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Xu Z, Zhu Y. Bibliometric Analysis of Psychological Distress in Stroke: Research Trends, Hot Spots, and Prospects- An Emphasis on China. J Multidiscip Healthc 2023; 16:4279-4291. [PMID: 38164461 PMCID: PMC10758185 DOI: 10.2147/jmdh.s434201] [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] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
Background Currently, the psychological problems of stroke patients are of great concern. It is a hot topic of clinical care research to analyze and discuss the current status and hot spots, frontiers and development trends of research on psychological distress of stroke patients, and to develop and implement psycho-social care programs to improve the quality of life of patients.However, there is an absence of visual overviews to assess the published literature systematically. Methods The Web of Science (WOS) database was used to search the relevant literature in this field, spanning the period 2009-2023, and the countries, institutions, and research keywords in this field were visualized and analyzed by CiteSpace analysis software. Results An analysis of 416 papers found that the overall trend of psychological distress in stroke patients was increasing, and the research hotspots were mainly focusing on the relationship between different risk factors and psychological distress in stroke patients, psychological distress in stroke caregivers, positive psychology in stroke patients, and interventions on psychological distress in stroke patients. In the future, the research population may gradually shift to stroke caregivers, and the research focus will be on developing and studying scales. Conclusion Visual analysis of psychological distress studies in stroke patients can provide strategies for clinical interventions and broaden thinking about clinical care.
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Affiliation(s)
- Zhiguo Xu
- Department of Pharmaceutical Engineering, School of Life and Health Sciences, Huzhou College, Huzhou, Zhejiang, People’s Republic of China
- Xiehe Union East China Stem Cell & Gene Engineering Corp., Ltd, Zhejiang Umbilical Cord Blood Hematopoietic Stem Cell Bank, Huzhou, Zhejiang, People’s Republic of China
| | - Yi Zhu
- Department of Medicine and Health, Shaoxing University Yuanpei College, Shaoxing, Zhejiang, People’s Republic of China
- Department of Nursing, Huzhou University, Huzhou, Zhejiang, People’s Republic of China
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Chen YM, Chen PC, Lin WC, Hung KC, Chen YCB, Hung CF, Wang LJ, Wu CN, Hsu CW, Kao HY. Predicting new-onset post-stroke depression from real-world data using machine learning algorithm. Front Psychiatry 2023; 14:1195586. [PMID: 37404713 PMCID: PMC10315461 DOI: 10.3389/fpsyt.2023.1195586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/29/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction Post-stroke depression (PSD) is a serious mental disorder after ischemic stroke. Early detection is important for clinical practice. This research aims to develop machine learning models to predict new-onset PSD using real-world data. Methods We collected data for ischemic stroke patients from multiple medical institutions in Taiwan between 2001 and 2019. We developed models from 61,460 patients and used 15,366 independent patients to test the models' performance by evaluating their specificities and sensitivities. The predicted targets were whether PSD occurred at 30, 90, 180, and 365 days post-stroke. We ranked the important clinical features in these models. Results In the study's database sample, 1.3% of patients were diagnosed with PSD. The average specificity and sensitivity of these four models were 0.83-0.91 and 0.30-0.48, respectively. Ten features were listed as important features related to PSD at different time points, namely old age, high height, low weight post-stroke, higher diastolic blood pressure after stroke, no pre-stroke hypertension but post-stroke hypertension (new-onset hypertension), post-stroke sleep-wake disorders, post-stroke anxiety disorders, post-stroke hemiplegia, and lower blood urea nitrogen during stroke. Discussion Machine learning models can provide as potential predictive tools for PSD and important factors are identified to alert clinicians for early detection of depression in high-risk stroke patients.
