Post-stroke Anxiety Research Articles

Red Blood Cell Indices in Relation to Post-stroke Psychiatric Disorders: A Longitudinal Study in a Follow-up Stroke Clinic.

Depression and anxiety after stroke are common conditions that are likely to be neglected. Abnormal red blood cell (RBC) indices may be associated with neuropsychiatric disorders. However, the association of RBC indices with post-stroke depression (PSD) and poststroke anxiety (PSA) has not been sufficiently investigated. We aimed to investigate the trajectory of post-stroke depression and anxiety in our follow- up stroke clinic at 1, 3, and 6 months, and the association of RBC indices with these. One hundred and sixty-two patients with a new diagnosis of ischemic stroke were followed up at 1, 3, and 6 months, and underwent Patient Health Questionnaire-9 (PHQ-9) and the general anxiety disorder 7-item (GAD-7) questionnaire for evaluation of depression and anxiety, respectively. First, we used Kaplan-Meier analysis to investigate the accumulated incidences of post-stroke depression and post-stroke anxiety. Next, to explore the association of RBC indices with psychiatric disorders after an ischemic stroke attack, we adjusted for demographic and vascular risk factors using multivariate Cox regression analysis. Of the 162 patients with new-onset of ischemic stroke, we found the accumulated incidence rates of PSD (1.2%, 17.9%, and 35.8%) and PSA (1.2%, 13.6%, and 15.4%) at 1, 3, and 6 months, respectively. The incident PSD and PSA increased 3 months after a stroke attack. Multivariate Cox regression analysis indicated independent positive associations between PSD risk and higher mean corpuscular volume (MCV) (OR=1.42, 95% CI=1.16-1.76), older age (OR=2.63, 95% CI=1.16-5.93), and a negative relationship between male sex (OR=0.95, 95% CI=0.91-0.99) and PSA. The risks of PSD and PSA increased substantially 3 months beyond stroke onset. Of the RBC indices, higher MCV, showed an independent positive association with PSD.

Serum Kynurenines Correlate With Depressive Symptoms and Disability in Poststroke Patients: A Cross-sectional Study

Background Poststroke depression (PSD) is related to adverse functional and cognitive prognosis in stroke patients. The participation of kynurenine pathway metabolites in depression has been previously proposed; however, there are few studies on its role in PSD and disability in stroke. Objective To investigate if there is a correlation between serum kynurenines levels with poststroke anxiety and depression symptoms and disability scales. Methods A cross-sectional case-control study was conducted in patients with first stroke, of >1 month and <1 year of evolution, with no history of previous psychiatric or neurological disorders; the Hospital Anxiety and Depression Scale (HADS), Montreal Cognitive Assessment (MoCA), functional evaluations (Barthel index, Functional Independence Measure [FIM]) were applied and serum kynurenines (Kyns) were determined. Results Sixty patients were included; significant depressive symptoms were found in 63% of the cases; a significant and positive correlation was obtained between levels of 3-hydroxykynurenine (3-HK) with HADS-T (r = 0.30, P = .025) and HADS-D (r = 0.28, P = .039). Depressed patients showed significantly higher levels of 3HK (P = .048) and KYNA (P = .0271) than nondepressed patients; the 3HK levels were inversely correlated with functional scales: Barthel index (r = −0.31, P = .02), FIM (r = −0.40, P = .01); in addition, serum 3HK levels were significantly higher in patients with poor sleep quality (P = .0190). Conclusions Serum Kyns show correlation with the presence and severity of depressive symptoms and with the disability and sleep quality. Kyns may be a potential marker of depression risk and disability in stroke in future.

The Prevalence and Predictors of Post-Stroke Depression and Anxiety During COVID-19 Pandemic

