MedWire News: The presence of depressive symptoms following stroke is related to the degree of functional independence and handicap, a Dutch study has shown.
The researchers say that the study, which is the first to focus on post-stroke depression in previously non-depressed individuals, might help predict outcomes and target and refine rehabilitation strategies.
Estimates of post-stroke depressive symptoms (PSDS) vary widely, from 11% to 78% in published studies, with the discrepancy being attributed to different methodologies and the high background rate of depression in elderly individuals.
Furthermore, there is debate as to the possible causes of PSDS, with the pathogenesis being confounded by shared physical and/or psychological risk factors for stroke and depression.
In an attempt to clarify these issues, Frank-Erik de Leeuw (Radboud University Nijmegen Medical Center) et al studied 420 consecutive individuals with acute ischemic stroke or transient ischemic attack (TIA) who did not have depression in the month preceding admission.
The overall prevalence of PSDS at 6–8 weeks was 13%, de Leeuw’s team reports in the journal Cerebrovascular Diseases. This figure did not vary significantly between TIA and cerebral infarction or between first-ever and recurrent stroke.
Pre-stroke factors such as age, gender, and educational level did not predict PSDS.
By contrast, several post-stroke features predicted PSDS. In multivariate analysis, an unfavorable outcome (as indicated by a modified Rankin Scale score of ≥2) was associated with a 2.56-fold increased risk for PSDS, while greater functional independence had a protective effect on PSDS (odds ratio 0.88 for each point increase on the Barthel Index).
The study authors say that this is the largest study to date to investigate depression in stroke patients and to control for possible pre-stroke confounding.
“Early detection of PSDS and associated factors might help to predict long-term outcome and could provide opportunities for early interventions, including (behavioral) rehabilitation treatment strategies,” they conclude.
“Prospective studies are needed to provide more insight in the time-course of PSDS and to identify which prognostic factors are associated with the persistence or development of PSDS in the long term.”
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