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Affiliation(s)
- Yu-Ming Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Yang-Chieh Brian Chen
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Fa Hung
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- College of Humanities and Social Sciences, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ching-Nung Wu
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan City, Taiwan
| | - Hung-Yu Kao
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan City, Taiwan
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Koob JL, Viswanathan S, Mustin M, Mallick I, Krick S, Fink GR, Grefkes C, Rehme AK. To engage or not engage: Early incentive motivation prevents symptoms of chronic post-stroke depression - A longitudinal study. Neuroimage Clin 2023; 37:103360. [PMID: 36889100 PMCID: PMC10009723 DOI: 10.1016/j.nicl.2023.103360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Although post-stroke depression (PSD) is known to disrupt motor rehabilitation after stroke, PSD is often undertreated and its relationship with motor impairment remains poorly understood. METHODS In a longitudinal study design we investigated, which factors at the early post-acute stage may increase the risk for PSD symptoms. We were especially interested in whether interindividual differences in the motivational drive to engage in physically demanding tasks indicate PSD development in patients suffering from motor impairments. Accordingly, we used a monetary incentive grip force task where participants were asked to hold their grip force for high and low rewards at stake to maximize their monetary outcome. Individual grip force was normalized according to the maximal force prior to the experiment. Experimental data, depression, and motor impairment were assessed from 20 stroke patients (12 male; 7.7 ± 6.78 days post-stroke) with mild-to-moderate hand motor impairment and 24 age-matched healthy participants (12 male). RESULTS Both groups showed incentive motivation as indicated by stronger grip force for high versus low reward trials and the overall monetary outcome in the task. In stroke patients, severely impaired patients showed stronger incentive motivation, whereas early PSD symptoms were associated with reduced incentive motivation in the task. Larger lesions in corticostriatal tracts correlated with reduced incentive motivation. Importantly, chronic motivational deficits were preceded by initially reduced incentive motivation and larger corticostriatal lesions in the early stage post-stroke. CONCLUSIONS More severe motor impairment motivates reward-dependent motor engagement, whereas PSD and corticostriatal lesions potentially disturb incentive motivational behavior, thereby increasing the risk of chronic motivational PSD symptoms. Acute interventions should address motivational aspects of behavior to improve motor rehabilitation post-stroke.
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Affiliation(s)
- Janusz L Koob
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany.
| | - Shivakumar Viswanathan
- Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, 52425 Juelich, Germany
| | - Maike Mustin
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany
| | - Imon Mallick
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany
| | - Sebastian Krick
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany; Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, 52425 Juelich, Germany
| | - Christian Grefkes
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany; Institute of Neuroscience and Medicine, Cognitive Neuroscience (INM-3), Forschungszentrum Jülich, 52425 Juelich, Germany; Department of Neurology, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany.
| | - Anne K Rehme
- Department of Neurology, University Hospital Cologne, 50937 Cologne, Germany
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Mikami K, Sudo T, Orihashi Y, Kimoto K, Mizuma A, Uesugi T, Kawamura R, Honma K, Nagata E, Yamamoto K, Takizawa S, Matsumoto H, Robinson RG. Effective Tools to Predict Depression in Acute and Subacute Phase of Ischemic Stroke. J Neuropsychiatry Clin Neurosci 2021; 33:43-48. [PMID: 33086923 DOI: 10.1176/appi.neuropsych.20040076] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite the high frequency of depression in the first year following stroke, few studies have predicted risk of depression after the acute and subacute stroke periods. The aim of this study was to identify, in the acute and subacute periods, measures that would predict major depression during the first year after stroke. METHODS Study subjects were inpatients with ischemic stroke aged 20-85 years within 6 weeks of onset. Patients were evaluated at baseline and at 3, 6, 9, and 12 months. Patients were diagnosed with major depression using the Structured Clinical Interview for DSM-IV. The severity of depressive symptoms was measured with the Patient Health Questionnaire-9 (PHQ-9) and the Montgomery-Åsberg Depression Rating Scale (MADRS). RESULTS Of the 152 potential patients who met inclusion criteria, 49 had follow-up evaluations; one patient with major depression in the acute and subacute periods was excluded from the analysis. Among the remaining 48 patients, the number of those with major depression during the first year of stroke onset was five (10.4%). Patients who developed major depression had significantly more depressive symptoms in the acute and subacute stroke phase as assessed by both the PHQ-9 and MADRS. Patients with PHQ-9 scores ≥9 in the acute and subacute stroke phases were significantly more likely to develop major depression in a chronic phase of stroke. CONCLUSIONS The self-administered PHQ-9 can identify patients in the acute and subacute stroke periods who are at increased risk for developing major depression during the first year after stroke.
