Post-stroke depression: A 2020 updated review

Plasma human cartilage glycoprotein-39 and depressive symptoms among acute ischemic stroke patients

OBJECTIVE

Our study aimed at evaluating the association between plasma human cartilage glycoprotein-39 (YKL-40) and depressive symptoms at 3 months among acute ischemic stroke patients.

METHODS

Plasma YKL-40 levels were measured in 619 patients with ischemic stroke who participated in the China Antihypertensive Trial in Acute Ischemic Stroke (CATIS). The patients' depressive symptoms at 3 months after stroke were assessed using the Hamilton Rating Scale for Depression (HRSD-24).

RESULTS

During the 3-month follow-up period, 242 (39.1 %) participants were classified as experiencing depressive symptoms. Patients in the highest quartile of YKL-40 had a 1.98-fold (95 %CI: 1.19-3.30, P for trend = 0.02) risk of depressive symptoms compared with those in the lowest quartile. Per 1-SD increase of logarithm-transformed YKL-40 was associated with a 32 % (95 % CI: 10 %-58 %) increased risk for the depressive symptoms. The multiple-adjusted spline regression model confirmed dose-response relationships between YKL-40 levels and depressive symptoms (P for linearity = 0.02). Adding YKL-40 to a model containing conventional risk factors significantly improved the discriminatory power (area under the receiver operating characteristic curve improved by 0.02, P = 0.04) and reclassification power for depressive symptoms (net reclassification improvement = 18.77 %, P = 0.02; integrated discrimination improvement = 1.30 %, P = 0.005).

CONCLUSIONS

Elevated YKL-40 levels might be a potential risk marker of depressive symptoms at 3 months among acute ischemic stroke patients.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT01840072.

Gene expression profiles of endothelium, microglia and oligodendrocytes in hippocampus of post-stroke depression rat at single cell resolution

Post-stroke depression (PSD) is a common but severe mental complication after stroke. However, the cellular and molecular understanding of PSD is still yet to be illustrated. In current study, we prepared PSD rat model (MD) via unilateral middle cerebral artery occlusion (MCAO) and chronic stress stimulation (DEPR), and isolated hippocampal tissues for single cell sequencing of 10x Genomics Chromium. First, we determined the presence of the increased cell population of endothelium and microglia and the compromised oligodendrocytes in MD compared to NC, MCAO and DEPR. The enriched functions of highly variable genes (HVGs) of endothelium and microglia suggested a reinforced blood-brain barrier in MD. Next, cell clusters of endothelium, microglia and oligodendrocytes were individually analyzed, and the subtypes with distinct functions were identified. The presence of expression profiles, intercellular communications and signaling pathways of these three cell populations of PSD displayed a similar but more aggressive appearance with DEPR compared to MCAO and NC. Taken together, this study characterized the specific gene profile of endothelium, microglia and oligodendrocytes of hippocampal PSD by single cell sequencing, emphasizing the crosstalk among them to provide theoretical basis for the in-depth mechanism research and drug therapy of PSD.

The use of process measures in studies investigating effects of psychotherapy for depressive symptoms following acquired brain injury: A scoping review

Persons with acquired brain injury (ABI) often experience mood problems like depression. While psychotherapy is widely accepted for managing depression in populations without ABI, its effectiveness for post-ABI depression is uncertain. The working mechanisms of psychotherapy in persons with ABI may differ from idiopathic depression. This scoping review aimed to identify studies on psychotherapeutic interventions for post-ABI depression, assess the use of process measures (instruments measuring the mechanisms of psychotherapy), and report effects on both process and primary outcome measures. In the 47 included studies, Cognitive Behavioural Therapy, Problem Solving Therapy, and Third-Wave Therapies were most frequently investigated. Results indicated that less than half of the studies implemented a process measure. Studies into Third-Wave Therapies most frequently implemented process measures. Around half of the studies found significant time or interaction effects on the process measure, while not necessarily finding effects on outcome measures for depression. Moreover, the review could not identify a specific type of intervention effective in improving depressive symptoms and the underlying process. Our findings emphasize that it is still unclear which psychotherapy works for whom, and how. To enhance understanding of effective interventions for post-ABI depression, it is crucial to incorporate process measures in future intervention studies.

Prevalence and network structure of depression and its association with quality of life among older stroke survivors: findings from a national survey in China

Background

Post-stroke depression (PSD) is a common neuropsychiatric problem associated with a high disease burden and reduced quality of life (QoL). To date, few studies have examined the network structure of depressive symptoms and their relationships with QoL in stroke survivors.

Aims

This study aimed to explore the network structure of depressive symptoms in PSD and investigate the interrelationships between specific depressive symptoms and QoL among older stroke survivors.

Methods

This study was based on the 2017-2018 collection of data from a large national survey in China. Depressive symptoms were assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CESD), while QoL was measured with the World Health Organization Quality of Life-brief version. Network analysis was employed to explore the structure of PSD, using expected influence (EI) to identify the most central symptoms and the flow function to investigate the association between depressive symptoms and QoL.

Results

A total of 1123 stroke survivors were included, with an overall prevalence of depression of 34.3% (n=385; 95% confidence interval 31.5% to 37.2%). A higher risk of PSD was significantly associated with limited activities of daily living (odds ratio (OR)=1.340; p=0.048), presence of heart diseases (OR=1.589; p=0.002) and more severe anxiety symptoms (OR=1.472; p<0.001). In the network model of depression, the most central symptoms were CESD3 ('feeling blue/depressed', EI: 1.180), CESD6 ('feeling nervous/fearful', EI: 0.864) and CESD8 ('loneliness', EI: 0.843). In addition, CESD5 ('hopelessness', EI: -0.195), CESD10 ('sleep disturbances', EI: -0.169) and CESD4 ('everything was an effort', EI: -0.150) had strong negative associations with QoL.

Conclusion

This study found that PSD was common among older Chinese stroke survivors. Given its negative impact on QoL, appropriate interventions targeting central symptoms and those associated with QoL should be developed and implemented for stroke survivors with PSD.

Association of post-stroke hemiplegic shoulder pain with sleep quality, mood, and quality of life

BACKGROUND

Hemiplegic Shoulder Pain (HSP) is a prevalent post-stroke complication, characterized by paralysis, spasticity, altered sensation, neuropathic pain, shoulder subluxation, and soft tissue injuries such as rotator cuff tears and bicipital tendonitis. Muscle imbalances, weakness, and altered scapular positioning further contribute to the exacerbation of HSP. These factors lead to poorer functional outcomes, reduced hand function, and difficulties in performing daily activities. HSP is often associated with substantial mental and physical health burdens. The disorder significantly impacts the rehabilitation process, as evidenced by the negative effects it can have on quality of life (QoL), sleep quality, and mental status.This study aimed to determine the relationships between pain intensity, sleep quality, depressive symptoms and QoL in patients with post-stroke HSP.

METHODS

This study was a cross-sectional survey of patients with chronic post-stroke HSP. The study included 164 patients who were referred to physiotherapy, rehabilitation, and neurology clinics for palliative and rehabilitative care. Demographic data, pain intensity (Numeric Pain Rating Scale, NPRS), QoL (SF- 36), sleep quality (Pittsburgh Sleep Quality Index, PSQI), and depression (Beck Depression Inventory-II, BDI-II) were assessed.

RESULTS

Participants exhibited low QoL, with a mean SF- 36 score of 46.25 ± 4.21. The mean and standard deviation for depression, sleep quality, and pain intensity were 12.375 ± 3.569 (moderate level), 9.901 ± 3.213 (relatively low level), and 4.689 ± 2.547 (moderate level), respectively. The variables of sleep quality, depression, pain intensity, education level, and duration of HSP were found to be significant predictors of QoL (P < 0.05). Individuals experiencing intense and moderate pain had 0.538 and 0.605 times the likelihood of having a favorable QoL, respectively, compared to those with mild pain. Similarly, individuals with intense and moderate depression had 0.461 and 0.551 times the likelihood of achieving a favorable QoL compared to those without depression. Participants with a diploma or university degree (OR: 2.475) were more likely to have a favorable QoL than those who were illiterate. Additionally, individuals who had experienced HSP for more than one year had 0.631 times the likelihood of achieving a favorable QoL compared to those whose HSP duration was less than one year. Regarding functional independence, individuals who were completely dependent and semi-dependent in performing daily activities had 0.391 and 0.462 times the likelihood of having a favorable QoL, respectively, compared to those who were completely independent.

CONCLUSION

Post-stroke HSP patients exhibited significant shoulder pain, depression, and poor sleep quality, leading to reduced QoL. Factors such as duration of HSP, sleep quality, depression, pain intensity, and education level were identified as influential in determining QoL for these patients.

Research hotspots and trends of post-stroke depression rehabilitation: a bibliometric analysis from 2003 to 2024

Background

Post-stroke depression (PSD) is a common complication of stroke and is associated with stroke prognosis. Rehabilitation plays an essential role in the comprehensive treatment of PSD. However, there are few bibliometric analyses of studies on PSD rehabilitation. This study aimed to comprehensively sort out the network of PSD rehabilitation through bibliometric analyses, analyze the research trends, focus on the hotspots related to PSD rehabilitation, and provide new research perspectives and guidance for future studies.

Methods

The Web of Science Core Collection (WoSCC) database was searched for studies about depression rehabilitation after a stroke. The search covered the period from January 1, 2003, to October 31, 2024. We analyzed countries, institutions, journals, authors and keywords using CiteSpace and VOSviewer software to create visualizations and perform a bibliometric analysis.

Results

A total of 2,227 papers were analyzed, with an increasing trend in the number of papers published each year. The United States had the highest number of published articles (458 publications), and Maastricht University and Utrecht University were the most published institutions (56 articles). Archives of Physical Medicine and Rehabilitation is the journal with the most cited publications (5,913 citations). Johanna M. A. is the most prolific author (24 publications).

