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Yan N, Hu S. The safety and efficacy of escitalopram and sertraline in post-stroke depression: a randomized controlled trial. BMC Psychiatry 2024; 24:365. [PMID: 38750479 PMCID: PMC11094958 DOI: 10.1186/s12888-024-05833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVES This study aims to evaluate the safety and efficacy of escitalopram and sertraline in post-stroke depression (PSD) patients, to provide more reliable therapeutics for cardiovascular and psychiatric clinical practice. METHODS We recruited 60 patients (aged 40-89 years old) with an ICD-10 diagnosis of PSD, who were then randomly assigned to two groups and treated with flexible doses of escitalopram (10 to 20 mg/day, n = 30) or sertraline (50 to 200 mg/day, n = 30) for consecutive 8 weeks, respectively. The 24-item Hamilton Depression Rating Scale (HAMD-24), the 14-item Hamilton Anxiety Rating Scale (HAMA-14), the Treatment Emergent Symptom Scale (TESS), the Montreal Cognitive Assessment Scale (MOCA), and the Activity of Daily Living scale (ADL) were used to assess patients before, during, and after treatment for depression, anxiety, adverse effects, cognitive function, and daily living activities. Repeated measures ANOVA, the Mann-Whitney U test, the chi-square test (χ2), or Fisher's exact test was employed to assess baseline demographics, response rate, adverse effects rate, and changes in other clinical variables. RESULTS Significant reduction in HAMD-24 and HAMA-14 scores was evaluated at baseline, as well as 1, 3, 4, 6, and 8 weeks of drug intervention (p < 0.01). There was a significant group difference in post-treatment HAMD-24 scores (p < 0.05), but no difference was observed in HAMA-14 scores (p > 0.05). Further analysis showed a significant variance in the HAMD-24 scores between the two groups at the end of the first week (p < 0.01). The incidence of adverse effects in both patient groups was mild, but there was a statistically significant difference between the two groups (p < 0.05). The improvement in cognitive function and the recovery of daily living abilities were comparable between both groups (p > 0.05). CONCLUSION Escitalopram and sertraline showed comparable efficacy for anxiety symptoms, cognitive function, and daily living abilities in PSD patients. In addition, escitalopram was more appropriate for alleviating depressive symptoms. To validate the conclusion, trials with a larger sample size are in demand in the future. The registration number is ChiCTR1800017373.
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Affiliation(s)
- Ning Yan
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
- Department of Psychiatry, Shanghai Jing'an District Mental Health Center, Shanghai, 200040, China
| | - Shaohua Hu
- Department of Psychiatry, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
- The Key Laboratory of Mental Disorder's Management in Zhejiang Province, Hangzhou, 310003, China.
- Brain Research Institute of Zhejiang University, Hangzhou, 310003, China.
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, 310003, China.
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, School of Brain Science and Brian Medicine, and MOE Frontier Science Center for Brain Science and Brain-Machine Integration, Zhejiang University School of Medicine, Hangzhou, 310003, China.
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, 310003, China.
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Ma R, Song J, Ding Y. Associations between Life's Essential 8 and post-stroke depression and all-cause mortality among US adults. Eur J Med Res 2024; 29:229. [PMID: 38610037 PMCID: PMC11015667 DOI: 10.1186/s40001-024-01834-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Depression is the common mental disease after stroke. Our objective was to investigate the correlation of Life's Essential 8 (LE8), the recently updated evaluation of cardiovascular health, with the occurrence of post-stroke depression (PSD) and all-cause mortality among United States (US) adults. METHODS Participants with stroke were chosen from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018. The relationship between LE8 and the risk of PSD was assessed through weighted multiple logistic models. A restricted cubic spline was employed for the examination of correlations. To demonstrate the stability of the results, sensitivity analysis and subgroup analysis were carried out. Furthermore, Cox regression models were used for the correlation between LE8 and all-cause mortality. RESULTS In this study, a total of 1071 participants were included for analysis. It was observed that LE8 score and PSD risk shared an inverse relationship in per 10 points increase [OR = 0.62 (0.52-0.74, P < 0.001)] in logistic regression models. The analysis of restricted cubic spline demonstrated approximately a noticeable inverse linear association between LE8 score and PSD risk. Sensitivity analysis verified the stability of the findings. Moreover, no statistically significant interactions were identified in subgroup analysis. A reverse association between LE8 score and all-cause mortality was also observed with a 10-point increase [HR = 0.85 (0.78-0.94, P < 0.001)] in cox regression models. CONCLUSIONS A negative correlation was discovered between LE8 score and PSD and all-cause mortality risk among US adults. We need to conduct large-scale prospective studies to further validate our results.
