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Shan W, Zhao J, Qiu C, Xu G, Feng J. Glial Fibrillary Acidic Protein Levels in Post-Stroke Depression: A Prospective Ischemic Stroke Cohort. Neuropsychiatr Dis Treat 2023; 19:2171-2178. [PMID: 37873533 PMCID: PMC10590582 DOI: 10.2147/ndt.s435006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
Background and Purpose Increased glial fibrillary acidic protein (GFAP) levels were found in cerebrovascular disease patients. The pathogenesis of depression after ischemic stroke remains largely unknown. Here, we aim to determine whether GFAP concentrations were associated with post-stroke depression (PSD) at 3 months. Methods From March 2022 to September 2022, patients with first-ever ischemic stroke were prospectively recruited. GFAP concentrations were detected within 24 h using an enzyme-linked immunosorbent assay. The PSD was defined as a Hamilton Depression Rating Scale 24-Item score ≥ 8. Results A total of 206 subjects with ischemic stroke (mean age: 63.6 years; 49.0% female) were enrolled. During the 90-day follow-up, 57 participants (27.7%) were observed in PSD. The median serum GFAP concentrations were 0.67 ng/mL. After adjustment for the covariates, higher increased GFAP levels were associated with increased risk of PSD (odds ratio [OR], 7.12; 95% confidence interval [CI], 3.29-15.44; P < 0.001). Also, the multivariate-adjusted OR of PSD associated with the fourth quartile of GFAP was 10.89 (95% CI, 3.53-33.60; P < 0.001) compared with the first quartile. Furthermore, the restricted cubic spline confirmed a linear association between GFAP and the risk of PSD (P for linearity < 0.001). Conclusion Our results indicated that increased circulating GFAP concentrations were significantly correlated with the risk of PSD at 3 months. Measuring the GFAP levels after ischemic stroke may add some values for the risk stratifying of PSD.
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Affiliation(s)
- Wanying Shan
- Department of Neurology, Suzhou Ninth People’s Hospital, Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Jie Zhao
- Department of Gerontology, Suzhou Ninth People’s Hospital, Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Chunfang Qiu
- Department of Neurology, Suzhou Ninth People’s Hospital, Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Guoli Xu
- Department of Neurology, Suzhou Ninth People’s Hospital, Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
| | - Jie Feng
- Department of Neurology, Suzhou Ninth People’s Hospital, Soochow University, Suzhou, Jiangsu, 215200, People’s Republic of China
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Symptomatic plaque enhancement is associated with early-onset post-stroke depression. J Affect Disord 2022; 306:281-287. [PMID: 35337924 DOI: 10.1016/j.jad.2022.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/07/2022] [Accepted: 03/10/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND The association between imaging features closely associated with symptomatic intracranial atherosclerotic plaques and early-onset post-stroke depression (PSD) is currently unclear. MATERIALS AND METHODS 76 ischemic stroke patients who underwent high-resolution vessel wall magnetic resonance imaging (HR-VWI) were divided into PSD and non-PSD groups according to their DSM-V diagnoses and HAMD-17 scores at 14 days after onset. Clinical data and the imaging features associated with symptomatic plaques (including the enhancement index (EI), remodeling index, and plaque surface irregularity) were compared between groups. Multifactorial logistic regression analysis was used to find independent predictors of early-onset PSD. Spearman rank correlation analysis explores the association between clinical data, symptomatic plaque imaging features, and HAMD-17 in patients. RESULTS The sample comprised 36 patients with early-onset PSD. The symptomatic plaque EI and infarct volume were significantly higher in depressed patients than in patients without depression (P < 0.05). Multivariate logistic regression showed that symptomatic plaque EI could be used as an independent predictor of early-onset PSD after correcting for the confounding factor of infarct volume (OR = 1.034, 95% CI:1.014-1.055, P = 0.001). In the total sample, symptomatic plaque EI, infarct volume, and HAMD-17 had a significant positive correlation with each other (P < 0.05). LIMITATIONS This study focused only on the patients' symptomatic plaques and did not monitor patients' systemic inflammation levels at the time of HR-VWI. CONCLUSIONS The degree of symptomatic plaque enhancement is an independent predictive imaging marker of early-onset PSD and can be used the early diagnosis of early-onset PSD.
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Zou L, Li X, Chen Q, Lv F, Min S. Focal points of preanesthesia evaluations for electroconvulsive therapy in patients with depression: a retrospective analysis of clinical characteristics in nonremission. BMC Anesthesiol 2022; 22:163. [PMID: 35619081 PMCID: PMC9134596 DOI: 10.1186/s12871-022-01686-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background This study explored the patient clinical characteristics that may affect electroconvulsive therapy (ECT) efficacy to enable improved focus during evaluations and preparation for ECT. Methods Patients were enrolled for ECT at the Department of Psychiatry and Anesthesiology of the First Affiliated Hospital of Chongqing Medical University from December 2017 to January 2019. The primary outcome in our study was defined as the development of nonremission. A multivariate logistic analysis was performed to identify the risk factors for nonremission. Results In total, 874 depressed patients were included in the study. After the ECT treatment, 255 cases (29.2%) exhibited nonremission. A multivariate logistic regression analysis of the variables was performed, and the results showed that atherosclerosis (OR 8.072, 95% CI 2.442 to 16.675; P = 0.001), COPD (OR 2.919, 95% CI 1.240 to 6.871; P = 0.014), diabetes (OR 2.202, 95% CI 1.115 to 4.348; P = 0.023) and smoking (OR 1.519, 95% CI 1.015 to 2.273; P = 0.042) were independent risk factors for nonremission. Conclusion In the retrospective analysis, we found that atherosclerosis, diabetes, COPD and smoking may be high-risk factors for nonremission. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01686-6.
