Severity Of Post-stroke Depression Research Articles

Serum Levels and Clinical Significance of NSE, BDNF and CNTF in Patients with Cancer-associated Ischemic Stroke Complicated with Post-stroke Depression.

The incidence of post-stroke depression (PSD) may be higher in patients with cancer-associated ischemic stroke (CAIS). The pathogenesis of PSD is mainly related to the emotional injury of stroke and the inability of neurons to effectively repair. This study aims to explore the clinical significance of serum neuron-specific enolase (NSE), brain-derived neurotrophic factor (BDNF) and ciliary neurotrophic factor (CNTF) expression levels in CAIS patients. Clinical data of 106 patients with CAIS admitted to Jinhua Guangfu Oncology Hospital from January 2012 to December 2022 were retrospectively analyzed. Serum levels of NSE, BDNF and CNTF were measured in all patients after admission. Depression screening was performed by Hamilton Depression Scale-17 (HAMD-17) three months after intravenous thrombolysis. Patients with HAMD-17 score >7 were included in the PSD group (n = 44), and patients with HAMD-17 score ≤7 were included in the non-PSD group (n = 62). The general data and serum levels of NSE, BDNF and CNTF were compared between the two groups. According to HAMD-17 scores, patients in PSD group were further divided into mild depression group (8-16 points), moderate depression group (17-23 points) and severe depression group (≥24 points), and the serum levels of NSE, BDNF and CNTF were compared among the three groups. Pearson's correlation test was used to analyze the correlation between HAMD-17 scores and serum NSE, BDNF and CNTF levels in PSD patients. Logistic regression model was used to determine the influencing factors of PSD in CAIS patients. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive efficacy of serum NSE, BDNF, CNTF and their combination on PSD. Among 106 CAIS patients, the incidence of PSD was 41.51% (44 cases), including 19 patients with mild PSD (43.18%), 14 patients with moderate PSD (31.82%), and 11 patients with severe PSD (25.00%). There were statistically significant differences in negative life events and complications after thrombolytic therapy between PSD and non-PSD patients (p < 0.05). The serum NSE level in PSD group was significantly higher than that in non-PSD group, and the serum BDNF and CNTF levels were notably lower than those in non-PSD group (all p < 0.001). The serum levels of NSE, BDNF and CNTF in patients with different severity of PSD were statistically significant (all p < 0.001). HAMD-17 scores in PSD patients were positively correlated with serum NSE levels (r = 0.676, p < 0.001) and negatively correlated with serum BDNF and CNTF levels (r = -0.661, p < 0.001; r = -0.401, p = 0.007, respectively). By binary logistic regression analysis, the levels of serum NSE, BDNF and CNTF were independent influencing factors for PSD in CAIS patients, among which NSE was a risk factor (odds ratio (OR) >1, p < 0.05), BDNF and CNTF were protective factors (OR <1, p < 0.05). This study reveals for the first time that the levels of serum NSE, BDNF and CNTF are closely related to the occurrence and development of PSD in CAIS patients. In clinical CAIS patients with abnormal changes in the above indicators, in addition to anti-tumor treatment and improvement of neurological deficit symptoms, attention should also be paid to the symptoms of psychological disorders.

Post-stroke arrhythmia could be a potential predictor for post-stroke depression

Post-stroke depression (PSD) is regarded as the consequence of multiple contributors involving the process of cognition, mood and autonomic system, with the specific mechanism unclear yet. As a common type of stroke-heart syndromes, post-stroke arrhythmia shared some common pathogenesis with PSD. We presumed that post-stroke arrhythmia might be an early distinguishable marker for the presence of PSD and aimed to verity their association in this study. Patients with first-ever ischemic stroke were enrolled. The presence of post-stroke ectopic arrhythmia and the symptoms of arrhythmia were recorded with anti-arrhythmia drugs prescribed when necessary. Patients were followed up 3 months later to identify their presence and severity of PSD using Hamilton Depression Scale (HAMD) and also presence and severity of arrhythmia. Characteristics including the prevalence of various types of arrhythmias were compared between PSD and non-PSD groups. The HAMD scores were compared between patients with and without arrhythmia in PSD group. Logistic regression was used to identify the independent predictor of PSD. Patients with PSD had higher prevalence of post-stroke arrhythmia especially newly-detected arrhythmia, symptomatic arrhythmia and poor-controlled arrhythmia. In PSD group, patients of post-stroke arrhythmia had higher scores of HAMD than those without arrhythmia. Presence of newly-detected, symptomatic and poor-controlled arrhythmias were independent predictor of PSD. post-stroke arrhythmia especially newly-detected arrhythmia and symptomatic arrhythmia could be an early predictor of PSD. Successful control of arrhythmia was associated with reduced prevalence and severity of PSD.