IntroductionStroke is associated with a rise in post-stroke depression (PSD) and anxiety (PSA). In this study, we evaluated the impact of COVID-19 pandemic on the rates of PSD and PSA. MethodsAll stroke admissions to two hospitals in Saudi Arabia during two months were prospectively evaluated for PSD and PSA. NIHSS and serum TSH assessed on admission. PSD and PSA were evaluated using Hospital Anxiety and Depression Scale (HADS). Post-stroke disability was assessed by mRS, while social support assessed by Multidimensional Scale of Perceived Social Support (MSPSS). ResultsAmong 50 participants (28 males), clinically significant PSD was found in 36%, while PSA in 32%. PSD associated with higher NIHSS (P < 0.001); lower MSPSS (P = 0.003); higher mRS (P = 0.001); and discontinuation of rehabilitation (P = 0.02). PSA was associated with higher TSH (P = 0.01); lower MSPSS (P = 0.03); while discontinuation of rehabilitation was related to less PSA (P = 0.034). Multivariate analysis showed that NIHSS (OR: 1.58, 95% CI: 742–3.37; P = 0.01); and MSPSS score (OR: 0.66, 95% CI: 0.47–0.94; P = 0.002) were associated with PSD; while PSA was related to TSH level (OR: 8.32, 95% CI:1.42–47.23; P = 0.02), and discontinuation of rehabilitation (OR: -0.96, 95% CI: -1.90–0.02; P = 0.04). ConclusionsOur research shows that the rise in PSD is related to stroke severity and this has not changed significantly during the pandemic; however, PSA showed a noticeable peak. Social deprivation and the lacking levels of rehabilitation related significantly to both.

Complications after stroke : Clinical challenges in stroke aftercare

Besides the treatment of cardiovascular risk factors, the prevention and treatment of secondary complications is the main focus of outpatient poststroke care. The spectrum of noteworthy complications after astroke changes during the course of the treatment and constitutes aspecific challenge of outpatient poststroke care. This article provides references to the importance, management, diagnosis and treatment of the wide spectrum of nonvascular complications after stroke in the context of outpatient stroke aftercare. Poststroke depression (PSD), anxiety disorders and post-stroke fatigue are common complications after stroke, which require a timely diagnosis and treatment. Furthermore, the incidence of newly diagnosed dementia is 20% within the first 6 months after astroke. Here too, therapeutic and preventive strategies especially in the early stage can delay the subsequent burden of the disease and the dependency on care. About half of every newly diagnosed epilepsy in patients older than 60years is the result of astroke. Falls and subsequent injuries are another important complication and a common reason for rehospitalization after astroke. Although nearly 50% of patients suffer from chronic pain after astroke this is often not sufficiently recognized. The wide spectrum of secondary complications after astroke constitutes acomplex, sustained and multidisciplinary challenge, which requires across-sectoral interaction of various and numerous actors in outpatient poststroke care.

High levels of plasma fibrinogen and prothrombin time are related to post-stroke emotional impairment

IntroductionStudies have shown that high levels of the fibrinogen (FIB) are related to anxiety and depression. However, the relationship between FIB and post-stroke emotional impairment (PSEI) remains unclear, which includes post-stroke anxiety (PSA) and post-stroke depression (PSD). MethodsA total of 555 patients with acute ischemic stroke (AIS) were enrolled in this study. Ultimately, 443 patients completed 1‐month follow‐up. Blood samples were collected at hospital admission. Clinical depression and anxiety were evaluated 1 month after stroke. ResultsHigh levels of FIB were observed in patients with PSEI compared with the non‐EI group (p = 0.003). Levels of FIB were divided into three tertiles, and the prevalence of PSEI was significantly higher in the third FIB tertile (p = 0.016). After adjusting potential confounders, the third FIB tertile was independently associated with the prevalence of PSEI (OR = 1.785, 95%CI = 1.049–3.039, p = 0.033), taking the first tertile as a reference. In this model, prothrombin time (PT) was also independently associated with the prevalence of PSEI (OR = 1.602, 95%CI = 1.181–2.173, p = 0.002). ConclusionHigh levels of plasma FIB and PT are associated with the prevalence of PSEI.

Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans

BackgroundThere is relatively limited information on the risk factors and outcome of new onset Poststroke Anxiety (PSA) in Low- and Middle-Income Countries. We estimated incidence, cumulative incidence, risk factors and outcome of new onset anxiety in the first year of stroke among African stroke survivors. MethodsWe analyzed the dataset of a completed clinical trial comprising patients enrolled to test an intervention designed to improve one-year blood pressure control among recent (≤ one month) stroke survivors in Nigeria. Anxiety was measured using the Hospital Anxiety and Depression Scale. Outcomes were assessed using the modified Rankin Scale (mRS), Community screening instrument for dementia (CSID) and Health Related Quality of Life in Stroke Patients (HRQOLISP-26). ResultsAmong 322 stroke survivors who were free of anxiety at baseline, we found a one-year cumulative incidence of 34% (95% CI = 28.6–39.3). Rates were 36.2% (95% CI =29.6–42.7) for men and 29.2% (95% CI =19.9–38.3) for women. In multivariate Cox regression analyses, haemorrhagic stroke type was associated with higher risk of new onset PSA (Hazard Ratio=1.52, 95% CI =1.01–2.29). New onset PSA was independently associated with cognitive [(mean difference (MD) in CSID scores=1.1, 95% C.I=0.2, 1.9)] and motor decline (MD in mRS scores= −0.2, 95% C.I= −0.4, −0.02), as well as poorer quality of life overtime (MD in total HRQOLISP-26 scores=3.6, 95% C.I=1.0, 6.2). ConclusionOne in 3 stroke survivors in Nigeria had PSA at one year. Clinicians in SSA should pay special attention to survivors of haemorrhagic stroke as they are at higher risk of incident anxiety and therefore its consequences.