Conclusion

Using bibliometric methods, relevant studies on PSD rehabilitation were reviewed. The hotspots of future research on PSD rehabilitation will center on the brain plasticity mechanism of PSD rehabilitation, PSD assessment, and new techniques of PSD rehabilitation. This article provides systematic information to support and guide future research in this area.

Effect of Virtual Reality-Based Rehabilitation on Mental Health and Quality of Life of Stroke Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVES

To conduct a meta-analysis to investigate the effect of virtual reality (VR)-based rehabilitation on the mental health and quality of life of stroke patients.

DATA SOURCES

The search strategy was conducted in 5 databases (PubMed, Scopus, Web of Science, Embase, and Cochrane Library databases) from inception to December 2023.

STUDY SELECTION

Randomized controlled trials (RCTs) comparing the effectiveness of standard rehabilitation and VR-based rehabilitation for stroke patients.

DATA EXTRACTION

Data from the included articles were extracted independently by 2 authors, with any disagreements resolved through consultation with a third author. The extracted data included the first author's name, country/region, publication year, sample size, mean/median age of participants, sex distribution (the proportion of males), VR type, duration of rehabilitation, comparison, intervention, and assessment of outcome.

DATA SYNTHESIS

A total of 29 studies involving 1561 stroke patients were included. The results showed that compared with standard rehabilitation, VR-based rehabilitation remarkably reduced anxiety symptoms [SMD=-0.97 (95% CI [-1.84, -0.09], P<.0001)], depression symptoms [SMD=-0.94 (95% CI [-1.46, -0.42], P<.001)], and improved quality of life [SMD=0.94 (95% CI [0.42, 1.45], P<.001)] of stroke patients. Subgroup analysis showed that immersive VR was particularly effective in reducing anxiety and depression symptoms compared to nonimmersive VR. The longer the duration of VR intervention, exceeding 6 weeks, the more significant the effect of improving anxiety and depression symptoms. Meanwhile, VR-based rehabilitation significantly improved the psychological state and quality of life of European patients.

CONCLUSIONS

VR-based rehabilitation significantly reduces anxiety and depression symptoms and enhances the quality of life in stroke patients compared to standard rehabilitation. The most notable improvements were observed with immersive VR-based rehabilitation programs over 6 weeks in duration, particularly among European patients.

A Home-Based Behaviour Change Intervention With Sedentary Behaviour and Physical Activity in People With Stroke and Diabetes-A Feasibility and Safety Study

BACKGROUND AND PURPOSE

Stroke survivors with type 2 diabetes mellitus (DM) face heightened cardiovascular risks, which are exacerbated by sedentary behaviour (SB). Despite existing interventions, there remains a gap in the literature regarding effective strategies to reduce SB and increase physical activity (PA). The purpose of this study was to explore the feasibility and safety of the 12-week 'Everyday Life is Rehabilitation' (ELiR) intervention comprising recruitment, adherence, practicality, and implementation into everyday life.

METHODS

Single-group longitudinal intervention study with 1-week baseline, motivational interviews at weeks 1 and 6, and 12-week follow-up. Stroke survivors with DM (N = 14) were recruited from Neurovascular Center at Zealand University Hospital, Roskilde. The ELiR intervention is a theory-based intervention that focuses on healthcare professionals (HCP) consultations with stroke survivors with DM to address SB and PA. Primary outcomes were recruitment, adherence, completion of physical tests (accelerometer measurements), cognitive tests, and safety. Secondary outcomes were sedentary time and steps collected using an accelerometer and glycated haemoglobin (HbA1c) measurements.

RESULTS

23 participants were recruited, of whom two were readmitted, one withdrew consent before the baseline test, and six were not discharged with a physiotherapy rehabilitation plan within 1-7 hospitalisation days. The remaining 14 were included and completed the study with a median modified Rankin scale (mRS) score of 1. The ELiR intervention revealed high adherence. Three participants experienced falls, and two were hospitalised. These incidents were not related to the intervention. Future adjustments include modified inclusion criteria, SMS-reminders, and point-of-care HbA1c measurements.

DISCUSSION

The ELiR intervention was feasible and safe. Falls and serious adverse events are in line with previously reported risks. Self-reported questionnaires and clinical tests had low and moderate adherence, whereas accelerometers had high adherence. However, the small sample size limits generalisability, and adjustments to the ELiR intervention are suggested to improve usability in physiotherapy practice before testing in RCT studies to confirm these findings.

Development of a screening tool for reduced vision among inpatients of hospital rehabilitation units

SIGNIFICANCE

This study developed a practical screening tool to identify reduced habitual vision (RHV) in hospital rehabilitation units. This tool would enhance patient care by enabling timely interventions in resource-limited settings.

PURPOSE

The study aimed to develop a practical and implementable screening tool to identify patients with RHV in hospital rehabilitation units. Potential vision measures, screening questions, and demographic variables were considered to determine the optimum combination.

METHODS

The cross-sectional study recruited 112 adult inpatients (aged 18+ years) from three rehabilitation units in an acute care hospital in Ontario, Canada, between October 2018 and February 2019. Data included an oral questionnaire on demographics, health status, and self-reported vision function, alongside vision assessments (distance visual acuity [VA], contrast sensitivity [CS], visual fields [VFs], and stereopsis). Univariate and multivariate logistic regression analyses were conducted to identify significant predictors of RHV, defined by VA >0.3 logMAR, CS <1.40 logCS, or any VF defect.

RESULTS

The average age of participants was 74.5 years (±14.3 years), and RHV was present in 48.7%. Significant predictors of RHV included self-reported "happiness" with vision with current spectacles and difficulty reading a newspaper. The optimal predictive factors were VA and VF testing (96% sensitivity), but for practical implementation, the combination of three self-reported questions (happiness with vision, difficulty reading a newspaper, and difficulty distinguishing facial expressions) demonstrated 74% sensitivity.

CONCLUSIONS

The study highlights that a combination of self-reported questions can effectively identify patients with RHV, providing a feasible alternative to direct vision assessments in resource-limited settings. Implementing this screening tool could improve patient care by enabling timely adaptations and referrals for eye care, ultimately enhancing rehabilitation outcomes and reducing falls risk. Further research is needed to refine the tool's sensitivity and explore its applicability in broader hospital and primary care settings.

Burden of psychological symptoms and disorders among individuals with hepatitis B: a systematic review, meta-analysis and meta-regression

Introduction

Hepatitis B is a highly contagious viral infection that has long been a significant global health concern. Given its adverse effects on the course of the disease, evaluating psychiatric outcomes is important. Despite indications of an increased risk of psychological outcomes among those with hepatitis B, the extent of this association remains unclear.

Methods

This PRISMA-adherent systematic review (PROSPERO: CRD42024564246) searched PubMed, Embase, Cochrane, and PsycINFO for all studies evaluating the prevalence and risk of anxiety and depressive symptoms in individuals with hepatitis B. Random effects meta-analyses and meta-regression were used for primary analysis.

Results

A total of 31 studies were included. We identified a high prevalence of depressive symptoms (Proportion=19%, 95% CI: 11-31) and anxiety (Proportion=30%, 95% CI: 18-45) among individuals with hepatitis B. There was also a significantly increased risk of depressive symptoms (RR=1.45, 95% CI: 1.00-2.09, P=0.049) and anxiety (RR=1.40, 95% CI: 1.11-1.78) in individuals with hepatitis B compared to controls. Subgroup analyses indicated that older age and chronic hepatitis B infection were associated with a higher prevalence of anxiety and depressive symptoms. The systematic review found that being single, unemployed, having a lower income, a lower education level, high comorbidities, and a family history of mental illness were significant risk factors for poorer psychological outcomes.

Conclusion

Our study highlights an increased vulnerability to anxiety and depressive symptoms among individuals with hepatitis B. We emphasize the urgent need for early detection and additional support for this at-risk group.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024564246.

A Pilot Study of Remote Ischemic Conditioning in Preventing Post-Stroke Depression

Background

Post-stroke depression (PSD) constitutes a significant complication that influences both patient survival and functional recovery following a stroke. Despite its prevalence, PSD still lacks a long-term, safe and effective treatment measure. Remote ischemic conditioning (RIC) is a simple and noninvasive procedure that exert neuroprotective effects. This pilot study aims to investigate the efficacy, safety, and feasibility of RIC as a preventive measure against PSD.

Methods

Acute ischemic stroke patients within 15 days post-event were considered eligible for study enrollment. Fifty participants were recruited and underwent daily RIC treatments for a 12-month period. Depressive symptoms were assessed utilizing the Patient Health Questionnaire-9 (PHQ-9) and the Hamilton Depression Rating Scale (HAMD) at baseline, as well as at 1, 3, 6, and 12-months post-intervention.

Results

The study found a gradual improvement in depressive symptoms among the 50 patients who completed the study over the 12-month treatment period, as evidenced by a consistent decline in pertinent scores. Moreover, merely two patients experienced mild adverse reactions.

Conclusion

The study's outcomes indicate that RIC is safe, well-tolerated, and feasible as a preventive measure for PSD. Consequently, it is advisable to conduct a comprehensive randomized controlled trial to further evaluate the effectiveness and safety of RIC in preventing PSD.

The effects of exercise interventions on depressive symptoms in stroke patients: a systematic review and meta-analysis

Purpose

This systematic review and meta-analysis aimed to evaluate the effects of exercise interventions on depressive symptoms in stroke patients.

Methods

Following PRISMA guidelines, We conducted searches in PubMed, Embase, CENTRAL, and Web of Science. The topic was the effect of exercise on depression levels in stroke patients. Patient's performance on depression scales after exercise was assessed using standardized mean difference (SMD) and 95% confidence intervals (95% CI). A random effects model (RE) was used to conduct a meta-analysis and compare the results between subgroups conducted based on adherence to ACSM guidelines and the length of exercise interventions.

