Severity Of Post-stroke Depression Research Articles

Subacute Default Mode Network Dysfunction in the Prediction of Post-Stroke Depression Severity

To identify patterns of rest functional connectivity (FC) in the whole brain with the default mode network (DMN) soon after stroke and to explore the predictive accuracy of the strength of rest FC in specific areas on poststroke severity of depression and anxiety symptoms. The protocol was accepted by the local ethics board, and all patients provided informed consent to participate. Resting-state functional magnetic resonance (MR) images were acquired 10 days after a first stroke in 24 patients without a history of psychiatric illness. Independent component analysis was used to isolate the DMN in each subject. Hamilton Depression Rating Scale (HDRS) 17 and Hamilton Anxiety Rating Scale (HARS) were recorded 10 days and 3 months after the stroke. Associations between severity of anxiety or depression symptoms and DMN functional connectivity were investigated with whole-brain analyses by using statistical parametric mapping software and were adjusted for age, sex, manual laterality, and National Institutes of Health Stroke Severity scores. Correlations were considered significant if P<.001, with a cluster size of more than 50 voxels. Ten days after stroke, anxiety severity was correlated with functional connectivity in the middle temporal cortex and the anterior midcingulate cortex, while at 3 months after stroke, a correlation was observed with the middle temporal cortex and the posterior cingulate cortex. Poststroke depressive symptom severity did not correlate with functional connectivity changes at 10-day follow-up, while the HDRS 17 score was correlated with functional connectivity in the left middle temporal cortex and precuneus at 3-month follow-up. These results suggest that a dysfunction of DMN functional connectivity involved in emotional control is associated with the severity of poststroke depression. Further studies are necessary to determine the mechanisms of this functional impairment.

A systematic review of therapeutic interventions for poststroke depression and the role of nurses

This systematic review explores the nursing role in the management of poststroke depression and identifies effective non-pharmacological interventions that nurses can use in the daily care of patients with stroke. Depression is a common complication poststroke and affects one-third of patients with stroke. It has a negative impact on functional recovery and social activities and is associated with increased morbidity and mortality. Detection and diagnosis of poststroke depression is inconsistent, and many depressed patients are under-treated. Although nurses recognise that observation and assessment are parts of their role in rehabilitation care, little is known about their role in assessing depression or the interventions they can use. A systematic review was conducted using the Cochrane method. Literature for the period 1993-2008 was searched in the electronic databases of CINAHL, Medline (PubMed), Nursing Journals (PubMed) and PsycINFO using the following keywords: cerebrovascular accident, stroke, depression, poststroke depression, treatment, therapy, treatment outcome, management. Fifteen articles and one systematic review were identified. There was strong evidence that information provision reduces the severity of depression. Other interventions with positive effects on the occurrence or severity of poststroke depression were as follows: life review therapy, motivational interviewing, a specific nursing support programme and physical exercise. Depression after stroke is an important problem with adverse effects on the patient's ability to participate in rehabilitation and on rehabilitation outcome. The interventions described can be implemented in nursing care of patients with poststroke depression. The variety of such interventions and the diversity of their nature and design are consistent with the practice of rehabilitation nursing. The findings of this review enable nurses to intervene effectively to reduce the occurrence and severity of depression in patients with stroke.

Depressão pós-AVC: aspectos psicológicos, neuropsicológicos, eixo HHA, correlato neuroanatômico e tratamento

CONTEXTO: A depressão pós-AVC (DPAVC) possui uma prevalência elevada. Apesar disso, ela é pouco detectada e tratada. Muitos fatores de risco e repercussões negativas na recuperação dos pacientes estão associados à DPAVC. OBJETIVO: Revisar alguns aspectos da DPAVC como: qualidade de vida, prejuízos cognitivos, eixo HHA, localização do AVC e tratamento. MÉTODOS: Pesquisa dos últimos 10 anos da base de dados MedLine/PubMed usando as palavras-chave post-stroke depression, stroke, quality of life, hypercortisolism, cogntitive dysfunction e treatment. RESULTADOS: A prevalência de DPAVC é de 23% a 60%. Há poucos estudos sobre a incidência de DPAVC. A DPAVC está associada a pior prognóstico e evolução, agravo das disfunções cognitivas e redução da qualidade de vida. O hipercortisolismo está associado à DPAVC que ocorre tardiamente ao AVC. AVC em gânglios da base, região frontal esquerda e estruturas do circuito prefrontosubcortical está relacionado à frequência e à gravidade da DPAVC. CONCLUSÕES: É necessário melhoria na metodologia dos estudos para maior esclarecimento sobre a fisiopatologia da incidência da DPAVC. Programas objetivando o aumento das taxas de detecção dos pacientes deprimidos se fazem necessários inclusive para a redução dos impactos negativos na recuperação desses pacientes.

Depression after First-Ever Ischemic Stroke: The Prognostic Role of Neuroanatomic Subtypes in Clinical Practice

Background: The relationship between poststroke depression (PSD) and Oxford Community Stroke Project (OCSP) subtypes is uncertain. Methods: 713 first-ever ischemic stroke patients recruited in a multicenter investigation to evaluate prevalence, onset time and severity of PSD. Stroke subtypes were considered as independent predictors of PSD occurrence by logistic regression. Results: Results showed similar prevalence of PSD in stroke subtypes with the exception of TACI. Only patients with total anterior cerebral ischemia (TACI) showed a higher PSD occurrence (OR: 1.76, CI: 1.14–2.71). Multivariate analysis underlined the role of severe functional impairment, previous depressive disorders and female sex. Neither the OCSP subgroups, nor left and right involvement were predictive of PSD. TACI and left-sided strokes were related to higher depression severity scores. Conclusions: In clinical practice, the definition of neuroanatomic subtypes provides little contribution specifically to PSD prediction after a first-ever ischemic stroke.

Cerebrovascular diseases and depression

Cerebrovascular diseases constitute a leading health hazard. The association between stroke and depression has been recognized for many years. Depression is the most common psychiatric disorder associated with cerebrovascular diseases, most episodes of post-stroke depression occur in the first 2 years after a cerebrovascular accident. Studies have found an association between lesion location, physical impairment, cognitive impairment, aphasia, and post-stroke depression. The location of the lesion in terms of proximity to the left frontal pole of the brain has a profound impact on the frequency and severity of post-stroke depression. Treatment modalities include pharmacotherapy, psychotherapy, electroconvulsive therapy, and rehabilitation. Understanding the psychologic and physical morbidity of post-stroke depression, as well as its timely, comprehensive treatment, are important for effective management.

Poststroke depression and lesion location. An attempted replication.

Recent evidence suggests that poststroke depression is associated with the location of the brain infarct, proximity to the frontal pole being associated with greater depression following left hemisphere injury, and an opposite relationship being seen with injury to the right hemisphere. This study was designed to replicate and extend previous investigation of this issue. Depression was assessed following recent stroke in patients with localized right (n = 16) or left (n = 19) hemisphere lesions. No overall differences between these groups were found on several measures of depression. Although there appeared to be a negative linear relationship between severity of depression and distance of the lesion from the frontal pole in left hemisphere patients, this association failed to attain statistical significance. A curvilinear relationship was evident in right hemisphere patients, with anterior and posterior lesions associated with high depression scores. These data support the notion that lesion location is associated with the severity of poststroke depression, although the nature of this association may be more complex than has previously been suggested.