Reminiscence therapy-based care program relieves post-stroke cognitive impairment, anxiety, and depression in acute ischemic stroke patients: a randomized, controlled study.

Cognitive and mental impairments are common health problems in acute ischemic stroke (AIS) patients. In this study, we aimed to assess the benefit of a reminiscence therapy-based care (RTBC) program on cognitive impairment restoration, anxiety, and depression reduction in AIS patients. Totally 130 AIS patients were recruited in this randomized, controlled study and randomly assigned to the RTBC group or control group in 1:1 ratio for 12-month intervention. Mini-Mental State Examination (MMSE), Montreal cognitive assessment (MoCA), Hospital Anxiety and Depression Scale for anxiety/depression (HADS-A/HADS-D), and Zung self-rating anxiety/depression scale (SAS/SDS) were assessed at month 0 (M0), M3, M6, M9, and M12. Meanwhile, patients' satisfaction was also evaluated at M3, M6, M9, and M12. RTBC increased MMSE score and MoCA score and reduced cognitive impairment patients' percentage assessed by MoCA score at M12 compared with control. RTBC reduced HADS-A score at M12, but not anxiety patients' percentage or severity by HADS-A at M12; besides, RTBC significantly lowered the SAS score at M9 and M12, and anxiety patients' percentage and severity by SAS at M12 compared with control. RTBC reduced HADS-D score at M9 and M12 (while statistically non-significant), but not depression patients' percentage or severity by HADS-D at M12; it decreased SDS score at M9 and M12, but not depression patients' percentage or severity by SDS at M12 compared with control. Additionally, RTBC obsessed higher patients' satisfaction at M3, M6, and M12 compared with control. RTBC could help reduce cognitive impairment, anxiety, and depression in post-stroke management for AIS patients.

Differential Association of Serum BDNF With Poststroke Depression and Poststroke Anxiety

ObjectivesTo investigate the correlation between brain-derived neurotrophic factor (BDNF) and risk factors, as well as functional outcome in poststroke depression (PSD) or poststroke anxiety (PSA). DesignCohort study. SettingStroke patients admitted to an urban rehabilitation hospital. ParticipantsStroke patients (N=162) without any previous history of depression and anxiety. InterventionsNot applicable. Main Outcome MeasuresSociodemographic information and comorbidities were recorded during hospital admission. Functional outcomes were assessed using FIM scores at time of admission and discharge. The influence of various factors such as BDNF and patient characteristics on functional outcome was investigated. Single-factor effect was examined using simple logistic regression, as was multi-factor effect using multiple logistic regression. The goodness-of-fit of those regression models was evaluated by the integrated area under ROC curve. ResultsPSD was diagnosed in 61 (37.7%) patients, and PSA was diagnosed in 40 (24.7%). Multiple logistic analysis showed that BDNF, divorce or separation, and history of smoking were significantly associated with the occurrence of PSD but not with the occurrence of PSA. The model combining low BDNF level and divorce or separation improved the prediction for PSD. Among the variables analyzed for prediction of functional outcome, serum BDNF had a minimum correlation with motor FIM scores in PSD but no significant correlation with motor FIM scores in PSA. ConclusionsBDNF is a valuable prediction for the occurrence of PSD but not for PSA. More strikingly, ischemic stroke patients who are divorced or separated with low serum BDNF have a much higher risk for PSD. BDNF has a minimum correlation with motor function outcome in PSD but no significant correlation with motor outcome in PSA.