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Affiliation(s)
- Ruicong Ma
- Department of Cardiology, The Second Hospital of Dalian Medical University, No.467 Zhongshan Road, Shahekou District, Dalian, 116021, Liaoning, People's Republic of China
| | - Junting Song
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, 116021, Liaoning, People's Republic of China
| | - Yanchun Ding
- Department of Cardiology, The Second Hospital of Dalian Medical University, No.467 Zhongshan Road, Shahekou District, Dalian, 116021, Liaoning, People's Republic of China.
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Yi HJ, Tan CH, Hong WP, Yu RL. Development and validation of the geriatric apathy scale: Examining multi-dimensional apathy profiles in a neurodegenerative population with cultural considerations. Asian J Psychiatr 2024; 93:103924. [PMID: 38232445 DOI: 10.1016/j.ajp.2024.103924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/04/2024] [Accepted: 01/06/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Apathy is a common motivational deficit in neurodegenerative diseases, but lacks a culturally sensitive tool accounting for ethnic Chinese culture's impact on motivation initiation. This study developed and validated the Geriatric Apathy Scale (GAS), comprehensively incorporating cultural nuances, setting diagnostic cutoffs, and examining apathy's multi-dimensional aspects in a neurodegenerative cohort. METHODS The 16-item GAS was developed by considering ethnic Chinese cultural characteristics and conducting a literature review. The study involved 296 participants, comprising 113 with Parkinson's disease (PD), 66 with Alzheimer's disease (AD), and 117 healthy controls (HC). All participants completed the GAS, Apathy Evaluation Scale (AES), Geriatric Depression Scale (GDS-15), Mini-Mental State Examination, and Activities of Daily Living (ADLs). RESULTS The GAS showed good internal consistency (r = 0.862) and test-retest reliability (r = 0.767). It correlated moderately with the AES (r = 0.639, p < .001), weakly with GDS-15 (r = 0.166, p < .01), and negatively with ADLs (r = -1.19, p < .05). Clinical diagnosis cutoff scores were identified at 15.5 for PD (sensitivity: 0.789; specificity: 0.693) and 12.5 for AD (sensitivity: 0.821; specificity: 0.632). Noteworthy disparities were observed in the Cognition and Social Motivation dimension, with elevated severity in both PD and AD compared to HC (p < .01). Interestingly, within-group comparisons revealed greater apathy severity in the Cognition and Social Motivation dimension for PD (p < .001) and AD (p = .001) versus Emotional Response and Expression and Spontaneous Behavioral Activation. CONCLUSIONS The GAS, a psychometrically validated scale, assesses apathy in neurodegenerative populations, accounting for ethnic Chinese culture's influence. It establishes clinical cutoff points and explores the multi-dimensional nature of apathy.
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Affiliation(s)
- Hsin-Jou Yi
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hsiang Tan
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Pin Hong
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Rwei-Ling Yu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Office of Strategic Planning, National Cheng Kung University, Tainan, Taiwan.
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Jiang Q, Wang X, Guo Y, Wang L, Lou Y, Wang H, Cao S. The association between blood pressure variability and depressive symptoms among middle-aged and older adults: Nationwide population-based cohort study. Asian J Psychiatr 2024; 91:103864. [PMID: 38142522 DOI: 10.1016/j.ajp.2023.103864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 12/26/2023]
Affiliation(s)
- Qingqing Jiang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Xiaohan Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yan Guo
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Linlin Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Yiling Lou
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Hengchang Wang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.
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Ji Y, Wang X, Wu H, Ni X, Ren C, Wang T, Zhu H, Jiang Y, Zheng K. Incidence and risk factors of post-stroke cognitive impairment in convalescent elderly patients with first-episode acute ischemic stroke. Asian J Psychiatr 2023; 84:103583. [PMID: 37043907 DOI: 10.1016/j.ajp.2023.103583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/05/2023] [Indexed: 04/14/2023]
Abstract
A total of 350 first-time AIS elderly patients (aged ≥60 years) were collected and analyzed. Multivariate Logistic regression analysis showed that the lesion site, frontal temporal, cerebral white matter degeneration, age ≥ 75 years, BMI ≥ 28, onset in autumn/winter, hospitalization expenses > 20,000 yuan/month, high DBPV, high NIHSS score, and high HAMD score were risk factors for PSCI. Higher education level was a protective factor. In conclusion, the incidence of PSCI in elderly AIS patients was relatively high and related to the several factors, which indicated that more attention should be paid for such patients to prevent PSCI.
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Affiliation(s)
- Yingying Ji
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Xiaolong Wang
- Wuxi Xinwu District Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Han Wu
- Rehabilitation Department, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuemei Ni
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Caili Ren
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China
| | - Tong Wang
- Rehabilitation Medicine Center, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Haohao Zhu
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China.
| | - Ying Jiang
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China.
| | - Kai Zheng
- Mental Health Center of Jiangnan University, Wuxi Central Rehabilitation Hospital, Wuxi, Jiangsu, China.
