.48]; p= 0.0002) and PHQ-9 (SMD= 3.20 [1.84, 4.56]; p&lt; 0.00001) scales. Of the seven studies, four showed significantly poorer prognosis in PSD patients with respect to NIHSS (SMD=1.54; [0.34, 2.74]; p&lt; 0.0001) and MMSE (SMD= -2.53 [3.79, 1.27]; p&lt; 0.0001). Conclusion: This study shows a significant association between serum Vitamin D levels and PSD. Further studies are needed to explore causal relationships and the effect of vitamin supplementation on stroke prognosis and outcomes in relation to PSD

Abstract TP24: C-Reactive Protein, and Homocysteine as a Predictors of Post Stroke Depression Among Stroke Patients: A Meta-Analysis and Meta Regression

Background: Post-stroke depression (PSD) is a common neuropsychiatric complication of stroke associated with poor functional outcome and increased mortality. Its pathophysiology is poorly understood, however, evidence suggests that neuroinflammation in reaction to the stroke could play a role in the development of PSD. Aim: To compare C-reactive protein (CRP), and homocysteine (Hcy) levels in post-stroke patients with and without PSD. Methods: We systematically searched all electronic databases from inception until May 30th 2023. We performed a conventional meta-analysis and adopted the DerSimonian and Laird random-effect model for the study variations [30]. Outcomes were reported as standard mean difference (SMD), and their corresponding 95% confidence interval (95% CI). Results: A total of 12 studies with 3,230 Patients were included in this analysis. The mean age of the overall cohort was 65.7 years with PSD patients appearing to be older than non-PSD patients (mean 68.3 years versus 63.1 years). In terms of gender distribution, there were more females in the PSD group compared with non-PSD groups (44.4% versus 40.7%). Compared to patients without post-stroke depression, it was found that patients with post-stroke depression had a higher levels of baseline CRP levels [SMD 0.16, (95% CI 0.08 to 0.25), p&lt;0.001], and Hcy [SMD 0.14, (95% CI 0.05 to 0.22), p&lt;0.001]. Meta-regression was performed using covariates including age, female gender, hypertension, diabetes mellitus, CAD, widowhood and family history of psychiatric disorder. For CRP there was no effect modifier, while for Hcy it was observed that a personal history of widowhood appeared as an only significant effect modifier (coefficient 1.998, p=0.038). Conclusion: Elevated baseline levels of CRP and Hcy were significantly higher in patients that developed PSD, suggesting that both could play a role in the pathophysiology of PSD and as a potential biomarker for diagnosing risk of depression post stroke.

Correlation of Circadian Rhythms and Improvement of Depressive Symptoms in Acute Ischemic Stroke Patients.

To investigate the correlation between evening melatonin timing secretion, dim light melatonin onset (DLMO), and post-stroke depression (PSD) in acute ischemic stroke (AIS) patients and their influence on the improvement of depressive symptoms. 120 patients with a recent magnetic resonance imaging confirmed stroke were included. Salivary melatonin samples were collected at 5 time points within 1 week after hospitalization (7 p.m.-11 p.m., 1 sample per hour). The circadian phase was defined by calculating DLMO secretion. Post-stroke depressive symptoms were evaluated by the 17-item Hamilton Rating Scale for Depression (HRSD) both on day 7 of hospitalization and 3 months after stroke. Patients were divided into PSD and non-PSD groups based on whether the acute phase HRSD score was ≥8. Similarly, patients were divided into the improved depressive symptoms (IDS) and no improvement in depressive symptoms (non-IDS) groups based on whether the HRSD score at 3 months was lower than at baseline. Neurological recovery at 3 months was assessed using the modified Rankin Scale (mRS). The difference in DLMO between PSD and non-PSD patients was not statistically significant (p =0.173). In the non-IDS group, there was a significant decrease in melatonin secretion at 10 p.m. (p =0.012), and DLMO was significantly later than in the IDS group (p =0.017). Logistic regression analysis showed that DLMO (OR 1.91, 95%CI:1.13-3.23, p = 0.016) was an independent risk factor for persistent no improvement in depressive symptoms, which was associated with a markedly worse prognosis (p <0.001). Our findings suggest possible interventions for the very early identification of non- IDS patients.

Efficacy and safety of acupuncture treatment for post-stroke depression: A protocol for systematic review and meta-analysis.