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Affiliation(s)
- Katsunaka Mikami
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Takeshi Sudo
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Yasushi Orihashi
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Keitaro Kimoto
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Atsushi Mizuma
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Tsuyoshi Uesugi
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Reina Kawamura
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Kazunari Honma
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Eiichiro Nagata
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Kenji Yamamoto
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Shunya Takizawa
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Hideo Matsumoto
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
| | - Robert G Robinson
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mikami, Sudo, Kimoto, Yamamoto, Matsumoto); Teikyo Heisei University Graduate School of Clinical Psychology, Tokyo (Sudo); Department of Clinical Pharmacology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Orihashi); Department of Neurology, Tokai University School of Medicine, Isehara, Kanagawa, Japan (Mizuma, Uesugi, Kawamura, Honma, Nagata, Takizawa); Department of Neurology, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan (Honma), and Department of Psychiatry, Carver College of Medicine, University of Iowa, Iowa City (Robinson)
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Wijeratne T, Sales C. Understanding Why Post-Stroke Depression May Be the Norm Rather Than the Exception: The Anatomical and Neuroinflammatory Correlates of Post-Stroke Depression. J Clin Med 2021; 10:jcm10081674. [PMID: 33919670 PMCID: PMC8069768 DOI: 10.3390/jcm10081674] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/30/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
Ischemic Stroke precedes depression. Post-stroke depression (PSD) is a major driver for poor recovery, negative quality of life, poor rehabilitation outcomes and poor functional ability. In this systematic review, we analysed the inflammatory basis of post-stroke depression, which involves bioenergetic failure, deranged iron homeostasis (calcium influx, Na influx, potassium efflux etc), excitotoxicity, acidotoxicity, disruption of the blood brain barrier, cytokine-mediated cytotoxicity, reactive oxygen mediated toxicity, activation of cyclooxygenase pathway and generation of toxic products. This process subsequently results in cell death, maladapted, persistent neuro-inflammation and deranged neuronal networks in mood-related brain regions. Furthermore, an in-depth review likewise reveals that anatomic structures related to post-stroke depression may be localized to complex circuitries involving the cortical and subcortical regions.
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Affiliation(s)
- Tissa Wijeratne
- School of Psychology and Public Health, La Trobe University, Melbourne 3000, Australia
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
- Department of Medicine, Faculty of Medicine, University of Rajarata, Saliyapura, Anuradhapura 50000, Sri Lanka
- Correspondence:
| | - Carmela Sales
- Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, St Albans 3021, Australia;
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A meta-analysis of poststroke depression risk factors comparing depressive-related factors versus others. Int Psychogeriatr 2020; 32:1331-1344. [PMID: 32014074 DOI: 10.1017/s1041610219002187] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Poststroke depression (PSD) is a public health issue, affecting one-third of stroke survivors, and is associated with multiple negative consequences. Reviews tried to identify PSD risk factors with discrepant results, highlighting the lack of comparability of the analyzed studies. We carried out a meta-analysis in order to identify clinical risk factors that can predict PSD. DESIGN PubMed and Web of Science were searched for papers. Only papers with a strictly defined Diagnostic and Statistical Manual of Mental Disorders depression assessment, at least 2 weeks after stroke, were selected. Two authors independently evaluated potentially eligible studies that were identified by our search and independently extracted data using standardized spreadsheets. Analyses were performed using MetaWin®, the role of each variable being given as a risk ratio (RR). RESULTS Eighteen studies were included in the meta-analysis. Identified risk factors for PSD with RR significantly above 1 were previous history of depression (RR 2.19, confidence interval (CI) 1.52-3.15), disability (RR 2.00, CI 1.58-2.52), previous history of stroke (RR 1.68, CI 1.06-2.66), aphasia (RR 1.47, CI 1.13-1.91), and female gender (RR 1.35, CI 1.14-1.61). Fixed effects model leads to identification of two more risk factors: early depressive symptoms with an RR of 2.32 (CI 1.43-3.79) and tobacco consumption (RR 1.40, CI 1.09-1.81). Time bias was found for alcohol consumption. Sample size was significantly involved to explain the role of "alcohol consumption" and "cognitive impairment." CONCLUSION Five items were significantly predictive of PSD. It might be of clinical interest that depressive-related risk factors (such as past depressive episodes) were having the largest impact.
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Dajpratham P, Pukrittayakamee P, Atsariyasing W, Wannarit K, Boonhong J, Pongpirul K. The validity and reliability of the PHQ-9 in screening for post-stroke depression. BMC Psychiatry 2020; 20:291. [PMID: 32517743 PMCID: PMC7285729 DOI: 10.1186/s12888-020-02699-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 05/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression affects about 30% of stroke survivors within 5 years. Timely diagnosis and management of post-stroke depression facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is recognized as a good screening tool for post-stroke depression. However, no validation studies have been undertaken for the use of the Thai PHQ-9 in screening for depression among Thai stroke patients. METHODS The objectives were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing its results with those of a psychiatric interview as the gold standard. First-ever stroke patients aged ≥45 years with a stroke duration 2 weeks-2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder and adjustment disorder with a depressed mood. The summed-scored-based diagnosis of depression with the PHQ-9 was obtained. Validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed. RESULTS In all, 115 stroke patients with a mean age of 64 years (SD: 10 years) were enrolled. The mean PHQ-9 score was 5.2 (SD: 4.8). Using the DSM-5 criteria, 11 patients (9.6%) were diagnosed with depressive disorder, 12 patients (10.5%) were diagnosed with adjustment disorder with a depressed mood. Both disorders were combined as a group of post-stroke depression. The Thai PHQ-9 had satisfactory internal consistency (Cronbach's alpha: 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored-based diagnosis, an optimal cut-off score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI: 0.78-0.96). CONCLUSIONS The Thai PHQ-9 has acceptable psychometric properties for detecting a mixture of major depression and adjustment disorder in post-stroke patients, with a recommended cut-off score of ≥6 for a Thai population.