Results

The analysis included 24 randomized controlled trials (RCTs) involving 1,757 participants. The meta-analysis revealed that exercise interventions had a significant positive effect on reducing depressive symptoms in stroke patients, with a standardized mean difference (SMD) of -0.43 (95% CI: 0.65, -0.21). Subgroup analysis indicated that high compliance with ACSM guidelines resulted in a more substantial reduction in depressive symptoms (SMD = -0.79, 95% CI: 1.10, -0.49), compared with low or uncertain compliance (SMD = -0.03, 95% CI: 0.16, 0.10). Longer exercise intervention was associated with greater mitigation of depressive symptoms. The differences between intervention groups of different lengths were statistically significant (p < 0.05).

Conclusion

These findings support the integration of tailored exercise programs into post-stroke care to optimize mental health outcomes. Compliance to ACSM-recommended exercise dosages significantly ameliorate depression levels in stroke patients. Further research is warranted to explore standardized exercise regimens in larger, multicenter trials.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/#recordDetails, identifier PROSPERO(CRD42024579095).

Development of evaluation index system for functional ability of older patients with stroke based on healthy aging: a modified Delphi study

Background

The prevalence of stroke in the older population is high and it is critical to promote and maintain the functional status of older patients post stroke. Health measures centered on functional ability can scientifically reflect the health status of older individuals. The aim of this study was to develop an evaluation index system for assessing the functional ability of older patients with stroke based on the World Health Organization Healthy Aging Model.

Methods

Key indicators were identified through literature analysis and semi-structured interviews with 10 older patients with stroke. A two-round expert consultation process was conducted to evaluate and revise the indicators. Subsequently, a hierarchical construction model was established using the analytic hierarchy process to determine the weight of each level indicator.

Results

The evaluation index system comprised three first-level, 13 s-level, and 53 third-level indicators. The weights ranged from 0.143-0.429 for first-level indicators, 0.052-0.349 for second-level indicators, and 0.040-0.667 for third-level indicators.

Conclusion

The developed evaluation index system demonstrates reliability for assessing the functional ability of older stroke patients and provides a standardized framework for nursing staff to conduct functional assessment of older stroke patients.

Vortioxetine alleviates motor, cognitive and emotional disorders in post-stroke rats by regulating the TLR-2/NF-κB pathway

Cognitive impairments following post-stroke significantly hinder neurological recovery and exacerbate patient morbidity, underscoring urgent need for effective therapeutic strategies. Vortioxetine (VTX), a prominent Selective Serotonin Reuptake Inhibitor (SSRI), boasts notable antidepressant, cognition-enhancing, and anti-inflammatory properties. This investigation delves into VTX's influence on motor skills, spatial learning-memory capabilities, and depressive behaviors in Middle Cerebral Artery Occlusion (MCAO) rats, alongside its underlying mechanisms. Our findings reveal that while VTX fails to entirely reverse ischemic-reperfusion damage, it substantially ameliorates spontaneous locomotor functions, augments post-stroke learning-memory capacities, and exhibits potent antidepressant and anxiety-like efficacy. Preliminary data propose that these beneficial effects may stem from inflammation modulation via the Toll-Like Receptor 2 (TLR-2)/Nuclear Factor-Kappa B (NF-κB) signaling pathway. Collectively, our work underscores VTX's promising role in enhancing motor, cognitive functions, and mitigating depressive symptoms following cerebrovascular accidents, potentially through inflammation regulation. These insights pave the way for novel interventions addressing post-stroke complications, warranting further exploration.

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.

Sex differences in age-associated neurological diseases-A roadmap for reliable and high-yield research

Once taken into consideration, sex differences in neurological diseases emerge in abundance: (i) Stroke severity is significantly higher in females than in males, (ii) Alzheimer's disease (AD) pathology is more pronounced in females, and (iii) conspicuous links with hormonal cycles led to female-specific diagnoses, such as catamenial migraines and epilepsy. While these differences receive increasing attention in isolation, they likely link to similar processes in the brain. Hence, this review aims to present an overview of the influences of sex chromosomes, hormones, and aging on male and female brains across health and disease, with a particular focus on AD and stroke. The focus here on advancements across several fields holds promise to fuel future research and to lead to an enriched understanding of the brain and more effective personalized neurologic care for all.

Vitamin D Deficiency in the Acute Phase of Stroke May Predict Post-stroke Depression: A Systematic Review and Meta-Analysis

OBJECTIVE

To conduct the association between vitamin D levels in the acute phase of stroke and post-stroke depression (PSD) in stroke patients.

METHODS

Five international databases (PubMed, Web of Science, Embase, Ovid MEDLINE(R), Cochrane Library) and one Chinese database (Wanfang Data) were searched for observational studies in any language reporting on PSD and vitamin D levels tested in the acute phase of stroke in stroke patients from inception to May 2024. Data extraction and study quality assessment were conducted by two authors independently. Qualitative and quantitative analyses of data were performed. The meta-analysis was registered in the PROSPERO database (CRD42023398581).

RESULTS

We included 7 studies containing 3537 participants in the systematic review and meta-analysis. All studies that met the inclusion and exclusion criteria were conducted in China. Vitamin D levels in the acute phase of stroke were lower in PSD patients compared with non-PSD patients (weighted mean difference = -14.97 nmol/L; 95% confidence interval = -19.54, -10.40). Stroke patients with vitamin D deficiency (<50 nmol/L) had an increased risk of PSD compared with stroke patients with vitamin D sufficiency (≥75 nmol/L) (odds ratio = 3.59; 95% confidence interval = 2.05, 6.27). However, the association between vitamin D insufficiency (50-75 nmol/L) and PSD were not statistically significant (odds ratio = 4.15; 95% confidence interval = 0.87, 19.78).

CONCLUSION

Vitamin D deficiency in the acute phase of stroke may be a risk factor for PSD.

Effectiveness of integrated care models for stroke patients: A systematic review and meta-analysis

INTRODUCTION

Given that stroke is a leading cause of disability and mortality worldwide, there is an urgent need for a coordinated healthcare approach to mitigate its effects. The objectives of this study were to perform a systematic review and meta-analysis of stroke integrated care models and develop recommendations for a representative model.

DESIGN

A systematic review and meta-analysis.

METHODS

The literature search identified randomized controlled trials comparing integrated care models with standard care for stroke patients. The included studies followed PICOs inclusion criteria. The qualitative analysis included creating a flowchart for the literature screening process, and tables detailing the basic characteristics of the included studies, the adherence to the ten principles and the results of the quality assessments. Subsequently, quantitative meta-analytical procedures were conducted to statistically pool the data and quantify the effects of the integrated care models on stroke patients' health-related quality of life, activities of daily living, and depression. The China National Knowledge Infrastructure (CNKI), Wanfang Data, Chongqing VIP Chinese Science and Technology Periodical Database (VIP), China Biology Medicine Disc (CBMDISC), Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), PubMed, Web of Science, Embase, Google Scholar, and Clinical Trials were searched from inception to March 13, 2024.

RESULTS

Of the 2547 obtained articles, 19 were systematically reviewed and 15 were included in the meta-analysis. The integrated care models enhanced stroke patients' health-related quality of life, ability to perform activities of daily living, and reduced depression. Adherence to the 10 principles varied: comprehensive services, patient focus, and standardized care delivery had strong implementation, while gaps were noted in geographic coverage, information systems, governance structures, and financial management.

CONCLUSION

Integrated care models improve outcomes for stroke patients and adherence to the 10 principles is vital for their implementation success. This study's findings call for a more standardized approach to implementing integrated care models, emphasizing the need for integrated services, patient-centred care, and interdisciplinary collaboration, while also addressing the identified gaps in terms of integration efforts.

CLINICAL RELEVANCE

This study provides evidence-based recommendations on the most effective integrated care approaches for stroke patients, potentially leading to better patient outcomes, reduced healthcare costs, and improved quality of life.

Novel Robotic Balloon-Based Device for Wrist-Extension Therapy of Hemiparesis Stroke Patients

Upper-limb paresis is one of the main complications after stroke. It is commonly associated with impaired wrist-extension function. Upper-limb paresis can place a tremendous burden on stroke survivors and their families. A novel soft-actuator device, the Balonikotron, was designed to assist in rehabilitation by utilizing a balloon mechanism to facilitate wrist-extension exercises. This pilot study aimed to observe the functional changes in the paralyzed upper limb and improvements in independent and cognitive functions following a 4-week regimen using the device, which incorporates a multimedia tablet application providing audiovisual feedback. The device features a cardboard construction with a hinge at wrist level and rails that guide hand movement as the balloon inflates, controlled by a microcontroller and a tablet-based application. It operates on the principle of moving the hand at the wrist by pushing the palm upwards through a surface actuated by a balloon. A model was developed to describe the relationship between the force exerted on the hand, the angle on hinge, the pressure within the balloon, and its volume. Experimental validation demonstrated a Pearson correlation of 0.936 between the model's force predictions and measured forces, supporting its potential for real-time safety monitoring by automatically shutting down when force thresholds are exceeded. A pilot study was conducted with 12 post-stroke patients (six experimental, six control), who participated in a four-week wrist-extension training program. Clinical outcomes were assessed using the Fugl-Meyer Assessment for the Upper Extremity (FMA-UE), Modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MOCA), wrist Range of Motion (ROM), and Barthel Index (BI). Statistically significant results were obtained for the Barthel index (p < 0.05) and FMA-UE, indicating that the experimental use of the device significantly improved functional independence and self-care abilities. The results of our pilot study suggest that the Balonikotron device, which uses the principles of mirror therapy, may serve as a valuable adjunct to conventional rehabilitation for post-stroke patients with hemiparetic hands (BI p = 0.009, MMSE p = 0.151, mRS p = 0.640, FMA-UE p = 0.045, MOCA p = 0.187, ROM p = 0.109).

Identification of Facilitators and Barriers to Functional Ability in Elderly Stroke Patients: A Descriptive Qualitative Study

Purpose

Stroke can cause long-term disability in elderly individuals, and improving the functional ability of patients is vital. This study sought to determine the facilitators and barriers to functional ability in elderly stroke patients from the perspective of healthy aging and to provide a theoretical basis for precise interventions.

