Evaluation of depression status and its influencing factors in convalescent elderly patients with first-episode stroke

Depressive symptoms changes in the new-onset stroke patients: A cross-lagged panel network analysis

BACKGROUND

Each year, there are approximately 10.3 million new stroke cases worldwide, with 2 million occurring in China. Post-stroke depression (PSD) is a common complication that negatively affects rehabilitation outcomes and increases long-term mortality.

OBJECTIVE

This study used network analysis to investigate the cross-sectional and longitudinal networks between depressive symptoms in new-onset stroke patients with PSD, aiming to identify the key symptoms and predictive relationships among distinct symptoms during the acute phase and 6 months after the stroke.

METHODS

This longitudinal descriptive study collected data from October 2022 to December 2023, including eligible new-onset stroke patients. Depressive symptoms were assessed using the CES-D scale, and network analysis was used to analyze the interactions between symptoms.

RESULTS

613 participants completed the data collection. The study found that D3 (Felt sadness) emerged as the central depressive symptom at both baseline and follow-up (EI value = 1.215 and 1.168, respectively). In the longitudinal network analysis, D7 (Sleep quality) displayed the strongest out-Expected Influence (value = 1.728), while D4 (Everything was an effort) showed the strongest in-Expected Influence (value = 1.322).

LIMITATIONS

The self-report measure is adopted for all depressive symptoms in the study, and there may be some deviation.

CONCLUSION

These symptom-level associations at cross-sectional and longitudinal networks extend our understanding of PSD symptoms in new-onset stroke patients by pointing to specific key depressive symptoms that may aggravate PSD. Recognizing these symptoms is imperative for the development of targeted interventions and treatments aimed at addressing PSD in new-onset stroke patients.

Influencing factors and predictive models of early post-stroke depression in patients with acute ischemic stroke

BACKGROUND

Post-stroke depression (PSD) refers to a depressive state that appears after stroke onset and is one of the most common complications in ischemic stroke patients. The occurrence of PSD exacerbates the risk of disability and increases the mortality of patients. Current diagnosis of PSD is severely underdiagnosed.

METHODS

Patients hospitalized for acute ischemic stroke between December 2019 and November 2022 in the Department of Neurology of Sinopharm Gezhouba Central Hospital were retrospectively collected. Patients' basic clinical information, test data and related questionnaire scores were collected. They were divided into PSD group and NPSD group. Multivariate regression was used to analyze the risk factors of post-stroke depression and establish a risk prediction model to draw nomograms. Receiver Operating Characteristic Curve (ROC), Calibration curve and Decision Curve Analysis (DCA) decision curve were drawn using R language to assess the clinical efficacy and clinical utility of the model.

RESULTS

Post-stroke depression in Acute Ischemic Stroke (AIS) patients was associated with single factors such as hypertension, living alone, education level, homocysteine level, National Institute of Health Stroke Scale (NIHSS) score, lymphocyte count, neutrophil count (P < 0.05). Among them, living alone, CRP level, hypertension, homocysteine level, education level, systemic immune inflammation index (SII), and NIHSS score were independent risk factors for post-stroke depression in AIS patients (P < 0.05). The seven selected variables were used to construct a risk prediction model, nomograms were drawn, and ROC curves were used to assess model discrimination, AUROC = 0.881. Calibration curve is used to evaluate the consistency of the model, DCA decision curve is used to evaluate the practicability of the model, and this model has good discrimination ability, calibration and clinical practicability.

CONCLUSION

The probability of PSD in AIS patients in this study was 26.51%. Independent risk factors for developing PSD, including CRP level, living alone, history of hypertension, homocysteine level, education level, SII, NIHSS score to establish risk prediction model and draw nomograms. The model was demonstrated to have good discrimination, calibration and clinical utility by internal validation.