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Affiliation(s)
- Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiao Li
- Departments of Psychiatry, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Feng Lv
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Increased high-mobility group box 1 levels are associated with depression after acute ischemic stroke. Neurol Sci 2021; 43:3131-3137. [PMID: 34800198 DOI: 10.1007/s10072-021-05571-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 08/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE Increased high-mobility group box 1 (HMGB1) levels were found in patients after acute ischemic stroke. The aim of this study was to examine whether the circulating HMGB1 levels could predict the 3-month post-stroke depression (PSD). METHODS The subjects were first-ever ischemic stroke patients who were hospitalized during the period from July 2020 to December 2020. HMGB1 concentrations were measured by enzyme-linked immunosorbent assay after admission. A 24-item Hamilton Depression Rating Scale was performed to evaluate PSD at 3 months after stroke. RESULTS The analyses included 324 participants (mean age, 63.7 years; 171 male). Ninety-four patients (29.0%) were diagnosed as having PSD at 3 months. The median serum HMGB1 levels at admission was 7.5 ng/mL (IQR, 4.4-11.3 ng/mL). The PSD distribution across the HMGB1 quartiles ranged between 17.5% (first quartile) and 57.5% (fourth quartile). After covariate adjustments, the fourth quartile of HMGB1 was found to be associated with a higher risk of PSD (as compared with first HMGB1 quartile, odd ratio, 1.26; 95% confidence interval [CI], 1.17-1.35; P < 0.001). The area under the receiver operating characteristic curve of HMGB1 was 0.726 (95% CI 0.660-0.792) for PSD. Similar results were found when HMGB1 was analyzed as continuous variable. Furthermore, the optimal cutoff point of circulating HMGB1 levels was 8.6 ng/mL, with a sensitivity of 69.2% and a specificity of 73.9%. CONCLUSIONS This study demonstrated that higher HMGB1 levels in the acute phase of ischemic stroke were associated with increased risk of PSD.
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Miao M, Du J, Che B, Guo Y, Zhang J, Ju Z, Xu T, Zhong X, Zhang Y, Zhong C. Circulating choline pathway nutrients and depression after ischemic stroke. Eur J Neurol 2021; 29:459-468. [PMID: 34611955 DOI: 10.1111/ene.15133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 09/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Choline pathway nutrients, including choline and betaine, are reported to exert antidepressant effects. However, there is little population-based evidence on the relationships between circulating choline and betaine and poststroke depression (PSD). We aimed to prospectively explore the associations between plasma choline and betaine and depression after ischemic stroke. METHODS This study was based on the China Antihypertensive Trial in Acute Ischemic Stroke. A total of 612 participants with plasma choline and betaine concentrations were included in the analysis. The study outcome was depression 3 months after ischemic stroke. Logistic regression models were performed to estimate the relationships between plasma choline and betaine and the risk of PSD. Risk reclassification and calibration of models with choline or betaine were analyzed. RESULTS Patients with PSD had lower choline and betaine levels than those without PSD (p < 0.05). Compared with tertile 1, the multivariable-adjusted odds ratios (95% CIs) for tertile 3 of choline and betaine were 0.54 (0.35-0.83) and 0.59 (0.38-0.92), respectively. Per 1 SD increase in choline or betaine was associated with a 25% (95% CI 9%-37%) or an 19% (95% CI 3%-32%) decreased risk of PSD, respectively. Furthermore, the addition of choline or betaine to the established risk factors model improved the risk reclassification for PSD, as shown by an increase in the net reclassification index and integrated discrimination improvement (all p < 0.05). CONCLUSIONS Patients with elevated levels of choline and betaine had a lower risk of depression after acute ischemic stroke, suggesting the protective significance of choline pathway nutrients for PSD.
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Affiliation(s)
- Mengyuan Miao
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Jigang Du
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Bizhong Che
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Yufei Guo
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Jintao Zhang
- Department of Neurology, The 88th Hospital of PLA, Shandong, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Tongliao, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Xiaoyan Zhong
- School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
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Gyanwali B, Lui B, Tan CS, Chong EJY, Vrooman H, Chen C, Hilal S. Cerebral Microbleeds and White Matter Hyperintensities are Associated with Cognitive Decline in an Asian Memory Clinic Study. Curr Alzheimer Res 2021; 18:399-413. [PMID: 34420506 DOI: 10.2174/1567205018666210820125543] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 05/21/2021] [Accepted: 05/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cerebral Small Vessel Disease (SVD); lacunes, Cerebral Microbleeds (CMBs), and White Matter Hyperintensities (WMH) have a vital role in cognitive impairment and dementia. SVD in lobar location is related to cerebral amyloid angiopathy, whereas SVD in a deep location with hypertensive arteriopathy. It remains unclear how different locations of SVD affect long-term cognitive decline. The present study aimed to analyse the association between different locations and severity of SVD with global and domain-specific cognitive decline over the follow-up interval of 3 years. METHODS We studied 428 participants who had performed MRI scans at baseline and at least 3 neuropsychological assessments. Locations of lacunes and CMBs were categorized into strictly lobar, strictly deep and mixed-location, WMH volume into anterior and posterior. The National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Harmonization Neuropsychological Battery was used to assess cognitive function. To analyse the association between baseline location and severity of SVD with cognitive decline, linear regression models with generalized estimated equations were constructed to calculate the mean difference, 95% confidence interval and two-way interaction factor between time and SVD. RESULTS Increased numbers of baseline CMBs were associated with a decline in global cognition as well as a decline in executive function and memory domains. Location-specific analysis showed similar results with strictly lobar CMBs. There was no association with strictly deep and mixed-location CMBs with cognitive decline. Baseline WMH volume was associated with a decline in global cognition, executive function and memory. Similar results were obtained with anterior and posterior WMH volumes. Lacunes and their locations were not associated with cognitive decline. CONCLUSION Strictly lobar CMBs, as well as WMH volume in anterior and posterior regions, were associated with cognitive decline. Future research focuses are warranted to evaluate interventions that may prevent cognitive decline related to SVD.