Patients and Methods

This study was conducted between December 2023 and January 2024. Eleven patients and eight medical staff from a tertiary hospital were selected for semi-structured interviews using purposive sampling. The interview data were analyzed using thematic analysis.

Results

A total of 19 interviewees participated, including 11 patients and eight medical staff members. Among the patients, four had hemorrhagic stroke and seven had ischemic stroke; ages ranged from 60 to 77 years. Among the medical staff, five had bachelor's degrees and three had master's degrees; ages ranged from 30 to 47 years. Five major themes were identified, including 16 sub-themes. Key themes included: medical service factors, health belief factors, patient factors, family factors, and social/environmental factors.

Conclusion

The core elements for improving the functional ability of patients are establishing a service model of multidisciplinary teamwork; guaranteeing the continuity of in-hospital and home rehabilitation; enriching the form and content of health education to improve patient knowledge of the disease; providing psychological support to alleviate patients' negative emotions; and establishing of effective social safeguards and support systems.

Associations between ambient benzene and stroke, and the mediating role of accelerated biological aging: Findings from the UK biobank

Benzene can cause respiratory diseases. However, the associations between benzene and stroke are unclear. A total of 13,116 patients with stroke and 377,120 controls from the UK Biobank were included. The benzene exposure concentrations were matched on the basis of the address information of each participant via a data form from the UK Department for Environment, Food and Rural Affairs. Weighted Cox regression was used to investigate the association between benzene and stroke risk. The polygenic risk score (PRS) was used to observe the joint effects of benzene exposure and genetic factors on stroke risk. We conducted a mediation analysis to investigate the mediating role of accelerated biological aging in this cohort study. After adjusting for covariates, every 1 μg/m3 increase in benzene exposure increased the risk of stroke by 70%, which may be mediated by accelerated biological aging. The population with high benzene exposure concentrations and high PRSs had a 44% greater risk of stroke than did those with low benzene exposure concentrations and low PRSs. Benzene exposure and the PRS have joint effects on the risk of stroke. Benzene exposure was associated with stroke risk, possibly through increased biological aging, and the PRS modified this association.

Behavioral Monitoring in Transient Ischemic Attack and Stroke Patients: Exploratory Micro- and Macrostructural Imaging Insights for Identifying Post-Stroke Depression with Accelerometers in UK Biobank

To examine the association between post-stroke depression (PSD) and macrostructural and microstructural brain measures, and to explore whether changes in accelerometer-measured physical activity (PA) are associated with PSD, we conducted an exploratory study in UK Biobank with dementia-free participants diagnosed with at least one prior stroke. Eligible participants (n = 1186) completed an MRI scan. Depression was classified based on positive depression screening scores (PHQ-2 ≥ 3). Multivariate linear regression models assessed the relationships between depression and structural and diffusion measures generated from brain MRI scans. Logistic regression models were used to examine the relationship between accelerometer-measured daily PA and future depression (n = 367). Depression was positively associated with total white matter hyperintensities (WMHs) volume (standardized β [95% CI]-0.1339 [0.012, 0.256]; FDR-adjusted p-value-0.039), periventricular WMHs volume (standardized β [95% CI]-0.1351 [0.020, 0.250]; FDR-adjusted p-value-0.027), and reduced MD for commissural fibers (standardized β [95% CI]--0.139 [-0.255, -0.024]; adjusted p-value-0.045). The odds of depression decreased by 0.3% for each daily minute spent in objectively measured light PA, while each minute spent in sleep from midnight to 6:00 AM was associated with a 0.9% decrease in the odds of depression. This early-stage analysis using a population cohort offers a scientific rationale for researchers using multimodal data sources to investigate the heterogenous nature of PSD and, potentially, identify stroke patients at risk of poor outcomes.

Post stroke sexual dysfunction - a current review

INTRODUCTION

Sexual dysfunction manifests as various challenges during sexual activity and is a prevalent condition that significantly impacts quality of life. Post stroke sexual dysfunction (PSSD) is particularly concerning, yet it is often overlooked by both healthcare providers and patients.

METHODS

We conducted a comprehensive literature review, examining research and reports related to sexual dysfunction following stroke. Our aim is to synthetize an extensive, detailed and up-to-date overview of its prevalence, underlying mechanisms, and interventions.

RESULTS AND CONCLUSION

PSSD, often underestimated among stroke survivors, has a high incidence but remains poorly understood in terms of its neurobiological mechanisms. Swift and accurate diagnosis, coupled with timely rehabilitative intervention, is crucial. However, the development of comprehensive guidelines is impeded by a lack of high-quality literature. This review seeks to present recent advances in understanding PSSD, and to advocate for a structured strategy in terms of the long-term rehabilitation of stroke survivors.

The doctor-patient perception mismatch: Improving approaches to assessing outcomes after ischemic stroke treated with reperfusion therapy

The long-term effects of ischemic stroke on cognition and mental health are not reflected in traditional outcome metrics, like the modified Rankin Scale (mRS) for functional independence. Consequently, this may lead to mismatches in perceptions of overall recovery, despite otherwise qualifying as having good functional outcomes (mRS 0-2). In our multicenter, multinational analysis, we aim to describe the prevalence of, and factors associated with, patient-reported cognitive impairment despite achieving good functional outcomes. Acute ischemic stroke patients at Cooper University Hospital (2021-2024) and Hospital Vall d'Hebron in Barcelona, Spain (2020-2021) treated with reperfusion therapy and achieved 90-day mRS 0-2 were surveyed with the previously-validated PROMIS Global-10 scale for physical health (PROMIS-PH) and mental health (PROMIS-MH). The primary outcome was the rate of fair or poor PROMIS-MH scores (≤ 11). Univariable and multivariable linear regressions for PROMIS-MH scores were performed. Of 157, 90-day mRS 0-2 patients, the mean age was 68 (standard deviation 15) years, and 61 % were male. Fair or poor PROMIS-MH scores were reported in 43 % of patients. Clinical factors independently associated with PROMIS-MH scores in a multivariable linear regression include: sex, tobacco use, PROMIS-PH score, and National Institutes of Health Stroke Scale at 3-day follow-up. Despite achieving favorable post-stroke mRS, there is a high prevalence of patient-reported cognitive impairment, underscoring an important gap in post-stroke care. The emphasis in post-stroke care should extend beyond the scope of traditional metrics, and should encompass evaluations and interventions targeting additional domains significant to overall patient recovery, especially patient-reported cognitive symptoms.

The effect of transcranial direct current stimulation and inhibitory control training on depression and anxiety among post-stroke individuals

BACKGROUND

Recent research has highlighted the role of fronto-parietal brain networks and cognitive control in mood disorders. Transcranial direct current stimulation (tDCS) and computer-based cognitive training are used in post-stroke rehabilitation. This study examined the combined effects ofof computer-based inhibitory control training (ICCT) and anodal tDCS on post-stroke depression and anxiety.

METHODS

Thirty-five participants were randomly assigned to one of three groups: active tDCS treatment (A), sham tDCS treatment with ICCT (T), or active tDCS with ICCT (AT), for a duration of ten days. Primary outcome measures included the Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAM-D), and Spielberger's State-Trait Anxiety Inventory (STAI-S/T). Statistical analysis was performed using a Mixed-model Analysis of Variance, with supplementary Bayesian analysis.

RESULTS

The AT group showed a significant improvement in BDI scores (p < .001), whereas no significant effects were observed on the HAM-D, STAI-T, or STAI-S scales.

CONCLUSIONS

The combination of tDCS and ICCT reduced depressive symptoms as measured by the BDI; while no significant effects were found with either treatment alone. Further research is needed to explore the mechanisms behind the synergistic effects in the treatment of post-stroke mood disorders.

Comparing the effectiveness of different exercise interventions on quality of life in stroke patients: a randomized controlled network meta-analysis

BACKGROUND

This study evaluates the comprehensive impact of different exercise interventions on the quality of life in stroke patients through network meta-analysis, aiming to provide scientific evidence for developing more effective rehabilitation programs and improving patients' physical, psychological, and social functions.

METHODS

This systematic review, registered in PROSPERO (CRD42024541517) and following PRISMA guidelines, searched multiple databases (PubMed, Web of Science, EMbase, Cochrane, Ebsco) until November 1, 2024. Studies were selected based on the PICOS criteria, including RCTs on stroke and exercise. Methodological quality was assessed using RoB 2. Data analysis involved effect size calculations and network meta-analysis in Stata 17.0, with publication bias detected via funnel plots.

RESULTS

This meta-analysis included 41 studies (2,578 stroke patients) from 15 countries, published between 2002 and 2024. Participants aged 50-70 underwent interventions lasting 3 weeks to 6 months. DTOT (Dual-task oriented training)was most effective for Quality of Life, Mental Health, and Upper Limb Function; AQE (Aquatic Exercise) for Physical Health and Social Participation; ST(Strength Training) for Pain and Vitality; CIT(Constraint-Induced Therapy) for Mobility and Recovery; BCT for Memory and Thinking; ALCE(Aquatic and Land Combined Exercise) for Emotion and ADL; and ULT(Upper Limb Training) for Communication. No significant publication bias was found.

CONCLUSION

This study indicates that different training methods have a significant impact on various dimensions of quality of life in stroke patients. Future research should focus on personalized rehabilitation programs, considering individual differences among patients, and explore multimodal integrated interventions to optimize outcomes. Long-term follow-up and outcome assessments should be strengthened to ensure the sustainability of interventions. Additionally, integrating mental health and social participation is essential to enhance overall quality of life. Emerging technologies such as VR, AI, and wearable devices can help optimize rehabilitation training. Interdisciplinary collaboration combining neuroscience, rehabilitation science, and psychology can provide more comprehensive rehabilitation solutions.