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Affiliation(s)
- Piyapat Dajpratham
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 9th floor Srisangwal Building, Siriraj Hospital, Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
| | - Panate Pukrittayakamee
- grid.10223.320000 0004 1937 0490Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wanlop Atsariyasing
- grid.10223.320000 0004 1937 0490Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kamonporn Wannarit
- grid.10223.320000 0004 1937 0490Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jariya Boonhong
- grid.7922.e0000 0001 0244 7875Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Krit Pongpirul
- grid.7922.e0000 0001 0244 7875Department of Preventive Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Stern-Nezer S, Eyngorn I, Mlynash M, Snider RW, Venkatsubramanian C, Wijman CAC, Buckwalter MS. Depression one year after hemorrhagic stroke is associated with late worsening of outcomes. NeuroRehabilitation 2018; 41:179-187. [PMID: 28505996 DOI: 10.3233/nre-171470] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Poststroke depression is the most common psychiatric sequelae of stroke, and it's independently associated with increased morbidity and mortality. Few studies have examined depression after intracranial hemorrhage (ICH). OBJECTIVE To investigate the relationship between depression, ICH and outcomes. METHODS A substudy of the prospective Diagnostic Accuracy of MRI in Spontaneous Intracerebral Hemorrhage (DASH) study, we included 89 subjects assessed for depression 1 year after hemorrhage. A Hamilton Depression Rating Scale score >10 defined depression. Univariate, multivariable, and trend analyses evaluated relationships between depression, clinical, radiographic, and inflammatory factors and modified Rankin score (mRS) at 90 days and one year. RESULTS Prevalence of depression at one year was 15%. Depression was not associated with hematoma volumes, presence of IVH or admission NIHSS, nor with demographic factors. Despite this, depressed patients had worse 1-year outcomes (p = 0.004) and were less likely to improve between 3 and 12 months, and more likely to worsen (p = 0.042). CONCLUSION This is the first study to investigate depression one year after ICH. Post-ICH depression was common and associated with late worsening of disability unrelated to initial hemorrhage severity. Further research is needed to understand whether depression is caused by worsened disability, or whether the converse is true.
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Affiliation(s)
- Sara Stern-Nezer
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Irina Eyngorn
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Michael Mlynash
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Ryan W Snider
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Chitra Venkatsubramanian
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.,Department of Neurosurgery Stanford, Stanford University, CA, USA
| | - Christine A C Wijman
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Marion S Buckwalter
- Stanford Stroke Center, Stanford, CA, USA.,Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA.,Department of Neurosurgery Stanford, Stanford University, CA, USA
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Xu HB, Xu YH, He Y, Xue F, Wei J, Zhang H, Wu J. Decreased Serum Brain-Derived Neurotrophic Factor May Indicate the Development of Poststroke Depression in Patients with Acute Ischemic Stroke: A Meta-Analysis. J Stroke Cerebrovasc Dis 2018; 27:709-715. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/26/2017] [Accepted: 10/05/2017] [Indexed: 12/16/2022] Open
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10
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Li J, Oakley LD, Li Y, Luo Y. Development and initial validation of a clinical measure to assess early symptoms of post‐stroke depression in the acute stroke patient. J Clin Nurs 2017; 27:784-794. [PMID: 28981176 DOI: 10.1111/jocn.14099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Jufang Li
- School of Nursing Wenzhou Medical University Wenzhou Zhejiang China
| | | | - Yun Li
- The First Affiliated Hospital of Wenzhou Medical University Wenzhou Zhejiang China
| | - Yong Luo
- The First Affiliated Hospital of Chongqing Medical University Chongqing China
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11