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 lesion location and depressive symptoms in acute ischemic stroke patients using voxel-based lesion-symptom mapping

Objective: The study aimed to investigate the association between lesion location and post-stroke depression (PSD) in acute ischemic stroke patients. Methods: In this case-control study, acute ischemic stroke patients were recruited from the Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), between September 2020 and June 2021. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, the patients were divided into the PSD and non-PSD groups. The 24-item Hamilton Rating Scale (HAMD) was used to evaluate the severity of depression. The Student's t-test, Mann-Whitney test, and Chi-square test were used to compare the clinical baseline characteristics of PSD and non-PSD groups. Voxel-based lesion-symptom mapping (VLSM) was applied to investigate the association between lesion location and depression occurrence and severity. Results: A total of 70 and 173 patients were admitted to the PSD and non-PSD groups, respectively. The mean age of patients was 59 years (23-86). There were 153 males and 90 females. Univariate analysis showed a significant difference only in Hamilton Anxiety (P=0.025) and Depression (P<0.001) scores between the PSD and non-PSD groups. VLSM analysis identified clusters within the anterior cingulate gyrus (Z=-3.05, P<0.001), left hippocampus (Z=-3.15, P<0.001), and left lingual lobe (Z=-3.08, P<0.001) where lesions were significantly associated with PSD. Additionally, the severity of PSD was associated with damage in the anterior cingulate gyrus (Z=-3.64, P<0.001), left hippocampus (Z=-3.51, P<0.001), left lingual lobe (Z=-4.18, P<0.001), and pericalcarine cortex (Z=-3.65, P<0.001). Conclusion: VLSM demonstrated that lesion location could be used to predict the occurrence of PSD in patients with acute ischemic stroke.

Impact of Lesion Locations on the Severity of Post-Stroke Depression

Background: Depression occurs in one-third of stroke patients, in what is known as post-stroke depression. The lesion sites in stroke have been associated with the degree of depression. However, studies have provided different perspectives, and this necessitates further clarification. This study investigates the relationship between the lesion sites and the severity of depression in ischemic stroke patients. Methods: This cross-sectional study was conducted between January and April 2020. All samples were obtained from admitted patients with ischemic stroke who agreed to participate in the study. Data were collected using Beck’s Depression Inventory-II (BDI-II), which was used to determine the severity of depression, and the lesion sites were based on radiological imaging interpretation. Results: The study showed a significant association between the lesion site and the degree of depression (OR = 5,368, p-value = 0,013). Lesions in the frontal lobe demonstrated stronger associations with the severity of depression. Conclusion: The location of the lesion, especially in the frontal lobe, was associated with more severe post-stroke depression.

Early-Onset Depression in Stroke Patients: Effects on Unfavorable Outcome 5 Years Post-stroke.

Background: Post-stroke depression (PSD) constitutes an essential complication of stroke and is associated with high-risk unfavorable outcome after stroke. The main objective of this prospective study was to determine the relationship between early-onset PSD (1 month after stroke) and functional outcomes 5 years after baseline enrollment.Methods: Four hundred thirty-six patients who met the criteria were included in this study from October 2013 to February 2015. The follow-up time for each patient was ~5 years, with follow-up every 3 months. Patients received questionnaires including the 17-item Hamilton Depression Scale (HAMD), the Mini-Mental State Examination (MMSE), the National Institutes of Health Stroke Scale (NIHSS), the modified Rankin Scale (mRS), and the Barthel Index (BI).Results: Of the 436 patients, 154 (35.3%) patients with the prevalence of PSD status at baseline, 26 (7.2%) patients with the prevalence of PSD status, and 73 (20.1%) had an unfavorable outcome 5 years after stroke. The odds ratio (OR) for unfavorable outcome at 5 years in the PSD group was ~2.2 relative to the non-PSD group after adjusting for potential risk factors [OR = 2.217, 95% confidence interval (CI) = 1.179–4.421, P = 0.015]. In the early-onset PSD group, HAMD scores were independently associated with 5-year unfavorable outcome rates (OR = 1.168, 95% CI = 1.015–1.345, P = 0.031).Conclusions: Our findings indicate that early-onset PSD status in Chinese patients is an independent risk factor for unfavorable outcome 5 years after stroke, and that the severity of PSD is also related to unfavorable outcome.