Antihypertensive strategies for the prevention of secondary stroke: a systematic review and meta-analysis

BACKGROUND

Stroke is an important contributor to disability and death globally. Hypertension is a main risk factor for recurrent stroke in patients with ischemic and hemorrhagic stroke or transient ischemic attack. Higher systolic blood pressure, diastolic blood pressure, pulse pressure and mean arterial pressure at admission are independently associated with the risk of stroke recurrence. Therefore, lowering blood pressure is recommended by guidelines to prevent the recurrence of stroke.

METHODS

A systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science databases was conducted through January 12, 2024. The search identified randomized controlled trials (RCTs) comparing antihypertensive drugs with control measures (placebo or no treatment) or standard blood pressure control (SBPC) with intensive blood pressure control (IBPC) for recurrent stroke prevention. Primary outcomes included overall and subtype stroke recurrence rates, fatal and non-fatal strokes, cardiovascular deaths, and myocardial infarctions (MIs). Secondary outcomes comprised non-fatal MIs and all-cause mortality. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random or fixed-effect models in Stata 15.0.

RESULTS

The analysis included 19 RCTs encompassing 72,048 patients. Twelve studies (n = 53,971) evaluated antihypertensive drugs against placebo or no treatment, while seven studies (n = 18,077) compared SBPC with IBPC. Antihypertensive therapy demonstrated significant risk reductions compared to placebo or no treatment for recurrent stroke (RR = 0.86, 95% CI: 0.75-0.97), cardiovascular deaths (RR = 0.92, 95% CI: 0.87-0.97), and MIs (RR = 0.87, 95% CI: 0.79-0.96). IBPC showed superior outcomes compared to SBPC, with significant reductions in recurrent stroke (RR = 0.87, 95% CI: 0.77-0.98), cardiovascular deaths (RR = 0.75, 95% CI: 0.61-0.91), and all-cause mortality (RR = 0.85, 95% CI: 0.73-0.95).

CONCLUSION

In stroke patients, antihypertensive therapy demonstrates significant protective effects against stroke recurrence, cardiovascular deaths, and MIs compared to placebo or no treatment. Additionally, IBPC provides enhanced protection against stroke recurrence, cardiovascular deaths, and all-cause mortality compared to SBPC.

Neurobiological Mechanisms Underlying Psychological Dysfunction After Brain Injuries

Despite the presentation of similar psychological symptoms, psychological dysfunction secondary to brain injury exhibits markedly lower treatment efficacy compared to injury-independent psychological dysfunction. This gap remains evident, despite extensive research efforts. This review integrates clinical and preclinical evidence to provide a comprehensive overview of the neurobiological mechanisms underlying neuropsychological disorders, focusing on the role of key brain regions in emotional regulation across various forms of brain injuries. It examines therapeutic interventions and mechanistic targets, with the primary goal of identifying pathways for targeted treatments. The review highlights promising therapeutic avenues for addressing injury-associated psychological dysfunction, emphasizing Nrf2, neuropeptides, and nonpharmacological therapies as multi-mechanistic interventions capable of modulating upstream mediators to address the complex interplay of factors underlying psychological dysfunction in brain injury. Additionally, it identifies sexually dimorphic factors as potential areas for further exploration and advocates for detailed investigations into sex-specific patterns to uncover additional contributors to these disorders. Furthermore, it underscores significant gaps, particularly the inadequate consideration of interactions among causal factors, environmental influences, and individual susceptibilities. By addressing these gaps, this review provides new insights and calls for a paradigm shift toward a more context-specific and integrative approach to developing targeted therapies for psychological dysfunction following brain injuries.

A predictive model for depression risk in individuals with hypertension: evidence from NHANES 2007-2020

OBJECTIVE

Hypertension increases the prevalence of depression to a certain extent and identification and diagnosis of depression frequently pose challenges for clinicians. The study aimed to construct and validate a scoring model predicting the prevalence of depression with hypertension.

METHODS

6124 individuals with hypertension were utilized from the 2007 to 2020 National Health and Nutrition Examination Survey database (NHANES), including 645 subjects that were assessed to have depressive symptoms, 390 in the development group and 255 in the validation group. Univariable and multivariable analyses were applied to analyze the impact of each parameter on depression with hypertension, resulting in establishment of a predictive model. Finally, the discriminability, calibration ability, and clinical efficacy of the model were verified for both the derivation set and validation set.

RESULTS

Ten variables comprised this model: age, gender, race, poverty to income ratio (PIR), smoke, sleep hours, exercise, diabetes, congestive heart failure, stroke. The area under the receiver operating characteristic curve for the derivation and validating sets was 0.790 and 0.723, respectively, which showed excellent discriminability. The model also fitted well with the actual prevalence of depression with hypertension in calibration and decision curve analysis (DCA) demonstrated that the depression model was practically useful.

CONCLUSION

This scoring model may provide an additional perspective for evaluating the underlying risk factors of depression for hypertensive individuals.

Association of sleep duration and sleep disorders with post-stroke depression and all-cause and cardiovascular disease mortality in US stroke survivors: results from NHANES 2005-2018

BACKGROUND

Sleep disturbance is a common concern among stroke survivors, yet the association of sleep duration and sleep disorders with post-stroke depression and all-cause and cardiovascular disease (CVD) mortality remains elusive. We aimed to explore these associations using data from the National Health and Nutrition Examination Survey (NHANES).

METHODS

Adult stroke survivors from NHANES 2005-2018 were included. Sleep information and stroke diagnoses were derived from self-reports on relevant questionnaires. Mortality data were collected by prospectively matching to the National Death Index. Multivariate logistic regression and Cox proportional hazards regression were used to explore these associations and calculate the odds ratio (OR) and hazard ratio (HR), respectively.

RESULTS

A total of 1101 stroke participants were included. In the fully adjusted model, sleep disorders were associated with increased odds of post-stroke depression (OR 2.689, p = 0.0146). Sleep duration was inversely associated with the odds of post-stroke depression; compared to normal sleep duration, short sleep duration was associated with increased odds of post-stroke depression (OR 2.196, p = 0.0059), whereas long sleep duration was not (p = 0.1435). Sleep disorders were associated with CVD mortality (HR of 1.948, p = 0.026) but not all-cause mortality (p = 0.224) in stroke survivors. Sleep duration was positively associated with all-cause mortality in stroke survivors (HR 1.075, p = 0.042); however, neither short nor long sleep duration was associated with mortality compared to normal sleep duration. Restricted cubic spline modeling suggested that sleep duration was nonlinearly and linearly associated with post-stroke depression and all-cause mortality, respectively. Age influenced the association between sleep disorders and CVD mortality in stroke survivors.

CONCLUSIONS

Sleep disorders and short sleep duration were associated with increased odds of post-stroke depression, whereas sleep disorders were associated with increased CVD mortality in stroke survivors. These findings underscore that achieving normal sleep duration and improving sleep disorders may reduce the odds of post-stroke depression and mortality.

Association between the systemic immunity-inflammation index and stroke: a population-based study from NHANES (2015-2020)

Background The systemic immunity-inflammation index(SII) is a new indicator of composite inflammatory response. Inflammatory response is an important pathological process in stroke. Therefore, this study sought to investigate the association between SII and stroke. Methods We collected data on participants with SII and stroke from the 2015-2020 cycle of National Health and Nutrition Examination Survey (NHANES) for the cross-sectional investigation. Multivariate linear regression models were used to test the association between SII and stroke. Fitted smoothing curves and threshold effect analysis were applied to describe the nonlinear relationship. Results A total of 13,287 participants were included in our study, including 611 (4.598%) participants with stroke. In a multivariate linear regression analysis, we found a significant positive association between SII and stroke, and the odds ratio (OR) [95% CI] of SII associating with prevalence of stroke was [1.02 (1.01, 1.04)] (P < 0.01). In subgroup analysis and interaction experiments, we found that this positive relationship was not significantly correlated among different population settings such as age, gender, race, education level, smoking status, high blood pressure, diabetes and coronary heart disease (P for trend > 0.05). Moreover, we found an nonlinear relationship between SII and stroke with an inflection point of 740 (1,000 cells /µl) by using a two-segment linear regression model. Conclusions This study implies that increased SII levels are linked to stroke. To confirm our findings, more large-scale prospective investigations are needed.

Gastrodin Ameliorates Post-Stroke Depressive-Like Behaviors Through Cannabinoid-1 Receptor-Dependent PKA/RhoA Signaling Pathway

Post-stroke depression (PSD) is a significant complication in stroke patients, increases long-term mortality, and exaggerates ischemia-induced brain injury. However, the underlying molecular mechanisms and effective therapeutic targets related to PSD have remained elusive. Here, we employed an animal behavioral model of PSD by combining the use of middle cerebral artery occlusion (MCAO) followed by spatial restraint stress to study the molecular underpinnings and potential therapies of PSD. Interestingly, we found that sub-chronic application of gastrodin (Gas), a traditional Chinese medicinal herb Gastrodia elata extraction, relieved depression-related behavioral deficits, increased the impaired expression of synaptic transmission-associated proteins, and restored the altered spine density in hippocampal CA1 of PSD animals. Furthermore, our results indicated that the anti-PSD effect of Gas was dependent on membrane cannabinoid-1 receptor (CB1R) expression. The contents of phosphorated protein kinase A (p-PKA) and phosphorated Ras homolog gene family member A (p(ser188)-RhoA) were decreased in the hippocampus of PSD-mice, which was reversed by Gas treatment, and CB1R depletion caused a diminished efficacy of Gas on p-PKA and p-RhoA expression. In addition, the anti-PSD effect of Gas was partially blocked by PKA inhibition or RhoA activation, indicating that the anti-PSD effect of Gas is associated with the CB1R-mediated PKA/RhoA signaling pathway. Together, our findings revealed that Gas treatment possesses protective effects against the post-stroke depressive-like state; the CB1R-involved PKA/RhoA signaling pathway is critical in mediating Gas's anti-PSD potency, suggesting that Gas application may be beneficial in the prevention and adjunctive treatment of PSD.

The association between social networks and functional recovery after stroke

BACKGROUND AND PURPOSE

Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization.