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Affiliation(s)
- Bibek Gyanwali
- Memory Aging & Cognition Centre, National University Health System, 21 Lower Kent Ridge Rd, Singapore
| | - Benedict Lui
- Memory Aging & Cognition Centre, National University Health System, 21 Lower Kent Ridge Rd, Singapore
| | - Chuen S Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 21 Lower Kent Ridge Rd, Singapore
| | - Eddie J Y Chong
- Department of Psychological Medicine, National University Hospital, 21 Lower Kent Ridge Rd, Singapore
| | - Henri Vrooman
- Departments of Radiology & Medical Informatics, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Christopher Chen
- Memory Aging & Cognition Centre, National University Health System, 21 Lower Kent Ridge Rd, Singapore
| | - Saima Hilal
- Memory Aging & Cognition Centre, National University Health System, 21 Lower Kent Ridge Rd, Singapore
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Paradoxical effect of statin medication on depressive disorder in first-ever ischemic stroke patients: possible antidepressant-like effect prestroke and the opposite in continuous medication poststroke. Int Clin Psychopharmacol 2021; 36:147-153. [PMID: 33724252 DOI: 10.1097/yic.0000000000000352] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Poststroke depression (PSD) is the most frequent complication after stroke. Statin is a widely used prophylactic for stroke. However, some researchers reported that poststroke statin may lead to a depressive change in stroke patients. We aimed to study the effect of different statin medication timing especially prestroke timing on PSD to adopt appropriate intervention around stroke. Patients with first-ever ischemic stroke were consecutively observed from January 2012 to June 2017. They were grouped by different initiation time of statin treatment. The follow-up endpoints were set to: (1) diagnosis of PSD within 1-year and (2) censor data. Cox regression model adjusted for confounding factors was performed. A total of 1571 patients were included in the analyses, among which 210 (13.4%) were comorbided with PSD, and the median time of the course was 30 (14-98) days. The patients who received both pre- and poststroke statin treatment had 1.99 times (P = 0.037) the hazard faced by patients who did not receive that medication. In contrast, sole statin pretreatment may have the tendency to reduce the risk of PSD. Our findings provide the primary results for the prestroke statin medication. The initiation timing of continuous regular statin treatment ahead of ischemic stroke could have a correlation with a higher risk of PSD.
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Che B, Zhu Z, Bu X, Yin J, Han L, Xu T, Ju Z, Liu J, Zhang J, Chen J, He J, Zhang Y, Zhong C. Multiple biomarkers covering several pathways for the prediction of depression after ischemic stroke. J Affect Disord 2021; 280:442-449. [PMID: 33242715 DOI: 10.1016/j.jad.2020.10.075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/10/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND To assess the potential incremental utility of multiple biomarkers reflecting several pathological pathways for the risk prediction of depression after stroke. METHODS We used data from the China Antihypertensive Trial in Acute Ischemic Stroke, and a panel of 13 circulating biomarkers were measured. The study outcome was depression (24-item Hamilton Depression Rating Scale score≥8) at 3 months after ischemic stroke. Logistic regression models were performed to evaluate the risk of depression associated with multiple biomarkers. Discrimination and risk reclassification for depression were analyzed. RESULTS Among 631 included ischemic stroke patients, elevated growth differentiation factor-15, anticardiolipin antibodies, antiphosphatidylserine antibodies and matrix metalloproteinase-9 were individually associated with increased risks of depression after stroke. The multiple biomarker analysis showed a clear gradient in the risk of depression with increasing numbers of elevated biomarkers, and multivariate adjusted odds ratio (95% confidence interval) of patients with 4 elevated biomarkers was 6.52 (2.24-18.95) compared with those without elevation in any of 4 biomarkers. The simultaneous inclusion of all 4 biomarkers to the conventional model significantly improved discrimination (C statistic increased from 0.702 to 0.748, P=0.004) and risk reclassification (net reclassification improvement 45.0%; integrated discrimination improvement 6.2%; both P<0.001) for depression after stroke. LIMITATIONS We selected biomarkers that had previously been reported to be promising predictors of depression after stroke, while other novel biomarkers not tested might have additional predictive value. CONCLUSIONS Simultaneously adding multiple biomarkers from several pathophysiological pathways to traditional risk factors provided substantial incremental utility of the risk stratification for depression after stroke.
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Affiliation(s)
- Bizhong Che
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China; Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Xiaoqing Bu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China; Department of Epidemiology, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Jieyun Yin
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Liyuan Han
- Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China
| | - Jiale Liu
- Department of Neurology, Jilin Central Hospital, Jilin, China
| | - Jintao Zhang
- Department of Neurology, the 88th Hospital of PLA, Taian, Shandong, China
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China.