Post-stroke depression, anxiety, and stress symptoms and their associated factors: A cross-sectional study

ABSTRACT Individuals post-stroke are subject to increased levels of mental health symptoms. This is a cross-sectional study explored levels of depression, anxiety, and stress symptoms and identified their predictors among Jordanian individuals with stroke. Outcome measures included Depression Anxiety Stress Scale, Fugl-Meyer assessment, goniometry, hand-held dynamometry, nine-hole peg test, Ashworth scale, Motor Activity Log, ten-meter walk test, and 12-item Short-Form health survey (SF-12). Descriptive analyses were used to describe prevalence of mental health symptoms and multiple variable linear regression models were used to identify their predictors. A total of 153 individuals participated in the study. Proportions of participants with mental health symptoms were 74.5% for depression, 52.9% for anxiety, and 68% for stress. Significant predictors of post-stroke mental health symptoms were SF-12 Mental Composite Score and grip strength for depression, anxiety, and stress. Depression and stress symptoms were significantly associated with discontinuation of rehabilitation services. Furthermore, self-reports of fewer sleep hours was significantly associated with anxiety and stress. Finally, Gender and self-reported physical diseases other than stroke were significantly associated with depression symptoms. We conclude that high proportions of Jordanian individuals’ post-stroke have suffered mental health symptoms. Future studies are required to design effective interventions to improve post-stroke mental health.

Electroacupuncture for post-stroke anxiety disorder on the base of the heart-brain theory: A randomized controlled trial从心脑论治电针中风后焦虑障碍:随机对照试验

ObjectiveTo evaluate the differences in the clinical effect and the safety in the treatment of post-stroke anxiety disorder (PSAD) between electroacupuncture (EA) and paroxetine on the base of the heart-brain theory. MethodsA total of 70 patients of PSAD were randomized into an EA group and a medication group, 35 cases in each one. In the EA group, four acupoints were selected and divided into two pairs. In the Pair A, there were Băihuì (百会 GV20) and Fēngfŭ (风府 GV16). In the Pair B, there were Xīnshū (心俞 BL15) and Shénmén (神门 HT7). After acupuncture, the electroacupuncture apparatus was applied. The duration of needle retention was 20 min. EA was given three times a week, totally for 4 weeks. In the medication group, paroxetine tablets were administered orally, 10 mg daily in the first 4 days and 20 mg afterwards, totally for 4 weeks. Before and after treatment, as well as in the follow-up period, Hamilton anxiety scale (HAMA), Barthel index (BI) for daily life ability, and clinical global impression (CGI) were observed and the clinical therapeutic effect was evaluated separately. ResultsA total of 3 cases were dropped-out in the medication group. Finally, 35 cases in the EA group and 32 cases in the medication group were included in the analysis. Compared with the scores before treatment, the scores of HAMA and CGI-SI (severity of illness) were lower and the scores of BI were higher after treatment and during the follow-up in either the EA group or the medication group (all P < 0.05). Compared with the scores after treatment, the differences were not significant in HAMA and CGI-SI scores during the follow-up in either the EA group or the medication group (all P > 0.05). Compared with the medication group, BI score in the EA group was higher in the follow-up, indicating the statistical significance (P < 0.05). After treatment, CGI-SI score was different statistically between the EA group and the medication group (P < 0.05). There were 5 cases with adverse reactions in the EA group and 9 cases in the medication group. ConclusionsThe therapeutic effect of electroacupuncture on the base of heart-brain theory is similar to the oral administration of paroxetine in the treatment of post-stroke anxiety disorder. This therapy relieves anxious emotions, promotes the recovery of limb function and has less adverse reactions in the patients.

The Effectiveness of Acupuncture Treatment for Post-Stroke Depression and Anxiety Disorder.

The Effectiveness of Acupuncture Treatment for Post-Stroke Depression and Anxiety Disorder.

Cerebrovascular Accident: Elaboration Of Psychoeducational Intervention For Caregivers

Introduction: Cerebrovascular accident (CVA), also known as stroke, is characterized by the interruption of blood flow in a particular area of the brain, being of the ischemic or hemorrhagic type. Its involvement can lead to emotional dysfunctions, among which depression, mania, bipolar disorder and post-stroke anxiety disorder. Objective: To propose psychoeducational intervention in a group of caregivers of the patients who were affected with stroke, aiming at a better understanding of the emotional aspects. Methodology: A welcome space will be provided for the companions to share their experiences through a conversation, followed by the delivery of psychoeducational material on the stroke. Results: It is known that there is usually a deficiency related to the qualification of the caregivers regarding the continuity of the physical and emotional assistance of the patient, which can lead to doubts, unrealistic expectations and inadequate management of the patient. Therefore, psychoeducation is a tool that can be used in the hospital context, since it is understood that the hospital psychologist has been increasingly active in the definition of behaviors and treatments within a multidisciplinary team. Conclusion: The need for a psychoeducational intervention in caregivers of patients diagnosed by CVA is necessary because of its abrupt character and reverberation on the caregiver, who needs guidelines to face the possible post-stroke psychological complications in the patient.