Influence of inflammatory status in the acute phase of stroke on post-stroke depression.

Thirty percent of stroke patients will suffer from post-stroke depression (PSD). Recent data suggest that inflammation accounts for a substantial amount of depression. Our primary objective was to assess the association between standard inflammation biomarkers in the acute phase of stroke and PSD at three months. The secondary objective was to elaborate a predictive model of PSD from clinical, biological and radiological data. We performed a retrospective analysis of a single-centre cohort of stroke patients with a three-month follow-up. Serum levels of C-reactive protein (CRP), fibrinogen, leukocyte count and neutrophil to lymphocyte ratio (NLR) were tested at admission and at peak. Mood was assessed at three months using the depression sub-scale of the Hospital Anxiety and Depression Scale (HADS). Association between inflammation biomarkers and HADS was evaluated with multi-linear regression adjusted on clinical and radiological parameters. Logistic predictive models of PSD at three months, with and without inflammation biomarkers, were compared. Three hundred and forty-eight patients were included, of whom 20.06% developed PSD. Baseline and peak values of all inflammatory markers were associated with the severity of PSD at three months. Area under the curve for the receiver operating characteristic curve of PSD prediction was 0.746 (CI 95% 0.592-0.803) with selected inflammation biomarkers and 0.744 (CI 95% 0.587-0.799) without. Most inflammation biomarkers are weakly associated with PSD, adding negligible value to predictive models. While they suggest the implication of inflammation in PSD pathogenesis, they are useless for the prediction of PSD, underscoring the need for more specific biomarkers.

The association between White matter microstructure alterations detected by Diffusional kurtosis imaging in Neural circuit and post-stroke depression

ABSTRACT Aim In order to study the mechanism of post-stroke depression (PSD), we used diffusion kurtosis imaging (DKI) to describe the changes in white matter (WM) microstructure in PSD patients, to investigate the association between WM damage in limbic-cortical-striatal-pallidal-thalamic (LCSPT) circuit and PSD, and the utility of DKI in the diagnosis of PSD. Methods Fifty-eight participants were divided into different groups: control group (n=20), stroke patients without depression (Non-PSD, n=21) and PSD group (n=17). All were taken DKI scans. The WM of bilateral superior frontal gyrus, middle frontal gyrus, inferior frontal gyrus, temporal lobe, parietal lobe, occipital lobe, the anterior and posterior limb of internal capsule, the genu and splenium of corpus callosum were selected as the regions of interest (ROI) and selected mean kurtosis (MK), radial kurtosis (RK), axial kurtosis (AK) as the DKI parameters. Results Compared with control and Non-PSD, MK of PSD group in bilateral superior frontal gyrus, middle frontal gyrus, temporal lobe and the genu of corpus callosum were decreased significantly, as well as the RK in left superior frontal gyrus, bilateral middle frontal gyrus and temporal lobe. But there was no significant difference in AK. Besides, the decrease in MK and RK in frontal and temporal lobe was negatively associated with the severity of PSD. Conclusion Our research indicated that the damage to WM microstructure in the frontal lobe, temporal lobe and the genu of corpus callosum may be related toPSD. DKI explores the microstructural changes of WM in PSD patients and may be an auxiliary diagnostic method for PSD.

