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Feng RF, Ma R, Wang P, Ji X, Zhang ZX, Li MM, Jiao JW, Guo L. Efficacy of escitalopram for poststroke depression: a systematic review and meta-analysis. Sci Rep 2022; 12:3304. [PMID: 35228575 PMCID: PMC8885641 DOI: 10.1038/s41598-022-05560-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Depression is very common after stroke, causing multiple sequelae. We aimed to explore the efficacy of escitalopram for poststroke depression (PSD). PubMed, Embase, Scopus, Cochrane Central Register of Controlled Trials, Clinical trials. gov, Wan fang Data (Chinese), VIP (Chinese) and CNKI (Chinese) were retrieved from inception to May 2021. We recruited Randomized Controlled Trials (RCTs) which met the inclusion criteria in our study. The depression rating scores, the incidence of PSD, adverse events as well as functional outcomes were analyzed. 11 studies and 1374 participants were recruited in our work. The results were depicted: the reduction of depression rating scores was significant in the escitalopram groups and the standard mean difference (SMD) was − 1.25 (P < 0.001), 95% confidence interval (95% CI), − 1.82 to − 0.68; the risk ratio (RR) of the incidence of PSD was 0.52 (95% CI, 0.29 to 0.91; P = 0.007 < 0.05), which was significantly lower in the escitalopram groups; Escitalopram is safe for stroke patients; there was improvement of the motor function. However, in sensitivity analyses, the conclusions of the motor function and the incidence of drowsiness were altered. The study suggests that escitalopram has a potentially effective role compared with control groups and demonstrates escitalopram is safe. However, the results of the motor function and the incidence of drowsiness should be considered carefully and remain to be discussed in the future.
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Affiliation(s)
- Rong-Fang Feng
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China
| | - Rui Ma
- College of Physical Education (Based School), Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Peng Wang
- Department of Basic Medicine, School of Nursing and Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China. .,Zhengzhou University of Industrial Technology, Zhengzhou, 450002, Henan, People's Republic of China. .,Medical School of Huanghe Science and Technology University, Zhengzhou, 450006, Henan, People's Republic of China.
| | - Xu Ji
- Henan University of Chinese Medicine, Zhengzhou, 450046, Henan, People's Republic of China
| | - Zhen-Xiang Zhang
- Department of Clinical Medicine, School of Nursing and Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Meng-Meng Li
- Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, 450007, People's Republic of China
| | - Jia-Wei Jiao
- Department of Basic Medicine, School of Nursing and Health, Zhengzhou University, Zhengzhou, 450001, Henan, People's Republic of China
| | - Li Guo
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, People's Republic of China.
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Schmauß M. Post-Stroke-Depression. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 89:145-147. [PMID: 33858025 DOI: 10.1055/a-1344-8184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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3
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Wei M, Huang Q, Liu Z, Luo Y, Xia J. Intestinal Barrier Dysfunction Participates in the Pathophysiology of Ischemic Stroke. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 20:401-416. [PMID: 33749565 DOI: 10.2174/1871527320666210322115808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/12/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022]
Abstract
The gastrointestinal tract is a major organ for the body to absorb nutrients, water and electrolytes. At the same time, it is a tight barrier to resist the invasion of harmful substances and maintain the homeostasis of the internal environment. Destruction of the intestinal barrier is linked to the digestive system, cardiovascular system, endocrine system and other systemic diseases. Mounting evidence suggests that ischemic stroke not only changes the intestinal microbes, but also increases the permeability of the intestinal barrier, leading to bacterial translocation, infection, and even sepsis. The intestinal barrier, as part of the gut-brain axis, has also been proven to participate in the pathophysiological process of ischemic stroke. However, little attention has been paid to it. Since ischemic stroke is a major public health issue worldwide, there is an urgent need to know more about the disease for better prevention, treatment and prognosis. Therefore, understanding the pathophysiological relationship between ischemic stroke and the intestinal barrier will help researchers further uncover the pathophysiological mechanism of ischemic stroke and provide a novel therapeutic target for the treatment of ischemic stroke. Here, we review the physiology and pathology between ischemic stroke and intestinal barrier based on related articles published in the past ten years about the relationship between ischemic stroke, stroke risk factors and intestinal flora, intestinal barrier, and discuss the following parts: the intestinal barrier; possible mechanisms of intestinal barrier destruction in ischemic stroke; intestinal barrier destruction caused by stroke-related risk factors; intestinal barrier dysfunction in ischemic stroke; targeting the intestinal barrier to improve stroke; conclusions and perspectives.