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Zhang Y, Zhao H, Fang Y, Wang S, Zhou H. The association between lesion location, sex and poststroke depression: Meta-analysis. Brain Behav 2017; 7:e00788. [PMID: 29075559 PMCID: PMC5651383 DOI: 10.1002/brb3.788] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/21/2017] [Accepted: 06/26/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Poststroke depression (PSD) is a common form of stroke patients. Whether the risk of PSD is influenced by the stroke lesion location and sex remains a matter of debate. The objective of this study was to examine the association between the risk of PSD and the stroke lesion location and sex by performing a systematic meta-analysis. METHODS Subgroup analyses were performed according to the time interval after stroke onset to assessment for PSD. A total of 31 reports involving 5,309 subjects (for lesion location analysis) and 5,489 subjects (for sex analysis) suffering from stroke were included in this meta-analysis. RESULTS The pooled odds ratio (OR) of PSD after a left-hemisphere stroke, compared with a right-hemisphere stroke was 1.11 (95% confidence interval [CI] 0.82-1.49) and OR of PSD after a male stroke, compared with a female stroke was 0.68 (95% CI 0.58-0.81). Subacute poststroke subgroup (1-6 months) significantly favored PSD occurring after a left hemisphere stroke (OR = 1.50, 95% CI 1.21-1.87). Furthermore, there was a statistically significant association between PSD and female stroke for studies with acute poststroke group (OR = 0.73, 95% CI 0.62-0.86) and subacute poststroke stroke phase (OR = 0.69, 95% CI 0.56-0.86). CONCLUSIONS This systematic review suggests that patients with left hemisphere stroke may be more susceptible to PSD during subacute phase of stroke and female stroke may be more susceptible to PSD during acute and subacute phase of stroke.
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Affiliation(s)
- Ying Zhang
- Department of Neurology The First People's Hospital of Shangqiu Henan China
| | - Hui Zhao
- Department of Cardiology The First People's Hospital of Shangqiu Henan China
| | - Yan Fang
- Department of Neurology The First People's Hospital of Shangqiu Henan China
| | - Suishan Wang
- Department of Neurology The First People's Hospital of Shangqiu Henan China
| | - Haiyun Zhou
- Department of Neurology The First People's Hospital of Shangqiu Henan China
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12
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Shi Y, Yang D, Zeng Y, Wu W. Risk Factors for Post-stroke Depression: A Meta-analysis. Front Aging Neurosci 2017; 9:218. [PMID: 28744213 PMCID: PMC5504146 DOI: 10.3389/fnagi.2017.00218] [Citation(s) in RCA: 141] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 06/23/2017] [Indexed: 12/18/2022] Open
Abstract
Background: Stroke not only impacts patients physically but also economically. Post-stroke depression (PSD), as a common complication of stroke, always obstructs the process of stroke rehabilitation. Accordingly, defining the risk factors associated with PSD has extraordinary importance. Although there have been many studies investigating the risk factors for PSD, the results are inconsistent. Objectives: The objectives of this study were to identify the risk factors for PSD by evidence-based medicine. Data sources: A systematic and comprehensive database search was performed of PubMed, Medline, CENTRAL, EMBASE.com, the Cochrane library and Web of Science for Literature, covering publications from January 1, 1998 to November 19, 2016. Study Selection: Studies on risk factors for PSD were identified, according to inclusion and exclusion criteria. The risk of bias tool, described in the Cochrane Handbook version 5.1.0, was used to assess the quality of each study. Meta-analysis was performed using RevMan 5.3 software. Results: Thirty-six studies were included for review. A history of mental illness was the highest ranking modifiable risk factor; other risk factors for PSD were female gender, age (<70 years), neuroticism, family history, severity of stroke, and level of handicap. Social support was a protective factor for PSD. Conclusion: There are many factors that have effects on PSD. The severity of stroke is an important factor in the occurrence of PSD. Mental history is a possible predictor of PSD. Prevention of PSD requires social and family participation.