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, 199 Renai Road, Industrial Park District, Suzhou, Jiangsu Province, 215123, China.
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Lu Y, Qian S, Chen H, Yuan P, Zhang R, Wang A, Zhang J, Ju Z, Zhang Y, Xu T, Zhong C. Plasma soluble suppression of tumorigenicity 2 and depression after acute ischemic stroke. Eur J Neurol 2021; 28:868-876. [PMID: 33368822 DOI: 10.1111/ene.14699] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND PURPOSE Soluble suppression of tumorigenicity 2 (sST2) might be related to stroke and depression, but the association of sST2 with poststroke depression (PSD) is unclear. The study aimed to prospectively assess the association between plasma sST2 levels and PSD. METHODS A total of 635 acute ischemic stroke patients with sST2 measurements from the China Antihypertensive Trial in Acute Ischemic Stroke were included in this analysis. We used the 24-item Hamilton Rating Scale for Depression to assess depression at 3 months, and PSD was defined as a score of ≥8. Logistic regression analysis was performed to estimate the risk of PSD associated with sST2, and net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to assess the predictive value of sST2. RESULTS Two hundred fifty (39.4%) patients developed depression at 3 months after ischemic stroke. Patients with PSD had higher sST2 levels than patients without PSD (172.7 vs. 153.8 pg/ml; p = 0.003). After adjustment for age, sex, education, National Institutes of Health Stroke Scale score, and other covariates, the odds ratio for the highest quartile of sST2 compared with the lowest quartile was 1.84 (95% confidence interval, 1.10-3.08) for PSD. Adding sST2 to a conventional model notably improved risk prediction for PSD (category-free NRI = 19.34%, 95% confidence interval = 4.39%-34.28%, p = 0.017; IDI = 1.20%, 95% confidence interval = 0.25%-2.15%, p = 0.014). CONCLUSIONS Increased plasma sST2 levels in the acute phase of ischemic stroke were significantly associated with the increased risk of PSD, independently of conventional risk factors.
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Affiliation(s)
- Yaling Lu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Sifan Qian
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Haichang Chen
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Pengcheng Yuan
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Rui Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Aili Wang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Jintao Zhang
- Department of Neurology, 88th Hospital of PLA, Shandong, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Tongliao, China
| | - Yonghong Zhang
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Tan Xu
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
| | - Chongke Zhong
- Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China
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Kan CN, Gyanwali B, Hilal S, Ng KP, Venketasubramanian N, Chen CLH, Xu X. Neuropsychiatric Correlates of Small Vessel Disease Progression in Incident Cognitive Decline: Independent and Interactive Effects. J Alzheimers Dis 2020; 73:1053-1062. [DOI: 10.3233/jad-190999] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Cheuk Ni Kan
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Bibek Gyanwali
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Saima Hilal
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Departments of Epidemiology and Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Kok Pin Ng
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | | | - Christopher Li-Hsian Chen
- Memory Aging and Cognition Centre, National University Health System, Singapore, Singapore
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
| | - Xin Xu
- Department of Pharmacology, National University of Singapore, Singapore, Singapore
- Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Lin W, Xiong L, Yang Z, Deng X, Zhu J, Chen C, Huang S, Ma Y, Zhu F. Severe Periodontitis Is Associated with Early-Onset Poststroke Depression Status. J Stroke Cerebrovasc Dis 2019; 28:104413. [PMID: 31582272 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104413] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/01/2019] [Accepted: 09/10/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Poststroke depression (PSD) is one of the most common complications after ischemic stroke, and periodontitis is associated with depression. However, whether severe periodontitis is associated with early-onset PSD status remains unknown. In this study, we aimed to investigate whether there is an association between severe periodontitis and PSD status in acute ischemic stroke patients. MATERIAL AND METHODS We recruited 202 acute ischemic stroke patients within 7 days after stroke onset. Pocket depth and clinical attachment loss were assessed by oral examination to define the severe periodontitis. On the basis of diagnosis of PSD status according to DSM-5 criteria and a 24-item Hamilton Depression Rating Scale score greater than or equal to 8 within 2 weeks after stroke onset, we stratified patients into PSD status or non-PSD status groups and identified the independent predictors for the development of PSD status in multivariate logistic analysis. RESULTS 77 (38.1%) patients were diagnosed as early-onset PSD status. PSD status group showed more severe periodontitis, lower income, lower Barthel Index (BI) score and Montreal Cognitive Assessment score, higher National Institutes of Health Stroke Scale score and modified Rankin scale (mRS) score compared with non-PSD status group. Multivariate logistic regression showed that severe periodontitis (odds ratio 2.401) and NIHSS score (>4, odds ratio 2.130) were independent predictors for early-onset PSD status. CONCLUSIONS Severe periodontitis is found to be an important independent predictor of early-onset PSD status in patients with acute ischemic stroke, in addition to the well-known prognostic factors such as nonminor stroke assessed by NIHSS greater than 4.
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Affiliation(s)
- Weifeng Lin
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China; Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Li Xiong
- BrainNow Research Institute, Shenzhen, Guangdong Province, China
| | - Zhi Yang
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Xuhui Deng
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Jinhua Zhu
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China
| | - Chunchun Chen
- Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China
| | - Shuxuan Huang
- Department of Neurology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Ying Ma
- Department of Cardiology, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China
| | - Feiqi Zhu
- Department of Neurology, The Affiliated Yuebei People's Hospital of Shantou University Medical College, Shaoguan, Guangdong Province, China; Cognitive Impairment Ward of Neurology Department, The Third Affiliated Hospital of Shenzhen University Medical College, Shenzhen, China.