Post-stroke depression is a common complication of stroke, with a high incidence rate and low recognition rate. Many patients do not receive effective intervention at the onset, which affects subsequent treatment outcomes. Post-stroke depression not only impacts the patient's mental well-being but also increases the risk of stroke recurrence and poor prognosis. Therefore, it has become a significant public health concern. Acupuncture has gained significant popularity in the treatment of post-stroke depression. However, there are inconsistent clinical research results regarding its efficacy and safety. This systematic review aims to gather and critically assess all available evidence regarding the effectiveness and safety of acupuncture in the treatment of post-stroke depression in patients. We will conduct thorough searches for relevant studies in multiple electronic databases (PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, VIP Database, Wan-fang Data and China Biomedical Database). Our search scope will encompass studies published from the inception of each database until September 2023. To evaluate the potential bias in all the included studies, we will adhere to the guidelines offered in the Cochrane Handbook. The total effective rate will be the primary outcome. To conduct a systematic review, we will employ RevMan 5.4 software. This study will obtain efficacy and safety of acupuncture for the treatment of post-stroke depression. The conclusions of this study will provide evidence-based perspectives that can guide clinical decision-making regarding the practicality and recommended timing of using acupuncture to treat post-stroke depression. Furthermore, this study will help advance the clinical application of acupuncture treatment for post-stroke depression and enhance its efficacy while ensuring patient safety.

Relationship between TIM3 Expression on Peripheral T Lymphocytes and Post-Stroke Depression.

T cell immunoglobulin and mucin domain-containing protein 3 (TIM3) is a regulatory molecule expressed on a variety of cell types, including CD3+ T cells. Few studies have been conducted to look into the correlation between TIM3 expression on peripheral T lymphocytes and post-stroke depression (PSD). To investigate the relationship between TIM3 expressions on peripheral T lymphocytes in PSD patients. Acute stroke patients without depression (NPSD) (n=65), PSD patients (n=23), and body mass index (BMI), age, and education-matched healthy controls (HC) (n=59) were enrolled. Using flow cytometry, TIM3 expression was examined in the peripheral CD3+ CD4+ and CD3+ CD8+ T lymphocytes. Evaluation of the depressive severity in PSD patients was assessed using a 17-item Hamilton Depression Rating Scale (HAM-D-17). We used enzyme-linked immunosorbent assay (ELISA) to determine the serum concentrations of IL-1β, IL-6, IL-10, and IL-18. We further assessed the relationships between TIM3 expression, serum cytokine levels, and the HAM-D-17 scores. CD3+ CD4+ T cells reduced significantly in PSD patients compared with the NPSD patients and HC. Both NPSD patients and PSD patients had a significant increase in TIM3 expression in their peripheral CD3+ CD4+ T lymphocytes, compared with HC. In PSD patients, a higher frequency of peripheral CD3+ CD8+ T lymphocytes showed significant expression of TIM3 compared to NPSD patients and HC. High TIM3 level on peripheral CD3+ CD8+ T lymphocytes was positively associated with the HAM-D score. Patients with PSD exhibit immune dysfunction. TIM3 might contribute to the development and severity of PSD, making it a potential therapeutic target.

Association between thyroid hormone levels in the acute stage of stroke and risk of poststroke depression: A meta-analysis.

Thyroid hormones have been indicated to be associated with depression, but their relationship with poststroke depression (PSD) remains controversial. Therefore, we performed a meta-analysis to explore the correlation between thyroid hormone levels in acute stroke and PSD. We searched databases for eligible studies. Standard mean differences (SMD) and 95% confidence intervals (CI) were applied to evaluate the association among levels of thyroid hormones, including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), in acute stroke patients and the risk of PSD. A total of 13 studies were included in the analysis. Compared to non-PSD patients, PSD patients had remarkably lower serum TSH and FT3 levels (TSH: SMD=-0.59, 95%CI=-1.04 to -.15, p=.009; FT3: SMD=-0.40, 95%CI=-.51 to -.30, p=.000) and higher serum FT4 levels (SMD=0.33, 95%CI=.07-.59, p=.013). Subgroup analysis showed that there may be a more statistically significant association between FT3 and the risk of PSD compared to TSH and FT4. Our results suggested that patients with lower serum TSH and FT3 levels as well as higher serum FT4 levels in the acute stage of stroke may be more susceptible to PSD.

Poststroke depression within the first year – phenomenology and clinical correlates from real-world data