Predictive value of inflammatory indicators for post-stroke depression in patients with ischemic stroke

To investigate the association of venous blood neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) and levels of interleukin-17 (IL-17) and IL-6 at 2 weeks after admission with the occurrence of post-stroke depression (PSD) in patients with first-ever acute ischemic stroke. The hospitalized patients with first-ever acute ischemic stroke were recruited consecutively from the Department of Neurology of Yijishan Hospital from March, 2015 to September, 2017. The demographic and baseline clinical data on admission and the imaging data were collected. The diagnosis of PSD was established in line with DSM-IV (SCID-I-R) at 3 months during the follow-up. The severity of PSD was assessed using the Hamilton Depression Scale (HAMD-17). Multivariate logistic regression analysis was used to investigate the correlation of NLR, PLR, IL-17, and IL-6 with PSD in these patients. A total of 376 patients with acute ischemic stroke were enrolled, including 224 male patients (59.57%) and 152 female patients (40.43%), whose mean age was 61.37±10.34 years. Of these patients 104 (27.66%) were found to have PSD. Univariate analysis showed that gender, years of education, BMI, widowhood, NIHSS score, MMSE score, mRS score, and laboratory indexes (NLR, PLR, IL-17, and IL-6) were all significantly correlated with PSD (all P &lt; 0.05). Multivariate logistic regression analysis showed that, after adjusting for the compounding factors, the third quartile of NLR (P &lt; 0.001), the third quartile of PLR (P=0.002), IL-17 (P=0.025) and IL-6 (P=0.016) were independent factors that predicted the occurrence of PSD. Elevated NLR and PLR at admission and levels of IL-17 and IL-6 at 2 weeks after admission are all independent predictors of the occurrence of PSD at 3 months after stroke.

Abstract TP159: Beta Blockers Do Not Increase the Risk of Post-Stroke Depression in a Predominantly Afro-Caribbean Population

Background: Depression is one of the most common neuropsychiatric disorders among ischemic stroke survivors, affecting up to 50%. Beta-blockers (BB) are commonly prescribed for stroke patients and the evidence for an association between BB use and depression is mixed. We explored this relationship in an urban, predominantly Afro-Caribbean stroke cohort. Hypothesis: The use of BB will be associated with an increase in frequency and severity of post-stroke depression. Methods: Observational, cross-sectional, prospective study of eligible non-demented patients with ischemic stroke in the past 3 years and without a history of major depression. Subjects were recruited from the inpatient stroke unit, outpatient stroke clinics (including at Kings County Hospital), and inpatient rehabilitation unit at SUNY Downstate Medical Center. Demographics, medical history, and current medications were recorded from medical records and patient interviews. Depression was assessed using Beck’s Depression Inventory (BDI). For bivariate analysis, the Mann-Whitney test was used to associate BB usage with BDI score. For multiple regression analysis, a general linear model was constructed, with square-root (BDI score) as the dependent variable. Covariates were history of myocardial infarction and/or coronary artery disease, NIH Stroke Scale, and age. Results: Of 83 subjects enrolled, 76 (91%) were Afro-Caribbean, 47 (56%) were female, and mean age was 66.9 (SD±12.7) yrs. Median (Q1,Q3) BDI score was 7 (3,10) for BB users (N=37), 5 (3,9) for no BB use (N=46) ( p =0.275). Controlling for covariates (sample n=83), the difference remained non-significant ( p =0.909). There were 10 patients with BDI scores over 13, indicating their depression was worse than minimal, and of these, 6 were on BB. Conclusion: BB use was not associated with a significant increase in the severity or frequency of depression in this urban, predominantly Afro-Caribbean post-stroke population.

Altered functional connectivity in post-ischemic stroke depression: A resting-state functional magnetic resonance imaging study

ObjectiveIn previous studies, post-stroke depression (PSD) was found to be related to stroke characteristics as well as social and psychological factors. This study identified altered functional connectivity (FC) in patients with PSD at the subacute phase in three brain networks: default mood network (DMN), cognitive control network (CCN), and affective network (AN). The correlation between FC and the severity of PSD was investigated. Materials and methodsResting-state functional magnetic resonance image (rs-fMRI) was performed on 26 PSD patients (6 females), 24 stroke patients without depression (5 females), and 24 age-matched normal controls (6 females) all aged 40–75 years. The FC values of DMN, CCN, and AN were calculated and compared among the three groups. The Hamilton Depression Rating Scale (HDRS) (17 items) was employed and the score was correlated with FC in the PSD group. ResultsThe FCs of the three networks were altered in PSD patients at the subacute phase compared to stroke patients without depression and normal controls (NC). Moreover, the left inferior parietal gyrus, the left orbital part of inferior frontal gyrus, and left angular gyrus (which indicated altered FC) were significantly correlated with HDRS scores in PSD patients. ConclusionsAlteration of the three neural networks might be correlated with the development of PSD at the subacute phase of stroke.