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12
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Antiphospholipid antibodies predict post-stroke depression after acute ischemic stroke. J Affect Disord 2019; 257:160-165. [PMID: 31301618 DOI: 10.1016/j.jad.2019.07.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/24/2019] [Accepted: 07/04/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Antiphospholipid activity was reported to be increased in depressive patients, while the impact of antiphospholipid antibodies (aPLs) on post-stroke depression (PSD) is unclear. We aimed to investigate the associations of aPLs, including antiphosphatidylserine (aPS) and anticardiolipin (aCL) antibodies with depression after acute ischemic stroke. METHODS aPS and aCL were measured in 497 ischemic stroke patients recruited from 7 of 26 participating hospitals of China Antihypertensive Trial in Acute Ischemic Stroke. 24-item Hamilton Depression Rating Scale was used to evaluate PSD status at 3 months after stroke. RESULTS Compared with aPS-negative or aCL-negative, the adjusted odds ratios (ORs) [95% confidence intervals (CIs)] associated with aPS-positive or aCL-positive were 1.77 (1.07-2.92) or 2.06 (1.11-3.80) for risk of PSD. On continuous analyses, per 1-SD increment of aPS and aCL were associated with 29% (OR 1.29, 95% CI 1.06-1.58) and 30% (OR 1.30, 95% CI 1.06-1.60) increased risks for PSD, respectively. Adding aPLs to conventional risk factors models significantly improved risk reclassification for PSD (net reclassification improvement index = 21.87%, P = 0.016 for aPS; net reclassification improvement index = 32.24%, P = 0.0004 for aCL). LIMITATIONS aPLs levels were tested only at baseline without serial measurements, and we were unable to detect the association between aPLs changes and PSD. CONCLUSIONS Higher aPS and aCL levels in the acute phase of ischemic stroke were associated with increased risk of 3-month PSD, suggesting that aPLs may play an important role in post-stroke depression prediction.
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Zhu M, Zhou H, Zhang W, Deng Y, Wang X, Zhang X, Yang L, Li M, Bai X, Lin Z. Stigma experienced by Chinese patients with stroke during inpatient rehabilitation and its correlated factors: a cross-sectional study. Top Stroke Rehabil 2019; 26:342-348. [PMID: 31104577 DOI: 10.1080/10749357.2019.1605759] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Stroke-related stigma can have a negative effect on patients, and is associated with stereotyping, prejudice, and discrimination; however, the exact stigma experienced by patients remains ambiguous. Objectives: To evaluate the stigma experienced by patients with stroke, determine associated factors, and explore relationships between stigma and early rehabilitation. Methods: Overall, we examined 288 patients with stroke. Patient characteristics were determined through medical records and investigations, while stigma status (comprising total stigma, internalized stigma, and enacted stigma), depression level, functional independence, and functional outcome were also assessed. Demographic and clinical characteristics were evaluated through univariate analysis, and significant variables were further analyzed through linear regression. The relationships between stigma and early rehabilitation (depression, functional independence, and functional outcomes) were also analyzed. Results: The sample's total stigma, internalized stigma, and enacted stigma scores were 47.76 ± 18.00, 30.07 ± 12.25, and 17.69 ± 6.37, respectively. Employment status before stroke, caregivers, physical impairment, and number of impairments were all relevant to all types of stigma (P< .05). The regression analysis showed that caregivers and physical impairment are the two main predictors of total, internalized, and enacted stigma (P< .01). The correlation analysis revealed that stigma is associated with depression (r = 0.671 ~ 0.690, P< .001), functional independence (r = -0.562~-0.707, P< .001), and functional outcomes (r = 0.436 ~ 0.637, P< .001). Conclusions: Stigma was moderate, and internalized stigma may be more apparent; therefore, physicians should pay more attention to patients who report or show signs of experiencing stroke-related stigma.
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Affiliation(s)
- Minfang Zhu
- a Department of Nursing , Nanfang Hospital, Southern Medical University , Guangzhou , Guangdong , China
| | - Hongzhen Zhou
- a Department of Nursing , Nanfang Hospital, Southern Medical University , Guangzhou , Guangdong , China
| | - Weibin Zhang
- b Department of Pathology , Jiangmen Central Hospital , Jiangmen , Guangdong , China.,c Department of Pathology , School of Basic Medical Sciences, Southern Medical University , Guangzhou, Guangdong , China
| | - Yingying Deng
- d Department of Neurosurgery , Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Xiaoyan Wang
- d Department of Neurosurgery , Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Xiaomei Zhang
- e Department of Neurology , Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
| | - Lei Yang
- a Department of Nursing , Nanfang Hospital, Southern Medical University , Guangzhou , Guangdong , China
| | - Muling Li
- a Department of Nursing , Nanfang Hospital, Southern Medical University , Guangzhou , Guangdong , China
| | - Xuejie Bai
- a Department of Nursing , Nanfang Hospital, Southern Medical University , Guangzhou , Guangdong , China
| | - Zhenzhou Lin
- e Department of Neurology , Nanfang Hospital, Southern Medical University , Guangzhou, Guangdong , China
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Analysis of Influencing Factors of Poststroke Depression: Is Higher Body Mass Index Always a Risk Factor of Poststroke Depression? J Nerv Ment Dis 2019; 207:203-208. [PMID: 30741774 DOI: 10.1097/nmd.0000000000000949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Poststroke depression (PSD) is a common complication of stroke. We sought to investigate the influencing factors of PSD and explored the association between body mass index (BMI) and PSD. A total of 397 stroke patients in a hospital in Qiqihar City, China, were included in this study in 2016. The order of independent variable importance was the score of the National Institute of Health Stroke Scale, frequency of stroke, age, BMI, and sleep duration. Sleep duration of 7 hours or more (compared with <7 hours) was negatively associated with the Self-Rating Depression Scale (SDS) score in all quantiles. BMI of 28.0 kg/m or more (compared with 24.0-28.0 kg/m) was negatively associated with SDS score, and the coefficients manifested a continuous increasing trend from P30 to P84.1 in patients aged 65 years or more. In addition, the relationship between BMI and SDS score demonstrated a "U"-shaped curve in patients aged less than 65 years. The National Institute of Health Stroke Scale score, the frequency of stroke, sleep duration, and BMI were the influencing factors of PSD. BMI played different roles in the two age groups.