A Retrospective Study to Identify Novel Factors Associated with Post-stroke Anxiety

Background and Purpose: Post-stroke anxiety (PSA) is common and disabling. PSA should be considered as an important outcome in stroke. However, there is a lack of understanding of factors that may be linked to PSA. The purpose of this study was to determine the frequency of PSA and sociodemographic and clinical factors associated with PSA in a cohort of racially and ethnically diverse stroke patients. Methods: We conducted a retrospective study of ischemic and hemorrhagic stroke patients seen in a stroke outpatient clinic from August 1, 2017 to June 30, 2018. Patients were eligible if a Generalized Anxiety Disorder 7-Item (GAD-7) instrument was available. GAD-7 scores greater than or equal to 10 indicated the presence of moderate to severe PSA. Multivariable logistic regression was used to identify independent sociodemographic and clinical factors associated with PSA. Results: Records from 289 stroke patients with a GAD-7 instrument were analyzed. PSA was common (21%; GAD-7 ≥ 10). Fifty-seven percent of females had a GAD-7 greater than or equal to 10 compared to 41% of females who had a GAD-7 less than 10 (P = .03). Multivariable analysis found that self-reported nonmarried status (odds ratio, 3.27; 95% confidence interval, 1.44-7.44), excessive fatigue (odds ratio, 4.46; 95% confidence interval, 1.87-10.63), and depression (odds ratio, 1.24; 95% confidence interval, 1.16-1.33) were independently associated with PSA. Conclusions: PSA may occur more frequently in those who report non-married, excessive fatigue, or depression. Trials of PSA interventions should consider the potential impact of social support, depression, and comorbid conditions contributing to post-stroke fatigue, including sleep apnea.

Association between Anxiety and Functional Outcomes in Patients with Stroke: A 1-Year Longitudinal Study.

ObjectiveAnxiety is one of the most common complications in patients with stroke, but studies on its relationship to functional outcomes are limited and controversial. We investigated the association between post-stroke anxiety (PSA) and a 1-year trajectory of functional outcome. MethodsA total of 423 patients were recruited within 2 weeks after a stroke (acute phase) during hospitalization. Of them, 306 (72.3%) completed follow-up examinations 1 year thereafter (chronic phase). Anxiety was evaluated using the Hospital Anxiety and Depression Scale-Anxiety subscale, and functional outcomes were measured using the National Institutes of Health Stroke Scale for stroke severity, the Barthel Index for activities of daily living (ADL), and the Mini-Mental State Examination for cognitive function at 2 weeks and 1 year. A range of demographic and clinical covariates were considered. The cross-sectional and longitudinal associations between PSA and functional outcomes were investigated. ResultsPSA at the acute phase was not associated with functional outcomes at the cross-sectional point, but predicted worsening of outcome on stroke severity and ADL 1 year after stroke. PSA at the chronic phase was cross-sectionally associated with poor functional outcomes in all three measures. All associations were independent of potential covariates. ConclusionScreening for anxiety is recommended even during the acute phase of stroke, considering its independent detrimental effect on functional prognosis. Screening for anxiety during the chronic phase is also encouraged, as this may reflect the functional status of stroke.