Prevalence and severity of poststroke depression among stroke survivors in Northeastern Nigeria

Background: Post stroke depression (PSD) is a common neuropsychiatric mood disorder believed to be under-diagnosed among stroke survivors. Objective: The aim of this study was to determine the prevalence and severity of PSD among stroke survivors in north-eastern Nigeria. Materials and Methods: A purposive sample of stroke survivors (N = 249) in six tertiary health institutions in north-eastern Nigeria completed a three-part survey. Part 1 elicited sociodemographic information and part 2 was a Patient Health Questionnaire-9, utilized to identify the presence of PSD and its severity, while part 3 was Barthel Index utilized to determine the level of independence of participants. Chi-square test was used to determine the difference in prevalence of PSD between gender, different occupational statuses, living conditions, previous history of stroke, and side of hemispheric lesion. Pearson product moment correlation coefficient was used to determine the relationship between depression and age, duration of stroke, and level of independence. Results: An overwhelming majority of the participants (93.6%) were depressed; females tend to be more depressed (P < 0.05) than males. Significant correlation was observed between age and level of independence and PSD (r = −0.157, P = 0.013 and r = 0.345, P < 0.001, respectively). However, there was no significant correlation between the duration of stroke and PSD (r = −0.111, P = 0.079). Conclusion: This study revealed a high prevalence of PSD in the study region with females being more at risk. Further, increase in age and decreased level of independence correlated with PSD.

Correlation between cerebellar metabolism and post-stroke depression in patients with ischemic stroke.

The neurochemical changes that occur in the brain of patients with post-stroke depression (PSD) are not fully understood. This study aims to explore the correlation between cerebellar metabolism changes and PSD using proton magnetic resonance spectroscopy (1H-MRS). Participants were assigned to 3 groups: 60 patients with PSD (PSD group), 60 stroke patients without depression (NOPSD group), and 60 healthy volunteers (HEAL group). T1 WI, T2 WI, DWI and 1H-MRS examination were performed for patients at 14 days, 3 months after the stroke, respectively, and for healthy volunteers once when included in the study. Cho/Cr and Cho/NAA ratios in the cerebellar hemisphere contralateral to the lesion were higher in the PSD group than those in the HEAL and NOPSD groups on 14th day after the stroke (P < 0.05). In PSD group, Cho/Cr and Cho/NAA ratios in the cerebellar hemisphere contralateral to the lesion were positively correlated to the HAMD scale scores at both 14 days and 3 months after stroke (P < 0.05); Higher Cho/Cr and Cho/NAA ratios, and lower NAA/Cr ratio in the cerebellar hemisphere contralateral to the lesion were observed at 3 months after stroke compared to that at 14 days after stroke. Cerebellar damage may lead to PSD, and the degree of cerebellar damage may be associated with severity of PSD.

Abstract TP373: Advancing Stroke Recovery Through Social and Emotional Support

Background: Post-stroke disability often disrupts family roles and responsibilities. Role reversal, in combination with the disabilities, is emotionally taxing and physically fatiguing for both the stroke survivor and the family caregiver. Depression can result and when left undermanaged can lead to poor health outcomes. Research has shown social support is an important factor in recovery, post-stroke and caregiver depression. Studies have indicated high levels of social support are associated with faster functional recovery and more extensive recovery in stroke survivors. Also, that social support is independently associated with the presence and severity of post stroke depression and that positive social interaction is a significant contributor to variance in initial post stroke depression. Purpose: The purpose of this critical review was to examine the research literature on the relationships of social support and coping strategies with health-related outcomes among stroke survivors and their family caregivers. Methods: Twenty-five articles published between 2000 and 2016, identified by key terms related to stroke survivor and caregiver emotional and adjustment support needs, social support, depression and effective interventions, were reviewed. Results: We found overwhelming evidence that attention to stroke survivor and caregiver social network can advance recovery and improve the health and well being of both stroke survivors and caregivers. Knowledge gaps and focus on emotional and adjustment support needs are not being adequately met by community-based health services. This points to an important need for changes in practice to acclimate stroke survivors and their family caregivers to their new life roles, but also the need for more rigorous studies. Conclusions: In addition to more research, there is a critical need for changes in facilitating transitions of care to meet the emotional and adjustment needs in the stroke population. Encouraging health professionals to screen for social network presence and size and promoting support-seeking behavior may help advance recovery and improve the health and well being of stroke survivors and family caregivers.