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Li W, Xiao WM, Chen YK, Qu JF, Liu YL, Fang XW, Weng HY, Luo GP. Anxiety in Patients With Acute Ischemic Stroke: Risk Factors and Effects on Functional Status. Front Psychiatry 2019; 10:257. [PMID: 31057444 PMCID: PMC6478797 DOI: 10.3389/fpsyt.2019.00257] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 04/04/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Anxiety is prevalent after a stroke. The pathophysiological mechanisms underlying the development of poststroke anxiety (PSA) remain unclear. The aim of this study was to investigate the clinical and neuroimaging risk factors for development of PSA and examine the effects of PSA on activities of daily living (ADL) and quality of life (QOL) in Chinese patients with ischemic stroke. Methods: Two hundred nineteen patients with acute ischemic stroke were recruited to the study. A series of comprehensive assessments, including Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale (HDRS), Lawton ADL Scale, and the Stroke-Specific Quality of Life (SSQOL) Scale, were conducted in the acute stage and 3 months after stroke. Magnetic resonance imaging assessment focused on evaluation of infarctions, white matter lesions, and brain atrophy. Results: In the acute stage and 3 months after stroke, 34 (16%) and 33 (15%) patients had PSA, respectively. Multiple logistic regression analysis indicated that HDRS (OR = 1.269, 95% CI = 1.182-1.364, P < 0.001) and acute infarcts in cerebral hemispheric white matter (CHWM; OR = 2.902, 95% CI = 1.052-8.007, P = 0.040) were significant correlates of PSA in the acute stage of stroke. Three months after stroke, these correlates remained significant predictors, along with male sex. Multiple linear regressions showed that age, NIHSS, HARS, and HDRS in the acute stage were significant predictors for both ADL and SSQOL at 3 months after stroke. Conclusion: Depressive symptoms are the major correlates of PSA while more severe PSA is associated with poorer ADL and health-related QOL. Acute lesions involving CHWM may correlate with PSA in ischemic stroke patients with mild-to-moderate neurologic deficits, supporting a lesion-location hypothesis in PSA.
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Affiliation(s)
- Wei Li
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Wei-Min Xiao
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Jian-Feng Qu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Yong-Lin Liu
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Xue-Wen Fang
- Department of Radiology, Dongguan People's Hospital, Dongguan, China
| | - Han-Yu Weng
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Gen-Pei Luo
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
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16
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Intracranial atherosclerotic disease. Neurobiol Dis 2018; 124:118-132. [PMID: 30439443 DOI: 10.1016/j.nbd.2018.11.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/25/2018] [Accepted: 11/09/2018] [Indexed: 12/16/2022] Open
Abstract
Intracranial atherosclerosis (ICAS) is a progressive pathological process that causes progressive stenosis and cerebral hypoperfusion and is a major cause of stroke occurrence and recurrence around the world. Multiple factors contribute to the development of ICAS. Angiography imaging techniques can improve the diagnosis of and the selection of appropriate treatment regimens for ICAS. Neither aggressive medication nor endovascular interventions can eradicate stroke recurrence in patients with ICAS. Non-pharmacological therapies such as remote ischemic conditioning and hypothermia are emerging. Comprehensive therapy with medication in combination with endovascular intervention and/or non-pharmacological treatment may be a potential strategy for ICAS treatment in the future. We summarized the epidemiology, pathophysiological mechanisms, risk factors, biomarkers, imaging and management of ICAS.