Psychobiotic Protection of Nutritional Supplements and Probiotics in Patients Undergoing Hemodialysis: A Randomized Trial

BACKGROUND/OBJECTIVES

The prevalence of depression and anxiety symptoms is remarkably high in malnourished individuals undergoing hemodialysis. The goal of this project was to evaluate the impact of administering an oral nutritional supplement combined with a probiotic blend on the microbiota, intestinal permeability, and depression symptoms in malnourished hemodialysis patients.

METHODS

With this aim, a randomized trial was conducted with three parallel groups: a control group with individualized diet, a supplement-placebo (SU-PL) group with oral nutritional supplementation (ONS), and a supplement-probiotic (SU-PR) group with ONS in conjunction with a probiotic blend. Blood and fecal samples were collected at basal time, and at 3 and 6 months. Several blood biomarkers, like zonulin, lipopolysaccharide-binding protein (LBP), lipopolysaccharide (LPS), and brain-derived neurotrophic factor (BDNF), were measured, and the fecal microbiome was sequenced with the Illumina platform. The Hospital Anxiety and Depression Scale (HADS) was used for the estimation of depression (HADS-D) and anxiety (HADS-A) symptoms, along with the standardized mental health index SF12-MH from the general health questionnaire SF-12.

RESULTS

The results showed that patients who consumed the probiotic blend maintained the LPS levels from their baseline readings and decreased their BDNF levels compared to the SU-PL or control groups. Moreover, a significant decrease in HADS-D scores (less depressive symptoms) and an increase in SF12-MH scores (higher quality of life) were found in that group in comparison to the other groups. The intervention produced an impact on the microbiome population, where the SU-PR group had reduced Akkermansia abundance with respect to the other groups, while their Acidaminococcus abundance decreased and their Barnesiella abundance increased with respect to the SU-PL group.

CONCLUSIONS

Overall, the results indicate that the probiotic with the nutritional supplement could reduce the intestinal permeability biomarkers and improve depressive symptoms and quality of life in malnourished hemodialysis patients.

Depression status and risk factors analysis based on the 'individual-social-health system' dimension: evidence from middle-aged and elderly people in China

BACKGROUND

Depression, as a common mental illness, is harmful and burdensome. As a country with a large elderly population, China has a heavy burden of depression going in the future. The study aims to portray the current situation of depression occurrence in middle-aged and elderly people in China and capture the risk triggers, in order to provide a theoretical basis for the improvement of the mental health status of middle-aged and elderly people, and the development of depression prevention, control and intervention strategies.

METHOD

The study used 2020 China Health and Retirement Longitudinal Study (CHARLS) data and 18 950 respondents aged >45 years as the study sample. Depression status was calculated according to the simplified version of the Depression Scale (CES-D10) and logistic regression analysis was used to explore the factors affecting depression.

RESULT

There were 34.14% of the 18 950 respondents who were depressed. The results of logistic regression showed that factors such as being under 65 years of age, female, living in rural areas, having low education, and poor health status were risk factors for depression.

CONCLUSION

The mental health of the middle-aged and elderly population is poor and affected by multidimensional factors. The Chinese government should continue to strengthen its efforts to prevent and treat depression in the middle-aged and elderly population, and establish individualised and comprehensive strategies and measures to enhance the operational effectiveness of the policy.

Innate immunity-mediated neuroinflammation promotes the onset and progression of post-stroke depression

Post-stroke depression (PSD) is a prevalent psychiatric disorder after stroke, with the incidence of approximately one-third among stroke survivors. It is classified as an organic mental disorder and has a well-documented association with stroke affecting various aspects of patients, such as the recovery of limb motor function, daily living self-care ability, and increasing the mortality of stroke survivors. However, the pathogenesis of PSD is not yet fully understood. Currently, immune inflammation is a research hotspot. This review focuses on the pathogenesis of PSD, particularly elucidating the role of inflammation in mediating neuroinflammation through innate immunity. Simultaneously, we highlight that peripheral inflammation following a stroke may trigger a detrimental cycle of neuroinflammation by activating innate immune pathways within the central nervous system, which could potentially contribute to the development of PSD. Lastly, we summarize potential treatments for PSD and propose targeting cytokines and innate immune pathways as novel therapeutic approaches.