Study on the relationship between post-stroke depression and neurological deficits

Objective To explore the relationship of post-stroke depression (PSD) with neurological function deficits and activities of daily living. Methods A total of 160 patients with stroke from August 2012 to September 2013 in Department of Neurology in our hospital were enrolled. Self-Rating Depression Scale (SDS), Hamilton Depression Rating Scale-17 Items (HAMD-17), National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) were used to assess depression, neurological function deficits and activities of daily living of stroke patients. Results A total of 65 patients (40.63%) appeared depression after stroke. Compared with non-PSD group, patients in PSD group presented more serious neurological function deficits ( P = 0.045) and less activities of daily living ( P = 0.000). The PSD group was further divided into 3 subgroups: mild, moderate and severe depression. Along with the increase of severity of PSD, NIHSS score increased ( P = 0.000, 0.000, 0.000) while Activities of Daily Living (ADL) score decreased ( P = 0.000, 0.000, 0.000). Pearson correlation analysis suggested that HAMD score was positively correlated with NIHSS score ( r = 0.534, P = 0.005), and negatively correlated with ADL score ( r = -0.645, P = 0.002). Conclusions PSD is closely related with the degree of neurological function deficits and activities of daily living. Curing the primary disease, reducing neurological dysfunction, taking early rehabilitation therapy, and improving the patients' activities of daily living will be helpful to alleviate the degree of PSD. DOI: 10.3969/j.issn.1672-6731.2016.05.005

Exploring a need for improved preclinical models of post-stroke depression.

Depression is one of the most common neuropsychiatric disorders associated with stroke. One in three patients who suffer from a stroke, report having depression-like symptoms. The mean prevalence for major and minor depression amongst stroke in patients is 21.6% and 20.0% respectively; the mean prevalence for outpatients is 24.0% and 23.9%. Increased severity of post-stroke depression has been associated with increased cognitive impairment and mortality. It is also considered to be one of the strongest correlates of impairment in activities of daily living after stroke. Whether the severity of depression impacts the degree of impairment, or vice versa, is not yet fully understood. Initially, post-stroke depression was thought to be a psychological response to the disability produced by stroke; however, studies in orthopedic patients with similar levels of disability, but a lower prevalence of depression, provide some evidence against such purely psychological explanations of post-stroke depression (Robinson and Spalletta, 2010).

The association between the severity of poststroke depression and clinical outcomes after first-onset stroke in Korean patients

ObjectiveThe purpose of the present study is to evaluate the association between poststroke depression (PSD) and clinical outcomes in first-onset stroke patients who are undergoing a rehabilitation program. MethodsThe present study included 180 inpatients that were recruited consecutively and followed up over a 6-month observational period. Poststroke depression was diagnosed using the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Symptoms of depression and clinical outcomes were assessed using the Beck Depression Inventory, the modified Barthel Index (MBI) and the Mini Mental State Examination (MMSE). All patients were assessed at baseline and at the end of the 6-month observational period. ResultsOf the 180 patients, 127 (70.6%) were diagnosed with minimal-to-mild depression (MMD), and 53 (29.4%) were diagnosed with moderate-to-severe depression (MSD). The mean change in MBI scores from baseline to 6 months was significantly higher (P=.029) in the MMD group (23.8) than in the MSD group (8.6). The odds ratio for an unfavorable outcome (MBI score <60) in patients with MSD was approximately 3.5 in relation to patients with MMD. The mean change in MMSE score (4.4 versus 7.4) was not significantly different between the MMD and MSD groups. ConclusionThe present findings suggest that the severity of PSD may be associated with clinical outcomes in Korean patients 6 months after a first-onset stroke. Our data agree with previous findings, which indicate that clinicians should carefully evaluate symptoms of depression in stroke patients during routine clinical practice. The methodological shortcomings of the present study may require further studies with adequate power and improved design to clarify the association between PSD and clinical outcomes following stroke.