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Madsen TE, DeCroce-Movson E, Hemendinger M, McTaggart RA, Yaghi S, Cutting S, Furie KL, Saad A, Siket MS, Jayaraman MV. Sex differences in 90-day outcomes after mechanical thrombectomy for acute ischemic stroke. J Neurointerv Surg 2018; 11:221-225. [DOI: 10.1136/neurintsurg-2018-014050] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 11/03/2022]
Abstract
BackgroundIt is largely unknown whether functional outcomes after mechanical thrombectomy for large vessel occlusion (LVO) ischemic strokes differ by sex in non-clinical trial populations. We investigated sex differences in 90-day outcomes among ischemic stroke patients receiving mechanical thrombectomy.MethodsThis was a prospective cohort of adults treated with mechanical thrombectomy for LVO at a single academic comprehensive stroke center from July 2015 to April 2017. Data on independence (mRS ≤2) at hospital discharge and 90 days were collected prospectively. Multiple logistic regression was used to determine the association between sex and 90-day independence, first adjusting for demographics, pre-stroke mRS, and NIHSS, then by co-morbidities and time to thrombectomy, and finally by vessel recanalization and use of intravenous thrombolysis.ResultsWe included 279 patients, 52% of whom were female. Compared with males, females were older (median years (IQR) 81 (75–88) vs. 71.5 (60–81), P<0.001) and had higher baseline NIHSS (mean SD 18.2±7.5 vs . 16.0±7.1, P=0.02). Similar proportions of males and females had pre-stroke mRS ≤2 (73.3% vs.67.1%, P=0.27). In multivariate analyses, males and females had a similar likelihood of being independent at discharge (aOR 0.71 (95%CI 0.32 to 1.58)), but females were less likely to be independent at 90 days (aOR 0.37 95% CI 0.16 to 0.87).ConclusionsIn patients treated with mechanical thrombectomy for LVOs at a large comprehensive stroke center, females were less likely to be independent at 90 days. Future research should investigate contributors to poor outcomes post-discharge in females with LVOs, along with potential interventions to improve outcomes.
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Levada OA, Troyan AS. Poststroke Depression Biomarkers: A Narrative Review. Front Neurol 2018; 9:577. [PMID: 30061860 PMCID: PMC6055004 DOI: 10.3389/fneur.2018.00577] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/26/2018] [Indexed: 11/13/2022] Open
Abstract
Poststroke depression (PSD) is the most prevalent psychiatric disorder after stroke, which is independently correlated with negative clinical outcome. The identification of specific biomarkers could help to increase the sensitivity of PSD diagnosis and elucidate its pathophysiological mechanisms. The aim of current study was to review and summarize literature exploring potential biomarkers for PSD diagnosis. The PubMed database was searched for papers published in English from October 1977 to December 2017, 90 of which met inclusion criteria for clinical studies related to PSD biomarkers. PSD biomarkers were subdivided into neuroimaging, molecular, and neurophysiological. Some of them could be recommended to support PSD diagnosing. According to the data, lesions affecting the frontal-subcortical circles of mood regulation (prefrontal cortex, basal nuclei, and thalamus) predominantly in the left hemisphere can be considered as neuroimaging markers and predictors for PSD for at least 1 year after stroke. Additional pontine and lobar cerebral microbleeds in acute stroke patients, as well as severe microvascular lesions of the brain, increase the likelihood of PSD. The following molecular candidates can help to differentiate PSD patients from non-depressed stroke subjects: decreased serum BDNF concentrations; increased early markers of inflammation (high-sensitivity C-reactive protein, ferritin, neopterin, and glutamate), serum pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-18, IFN-γ), as well as pro-inflammatory/anti-inflammatory ratios (TNF-α/IL-10, IL-1β/IL-10, IL-6/IL-10, IL-18/IL-10, IFN-γ/IL-10); lowered complement expression; decreased serum vitamin D levels; hypercortisolemia and blunted cortisol awakening response; S/S 5-HTTLPR, STin2 9/12, and 12/12 genotypes of the serotonin transporter gene SLC6A4, 5-HTR2a 1438 A/A, and BDNF met/met genotypes; higher SLC6A4 promoter and BDNF promoter methylation status. Neurophysiological markers of PSD, that reflect a violation of perception and cognitive processing, are the elongation of the latency of N200, P300, and N400, as well as the decrease in the P300 and N400 amplitude of the event-related potentials. The selected panel of biomarkers may be useful for paraclinical underpinning of PSD diagnosis, clarifying various aspects of its multifactorial pathogenesis, optimizing therapeutic interventions, and assessing treatment effectiveness.
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Affiliation(s)
- Oleg A Levada
- State Institution "Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine", Zaporizhzhia, Ukraine
| | - Alexandra S Troyan
- State Institution "Zaporizhzhia Medical Academy of Postgraduate Education Ministry of Health of Ukraine", Zaporizhzhia, Ukraine
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Liang Y, Chen YK, Mok VCT, Wang DF, Ungvari GS, Chu WCW, Kang HJ, Tang WK. Cerebral Small Vessel Disease Burden Is Associated With Poststroke Depressive Symptoms: A 15-Month Prospective Study. Front Aging Neurosci 2018. [PMID: 29541025 PMCID: PMC5835754 DOI: 10.3389/fnagi.2018.00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Objective: All types of cerebral small vessel disease (SVD) markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds, and perivascular spaces were found to be associated with poststroke depressive symptoms (PDS). This study explored whether the combination of the four markers constituting an overall SVD burden was associated with PDS. Methods: A cohort of 563 patients with acute ischemic stroke were followed over a 15-month period after the index stroke. A score of ≥7 on the 15-item Geriatric Depression Scale was defined as clinically significant PDS. Scores of the four SVD markers ascertained on magnetic resonance imaging were summed up to represent total SVD burden. The association between SVD burden and PDS was assessed with generalized estimating equation models. Results: The study sample had a mean age of 67.0 ± 10.2 years and mild-moderate stroke [National Institutes of Health Stroke Scale score: 3, interquartile, 1-5]. PDS were found in 18.3%, 11.6%, and 12.3% of the sample at 3, 9, and 15 months after stroke, respectively. After adjusting for demographic characteristics, vascular risk factors, social support, stroke severity, physical and cognitive functions, and size and locations of stroke, the SVD burden was associated with an increased risk of PDS [odds ratio = 1.30; 95% confidence interval = 1.07-1.58; p = 0.010]. Other significant predictors of PDS were time of assessment, female sex, smoking, number of acute infarcts, functional independence, and social support. Conclusion: SVD burden was associated with PDS examined over a 15-month follow-up in patients with mild to moderate acute ischemic stroke.
