Abstract-Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice. (Stroke. 2017;48:e30-e43.

BackgroundThe Infectious Disease Society of America (IDSA) 2010 Clinical Practice Guidelines for the management of cryptococcosis outlined three key populations at risk of disease: (1) HIV-infected, (2) transplant recipient, and (3) HIV-negative/non-transplant. However, direct comparisons of management, severity and outcomes of these groups have not been conducted.Methodology/Principal FindingsAnnual changes in frequency of cryptococcosis diagnoses, cryptococcosis-attributable mortality and mortality were captured. Differences examined between severe and non-severe disease within the context of the three groups included: demographics, symptoms, microbiology, clinical management and treatment. An average of nearly 15 patients per year presented at Duke University Medical Center (DUMC) with cryptococcosis. Out of 207 study patients, 86 (42%) were HIV-positive, 42 (20%) were transplant recipients, and 79 (38%) were HIV-negative/non-transplant. HIV-infected individuals had profound CD4 lymphocytopenia and a majority had elevated intracranial pressure. Transplant recipients commonly (38%) had renal dysfunction. Nearly one-quarter (24%) had their immunosuppressive regimens stopped or changed. The HIV-negative/non-transplant population reported longer duration of symptoms than HIV-positive or transplant recipients and 28% (22/79) had liver insufficiency or underlying hematological malignancies. HIV-positive and HIV-negative/non-transplant patients accounted for 89% of severe disease cryptococcosis-attributable deaths and 86% of all-cause mortality.Conclusions/SignificanceIn this single-center study, the frequency of cryptococcosis did not change in the last two decades, although the underlying case mix shifted (fewer HIV-positive cases, stable transplant cases, more cases with neither). Cryptococcosis had a relatively uniform and informed treatment strategy, but disease-attributable mortality was still common.

Background and Purpose-Patients with stroke and transient ischemic attack (TIA) often have comparable comorbidities, but it is unclear whether they have similar rates of depression or antidepressant use. Methods-This study was a secondary analysis of a prospective cohort registry that enrolled subjects from 2006 to 2008 in the United States. Depression (defined by the Patient Health Questionnaire-8 score Ն10) and medication use were prospectively assessed 3 and 12 months after hospitalization in 1450 subjects with ischemic stroke and 397 subjects with TIA. Results-The proportional frequency of depression after stroke and TIA was similar at 3 months (17.9% versus 14.3%, Pϭ0.09) and at 12 months (16.4% versus 12.8%, Pϭ0.08). The rates of newly identified depression between 3 and 12 months were also similar (8.7% versus 6.2%, Pϭ0.12). Persistent depression (defined as Patient Health Questionnaire-8 score Ն10 at both 3 and 12 months) was present in 134 (9.2%) of those with stroke and in 30 (7.6%) of those with TIA.Younger age, greater stroke-related disability, and inability to work at 3 months were associated with persistent depression in subjects with stroke. Among subjects with persistent depression, 67.9% of those with stroke and 70.0% of those with TIA were not using antidepressants at either time point (Pϭ0.920). Conclusions-Stroke and TIA subjects had a similar frequency of depression at 3 and 12 months after hospitalization and similar rates of newly identified depression between 3 and 12 months. A high proportion of those with persistent depression was untreated. (Stroke. 2012;43:1609-1616.)

Background and Purpose Kidney disease is a frequent comorbidity in patients presenting with acute ischemic stroke. We evaluated whether the estimated glomerular filtration rate (eGFR) on admission is associated with post-stroke in-hospital mortality or discharge disposition. Methods In this cohort study, data from ischemic stroke patients in GWTG Stroke linked to fee for service Medicare data were analyzed. The Modification of Diet in Renal Disease (MDRD) study equation was used to calculate the eGFR (mL/min/1.73 m2). Dialysis was identified by ICD-9 codes. Adjusted multivariable Cox proportional hazards models were used to determine the independent associations of eGFR with discharge disposition and in-hospital mortality. Adjusted individual models also examined whether the association of clinical and demographic factors with outcomes varied by eGFR level. Results Of 232, 236 patients, 47.3% had an eGFR≥60, 26.6% an eGFR 45–59, 16.8% an eGFR 30–44, 5.6% an eGFR 15–29, 0.7% an eGFR<15 without dialysis, and 2.8% were receiving dialysis. Of the total cohort, 11.8% died during the hospitalization or were discharged to hospice and 38.6% were discharged home. After adjusting for other relevant variables, renal dysfunction was independently associated with an increased risk of in-hospital mortality which was highest among those with eGFR <15 without dialysis (OR 2.52, 95%CI 2.07–3.07). An eGFR 15–29 (OR 0.82, 95% CI 0.78–0.87), eGFR<15 (OR 0.72, 95%CI 0.61–0.86) and dialysis (OR 0.86, 95% CI 0.79–0.94) remained associated with lower odds of being discharged home. In addition, the associations of several clinical and demographic factors with outcomes varied by eGFR level. Conclusions eGFR on admission is an important predictor of post-stroke short-term outcomes.