BackgroundStudies of poststroke depression (PSD) in Singapore are limited. Specifically, the dynamic epidemiology and phenomenology of PSD in the different stroke types are unknown. ObjectivesThis study aims to characterize the epidemiology and phenomenology of PSD in both the hospital setting, and in the community setting up to one year after stroke. MethodsReal-world clinical data of 1732 consecutive stroke patients in a tertiary stroke centre was extracted from inception in January 2010 to 30 November 2021. The Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ) were used to identify PSD. Demographic, comorbidities and stroke-related variables, and stroke severity were extracted and analysed by stroke type – ischemic, haemorrhagic, and strategic, at the hospitalisation and community follow-up cross-sections. For each group, the characteristics of those with PSD were compared against those without PSD. Logistic regression was performed to identify PSD predictors. Phenomenology was mapped by the relative frequencies of endorsed items on PHQ and HADS in PSD patients. ResultsThe prevalence of in-hospital PSD was 19.24 % in ischemic stroke, and 24.59 % in both haemorrhagic strokes and strategic basal ganglia/thalamus strokes. Prevalence of PSD in 547 stroke patients who were followed-up ≤ 12 months was 6.42 % in ischemic strokes, 3.52 % in haemorrhagic strokes and 5.23 % among strategic strokes. The association of right sided, bilateral strokes, strategic strokes, and large vessel aetiology with PSD only exists for ischemic strokes. Greater functional impairment and a past psychiatric history are independent predictive factors of PSD in all stroke types. Symptom profile of in-hospital PSD includes anxious distress. ConclusionThese findings have immediate clinical applicability considering the representativeness of the study sample.

High-frequency rTMS of the left dorsolateral prefrontal cortex for post-stroke depression: A systematic review and meta-analysis

ObjectiveThis meta-analysis investigated the therapeutic efficacy of high-frequency repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) for treatment of post-stroke depression (PSD). MethodsTen articles with 266 patients in rTMS group and 258 patients in control group were included. The primary outcome was performed to examine the efficacy of rTMS for PSD. Secondary outcomes of response rates and remission rates and subgroup analyses were further explored. ResultsOur meta-analysis revealed a significant pooled effect size (the standard mean difference (SMD) was −1.45 points (95% CI, −2.04 to −0.86; p < 0.00001)). The odds ratio (OR) of the response rate and remission rate were 8.41 (95% CI, 2.52–28.12, p = 0.0005) and 6.04 (95% CI, 1.5–24.39, p = 0.01). Moreover, rTMS treatment for PSD patients in subacute phase and targeting the left DLPFC at 5-cm anterior to the left motor hotspot or the midpoint of the middle frontal gyrus showed significant antidepressant effect. In addition, the Hamilton Depression Rating Scale (HAMD) was sensitive to detect depressive changes in patients. ConclusionsOur meta-analysis elucidated that the application of high-frequency rTMS over the left DLPFC was an effective treatment alternative for PSD. SignificanceOur meta-analysis may help to develop more reasonable treatment strategies in clinical practice for PSD patients.

Effectiveness of a family-based program for post-stroke patients and families: A cluster randomized controlled trial

ObjectiveTo examine the effectiveness of a family-based program for post-stroke patients and their families. MethodsA cluster randomized controlled trial design was used. Participants were randomly selected in the experimental group (3 districts) and the comparison group (3 districts), with 62 families recruited. Sixty-two persons with new stroke and families (family caregivers and family members) who met the inclusion criteria were assigned to two groups, 31 in each group. Using the Neuman System Model as a framework, we implemented the stressors assessment and family-based intervention into the program. Participants in the comparison group received usual care, and those in the experimental group underwent a stressors assessment and received the family-based program. Measurement of functional status, depression, and complications in post-stroke patients and family function in family caregivers and family members, as well as caregiver burden and caregiver stress in family caregivers, were assessed at baseline, 4 weeks, and 12 weeks after enrollment. Data analysis included descriptive statistics, the chi-square test, Bonferroni test, and repeated measures analysis of variance. ResultsAfter participating in a 12-week family-based program, post-stroke patients in the experimental group showed statistically significant improvements in their functional status and decreased depression compared to the comparison group (P < 0.05). The family function of the experimental group was significantly improved, and caregivers’ burden and stress were decreased compared to the comparison group (P < 0.05). Three patients in the experimental group and seven in the comparison group experienced complications. ConclusionsThe study findings suggest that the present family-based program improved family function in family caregivers and family members and decreased caregiver burden and stress in family caregivers. The program also improved functional status and reduced depression in post-stroke patients. It is suggested the duration of the program be extended to assess its sustainable effectiveness.

The characteristics of brain network in patient with post-stroke depression under cognitive task condition.