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Affiliation(s)
- Minping Wei
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
| | - Qin Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
| | - Zeyu Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
| | - Yunfang Luo
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
| | - Jian Xia
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan 410008. China
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Chollet F, Rigal J, Marque P, Barbieux-Guillot M, Raposo N, Fabry V, Albucher JF, Pariente J, Loubinoux I. Serotonin Selective Reuptake Inhibitors (SSRIs) and Stroke. Curr Neurol Neurosci Rep 2018; 18:100. [PMID: 30353288 DOI: 10.1007/s11910-018-0904-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The interest in SSRIs after stroke has increased in the past few years, with better knowledge of post-stroke depression and with the demonstrated capacity of some SSRIs to act on the functional recovery of non-depressed subjects. RECENT FINDINGS Arguments for the action of SSRIs in favour of post-stroke neurological function recovery have improved through new elements: basic science and preclinical data, positive clinical trials and repeated series of stroke patient meta-analysis, and confirmation of favourable safety conditions in post-stroke patients. Global coherence is appearing, showing that SSRIs improve stroke recovery in non-depressed patients when given for 3 months after the stroke, with highly favourable safety conditions and a favourable benefit/risk ratio. Large series are still needed.
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Affiliation(s)
- F Chollet
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France. .,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France.
| | - J Rigal
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - P Marque
- Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France.,Rehabilitation Department, Hôpital de Rangueil, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - M Barbieux-Guillot
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - N Raposo
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - V Fabry
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - J F Albucher
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - J Pariente
- Neurology Department, Hôpital Pierre-Paul Riquet, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.,Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
| | - I Loubinoux
- Toulouse Neuro-Imaging, Inserm, UPS, Université de Toulouse, Toulouse, France
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5
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Kim J, Kim Y. Which Patients Are Prescribed Escitalopram?: Predictors for Escitalopram Prescriptions and Functional Outcomes among Patients with Acute Ischemic Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15061085. [PMID: 29843379 PMCID: PMC6025022 DOI: 10.3390/ijerph15061085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/21/2018] [Accepted: 05/25/2018] [Indexed: 01/30/2023]
Abstract
Recent studies have demonstrated that antidepressants could enhance functional recovery via neuroplasticity beyond solely treating depression. However, since Koreans typically show a greater aversion to seeking psychiatric care than citizens of Western countries, the number of antidepressant prescriptions is low. Through this study, we aim to identify the factors that lead to the prescription of antidepressants in subjects with acute ischemic stroke (AIS) in clinical practice. A total of 775 patients with ischemic stroke (IS) participated in this study from March 2010 to May 2013. We used binary logistic regression to find predictors for escitalopram prescriptions. To reveal predictors for short-term functional outcomes, we used an adjusted regression model using a propensity score. Among the 775 participants, 39 (5.03%) were prescribed escitalopram. The duration of hospital stay (odds ratio (OR) = 1.07; 95% confidence interval (CI) = 1.04–1.10) and the use of mechanical ventilation were significantly more closely related to escitalopram prescriptions as compared to non-escitalopram prescriptions (OR = 5.15; 95% CI = 1.53–17.40). The use of escitalopram, on the other hand, was not significantly associated with short-term functional outcomes (OR = 1.27; 95% CI = 0.50–3.25). Duration of hospital stay and use of mechanical ventilation were significantly related to escitalopram prescriptions.
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Affiliation(s)
- Jarim Kim
- School of Communication, Kookmin University, Bugak Hall 603, 77 Jeongneung-ro, Seongbuk-gu, Seoul 02707, Korea.
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul 05355, Korea.
- College of Medicine, Seoul National University, Seoul 03080, Korea.