METHODS

Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry. TCSDS aims to identify disparities in hospital-to-home transitions after stroke. SDOH were collected by trained interviewers at hospital discharge. The mRS was assessed at discharge, 30- and 90-day post-stroke. Multinomial logistic regression models examined contributions of each SDOH to mRS improvement or worsening (compared to no change) from discharge to 30- and 90-day, respectively.

RESULTS

Of 1190 participants, median age was 64 years, 42% were women, 52% were non-Hispanic White, and 91% had an ischemic stroke. Those with a limited social support network had greater odds of functional decline at 30 days (aOR = 1.39, 1.17-1.66), adjusting for age and onset to arrival time and at 90 days (aOR = 1.50, 1.10-2.05) after adjusting for age. Results were consistent after further adjustment for additional SDOH and participant characteristics. Individuals living with a spouse/partner had reduced odds of functional decline at 90 days (aOR = 0.74, 0.57-0.98); however, results were inconsistent with more conservative modeling approaches.

CONCLUSION

The findings highlight the importance of SDOH, specifically having a greater number of individuals in your social network in functional recovery after stroke.

Causal association between mental disorders and cerebrovascular diseases: Evidence from Mendelian randomization study

BACKGROUND AND OBJECTIVE

Observational studies have suggested that mental disorders and cerebrovascular diseases (CVDs) may be risk factors for each other, but genetic evidence of a causal relationship is still lacking. We used Mendelian randomization (MR) studies to explore the causal relationship between mental disorders and CVDs from the genetic perspective.

METHODS

To investigate the causal association between major depressive disorder (MDD), anxiety, attention deficit/hyperactivity disorder (ADHD), bipolar disorder and schizophrenia five kinds of mental disorders and CVDs using two-sample two-way MR analysis based on publicly available genome-wide association study (GWAS) data. We used as instrumental variables (IVs) single-nucleotide polymorphisms (SNPs) that were strongly associated with mental disorders and CVDs. IVW method was used as the main analysis method, and MR-IVW, MR-Egger methods, MR-PRESSO test, leave-one-out analysis and funnel plot were used for sensitivity analysis. We further conducted a meta-analysis to summarize the currently available MR analyses.

RESULTS

The results of forward MR study showed that there was a significant causal relationship between ADHD and AS (any stroke) (p(AS) = 0.001, OR (95%CI) =1.118 (1.047-1.195)), any ischemic stroke (AIS) (p(AIS) = 0.004, OR (95%CI) =1.118(1.035-1.206)) and large artery stroke (LAS) (p(LAS) = 0.026, OR (95%CI): 1.206(1.023-1.422)). No heterogeneity, pleiotropy and outliers were found in sensitivity analysis. The reverse MR study showed that IA (intracranial aneurysm) (p(IA) = 0.033, OR (95%CI) = 1.123(1.009-1.249)) and UIA (unruptured intracranial aneurysm) (p(UIA) = 0.015, OR (95%CI) =1.040(1.008-1.074)) were risk factors for schizophrenia. Sensitivity analysis showed no pleiotropy, but there was heterogeneity. After excluding outliers, MR analysis showed that IA and UIA were still risk factors for schizophrenia. Our meta-analyses found statistical significance in causal relationships between ADHD and LAS (OR (95%CI) =1.18 (1.06-1.32), p = 0.003), IA and schizophrenia (OR (95%CI) =1.05 (1.02-1.08), p = 0.002) and UIA and schizophrenia (OR (95%CI) =1.03 (1.01-1.06), p = 0.010).

CONCLUSION

The MR study and meta-analysis suggest that genetically predicted ADHD is a risk factor for LAS, and IA and UIA increase the risk of schizophrenia. The result has implications for the development of feasible prevention strategies in the future.

Does Self-Reported BMI Modify the Association Between Stroke and Depressive Symptoms?

BACKGROUND

Depressive symptoms are common in stroke survivors. While obesity has been associated with stroke and depression, its influence on the association between stroke and depressive symptoms is unknown.

METHODS

Cross-sectional data from 2015 to 2016 Canadian Community Health Survey was used. History of stroke was self-reported and our outcome of interest was depressive symptoms in the prior 2 weeks, measured using the 9-item Patient Health Questionnaire. Self-reported body mass index (BMI) was modeled as cubic spline terms to allow for nonlinear associations. We used multivariable logistic regression to evaluate the association between stroke and depressive symptoms and added an interaction term to evaluate the modifying effect of BMI.

RESULTS

Of the 47,521 participants, 694 (1.0%) had a stroke and 3314 (6.5%) had depressive symptoms. Those with stroke had a higher odds of depressive symptoms than those without (aOR = 3.13, 95% CI 2.48, 3.93). BMI did not modify the stroke-depressive symptoms association (P interaction = 0.242) despite the observed variation in stroke-depressive symptoms association across BMI categories,: normal BMI [18.5-25 kg/m2] (aOR† = 3.91, 95% CI 2.45, 6.11), overweight [25-30 kg/m2] (aOR† = 2.63, 95% CI 1.58, 4.20), and obese [>30 kg/m2] (aOR† = 2.76, 95% CI 1.92, 3.94). Similar results were found when depressive symptoms were modeled as a continuous measure.

CONCLUSION

The association between stroke and depressive symptoms is not modified by BMI, needing additional work to understand the role of obesity on depression after stroke.

Effects of selective serotonin reuptake inhibitors on platelet functions: a literature review

PURPOSE OF REVIEW

Many epidemiological studies have evidenced an increased bleeding risk associated with selective serotonin reuptake inhibitors (SSRIs), yet the underlying mechanisms remain unclear. This review summarizes data on SSRIs' effects on platelet functions assessed with assays used in clinical practice and highlights the areas that deserve further investigation.

RECENT FINDINGS

Conflicting results of SSRI effects on platelet aggregation were observed irrespectively of the agonist used, the antidepressant drug or the study type. Alike, discrepant results were reported with flow-cytometry-based assays assessing either platelet surface glycoprotein levels, integrin activation, agonist-induced secretion of intraplatelet granule content or membrane anionic phospholipid exposure. Other tests may have detected a platelet function defect in SSRIs samples, however, results were largely inconsistent.

SUMMARY

Critical literature examination unveils very low certainty of evidence on potential SSRI effect on platelet functions. Findings are often inconsistent even when similar methods are used, most likely because of differences in study design, included patients (age, comorbid conditions), SSRIs' type and dose, uncontrolled confounding factors, and statistical analysis power. Further studies are needed to disentangle any intrinsic antiplatelet effect of SSRIs and the multiple confounding factors, mainly the depression control itself and the degree of platelet SERT inhibition.

Irritability in stroke: a protocol for a prospective study

Background

Poststroke irritability (PSI) is common among stroke survivors and can lead to a poor quality of life, difficulties in social interactions, criticism from caregivers, and caregiver stress. The planned study will evaluate the clinical, neuropsychological, and magnetic resonance imaging (MRI) correlates of PSI in a cohort of stroke survivors. In addition, the study will examine the 15-month progression of PSI.

Methods

This will be a prospective cohort study that will recruit 285 participants. Participants and their caregivers will undergo detailed assessments at a research clinic at 3, 9, and 15 months after stroke onset (T1/T2/T3). The irritability/lability subscale of the Chinese version of the Neuropsychiatric Inventory (CNPI) will be completed by caregivers. Potential covariates will also be measured. Patients will undergo MRI, including diffusion-weighted imaging, within 1 week of stroke onset. A stepwise logistic regression will be performed to evaluate the importance of lesions in the regions of interest (ROIs) along with other significant variables identified in univariate analyses. These analyses will be repeated for patients with and without PSI at T2 and T3. Repeated measures analysis of covariance (ANCOVA) will be used to assess changes in CNPI scores for the entire sample. In ANCOVA analyses, the frequency of infarcts in the ROIs will be treated as the predictor.

Discussion

This will be the first MRI study on PSI in stroke survivors. The findings will provide insights into the association of the orbitofrontal cortex, anterior cingulate cortex, anterior temporal lobe, insula, amygdala, thalamus, and basal ganglia lesions with the risk of PSI.

Associating Disrupted Intrinsic Functional Networks with Cognitive and Socio-Affective Skills Following Cerebellar Stroke

Stroke patients often experience post-stroke emotional impairments, yet the underlying pathophysiology remains unclear. At the brain level, dysregulation of socio-affective skills should be considered through alterations in brain networks instead of isolated regions. Investigating network alterations may be crucial in explaining emotional or cognitive deficits. In this context, and in line with the dysmetria of thought theory, cerebello-cortical networks' alterations could explain socio-affective functioning. To examine whether impairments in intrinsic functional networks following a cerebellar stroke are associated with poor cognitive and socio-affective performance. Thirty-six cerebellar stroke patients underwent resting-state functional MRI scans at the early stage (T1). They were assessed through a battery of clinical evaluations for cognitive and socio-affective skills. At the chronic stage (T2), evaluations were repeated with additional ecological momentary assessments (EMA) for emotional behavior. The global efficiencies of four resting-state functional brain networks associated with the cerebellum were determined. Patients were classified into subgroups of high and low functioning based on the evaluations and compared. Poorer global efficiency in the default-mode network was present in the subgroup with higher depression (T1: p = 0.034, T2: p = 0.006) and low EMA positive mood (p = 0.048), while lower efficiency in the dorsal attentional network was shown in the subgroup with lower verbal memory (T1: p = 0.004, T2: p = 0.048). Disruptions in intrinsic functional networks are linked to poorer cognition and emotion for some cerebellar stroke patients, partially supporting the theory of 'dysmetria of thought'.

Association between sleep disorder and depression in stroke in the National Health and Nutrition Examination Surveys (NHANES) 2005 to 2014

BACKGROUND

To investigate the association between sleep disorder and depression in stroke population using data from the National Health and Nutrition Examination Surveys (NHANES) conducted between 2005 and 2014.

METHODS

Participants included stroke population who reported on sleep disorder and completed the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptom. Sleep disorder was self-reported and categorized dichotomously. Multivariate logistic regression, subgroup analysis, receiver operating characteristic curve (ROC) and restricted cubic spline (RCS) were used to explore the association between sleep disorder and depression.