Effect of ischemic lesions in medial prefrontal cortex and nucleus accumbens on affective behavior in rats

Post-stroke depression (PSD) and post-stroke anxiety (PSA) are usually undertreated and many cases may remain undiagnosed, indicating a need for a better understanding of the underlying mechanisms. Current animal models of PSD and PSA using the middle cerebral artery occlusion model may be associated with motor deficits that can interfere with behavioral tests of depression- and anxiety-like behavior. Unilateral lesions of the medial prefrontal cortex (mPFC) have been reported to induce a depression- and anxiety-like phenotype in mice. The aim of this study was to examine the effects of unilateral microinjections of the vasoconstrictor endothelin-1 (ET-1) in the mPFC alone or in combination with the nucleus accumbens (NAc) on the behavior of rats after 2 and 6 weeks. Specifically, we measured anxiety- and depressive-like behavior, locomotion, and cognition. ET-1 injections in the mPFC and NAc resulted in replicable and localized lesions. Lesions to the mPFC and NAc resulted in more time spent in the open arms of the Elevated Plus Maze compared to sham-operated animals at 2 weeks post stroke, indicating decreased anxiety. This effect did not persist until 6 weeks post injection. No differences in locomotion, cognition and depressive-like behavior were found at either time point. In summary, unilateral lesions of mPFC and NAc did not produce a reliable and persistent anxiety and depression phenotype in rats.

A longitudinal study of the associations of BDNF genotype and methylation with poststroke anxiety

Although the precise etiology of poststroke anxiety (PSA) has yet to be fully elucidated, it is known that brain-derived neurotrophic factor (BDNF) is important for neural plasticity and long-term potentiation, associated with the pathophysiology of anxiety. The expression of BDNF is regulated by epigenetic and genetic profiles. Thus, we investigated the association between BDNF methylation status and PSA at 2 weeks and 1 year after stroke while accounting for interactions with the BDNF Val66Met polymorphism. The baseline sample comprised 286 patients who were assessed at 2 weeks after stroke; of these patients, 222 (78%) were followed up with at 1 year after stroke. The presence of PSA was determined using the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS), and the effects of BDNF methylation status and polymorphisms on PSA status were assessed with multivariate logistic regression models. The prevalence of PSA was slightly lower (27 [9.4%]) at baseline, and 35 (15.8%) patients were identified as having PSA at the 1-year follow-up. Stroke patients with a higher average methylation status were more likely to have PSA at 1 year. The BDNF Val66Met polymorphism was not independently associated with PSA during either the acute or chronic phase after stroke, but there was a significant interactive effect between BDNF methylation and genotype on PSA at 2 weeks. In this study, BDNF methylation in combination with the met/met BDNF polymorphism (Val66Met polymorphism) was associated with PSA. These findings may help identify patients at higher risk for PSA.

Canadian Stroke Best Practice Recommendations: Mood, Cognition and Fatigue following Stroke, 6th edition update 2019.

The 2019 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for Mood, Cognition and Fatigue following Stroke is a comprehensive set of evidence-based guidelines addressing three important issues that can negatively impact the lives of people who have had a stroke. These include post-stroke depression and anxiety, vascular cognitive impairment, and post-stroke fatigue. Following stroke, approximately 20% to 50% of all persons may be affected by at least one of these conditions. There may also be overlap between conditions, particularly fatigue and depression. If not recognized and treated in a timely matter, these conditions can lead to worse long-term outcomes. The theme of this edition of the CSBPR is Partnerships and Collaborations, which stresses the importance of integration and coordination across the healthcare system to ensure timely and seamless care to optimize recovery and outcomes. Accordingly, these recommendations place strong emphasis on the importance of timely screening and assessments, and timely and adequate initiation of treatment across care settings. Ideally, when screening is suggestive of a mood or cognition issue, patients and families should be referred for in-depth assessment by healthcare providers with expertise in these areas. As the complexity of patients treated for stroke increases, continuity of care and strong communication among healthcare professionals, and between members of the healthcare team and the patient and their family is an even bigger imperative, as stressed throughout the recommendations, as they are critical elements to ensure smooth transitions from acute care to active rehabilitation and reintegration into their community.

Anxiety in Patients With Acute Ischemic Stroke: Risk Factors and Effects on Functional Status.