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Yeo SH, Lim ZJI, Mao J, Yau WP. Effects of Central Nervous System Drugs on Recovery After Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin Drug Investig 2018; 37:901-928. [PMID: 28756557 DOI: 10.1007/s40261-017-0558-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Pilot trials have suggested that pharmacotherapy may aid stroke recovery. The aim of this study was to systematically review the effects of antidepressants, anti-Alzheimer drugs, anti-Parkinson drugs, central nervous system (CNS) stimulants and piracetam on gross motor function, cognition, disability, dependency and quality of life (QOL) after stroke. METHODS PubMed, EMBASE and the Cochrane Central Register of Controlled Trials databases were searched, and 44 randomized controlled trials that compared outcomes of interest between drug treatment and placebo or no treatment were included. For each study, standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval (CI) were calculated. Meta-analyses were conducted to pool results using either the fixed-effects or random-effects model. RESULTS Selective serotonin reuptake inhibitors (SSRIs) improved gross motor function (SMD 0.54, 95% CI 0.22-0.85; three studies), disability (SMD 0.49, 95% CI 0.32-0.66; 14 studies) and QOL (MD 6.46, 95% CI 4.71-8.22; two studies), but there was insufficient evidence for their use in enhancing global cognition (SMD 0.23, 95% CI -0.01 to 0.46; five studies) and dependency (risk ratio 0.81, 95% CI 0.68-0.97; one fluoxetine study). In particular, gross motor function was improved by fluoxetine (SMD 0.64, 95% CI 0.31-0.98; two studies), while disability was improved by paroxetine (SMD 1.05, 95% CI 0.63-1.46; two studies), citalopram (SMD 0.51, 95% CI 0.08-0.93; two studies) and fluoxetine (SMD 0.41, 95% CI 0.22-0.60; nine studies). There is insufficient evidence for the use of anti-Alzheimer drugs, anti-Parkinson drugs, CNS stimulants and piracetam to promote stroke recovery. CONCLUSIONS Administration of SSRIs may improve gross motor function, reduce disability and enhance QOL for patients recovering from stroke.
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Affiliation(s)
- See-Hwee Yeo
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Zheng-Jie Ian Lim
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Jia Mao
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore
| | - Wai-Ping Yau
- Department of Pharmacy, Faculty of Science, National University of Singapore, 18 Science Drive 4, Singapore, 117543, Singapore.
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Deng L, Qiu S, Yang Y, Wang L, Li Y, Lin J, Wei Q, Yang L, Wang D, Liu M. Efficacy and tolerability of pharmacotherapy for post-stroke depression: a network meta-analysis. Oncotarget 2018; 9:23718-23728. [PMID: 29805769 PMCID: PMC5955092 DOI: 10.18632/oncotarget.23891] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/13/2017] [Indexed: 02/05/2023] Open
Abstract
Background Post-stroke depression (PSD) occurs in approximately one third of stroke survivors, leading to great disability and mortality. As there is no consensus on the optimal pharmacological treatment for PSD, we aimed to evaluate the relative efficacy and tolerability of the available pharmacological interventions. Materials and Methods We did a network meta-analysis to incorporate evidence from relevant trials providing direct and indirect comparisons. We searched PubMed, the Cochrane Library Central Register of Controlled Trials, Embase and the reference lists of relevant articles up to March, 2017 for randomized controlled trials (RCTs), for different pharmacotherapies of PSD. For efficacy analysis, the primary outcome was the mean change in Hamilton Depression Scale (HAMD) score between baseline and endpoint. For tolerability analysis, the outcome was presented by the discontinuation for any reason. This study is registered with PROSPERO, number CRD42016049049. Results From a total of 869 citations, 15 RCTs with 876 participants were included. 13 drugs were considered. For efficacy, paroxetine ranked the best for HAMD reduction, followed by imipramine, reboxetine, nortriptyline, citalopram and fluoxetine at the end of treatment. However, duloxetine ranked the best at 4-week and 8-week duration for HAMD reduction. For tolerability, paroxetine ranked the best but there is no significant result between any comparisons. Conclusions Paroxetine is probably the best option to consider for patients with PSD. To get a quicker relief of depression, duloxetine might be useful for its rapid onset of antidepressant action. The tolerability was comparable among all the antidepressants. But more high-quality RCTs are needed.