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Affiliation(s)
- Yu Shi
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical UniversityGuangzhou, China
| | - Dongdong Yang
- Department of Neurology, Zhengzhou People's HospitalZhengzhou, China
| | - Yanyan Zeng
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical UniversityGuangzhou, China
| | - Wen Wu
- Department of Rehabilitation, Zhujiang Hospital, Southern Medical UniversityGuangzhou, China
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13
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Zhu L, Han B, Wang L, Chang Y, Ren W, Gu Y, Yan M, Wu C, Zhang XY, He J. The association between serum ferritin levels and post-stroke depression. J Affect Disord 2016; 190:98-102. [PMID: 26496014 DOI: 10.1016/j.jad.2015.09.074] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/27/2015] [Accepted: 09/18/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Post-stroke depression (PSD) is a common neuropsychiatric affective disorder occurring after stroke. Elevated serum ferritin levels have been reported to contribute to depression. Our aim was to determine whether there is a relationship between serum ferritin levels and PSD. METHODS 196 ischemic stroke patients were consecutively recruited within the first 24h of stroke onset and were followed up for 2 months. Serum ferritin levels were assayed by electrochemiluminescence immunoassay at hospital admission. Clinical depression was diagnosed according to DSM-IV criteria and a HAMD -17 score of ≥ 7. Meanwhile, 100 normal control subjects were also recruited. RESULTS We found that 56 stroke patients (28.6%) were diagnosed with PSD at two months. There was a significant intergroup difference in serum ferritin levels within 24h after admission (F=25.044, P<0.001). Serum ferritin levels were significantly higher at admission in PSD patients than in non-PSD patients and normal controls. There was a positive correlation between serum ferritin levels and hs-CRP at admission in PSD patients (r=0.129, P=0.042). In multivariate analyses, serum levels of ferritin ≥ 130.15 µg/L were independently associated with PSD at two months [odds ratio OR=5.388, 95%CI:1.725-16.829; P=0.004] after adjusting for all possible variables. LIMITATIONS We excluded patients with severe aphasia and with serious conditions.In addition, the information for dietary intake was not recorded, which may influence body iron stores. CONCLUSION Our findings show that elevated serum ferritin levels at admission are associated with PSD and may predict its development at 2 months post-stroke.
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Affiliation(s)
- Lin Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Bin Han
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Liping Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yaling Chang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Wenwei Ren
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yingying Gu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Mengjiao Yan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Chaowen Wu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiang Yang Zhang
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston,TX, USA
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Department of Psychology,Wenzhou Medical University, Wenzhou 325000, China.
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14
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Ahn DH, Lee YJ, Jeong JH, Kim YR, Park JB. The effect of post-stroke depression on rehabilitation outcome and the impact of caregiver type as a factor of post-stroke depression. Ann Rehabil Med 2015; 39:74-80. [PMID: 25750875 PMCID: PMC4351498 DOI: 10.5535/arm.2015.39.1.74] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 09/11/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the effect of post-stroke depression (PSD) on rehabilitation outcome and to investigate the risk factors of PSD, especially, the role of caregivers type (family or professional) in subacute stroke patients. METHODS Two hundred twenty-six stroke patients were enrolled retrospectively. All the subjects' basic characteristics, Korean version of the Beck Depression Inventory (K-BDI), Korean version of the Modified Barthel Index (K-MBI), and the modified Rankin Scale (mRS) were recorded when the patient was transferred into the Department of Rehabilitation Medicine and at the time of discharge. The results were statistically analyzed by using SPSS ver. 20.0. RESULTS The patients' K-BDI score showed a significantly negative association with K-MBI at discharge (β=-0.473, p<0.001) and a significantly positive association with the mRS score at discharge (β=0.316, p<0.001). Patients with lesions on the left hemisphere (odds ratio [OR], 3.882; 95% confidence interval [CI], 1.726-8.733) and professional caregiver support (OR, 0.028; 95% CI, 0.012-0.065) had a higher rate of depression. CONCLUSION Depression was prevalent in stroke patients, and it had a negative effect on patients' functional outcome. Patients who had a lesion on the right hemisphere had less depression. The type of caregiver was related to the incidence of subacute PSD, and family caregivers were found to lower the frequency of stroke patients' depression.