RESULTS

The final sample included 566 stroke survivors (weighted n = 3,326,625). Multivariate logistic regression analysis confirmed that sleep disorder was independently associated with an increased risk of depression even after adjusting for potential confounders (OR = 2.616, 95 % CI: 2.561 to 2.599, P < 0.0001). Subgroup analysis indicated that this association was particularly strong among female stroke population (OR = 5.515). Sleep disorder as a significant predictor of depression, while the relationship between sleep time and depression is characterized by non-linearity.

CONCLUSIONS

Sleep disorder is significantly associated with an increased risk of depression in stroke. This relationship remains robust across various sociodemographic and lifestyle factors, highlighting the need for integrated interventions targeting both sleep and mood disturbances in stroke care.

From guidelines to clinical practice in care for ischaemic stroke patients: A systematic review and expert opinion

BACKGROUND AND PURPOSE

Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance.

METHODS

A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke. After data extraction, experts rated the recommendations on dimensions of applicability, that is, actionability, feasibility and validity, on a 9-point Likert scale. Agreement was defined as a score of ≥8 by ≥80% of the experts.

RESULTS

Eighteen articles were identified and 48 recommendations were ultimately extracted. Papers were included only if they described the whole acute care process for patients with ischaemic stroke. Data extraction and analysis revealed variation in terms of both content and comprehensiveness of this description. Experts reached agreement on 34 of 48 (70.8%) recommendations in the dimension actionability, for 16 (33.3%) in feasibility and for 15 (31.3%) in validity. Agreement on all three dimensions was reached for seven (14.6%) recommendations: use of a stroke unit, exclusion of intracerebral haemorrhage as differential diagnosis, administration of intravenous thrombolysis, performance of electrocardiography/cardiac evaluation, non-invasive vascular examination, deep venous thrombosis prophylaxis and administration of statins if needed.

DISCUSSION AND CONCLUSION

Substantial variation in agreement was revealed on the three dimensions of the applicability of recommendations. This overview can guide stroke physicians in improving the care process and removing barriers where implementation may be hampered by validity and feasibility.

Hippocampal exosomes from stroke aggravate post-stroke depression by regulating the expression of proBDNF and p75NTR and altering spine density

Post-stroke depression (PSD) affects millions of patients who suffer cerebral stroke. However, the molecular mechanisms and pathophysiology are poorly understood. Previous studies have shown that exosomes have been proven to be involved in neuropsychiatric disorders such as stroke and post-stroke depression in neurotransmitter release, neuronal remodeling, and neuron angiogenesis. Here we extracted and purified hippocampal exosomes from stroke mouse model to investigate mechanisms of hippocampal exocytosis in PSD assessed by using behavioral tests and biochemical methods. Aiming at the effect of hippocampal exosomes from stroke on the development of PSD, behavioral test was compared including sugar water preference experiment, open fields, forced swimming test, to explore it in depth. Further, the expression of depression-related protein (proBDNF and p75NTR) and synapse-associated proteins (Synaptotagmin and PSD95) was evaluated by Western blotting, RT-qPCR or immunofluorescence staining. Density of dendritic protrusions of neurons was assessed by Golgi staining to measure changes in spine density after the treatment of hippocampal exosomes from stroke. Our results revealed that injection of exosomes from stroke models significantly aggravated depressive-like behaviors, increase of depression-related protein (proBDNF and p75NTR) expression and deficiency of synapse-associated proteins (Synaptotagmin and PSD95) expression, and the decreased number of spin density. Our findings together suggest that hippocampal exosomes from stroke cause exacerbation of depressive-like behavior in mice, possibly resulting from the regulation of neurogenesis by its depression-associated proteins (proBDNF and p75NTR). Therefore, hippocampal exosomes from stroke are promising targets for the diagnosis and treatment of PSD.

Clinical study of different frequency transcranial magnetic stimulation combined with paroxetine in the treatment of poststroke depression with insomnia

BACKGROUND

Study the treatment of poststroke depression and insomnia using varied repetitive transcranial magnetic stimulation (rTMS) frequencies alongside paroxetine. Aim to enhance rTMS effectiveness for depression, insomnia, neurological impairment, and daily living skills.

METHODS

Ninety poststroke depression (PSD) patients were randomly divided into a low-frequency group (low-frequency rTMS + enteric-coated paroxetine), a high-frequency group (high-frequency rTMS + enteric-coated paroxetine), and a control group (sham stimulation + enteric-coated paroxetine). The treatment was administered 5 times a week for a total of 2 weeks. Before treatment, at the end of the 2-week treatment, and at the end of the 6-week follow-up, the 3 groups of patients were assessed using the Hamilton Depression Rating Scale (HAMD), Pittsburgh Sleep Quality Index (PSQI), National Institutes of Health Stroke Scale (NIHSS), and Modified Barthel Index (MBI). The mean differences of scores measured at different frequencies and at different times were analyzed by repeated measure one-way analysis of variance.

RESULTS

The interaction between different frequency and score before and after treatment was significant. HAMD, PSQI, and NIHSS scores of the 3 groups after 2 weeks of treatment and 6 weeks of follow-up were significantly lower than before treatment, while MBI scores were opposite. The main effect of treatment scores in different frequency groups showed that HAMD, NIHSS, and MBI scores were not significantly different among the 3 groups before treatment. The HAMD, PSQI, and NIHSS scores of the low frequency group and the high frequency group were significantly lower than those of the control group after treatment, and the MBI scores were the opposite, except that there was no significant difference in HAMD-17 scores among the 3 groups at the 6-week follow-up. Among them, HAMD score in high-frequency group was significantly lower than that in low-frequency group, and PSQI score was significantly higher than that in low-frequency group.

CONCLUSION

Low-frequency rTMS combined with medication has a better therapeutic effect on the insomnia symptoms of PSD, while high-frequency rTMS combined with medication has a more pronounced therapeutic effect on the depressive symptoms of PSD. Both high-frequency and low-frequency rTMS have an improving effect on neurofunctional deficits and activities of daily living.

Moderating Role of Self-Regulation Difficulties in the Momentary Associations Between Depressive Symptoms and Participation Poststroke

IMPORTANCE

Because depressive symptoms are momentarily associated with lower levels of participation poststroke, it is crucial to investigate what moderates such associations to identify a potential intervention target to reduce the momentary links between depressive symptoms and participation poststroke. Self-regulation seems to be a potential moderator of such associations.

OBJECTIVE

To investigate the extent to which difficulties in self-regulation moderate the momentary associations between depressive symptoms and participation poststroke.

DESIGN

This study uses a real-time, repeated-measures design using smartphone-based ecological momentary assessment surveys five times a day for 10 days. We performed multilevel modeling to uncover the momentary associations among the study variables.

SETTING

Community.

PARTICIPANTS

39 people with stroke.

OUTCOMES AND MEASURES

We obtained real-time data for difficulties in self-regulation (total, cognitive, behavioral, and emotion regulation), depressive symptoms, and participation in daily activities (performance in daily activities and satisfaction with performing daily activities).

RESULTS

We included 1,612 survey responses in the analysis. Higher depressive symptoms were momentarily associated with lower levels of performance (β = -0.05 to -0.07, p < .001) and satisfaction (β = -0.04 to -0.06, p < .05), regardless of adjusting for self-regulation variables and other covariates. Difficulties in total self-regulation (β = -0.01, p < .001) and emotion regulation (β = -0.02, p < .001) magnified the negative associations between depressive symptoms and satisfaction with performing daily activities.

CONCLUSIONS AND RELEVANCE

Using self-regulation and emotion regulation strategies may be a target for just-in-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke. Plain-Language Summary: Depressive symptoms have immediate and real-time associations with lower levels of participation in daily activities in people with stroke. Self-regulation, including cognitive regulation (e.g., goal setting, planning strategies), behavioral regulation (e.g., controlling impulsive behaviors), and emotion regulation (e.g., managing negative feelings), may be an intervention target for reducing the immediate associations between depressive symptoms and lower levels of participation poststroke. Thus, we investigated whether difficulties in self-regulation variables magnify the negative real-time associations between depressive symptoms and participation poststroke. To obtain real-time data on difficulties in self-regulation variables, depressive symptoms, and participation (i.e., performance and satisfaction), we asked 39 community-dwelling people with stroke to answer smartphone surveys. The results showed that difficulties in total self-regulation and emotion regulation magnified the negative associations between depressive symptoms and satisfaction with performing daily activities. Our findings suggest that self-regulation and emotion regulation strategies may be a target for real-time intervention for reducing the momentary associations between depressive symptoms and satisfaction with performing daily activities poststroke.

The Impact of Functionality and Psychological Outcome on Social Engagement 3-months after Intracerebral Hemorrhage

BACKGROUND

Although it is well-known that intracerebral hemorrhage (ICH) is associated with physical and psychological morbidity, there is scant data on factors influencing social engagement after ICH. Understanding the relationship between functionality, psychological outcome and social engagement post-bleed may facilitate identification of patients at high risk for social isolation after ICH.

METHODS

Patients ≥18-years-old with non-traumatic ICH from January 2015-March 2023 were identified from the Neurological Emergencies Outcomes at NYU (NEON) registry. Data on discharge functionality were collected from the medical record. 3-months post-bleed, patients/their legally-authorized representatives (LARs) were contacted to complete Neuro-QoL social engagement, anxiety, depression, and sleep inventories. Patients were stratified by ability to participate in social roles and activities (good=T-score>50, poor=T-score≤50) and satisfaction with social roles and activities (high=T-score>50 and low=T-score≤50). Univariate comparisons were performed to evaluate the relationship between post-bleed social engagement and both functionality and psychological outcome using Pearson's chi-square, Fisher's Exact test, and Mann-Whitney U tests. Multivariate logistic regression was subsequently performed using variables that were significant on univariate analysis (p<0.05).