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Affiliation(s)
- Linghui Deng
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yan Yang
- Kidney Research Institute, Division of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Wang
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuxiao Li
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Lin
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Deren Wang
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ming Liu
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Wang Z, Zhu M, Su Z, Guan B, Wang A, Wang Y, Zhang N, Wang C. Post-stroke depression: different characteristics based on follow-up stage and gender–a cohort perspective study from Mainland China. Neurol Res 2017; 39:996-1005. [PMID: 28828931 DOI: 10.1080/01616412.2017.1364514] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Zixuan Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases (NCRC-ND), Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Meifang Zhu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases (NCRC-ND), Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhaoping Su
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases (NCRC-ND), Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Boyuan Guan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases (NCRC-ND), Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases (NCRC-ND), Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center of Neurological Diseases (NCRC-ND), Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ning Zhang
- China National Clinical Research Center of Neurological Diseases (NCRC-ND), Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunxue Wang
- China National Clinical Research Center of Neurological Diseases (NCRC-ND), Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Whitmore CA. The risk of initiating fluoxetine for motor deficits after ischemic stroke in patients with bipolar disorder. ARCH CLIN PSYCHIAT 2017. [DOI: 10.1590/0101-60830000000131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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Abstract
PURPOSE OF REVIEW This article provides a synopsis of the immediate and delayed medical complications of stroke, with an emphasis on prevention and management of these complications. RECENT FINDINGS Meta-analysis of the trials for endovascular treatment of acute stroke shows no significant increase in hemorrhagic events. Rehabilitation guidelines published by the American Heart Association and American Stroke Association in 2016 aid in providing the best clinical practice for patients with stroke, from the time of their initial hospitalization to their return to the community. SUMMARY Medical complications from stroke are common and are associated with poor clinical outcomes, increased length of hospital stays and higher rates of readmission, increased cost of care, delayed time to rehabilitation, and increased mortality. Being cognizant of the common complications encountered, taking appropriate measures to prevent them, and knowing how to manage them when they do occur are essential to the continued care of patients with stroke.
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Desmaele S, Putman K, De Wit L, Dejaeger E, Gantenbein AR, Schupp W, Steurbaut S, Dupont AG, De Paepe K. A comparative study of medication use after stroke in four countries. Clin Neurol Neurosurg 2016; 148:96-104. [DOI: 10.1016/j.clineuro.2016.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 05/31/2016] [Accepted: 07/02/2016] [Indexed: 01/04/2023]
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12
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Laures-Gore JS, Farina M, Moore E, Russell S. Stress and depression scales in aphasia: relation between the aphasia depression rating scale, stroke aphasia depression questionnaire-10, and the perceived stress scale. Top Stroke Rehabil 2016; 24:114-118. [PMID: 27348232 DOI: 10.1080/10749357.2016.1198528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Assessment and diagnosis of post-stroke depression (PSD) among patients with aphasia presents unique challenges. A gold standard assessment of PSD among this population has yet to be identified. OBJECTIVES The first aim was to investigate the association between two depression scales developed for assessing depressive symptoms among patients with aphasia. The second aim was to evaluate the relation between these scales and a measure of perceived stress. METHOD Twenty-five (16 male; 9 female) individuals with history of left hemisphere cerebrovascular accident (CVA) were assessed for depression and perceived stress using the Stroke Aphasic Depression Questionnaire-10 (SADQ-10), the Aphasia Depression Rating Scale (ADRS), and the Perceived Stress Scale (PSS). RESULTS SADQ-10 and ADRS ratings were strongly correlated with each other (r = 0.708, p < 0.001). SADQ-10 ratings were strongly correlated with PSS ratings (r = 0.620, p = 0.003), while ADRS ratings were moderately correlated (r = 0.492, p = 0.027). Item analysis of each scale identified items which increased both inter-scale correlation and intra-scale consistency when excluded. CONCLUSIONS The SADQ-10 and ADRS appear to be acceptable measures of depressive symptoms in aphasia patients. Measurements of perceived stress may also be an important factor in assessment of depressive symptoms.