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Affiliation(s)
- Yan Liang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Vincent Chung-Tong Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - De-Feng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Gabor S Ungvari
- Graylands Hospital, The University of Notre Dame Australia, Perth, WA, Australia
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Hospital, Gwangju, South Korea
| | - Wai-Kwong Tang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong Kong.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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Gall S, Phan H, Madsen TE, Reeves M, Rist P, Jimenez M, Lichtman J, Dong L, Lisabeth LD. Focused Update of Sex Differences in Patient Reported Outcome Measures After Stroke. Stroke 2018; 49:531-535. [PMID: 29438087 DOI: 10.1161/strokeaha.117.018417] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/03/2017] [Accepted: 12/20/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Seana Gall
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Hoang Phan
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Tracy E Madsen
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Mathew Reeves
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Pamela Rist
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Monik Jimenez
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Judith Lichtman
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Liming Dong
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.)
| | - Lynda D Lisabeth
- From the Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (S.G., H.P.); Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.); Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing (M.R.); Division of Preventive Medicine, Department of Medicine (P.R.) and Division of Women's Health (M.J.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT (J.L.); and Department of Epidemiology, University of Michigan, Ann Arbor (L.D., L.D.L.).
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Elevated circulating homocysteine and high-sensitivity C-reactive protein jointly predicts post-stroke depression among Chinese patients with acute ischemic stroke. Clin Chim Acta 2018; 479:132-137. [PMID: 29325799 DOI: 10.1016/j.cca.2018.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Homocysteine (HCY) and high sensitivity C reactive protein (hs-CRP) were suggested to be involved in post-stroke depression (PSD), which is a frequent mood disorder after stroke. However, the combined effect of HCY and hs-CRP on PSD remains unclear. METHODS A total of 598 acute ischemic stroke patients from 7 of 26 centers participating in the China Antihypertensive Trial in Acute Ischemic Stroke with HCY or hs-CRP measurements were included in this analysis. PSD status was evaluated by 24-item Hamilton Depression Rating Scale at 3 months after stroke. RESULTS Two hundred and forty-one (40.30%) participants were considered as PSD. HCY and hs-CRP levels were not significantly different between PSD and non-PSD patients. Interesting, in a maximally adjusted model, the odds ratio (95% confidence interval) of PSD was 1.90 (1.18-3.06) for coexistence of HCY ≥ 14.65 μmol/l and hs-CRP ≥ 1.90 mg/l compared with the other levels (HCY < 14.65 μmol/l and/or hs-CRP < 1.90 mg/l). Adding combination of HCY and hs-CRP to a model containing conventional risk factors could significantly improve risk reclassification for PSD. CONCLUSIONS Coexistence of both higher HCY and higher hs-CRP in the acute phase of ischemic stroke were associated with subsequent PSD, independently of established conventional risk factors.
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Douven E, Köhler S, Rodriguez MMF, Staals J, Verhey FRJ, Aalten P. Imaging Markers of Post-Stroke Depression and Apathy: a Systematic Review and Meta-Analysis. Neuropsychol Rev 2017; 27:202-219. [PMID: 28831649 PMCID: PMC5613051 DOI: 10.1007/s11065-017-9356-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 07/27/2017] [Indexed: 01/15/2023]
Abstract
Several brain imaging markers have been studied in the development of post-stroke depression (PSD) and post-stroke apathy (PSA), but inconsistent associations have been reported. This systematic review and meta-analysis aims to provide a comprehensive and up-to-date evaluation of imaging markers associated with PSD and PSA. Databases (Medline, Embase, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews) were searched from inception to July 21, 2016. Observational studies describing imaging markers of PSD and PSA were included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated to examine the association between PSD or PSA and stroke lesion laterality, type, and location, also stratified by study phase (acute, post-acute, chronic). Other imaging markers were reviewed qualitatively. The search retrieved 4502 studies, of which 149 studies were included in the review and 86 studies in the meta-analyses. PSD in the post-acute stroke phase was significantly associated with frontal (OR 1.72, 95% CI 1.34–2.19) and basal ganglia lesions (OR 2.25, 95% CI 1.33–3.84). Hemorrhagic stroke related to higher odds for PSA in the acute phase (OR 2.58, 95% CI 1.18–5.65), whereas ischemic stroke related to higher odds for PSA in the post-acute phase (OR 0.20, 95% CI 0.06–0.69). Frequency of PSD and PSA is modestly associated with stroke type and location and is dependent on stroke phase. These findings have to be taken into consideration for stroke rehabilitation programs, as this could prevent stroke patients from developing PSD and PSA, resulting in better clinical outcome.
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Affiliation(s)
- Elles Douven
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Maria M F Rodriguez
- Hospital Alvaro Cunqueiro, Department of Psychiatry, Complexo Universitario de Vigo, Vigo, Spain
| | - Julie Staals
- Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands
| | - Pauline Aalten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Alzheimer Center Limburg, Maastricht University, Dr. Tanslaan 12, PO Box 616 (DRT 12), 6200 MD, Maastricht, The Netherlands.
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