Post-stroke depression (PSD) may be associated with the altered brain network property. This study aimed at exploring the brain network characteristics of PSD under the classic cognitive task, i.e., the oddball task, in order to promote our understanding of the pathogenesis and the diagnosis of PSD. Nineteen stroke survivors with PSD and 18 stroke survivors with no PSD (non-PSD) were recruited. The functional near-infrared spectroscopy (fNIRS) covering the dorsolateral prefrontal cortex was recorded during the oddball task state and the resting state. The brain network characteristics were extracted using the graph theory and compared between the PSD and the non-PSD subjects. In addition, the classification performance between the PSD and non-PSD subjects was evaluated using features in the resting and the task state, respectively. Compared with the resting state, more brain network characteristics in the task state showed significant differences between the PSD and non-PSD groups, resulting in better classification performance. In the task state, the assortativity, clustering coefficient, characteristic path length, and local efficiency of the PSD subjects was larger compared with the non-PSD subjects while the global efficiency of the PSD subjects was smaller than that of the non-PSD subjects. The altered brain network properties associated with PSD in the cognitive task state were more distinct compared with the resting state, and the ability of the brain network to resist attack and transmit information was reduced in PSD patients in the task state. This study demonstrated the feasibility and superiority of investigating brain network properties in the task state for the exploration of the pathogenesis and new diagnosis methods for PSD.

Risk factors for post-stroke depression in patients with mild and moderate strokes.

To determine the possible risk factors for post-stroke depression in patients with mild and moderate acute strokes. A cross-sectional descriptive study was conducted involving 129 patients with mild and moderate acute strokes. The patients were divided into post-stroke depression and non-depressed stroke groups according to the Hamilton Depression Rating Scale for Depression-17 item and Patient Health Questionnaire-9 item assessments. All participants were evaluated based on clinical characteristics and a battery of scales. Patients with post-stroke depression had an increased stroke frequency, severe stroke symptoms and poor performance in activities of daily living (ADL), cognitive function, sleep quality, interest in pleasurable activities, negative life events, and utilization of social support compared to stroke patients without depression. The Negative Life Event Scale (LES) score was significantly and independently associated with an increased probability of depression in stroke patients. Negative life events were shown to be independently associated with the incidence of depression in patients with mild and moderate acute strokes, likely mediating the influence of other predictors of depression, such as a history of stroke, decreased ADL ability, and utilization of support.

Associations of vitamin D-related single nucleotide polymorphisms with post-stroke depression among ischemic stroke population.

To investigate the relationship between single nucleotide polymorphisms (SNPs) related to vitamin D (VitD) metabolism and post-stroke depression (PSD) in patients with ischemic stroke. A total of 210 patients with ischemic stroke were enrolled at the Department of Neurology in Xiangya Hospital, Central South University, from July 2019 to August 2021. SNPs in the VitD metabolic pathway (VDR, CYP2R1, CYP24A1, and CYP27B1) were genotyped using the SNPscan™ multiplex SNP typing kit. Demographic and clinical data were collected using a standardized questionnaire. Multiple genetic models including dominant, recessive, and over-dominant models were utilized to analyze the associations between SNPs and PSD. In the dominant, recessive, and over-dominant models, no significant association was observed between the selected SNPs in the CYP24A1 and CYP2R1 genes and PSD. However, univariate and multivariate logistic regression analysis revealed that the CYP27B1 rs10877012 G/G genotype was associated with a decreased risk of PSD (OR: 0.41, 95% CI: 0.18-0.92, p = 0.030 and OR: 0.42, 95% CI: 0.18-0.98, p = 0.040, respectively). Furthermore, haplotype association analysis indicated that rs11568820-rs1544410-rs2228570-rs7975232-rs731236 CCGAA haplotype in the VDR gene was associated with a reduced risk of PSD (OR: 0.14, 95% CI: 0.03-0.65, p = 0.010), whereas no significant association was observed between haplotypes in the CYP2R1 and CYP24A1 genes and PSD. Our findings suggest that the polymorphisms of VitD metabolic pathway genes VDR and CYP27B1 may be associated with PSD in patients with ischemic stroke.

Management of Post Stroke Depression (PSD) Through Physical Exercise

About one-third of patients with post-stroke depression (PSD), a common psychological disorder that impacts many stroke survivors, eventually experience depression. This depression may impair recovery and rehabilitation, lower quality of life, and raise mortality. The association between depression and stroke is complex and the underlying causes are still unclear, but there is evidence to support the possibility that both psychosocial and anatomical factors may play a role. PSD management is difficult and necessitates a multidisciplinary approach. Although some people respond well to conventional treatments like psychotherapy and medication, they may not be appropriate or available to everyone. On the other hand, a promising non-pharmacological intervention for the management of PSD is physical exercise. Physical exercise has emerged as a viable additional or substitute intervention for PSD control. There is mounting evidence that suggests physical activity can elevate mood and lessen depressive symptoms in PSD patients. Studies have shown that exercise interventions, such as aerobic exercise, resistance training, yoga, etc. can help stroke survivors with PSD who struggle with depression and anxiety as well as their general quality of life. Additionally, exercise has been linked to improvement in brain functions. This review intends to look at the evidence of physical exercise's value in treating PSD, its underlying causes, and considerable beneficial effect of exercise on depression, physical functions, and cognitive functions in stroke patients