Background: Anxiety is prevalent after a stroke. The pathophysiological mechanisms underlying the development of poststroke anxiety (PSA) remain unclear. The aim of this study was to investigate the clinical and neuroimaging risk factors for development of PSA and examine the effects of PSA on activities of daily living (ADL) and quality of life (QOL) in Chinese patients with ischemic stroke. Methods: Two hundred nineteen patients with acute ischemic stroke were recruited to the study. A series of comprehensive assessments, including Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale (HDRS), Lawton ADL Scale, and the Stroke-Specific Quality of Life (SSQOL) Scale, were conducted in the acute stage and 3 months after stroke. Magnetic resonance imaging assessment focused on evaluation of infarctions, white matter lesions, and brain atrophy. Results: In the acute stage and 3 months after stroke, 34 (16%) and 33 (15%) patients had PSA, respectively. Multiple logistic regression analysis indicated that HDRS (OR = 1.269, 95% CI = 1.182–1.364, P < 0.001) and acute infarcts in cerebral hemispheric white matter (CHWM; OR = 2.902, 95% CI = 1.052–8.007, P = 0.040) were significant correlates of PSA in the acute stage of stroke. Three months after stroke, these correlates remained significant predictors, along with male sex. Multiple linear regressions showed that age, NIHSS, HARS, and HDRS in the acute stage were significant predictors for both ADL and SSQOL at 3 months after stroke. Conclusion: Depressive symptoms are the major correlates of PSA while more severe PSA is associated with poorer ADL and health-related QOL. Acute lesions involving CHWM may correlate with PSA in ischemic stroke patients with mild-to-moderate neurologic deficits, supporting a lesion-location hypothesis in PSA.

Mind-Body Interventions, Psychological Stressors, and Quality of Life in Stroke Survivors.

Background and Purpose- Psychological stressors, including poststroke depression, poststroke anxiety, and posttraumatic stress disorder, are highly prevalent in stroke survivors. These symptoms exact a significant toll on stroke survivors. Clinical and research efforts in stroke recovery focus on motor disability, speech and language deficits, and cognitive dysfunction while largely neglecting psychological stressors. Evidence suggests mind-body interventions in other chronic illness populations decrease symptoms of depression, regulate immune responses, and promote resilience, yet similar studies are lacking in stroke populations. This review aims to synthesize evidence of the effects of mind-body interventions on psychological stressors, quality of life, and biological outcomes for stroke survivors. Methods- A systematic search of PubMed, PsycINFO, and CINAHL was conducted from database inception to November 2017. Results- Eight studies were included in the review, with a total of 292 participants. Mind-body interventions included yoga or tai chi. Of the 5 included randomized controlled trials, most were pilot or feasibility studies with small sample sizes. Psychological stressors, including poststroke depression and anxiety, along with the quality of life, improved over time, but statistically significant between-group differences were largely absent. The 3 included studies with a qualitative design reported themes reflecting improvement in psychological stressors and quality of life. No included studies reported biological outcomes. Conclusions- Studies of mind-body interventions suggest a possible benefit on psychological stressors and quality of life; however, rigorously designed, sufficiently powered randomized controlled trials with mixed-methods design are warranted to delineate specific treatment effects of these interventions. Studies with both biological and psychological stressors as outcomes would provide evidence about interaction effects of these factors on stroke-survivor responses to mind-body interventions.

Abstract NS7: Identifying and Understanding Factors Associated with Post-Stroke Anxiety

Background and Purpose: Prior data indicate that the profile of stroke survivors differs from those with anxiety in the absence of other clinical comorbidities. The purpose of this study was to determine the prevalence of PSA and to understand factors associated with PSA in a cohort of stroke survivors. Methods: A retrospective study (August 2017-May 2018) of electronic health records from 194 ischemic stroke survivors were examined. Stroke survivors were screened for PSA using the Generalized Anxiety Disorder 7-Item (GAD-7; range 0-21) scale two to eight weeks post-hospitalization for stroke during a stroke clinic visit. GAD-7 scores ≥ 10 indicated moderate to severe anxiety. Examples of factors examined included medical, social, stroke severity, excessive daytime sleepiness (Epworth Sleepiness Scale; ESS), and depression (Patient Health Questionnaire-9; PHQ-9). Univariable analysis were used to determine significance (p &lt; 0.05). T-tests were used for continuous variables and the chi-square test for categorical variables. Results: Twenty-five percent of stroke survivors had a GAD-7 score ≥ 10 and significantly higher mean ESS (11 ± 5) and PHQ-9 (13 ± 6) scores (p&lt;.0001) indicating co-morbid symptoms. Although not significantly different in this sample size, 32% of women had a GAD-7 score ≥ 10 compared to 21% men (p = .05). Stroke survivors with moderate to severe anxiety were more likely to be single, divorced, or widowed (p = 0.0006). Conclusions: PSA is common after ischemic stroke and may occur more frequently in women and those who are single, divorced, or widowed. Post-stroke trials of psychological interventions should consider PSA and its relationship to excessive daytime sleepiness and depression as well as treatment approaches for concurrent co-morbid conditions.