RESULTS

The social engagement inventories were completed for 55 patients with ICH; 29 (53 %) by the patient alone, 14 (25 %) by a LAR alone, and 12 (22 %) by both patient and LAR. 15 patients (27 %) had good ability to participate in social roles and activities and 10 patients (18 %) had high satisfaction with social roles and activities. Social engagement was associated with both functionality and psychological outcome on univariate analysis, but on multivariate analysis, it was only related to functionality; post-bleed ability to participate in social roles and activities was associated with discharge home, discharge GCS score, discharge mRS score, and discharge NIHSS score (p<0.05) and post-bleed satisfaction with social roles and activities was related to discharge mRS score and discharge NIHSS score (p<0.05).

CONCLUSION

In patients with nontraumatic ICH, social engagement post-bleed was related to discharge functionality, even when controlling for depression, anxiety, and sleep disturbance.

Effects of acupuncture combined with five-element music for people with mild/moderate post-stroke depression: A randomized controlled trial

OBJECTIVES

To evaluate the efficacy and safety of acupuncture combined with five-element music (FEM) as an therapeutic strategy for the physical and mental state of Post-stroke depression patients.

DESIGN AND SETTING

Multicenter, randomized clinical trial conducted at 3 hospitals in China and enrolling 237 patients with PSD between June 2019 and April 2021. Participants mild/moderate PSD (17-item GRID Hamilton Depression Scale (HAMD) score 7-24) were randomly assigned (1:1) to acupuncture combined with FEM (AFEM) group or cognitive behavioral therapy (CBT) group.

MAIN OUTCOME MEASURES

The primary outcome was change and differences between the groups in HAMD-17 from baseline to week 12. Secondary outcomes included Fugl-Meyer Assessment Scale score and Stroke-Specific Quality of Life Scale (SS-QOL) score.

RESULTS

The 237 patients in this intention-to-treat analysis were randomized into either the AFEM group (n=119) or the cognitive behavioral therapy (CBT) group (n=118). Of these 237 participants, 225 (94.9 %) completed all outcome measurements at week 12. The AFEM and CBT groups both showed significant improvement in HAMD-17 from baseline to week 12. Patients in the AFEM group had significantly lower HAMD-17 scores of -3.56 at week 8 (95 % CI,-4.59 to -2.53; p <.001) and -3.50 at week 12 (95 % CI,-4.53 to -2.46; p<.001) than patients in the CBT group. The SS-QOL score improved significantly at week 12. The Fugl-Meyer score was significantly lower in the AFEM group than in the CBT group at week 4, but this difference was not statistically significant upon follow-up at weeks 8 and 12. The incidence of treatment-related adverse events was 2.1 % in the AFEM group, with no serious adverse events reported.

CONCLUSIONS

The results suggest that acupuncture and five-element music significantly improve the depressive symptoms in this cohort of Chinese PSD patients, and the toxicities were similar with CBP group.

REGISTRATION

This study registered with the ClinicalTrials.gov Identifier: ChiCTR1900023741.

Benzodiazepine Utilization in Ischemic Stroke Survivors: Analyzing Initial Excess Supply and Longitudinal Trends

BACKGROUND

Benzodiazepines are commonly prescribed for post-acute ischemic stroke for anxiety, insomnia, and agitation. While guidelines discourage use in those aged ≥65 years, little is known about prescription patterns at the national level.

METHODS

We analyzed a 20% sample of US Medicare claims from April 1, 2013, to September 30, 2021. We selected beneficiaries aged ≥65 years discharged alive following an acute ischemic stroke who had traditional Medicare coverage and 6 months' prior enrollment in Parts A (hospital insurance), B (Medical insurance), and D (drug coverage). We excluded those with prior benzodiazepine prescriptions, self-discharges, or discharge to skilled nursing facilities. We examined demographics, comorbidities, first prescription days' supply, cumulative incidences of benzodiazepine first prescription fills within 90 days after discharge, and geographic and yearly trends.

RESULTS

We included 126 050 beneficiaries with a mean age of 78 years (SD, 8); 54% were female and 82% were White. Within 90 days, 6127 (4.9%) initiated a benzodiazepine. Among new prescriptions, lorazepam (40%) and alprazolam (33%) were the most prescribed. Most (76%) of first fills had a day's supply over 7 days and 55% between 15 and 30 days. Female initiation rates were higher (5.5% [95% CI, 5.3-5.7]) than male initiation rates (3.8% [95% CI, 3.6%-3.9%]). Rates were highest in the southeast (5.1% [95% CI, 4.8%-5.3%]) and lowest in the midwest (4.0% [95% CI, 3.8%-4.3%]), with a modest nationwide initiation decline from 2013 to 2021 (cumulative incidence difference, 1.6%).

CONCLUSIONS

Despite a gradual decline in benzodiazepine initiation from 2013 to 2021, we noted excessive supplies in prescriptions post-acute ischemic stroke discharge, underscoring the need for improved policies.

EEG microstate as a biomarker of post-stroke depression with acupuncture treatment

Background

Post-stroke depression (PSD) is a prevalent psychiatric complication among stroke survivors. The PSD researches focus on pathogenesis, new treatment methods and efficacy prediction. This study explored the electroencephalography (EEG) microstates in PSD and assessed their changes after acupuncture treatment, aiming to find the biological characteristics and the predictors of treatment efficacy of PSD.

Methods

A 64-channel resting EEG data was collected from 70 PSD patients (PSD group) and 40 healthy controls (HC group) to explore the neuro-electrophysiological mechanism of PSD. The PSD patients received 6 weeks of acupuncture treatment. EEG data was collected from 60 PSD patients after acupuncture treatment (MA group) to verify whether acupuncture had a modulating effect on abnormal EEG microstates. Finally, the MA group was divided into two groups: the remission prediction group (RP group) and the non-remission prediction group (NRP group) according to the 24-Item Hamilton Depression Scale (HAMD-24) reduction rate. A prediction model for acupuncture treatment was established by baseline EEG microstates.

Results

The duration of microstate D along with the occurrence and contribution of microstate C were reduced in PSD patients. Acupuncture treatment partially normalized abnormal EEG microstates in PSD patients. Baseline EEG microstates predicted the efficacy of acupuncture treatment with an area under the curve (AUC) of 0.964.

Conclusion

This study provides a novel viewpoint on the neurophysiological mechanisms of PSD and emphasizes the potential of EEG microstates as a functional biomarker. Additionally, we anticipated the therapeutic outcomes of acupuncture by analyzing the baseline microstates, which holds significant practical implication for the PSD treatment.

The Relationship Between Dyadic Coping and Mental Health in Stroke Survivors and Their Spouse Caregivers: An Actor-Partner Interdependence Model

AIM

To investigate the relationship among dyadic coping, mental health and the individual and mutual influences on stroke survivors and their spouse caregivers.

DESIGN

A cross-sectional descriptive study was conducted in China from November 2019 to August 2020. The STROBE checklist was used to report the present study.

METHODS

The analysis included 224 dyads of stroke survivors and their spouse caregivers in China. Data on stroke survivors and their spouse caregivers were collected using the Dyadic Coping Inventory (DCI), the Patient Health Questionnaire nine-item scale (PHQ-9) and the Generalised Anxiety Disorder seven-item scale (GAD-7). The dyadic analysis was conducted based on the Actor-Partner Interdependence Model (APIM).

RESULTS

Regarding actor effects, spouse caregivers' dyadic coping and perceived dyadic coping had a negative predictive effect on their own anxiety and depression. Stroke survivors' perceived dyadic coping had a negative effect on their own depression. Regarding partner effects, spouse caregivers' perceived dyadic coping also had a negative predictive effect on the depression of the patients. In contrast, stroke survivors' perceived dyadic coping was positively associated with spouse caregivers' anxiety and depression. These findings suggested that mental health of stroke survivors and their spouse caregivers was affected by various dyadic coping dimensions.

CONCLUSIONS

Our research has the potential to contribute to the understanding dyadic coping and mental health of stroke survivor-spouse caregiver dyads. The findings reveal that the coping strategies employed by stroke couples are closely related to the mental health of both partners.

IMPACT

This study provides evidence for the significant impact of dyadic coping on the psychological well-being of stroke survivors and their spouse caregivers. Therefore, dyadic interventions aiming at strengthening dyadic coping may have positive effects on their mental health.

PATIENT OR PUBLIC CONTRIBUTION

This study directly involved the patients and family caregivers in hospital settings.

Dental prosthesis use moderates association between tooth loss and risk of depressive symptoms in older adults with severe tooth loss: The JAGES cohort trial

PURPOSE

Depression is a leading cause of disability. Although tooth loss increases the risk of depressive symptoms, it is unclear whether dental prosthesis use moderates this risk. This study aimed to investigate whether dental prosthesis use moderates the association between tooth loss and new depressive symptoms in older adults.

METHODS

This cohort study used data from the 2016 and 2019 Japan Gerontological Evaluation Study (JAGES). The participants were independent older adults aged ≥65 years without depressive symptoms in 2016. The onset of depressive symptoms in 2019 was the outcome variable. The exposure variables were dental status (≥20 teeth, 10-19 teeth with or without dental prostheses, and 0-9 teeth with or without dental prostheses) in 2016. Risk ratios (RRs) and 95% confidence intervals (CIs) were estimated using Poisson regression models with potential confounders as covariates.

RESULTS

The analysis included 50,169 participants (mean age: 72.8 [standard deviation, 5.4] years). During follow-up, the incidence of depressive symptoms was 11.3%. Compared to those who had ≥20 teeth, the RR of depressive symptom onset was highest among those who had 0-9 teeth without dental prostheses (RR, 1.27; 95% CI, 1.04-1.56), after the adjustment for confounders. However, this risk was lower in those with 0-9 teeth and dental prostheses (RR, 1.08; 95% CI, 1.01-1.15).

CONCLUSIONS

These data highlight the potential of dental prostheses as an important factor in reducing the risk of depressive symptoms among individuals with severe tooth loss.