Association between Life's simple 7 and post-stroke depression symptom from 2005-2016 NHANES survey: A cross-sectional study

BACKGROUND

Depression symptoms are a common complication of stroke and heart disease and is a predictor of Post-stroke depression (PSD). However, the relationship between overall cardiovascular health indicators and PSD remains unclear.

METHODS

Data were collected from stroke patients in the 2005-2016 National Health and Nutrition Examination Surveys (NHANES) survey. Depression was defined as a Patient Health Questionnaire-9 (PHQ-9) score ≥10. In addition, PSD was defined as the coexistence of stroke and depression. Life's Simple 7 (LS7) provides an assessment of cardiovascular health and consists of 7 items. The LS7 scores range from 0 to 14 and can also be categorized into poor (0-7), average (8-10), and ideal (11-14). Logistic regression models were used to investigate the relationship between LS7 and PSD.

RESULTS

The average age of participants was 64.2 years, with 45.1% and 34.3 % being male and non-Hispanic whites, respectively. After adjusting for age, sex, race, education, and income, the LS7 scores were found to be associated with reduced PSD odds (OR: 0.76, 95% CI: 0.68-0.85, P: <0.001), as well as the number of ideal LS7 metrics (OR: 0.69, 95% CI: 0.56-0.85, P: <0.001). Furthermore, non-poor LS7 was also associated with a lower risk of PSD compared to poor LS7 (OR: 0.48, 95% CI: 0.25-0.91, P: 0.01). This association was stable in stratification analyses.

CONCLUSION

Cardiovascular health status assessed by LS7 was negatively associated with PSD. Future studies are required to verify these findings.

The safety and efficacy of escitalopram and sertraline in post-stroke depression: a randomized controlled trial

OBJECTIVES

This study aims to evaluate the safety and efficacy of escitalopram and sertraline in post-stroke depression (PSD) patients, to provide more reliable therapeutics for cardiovascular and psychiatric clinical practice.

METHODS

We recruited 60 patients (aged 40-89 years old) with an ICD-10 diagnosis of PSD, who were then randomly assigned to two groups and treated with flexible doses of escitalopram (10 to 20 mg/day, n = 30) or sertraline (50 to 200 mg/day, n = 30) for consecutive 8 weeks, respectively. The 24-item Hamilton Depression Rating Scale (HAMD-24), the 14-item Hamilton Anxiety Rating Scale (HAMA-14), the Treatment Emergent Symptom Scale (TESS), the Montreal Cognitive Assessment Scale (MOCA), and the Activity of Daily Living scale (ADL) were used to assess patients before, during, and after treatment for depression, anxiety, adverse effects, cognitive function, and daily living activities. Repeated measures ANOVA, the Mann-Whitney U test, the chi-square test (χ2), or Fisher's exact test was employed to assess baseline demographics, response rate, adverse effects rate, and changes in other clinical variables.

RESULTS

Significant reduction in HAMD-24 and HAMA-14 scores was evaluated at baseline, as well as 1, 3, 4, 6, and 8 weeks of drug intervention (p < 0.01). There was a significant group difference in post-treatment HAMD-24 scores (p < 0.05), but no difference was observed in HAMA-14 scores (p > 0.05). Further analysis showed a significant variance in the HAMD-24 scores between the two groups at the end of the first week (p < 0.01). The incidence of adverse effects in both patient groups was mild, but there was a statistically significant difference between the two groups (p < 0.05). The improvement in cognitive function and the recovery of daily living abilities were comparable between both groups (p > 0.05).