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Affiliation(s)
- Dong-Heun Ahn
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Yung-Jin Lee
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Ji-Hun Jeong
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Yong-Rok Kim
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Jong-Bum Park
- Department of Rehabilitation Medicine, Konyang University College of Medicine, Daejeon, Korea
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15
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Gurr B, Muelenz C. A Follow-up Study of Psychological Problems After Stroke. Top Stroke Rehabil 2015; 18:461-9. [DOI: 10.1310/tsr1805-461] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Post-stroke depression and lesion location: a systematic review. J Neurol 2014; 262:81-90. [PMID: 25308633 DOI: 10.1007/s00415-014-7534-1] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 10/04/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022]
Abstract
Post-stroke depression (PSD) is a frequent problem in stroke rehabilitation. Several studies have evaluated association between the lesion location and the risk of depression. Different conclusions and contradictory findings have been published. The aim of the present study was to perform a systematic meta-analysis to evaluate the relationship between PSD and lesion location. We researched PubMed, ISI Web of Science, EMBASE, and systematically reviewed available publications reporting investigations on stroke location and risk of PSD. Subgroup analyses were performed according to the time since stroke onset to assessment for PSD or the source of patients. Odds ratios (ORs) and 95 % confidence intervals (CIs) were used for pooled analyses. Heterogeneity was assessed with Cochran's Q test and I (2) test. Begg's funnel plot and Egger's test were used to examine the publication bias. A total of 43 studies involving 5,507 patients suffering from stroke were included in this meta-analysis. The pooled OR with 95 % CI for the overall association of stroke location and depression risk was 0.99 (0.88-1.11). Subgroups analyses highlighted that only studies with subacute post-stroke group (1-6 months) showed a statistical association between right hemisphere stroke and risk of depression (OR = 0.79, 95 % CI 0.66-0.93). This systematic review offered no support for the hypothesis that lesion of the left hemisphere was associated with an increased risk of depression after stroke. We only find significant association between right hemisphere stroke and incidence of depression for studies within subacute post-stroke phase.
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17
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Cheng SY, Zhao YD, Li J, Chen XY, Wang RD, Zeng JW. Plasma levels of glutamate during stroke is associated with development of post-stroke depression. Psychoneuroendocrinology 2014; 47:126-35. [PMID: 25001962 DOI: 10.1016/j.psyneuen.2014.05.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 05/01/2014] [Accepted: 05/09/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Depression is a frequent mood disorder that affects around 33% of stroke patient. Our aim was to test the possible association between plasma glutamate and the development of post-stroke depression (PSD) in Chinese patients. METHODS The subjects were first-ever acute ischemic stroke (AIS) patients who were hospitalized during the period from November 2011 to September 2013. Clinical information and stroke severity was collected at admission. Neurological and neuropsychological evaluations were conducted at the 3-month follow-up. Plasma glutamate levels were analyzed at baseline using liquid chromatography followed by tandem mass spectrometry. Glutamate oxaloacetate transaminase (GOT), glutamate-pyruvate transaminase (GPT) and blood markers were also tested. Multivariate analyses were performed using logistic regression models. RESULTS During the study period, 209 patients were included in the analysis. Seventy patients (33.5%) were diagnosed as having major depression at 3 month. Patients with major depression showed higher levels of plasma glutamate [299 (235-353) vs. 157 (108-206) μM, P<0.0001] and lower GOT [14 (11-20) vs. 21 (15-32)U/L, P<0.0001] at admission. In multivariate analyses, plasma glutamate and GOT were independent predictors of PSD at 3 months [odds ratio (OR): 1.03 (1.02-1.04), P<0.0001; 0.84 (0.75-0.97), P=0.003]. Plasma levels of glutamate >205 μM were independently associated with PSD (OR, 21.3; 95% CI, 8.28-67.36, P<0.0001), after adjustment for possible variables. CONCLUSION The present study demonstrates a strong relationship between plasma glutamate and GOT levels at admission and the development of PSD within 3 months. Further studies are necessary to confirm this association, which may open the way to the proposal of new therapeutic options.
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Affiliation(s)
- Sai-Yu Cheng
- Department of Neurology, Second Affiliated Hospital and Xin Qiao Hospital, Third Military Medical University, Chongqing 400037, China.