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Affiliation(s)
- Jacqueline S Laures-Gore
- a Department of Educational Psychology, Communication Sciences and Disorders Program , Georgia State University , Atlanta , Georgia
| | - Matthew Farina
- a Department of Educational Psychology, Communication Sciences and Disorders Program , Georgia State University , Atlanta , Georgia
| | - Elliot Moore
- b Department of Electrical and Computer Engineering , Georgia Institute of Technology , Atlanta, Georgia
| | - Scott Russell
- c School of Electrical and Computer Engineering , Grady Memorial Health System , Atlanta, Georgia
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13
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Mittal N, Hurn PD, Schallert T. Exploring a need for improved preclinical models of post-stroke depression. Neural Regen Res 2016; 11:561-2. [PMID: 27212911 PMCID: PMC4870907 DOI: 10.4103/1673-5374.180736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Nitish Mittal
- College of Pharmacy, University of Texas at Austin, Austin, TX, USA
| | - Patricia D Hurn
- Department of Neuroscience, University of Texas at Austin, Austin, TX, USA; University of Texas System, Austin, TX, USA
| | - Timothy Schallert
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1470] [Impact Index Per Article: 183.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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Salinas J, Beiser A, Himali JJ, Rosand J, Seshadri S, Dunn EC. Factors Associated With New-Onset Depression After Stroke. J Neuropsychiatry Clin Neurosci 2016; 28:286-291. [PMID: 27056020 PMCID: PMC5474200 DOI: 10.1176/appi.neuropsych.15110388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To better identify stroke survivors at risk for depression who may benefit from early prevention through targeted strategies in the acute-subacute poststroke period, we examined 118 Framingham Heart Study stroke survivors with longitudinal prestroke depression assessments. Among those who developed poststroke depression, most lacked a history of depressive symptoms 5 years prior to their stroke. Sex (female), advanced age, and prestroke factors (smoking and functional dependence) were associated with new-onset depression poststroke. These findings suggest fully characterizing and accounting for prestroke factors, including psychosocial and behavioral determinants, may inform the predictive modeling needed to determine whether targeted preventive trials early in stroke recovery will improve stroke outcomes.
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Affiliation(s)
- Joel Salinas
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexa Beiser
- The Framingham Heart Study, Boston, MA, USA,Department of Biostatistics, Boston University School of Medicine, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jayandra J. Himali
- The Framingham Heart Study, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Jonathan Rosand
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sudha Seshadri
- The Framingham Heart Study, Boston, MA, USA,Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Erin C. Dunn
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kapfhammer HP. [Coexistent depressive and anxiety disorders in neurological diseases: from a perspective of multimorbidity]. DER NERVENARZT 2014; 85:437-44. [PMID: 24619147 DOI: 10.1007/s00115-013-3936-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The high rate of coexistent emotional disorders in neurological diseases is challenging. As a rule this coexistence comprises a more dramatic subjective suffering, reduced psychological coping, possible negative interferences with somatic treatments and rehabilitation, an impaired quality of life and higher grades of psychosocial disability. It may also lead to an overall increased risk of somatic morbidity and even mortality in the further course of illness. The complex interrelations may be favorably integrated within a biopsychosocial model. Psychological and psychosocial stressors can be appreciated on their own discrete levels but have to be reflected in their neurobiological correlates. Both neurological and emotional disorders frequently share decisive pathogenetic mechanisms, i.e. the underlying process of neurological disease may contribute to major affective problems also in a somatopsychic direction. From a perspective of multimorbidity the prevalence and clinical relevance of coexistent depressive and anxiety disorders, common pathogenetic mechanisms and implications for treatment will be described for stroke and Parkinson's disease, as selected neurological disorders.
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Affiliation(s)
- H P Kapfhammer
- Klinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich,
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Pharmacological therapies in post stroke recovery: recommendations for future clinical trials. J Neurol 2013; 261:1461-8. [PMID: 24221642 DOI: 10.1007/s00415-013-7172-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/20/2013] [Accepted: 10/21/2013] [Indexed: 12/22/2022]
Abstract
Stroke is a leading cause of serious long-term disability in adults and is the second leading cause of death worldwide. Early reperfusion and neuroprotection techniques have been the focus of much effort with the aim of very acute treatment of the stroke. Targeting different mechanisms, pharmacological therapies have the potential to reduce disability in a large fraction of patients who survive the acute stroke. The brain's capacity to reorganize after stroke through plasticity mechanisms can be modulated by pharmacological agents. A number of therapeutic interventions are under study, including small molecules, growth factors, and monoclonal antibodies. Recently it has been shown that the SSRI fluoxetine improved motor deficit in patients with ischaemic stroke and hemiplegia which appeared to be independent of the presence of depression. In this context, it is of major importance to support innovative research in order to promote the emergence of new pharmacological treatments targeting neurological recovery after stroke, as opposed to acute de-occlusion and neuroprotection. This paper is the work of a group of 14 scientists with aim of (1) addressing key areas of the basic and clinical aspects of human brain plasticity after stroke and potential pharmacological targets for recovery, (2) asking questions about the most appropriate characteristics of clinical trials testing drugs in post stroke recovery and (3) proposing recommendations for future clinical trials.
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