CONCLUSION

Escitalopram and sertraline showed comparable efficacy for anxiety symptoms, cognitive function, and daily living abilities in PSD patients. In addition, escitalopram was more appropriate for alleviating depressive symptoms. To validate the conclusion, trials with a larger sample size are in demand in the future. The registration number is ChiCTR1800017373.

Associations between Life's Essential 8 and post-stroke depression and all-cause mortality among US adults

BACKGROUND

Depression is the common mental disease after stroke. Our objective was to investigate the correlation of Life's Essential 8 (LE8), the recently updated evaluation of cardiovascular health, with the occurrence of post-stroke depression (PSD) and all-cause mortality among United States (US) adults.

METHODS

Participants with stroke were chosen from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The relationship between LE8 and the risk of PSD was assessed through weighted multiple logistic models. A restricted cubic spline was employed for the examination of correlations. To demonstrate the stability of the results, sensitivity analysis and subgroup analysis were carried out. Furthermore, Cox regression models were used for the correlation between LE8 and all-cause mortality.

RESULTS

In this study, a total of 1071 participants were included for analysis. It was observed that LE8 score and PSD risk shared an inverse relationship in per 10 points increase [OR = 0.62 (0.52-0.74, P < 0.001)] in logistic regression models. The analysis of restricted cubic spline demonstrated approximately a noticeable inverse linear association between LE8 score and PSD risk. Sensitivity analysis verified the stability of the findings. Moreover, no statistically significant interactions were identified in subgroup analysis. A reverse association between LE8 score and all-cause mortality was also observed with a 10-point increase [HR = 0.85 (0.78-0.94, P < 0.001)] in cox regression models.

CONCLUSIONS

A negative correlation was discovered between LE8 score and PSD and all-cause mortality risk among US adults. We need to conduct large-scale prospective studies to further validate our results.

Development and validation of the geriatric apathy scale: Examining multi-dimensional apathy profiles in a neurodegenerative population with cultural considerations

BACKGROUND

Apathy is a common motivational deficit in neurodegenerative diseases, but lacks a culturally sensitive tool accounting for ethnic Chinese culture's impact on motivation initiation. This study developed and validated the Geriatric Apathy Scale (GAS), comprehensively incorporating cultural nuances, setting diagnostic cutoffs, and examining apathy's multi-dimensional aspects in a neurodegenerative cohort.

METHODS

The 16-item GAS was developed by considering ethnic Chinese cultural characteristics and conducting a literature review. The study involved 296 participants, comprising 113 with Parkinson's disease (PD), 66 with Alzheimer's disease (AD), and 117 healthy controls (HC). All participants completed the GAS, Apathy Evaluation Scale (AES), Geriatric Depression Scale (GDS-15), Mini-Mental State Examination, and Activities of Daily Living (ADLs).

RESULTS

The GAS showed good internal consistency (r = 0.862) and test-retest reliability (r = 0.767). It correlated moderately with the AES (r = 0.639, p < .001), weakly with GDS-15 (r = 0.166, p < .01), and negatively with ADLs (r = -1.19, p < .05). Clinical diagnosis cutoff scores were identified at 15.5 for PD (sensitivity: 0.789; specificity: 0.693) and 12.5 for AD (sensitivity: 0.821; specificity: 0.632). Noteworthy disparities were observed in the Cognition and Social Motivation dimension, with elevated severity in both PD and AD compared to HC (p < .01). Interestingly, within-group comparisons revealed greater apathy severity in the Cognition and Social Motivation dimension for PD (p < .001) and AD (p = .001) versus Emotional Response and Expression and Spontaneous Behavioral Activation.

CONCLUSIONS

The GAS, a psychometrically validated scale, assesses apathy in neurodegenerative populations, accounting for ethnic Chinese culture's influence. It establishes clinical cutoff points and explores the multi-dimensional nature of apathy.