| | - Yan-Dong Zhao
- Department of Neurobiology, College of Basic Medical Sciences, Chongqing Key Laboratory of Neurobiology, Third Military Medical University, Chongqing 400038, China
| | - Jie Li
- Department of Neurology, Second Affiliated Hospital and Xin Qiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Xiao-Yan Chen
- Department of Neurology, Second Affiliated Hospital and Xin Qiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Ruo-Dan Wang
- Department of Neurology, Second Affiliated Hospital and Xin Qiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jun-Wei Zeng
- Department of Physiology, Zunyi Medical College, Zunyi 563000, Guizhou Province, China
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18
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Brown C, Hasson H, Thyselius V, Almborg AH. Post-stroke depression and functional independence: a conundrum. Acta Neurol Scand 2012; 126:45-51. [PMID: 21992112 DOI: 10.1111/j.1600-0404.2011.01595.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES People who suffer a stroke are at risk of developing post-stroke depression (PSD). Not only does this lower their quality of life but it also increases their risk of another stroke or death. This study aimed to investigate the factors associated with PSD in order to better direct rehabilitation efforts aimed at cutting the incidence of PSD. MATERIAL AND METHODS This study was based on all patients admitted to the stroke unit of a hospital in southern Sweden from 1 October 2003 to 30 November 2005. The total number of patients involved was 181. Measures were collected at 2 ± 1 weeks after discharge from hospital, 3 ± 0.5 months after the occurrence of the stroke and 12 ± 1 months after the occurrence of the stroke. Information collected was results from the Center of Epidemiologic Studies Depression Scale and the Barthel Index together with demographic data including age, sex, time since stroke and relationship status. RESULTS Those patients involved in the study were mainly men (58-59%) and generally those either married or cohabiting (53-57%). The age of respondents ranged from 32 to 92 years with a mean age of 74.0 (95%CI 72.37-75.63) at 2 ± 1 weeks after discharge. The Barthel Index scores ranged from 15 to 100 with means of between 88.7 and 91.7. Between 15% and 19% of the group were clinically depressed during the time frame of the study. The Barthel Index, measuring functional independence in terms of need for assistance with personal activities of daily living (P-ADL), was consistently associated with PSD. CONCLUSIONS The differences found in levels of depression between those with lower functional independence after a stroke compared to those more independent in P-ADL, raise the possibility that attention should be paid to therapeutic rehabilitation for stroke patients to help them recover as much functional independence as possible in order to improve their quality of life and lower their chances of developing PSD.
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Affiliation(s)
- C Brown
- School of Public Health, Griffith University, Logan Campus, University Drive, Meadowbrook, Qld, Australia.
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19
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Affiliation(s)
- Birgit Gurr
- Poole Stroke Unit Poole Hospital and Neuropsychology Service Poole Community Clinic
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20
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Kouwenhoven SE, Kirkevold M, Engedal K, Kim HS. Depression in acute stroke: prevalence, dominant symptoms and associated factors. A systematic literature review. Disabil Rehabil 2010; 33:539-56. [DOI: 10.3109/09638288.2010.505997] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Depression is common after stroke. Post-stroke depression (PSD) is an independent predictor of poor long-term functional outcome following stroke. PSD has been associated with poor social and rehabilitation outcomes, cognitive impairment and increased mortality. Prevalence varies widely between studies because of differences in patient selection, time, evaluation methods and diagnostic criteria. Approximately a third of stroke survivors may suffer from PSD. Potential confounders include anosognosia, apathy and emotional lability. The identification of risk factors is important to prevent and detect PSD early, and provide appropriate interventions. PSD may be associated with restriction in social activities and dependence in activities of daily living in the chronic phase of stroke. Pharmacologic and rehabilitation strategies are needed to treat PSD. More evidence is required before recommendations can be made about the routine use of antidepressants to prevent PSD.
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Rush BK, McNeil RB, Gamble DM, Luke SH, Richie AN, Albers CS, Brown RD, Brott TG, Meschia JF. Behavioral Symptoms in Long-Term Survivors of Ischemic Stroke. J Stroke Cerebrovasc Dis 2010; 19:326-32. [DOI: 10.1016/j.jstrokecerebrovasdis.2009.09.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 08/06/2009] [Accepted: 09/10/2009] [Indexed: 11/27/2022] Open
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Ettinger AB, Copeland LA, Zeber JE, Van Cott AC, Pugh MJV. Are psychiatric disorders independent risk factors for new-onset epilepsy in older individuals? Epilepsy Behav 2010; 17:70-4. [PMID: 19913462 DOI: 10.1016/j.yebeh.2009.10.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 09/28/2009] [Accepted: 10/10/2009] [Indexed: 11/30/2022]
Abstract
This retrospective study examined whether psychiatric conditions are directly related to epilepsy or, rather, are associated with underlying central nervous system (CNS) disorders linked to subsequent epilepsy. We examined data from a sample of older veterans (>65 years) receiving care from the Veterans Health Administration during fiscal year 2000. We compared individuals with new-onset epilepsy and individuals without epilepsy to examine the extent to which psychiatric disorders were associated with new-onset epilepsy; this analysis controlled for demographic and premorbid neurological risk factors previously associated with new-onset epilepsy. Premorbid psychiatric conditions occurred at higher rates in the epilepsy versus nonepilepsy groups, foremost including depression (17% vs 12%), anxiety (12% vs 8%), psychosis (12% vs 5%), and substance abuse (8% vs 4%). However, in the final model, only psychosis (OR=1.4, CI 1.2-1.6) was significantly associated with epilepsy when controlling for neurological disorders and psychiatric conditions (e.g., stroke, dementia, brain tumor, head injury).
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