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Tan M, Li H, Wang X. Analysis of the current status of rehabilitation motivation and its influencing factors in older adults with stroke: a cross-sectional study. Front Aging Neurosci 2023; 15:1186681. [PMID: 37181623 PMCID: PMC10174289 DOI: 10.3389/fnagi.2023.1186681] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/10/2023] [Indexed: 05/16/2023] Open
Abstract
Objective Among stroke patients, exercise adherence is an important factor in reducing the rate of physical disability and mortality. Rehabilitation exercise after stroke is a safe and effective measure to restore normal body functions, but the analysis of factors influencing patients' motivation for rehabilitation is not well established. Therefore, this study will explore the influencing factors of rehabilitation motivation in older adults with stroke so as to reduce the disability rate of stroke. Method A convenience sampling method was used to study 350 patients in a stroke ward of a tertiary care hospital in Jinzhou, Liaoning Province. Patients' general demographic data, Multidimensional Scale of Perceived Social Support (PSSS), Questionnaire of Exercise Adherence (EAQ), Tampa scale of kinesiophobia (TSK-11), and Motivation in stroke patients for rehabilitation scale (MORE) were assessed. ANOVA or t-test analysis, correlation analysis, and linear regression analysis were used to explore the factors influencing the motivation for rehabilitation in older adults with stroke. Results The results showed that stroke patients' motivation for rehabilitation was at a moderate level. Perceived social support, exercise adherence, and stroke motivation were positively correlated (r = 0.619, p < 0.01; r = 0.569, p < 0.01), and kinesiophobia was negatively correlated with stroke motivation (r = -0.677, p < 0.01). Time of stroke, location of the lesion, perceived social support, exercise adherence, and kinesiophobia are influential factors affecting patients' motivation to recover. Conclusion In the rehabilitation program for older adult patients with stroke, healthcare providers should specify targeted rehabilitation measures according to the different degrees of the patient's condition, so as to improve the effectiveness of rehabilitation medical implementation.
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Affiliation(s)
- Mingyang Tan
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- Department of Nursing, Jinzhou Medical University, Jinzhou, China
- *Correspondence: Hongyu Li,
| | - Xiuli Wang
- Department of Radiotherapy, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, China
- Xiuli Wang,
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Yao S, Xie H, Wang Y, Shen N, Chen Q, Zhao Y, Gu Q, Zhang J, Liu J, Sun J, Tong Q. Predictive microbial feature analysis in patients with depression after acute ischemic stroke. Front Aging Neurosci 2023; 15:1116065. [PMID: 37032826 PMCID: PMC10076592 DOI: 10.3389/fnagi.2023.1116065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Post-stroke depression (PSD) is the most common emotional problem following a stroke, which requires early diagnosis to improve the prognosis. Gut microbiota plays important role in the pathological mechanisms of acute ischemic stroke and influences the outcome of patients. However, the relationship between PSD and gut microbiota remains unknown. Here, we explored whether the microbial signatures of gut microbiota in the patients with stroke could be an appropriate predictor of PSD. Methods Fecal samples were collected from 232 acute ischemic stroke patients and determined by 16s rRNA sequencing. All patients then received 17-Hamilton Depression Rating Scale (HAMD-17) assessment 3 months after discharge, and were further divided into PSD group and non-PSD group. We analyzed the differences of gut microbiota between these groups. To identify gut microbial biomarkers, we then established microbial biomarker model. Results Our results showed that the composition of gut microbiota in the PSD patients differed significantly from that in non-PSD patients. The genus Streptococcus, Akkermansia, and Barnesiella were significantly increased in PSD patients compared to non-PSD, while the genus Escherichia-Shigella, Butyricicoccus, and Holdemanella were significantly decreased. Correlation analyses displayed that Akkermansia, Barnesiella, and Pyramidobacter were positively correlated with HAMD score, while Holdemanella was negatively correlated with HAMD score. The optimal microbial markers were determined, and the combination achieved an area under the curve (AUC) value of 0.705 to distinguish PSD from non-PSD. Conclusions Our findings suggest that PSD patients had distinct gut microbiota compared to non-PSD patients, and explore the potential of microbial markers, which might provide clinical decision-making in PSD.
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Affiliation(s)
- Shanshan Yao
- Department of Geriatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Huijia Xie
- Department of Geriatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Ya Wang
- Department of Geriatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Nan Shen
- Department of Geriatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qionglei Chen
- Department of Geriatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiting Zhao
- Department of Geriatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Qilu Gu
- Department of Geriatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Junmei Zhang
- Department of Geriatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiaming Liu
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
- *Correspondence: Jiaming Liu,
| | - Jing Sun
- Department of Geriatrics, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Jing Sun,
| | - Qiuling Tong
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
- Qiuling Tong,
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