Incidence and risk factors of post-stroke cognitive impairment in convalescent elderly patients with first-episode acute ischemic stroke

A total of 350 first-time AIS elderly patients (aged ≥60 years) were collected and analyzed. Multivariate Logistic regression analysis showed that the lesion site, frontal temporal, cerebral white matter degeneration, age ≥ 75 years, BMI ≥ 28, onset in autumn/winter, hospitalization expenses > 20,000 yuan/month, high DBPV, high NIHSS score, and high HAMD score were risk factors for PSCI. Higher education level was a protective factor. In conclusion, the incidence of PSCI in elderly AIS patients was relatively high and related to the several factors, which indicated that more attention should be paid for such patients to prevent PSCI.

Analysis of the current status of rehabilitation motivation and its influencing factors in older adults with stroke: a cross-sectional study

Objective

Among stroke patients, exercise adherence is an important factor in reducing the rate of physical disability and mortality. Rehabilitation exercise after stroke is a safe and effective measure to restore normal body functions, but the analysis of factors influencing patients' motivation for rehabilitation is not well established. Therefore, this study will explore the influencing factors of rehabilitation motivation in older adults with stroke so as to reduce the disability rate of stroke.

Method

A convenience sampling method was used to study 350 patients in a stroke ward of a tertiary care hospital in Jinzhou, Liaoning Province. Patients' general demographic data, Multidimensional Scale of Perceived Social Support (PSSS), Questionnaire of Exercise Adherence (EAQ), Tampa scale of kinesiophobia (TSK-11), and Motivation in stroke patients for rehabilitation scale (MORE) were assessed. ANOVA or t-test analysis, correlation analysis, and linear regression analysis were used to explore the factors influencing the motivation for rehabilitation in older adults with stroke.

Results

The results showed that stroke patients' motivation for rehabilitation was at a moderate level. Perceived social support, exercise adherence, and stroke motivation were positively correlated (r = 0.619, p < 0.01; r = 0.569, p < 0.01), and kinesiophobia was negatively correlated with stroke motivation (r = -0.677, p < 0.01). Time of stroke, location of the lesion, perceived social support, exercise adherence, and kinesiophobia are influential factors affecting patients' motivation to recover.

Conclusion

In the rehabilitation program for older adult patients with stroke, healthcare providers should specify targeted rehabilitation measures according to the different degrees of the patient's condition, so as to improve the effectiveness of rehabilitation medical implementation.

Predictive microbial feature analysis in patients with depression after acute ischemic stroke

Introduction

Post-stroke depression (PSD) is the most common emotional problem following a stroke, which requires early diagnosis to improve the prognosis. Gut microbiota plays important role in the pathological mechanisms of acute ischemic stroke and influences the outcome of patients. However, the relationship between PSD and gut microbiota remains unknown. Here, we explored whether the microbial signatures of gut microbiota in the patients with stroke could be an appropriate predictor of PSD.

Methods

Fecal samples were collected from 232 acute ischemic stroke patients and determined by 16s rRNA sequencing. All patients then received 17-Hamilton Depression Rating Scale (HAMD-17) assessment 3 months after discharge, and were further divided into PSD group and non-PSD group. We analyzed the differences of gut microbiota between these groups. To identify gut microbial biomarkers, we then established microbial biomarker model.

Results

Our results showed that the composition of gut microbiota in the PSD patients differed significantly from that in non-PSD patients. The genus Streptococcus, Akkermansia, and Barnesiella were significantly increased in PSD patients compared to non-PSD, while the genus Escherichia-Shigella, Butyricicoccus, and Holdemanella were significantly decreased. Correlation analyses displayed that Akkermansia, Barnesiella, and Pyramidobacter were positively correlated with HAMD score, while Holdemanella was negatively correlated with HAMD score. The optimal microbial markers were determined, and the combination achieved an area under the curve (AUC) value of 0.705 to distinguish PSD from non-PSD.

Conclusions

Our findings suggest that PSD patients had distinct gut microbiota compared to non-PSD patients, and explore the potential of microbial markers, which might provide clinical decision-making in PSD.