Abstract 147: Perceived Social Support is Related to Initial Severity of Post-Stroke Depression, but Not to Depression Improvement

Background: Post-stroke depression (PSD) is a common occurrence after stroke, with multiple associated co-morbidities, and is often undermanaged. Perceived social support has been shown to be related to the presence of PSD; however, little is known about the relationship of social support and its specific dimensions to baseline PSD severity and depression improvement. Methods: We conducted a secondary analysis of data collected as part of a PSD cohort study in which depressed and non-depressed patients were matched 1:1 and enrolled at approximately one month post-stroke. PSD presence was assessed by a structured clinical interview, and PSD severity by the total PHQ-9 score. PSD improvement was measured at 12 weeks, and was defined as a PHQ-9 score &lt; 5 or a decrease by at least 50% from baseline. We constructed multivariable regression models to assess the relationships between social support, as measured by the Medical Outcomes Study Social Support Survey (MOS-SSS) and its subscales, clinical and demographic covariates, and PSD presence, severity, and improvement. Results: Among 385 ischemic stroke patients (203 non-depressed and 182 depressed), baseline MOS-SSS scores were associated with initial PSD presence (OR: 0.987, 95% CI = [0.976, 0.998]), but were not predictive of PSD improvement at 12 weeks (OR: 0.997, 95% CI = [0. 983, 1.011]). The positive social interaction dimension of social support was a significant contributor to variance in baseline PSD severity in all study participants (semi-partial R2: 8.65E-3, p=0.03), especially in the depressed cohort (semi-partial R2: 2.66E-2, p=0.02). Conclusions: Self-reported social support was independently associated with the presence and severity of PSD one month post-stroke. However, we did not find a relationship between baseline social support and subsequent depression improvement independent of other clinical and demographic factors. This suggests that depression interventions may be effective even in patients with low initial social support. Positive social interactions, in the form of leisure or recreational activities, may help to prevent or attenuate initial PSD severity.

Depressive disorders among elderly and senile patients during rehabilitation after acute ischemic stroke

To define the probability of depression after an ischemic stroke in elderly and senile age and the impact of depressive disorders on rehabilitative treatment, a comparative study of 186 patients aged over 70 and 110 patients aged 33–60 was carried out. The results prove that the frequency of occurrence and severity of poststroke depression do not depend on age. However, depression has a greater impact on the results of rehabilitative treatment among elderly patients than among young and middle-aged patients, which is due to the existence of prestroke emotional and volitional disorders typical of elderly and senile age. Explicit motor disorders resulting from stroke rarely contribute to the development of depression in elderly and senile age, although a combination of severe paralysis and depression negatively affects the rehabilitation results among older patients. Speech and pelvic disorders do not encourage depression and have no negative effect on the results of rehabilitative treatment among the elderly and senile patients, while the situation among the younger patients is opposite.

Abstract TP42: Brain Plasticity Changes in Default Mode Network after Stroke

Background: Resting-state fMRI (rs-fMRI) has been used for assessing task-free brain activity changes after stroke. One prominent resting-state neural network is the default mode network (DMN) that has been suggested to be suppressed during cognitive tasks. Older adults often show difficulties in suppressing DMN compared to younger adults during cognitive task performance. Moreover, dysfunction of DMN appears to be linked with the severity of post-stroke depression. Here we explored brain plasticity changes in DMN in stroke subjects. Methods: 9 stroke subjects (mean age=60.3, 5 Male) and 5 normal healthy subjects (mean age=48, 4 Male) underwent two rs-fMRI scans. Patients participated in the 1st scan within 7 days after onset and within 6 months (mean ~3 months) postonset in the 2nd scan. Brain plasticity changes were examined by functional connectivity measures that were computed using region-of-interest analysis. Rs-fMRI data were pre-processed in AFNI. The resulting time-series from 6 common seeds in DMN were averaged over each seed and correlated with that from every other seed to generate the Pearson correlation coefficients. These correlations were then z-transformed representing the 15 unique functional connections (fconn) in DMN. Fconn changes were determined with intraclass correlation (ICC), which measures reproducibility of fconn between scans. A reliable connection, as suggested to be an ICC ≥ 0.5, requires a small within-subject plasticity change compared to the between-subject variance. Results: Shown in Table 1. Conclusion: As seen from Table 1, fconn between RtLatPar and PC may undergo plasticity changes after stroke (ICC &lt; 0.5) as would be reliable in the normal group. Fconn between LtLatPar and PC, mPFC and PC, right and left LatPar were found to be significant and reliable, which could be due to less suppression in DMN and higher between-subject variability after stroke.