Depression as a Risk Factor for the Incidence of First-Ever Stroke in 85-Year-Olds

Liebetrau, Martin; Steen, Bertil; Skoog, Ingmar

doi:10.1161/strokeaha.107.490797

Cited by 66 publications

(63 citation statements)

References 33 publications

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“…We excluded 87 because the association of baseline cognitive impairment and future stroke was not reported, 6 because most of the participants had a history of stroke at baseline, 3 because they were duplicate reports and 1 because no adjusted estimate was reported. 17 Our final primary analysis included 18 cohort studies [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] (Figure 1). Characteristics of the 18 included studies are shown in Table 1.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Transient ischemic attacks were included as outcomes in 2 studies. Participants were derived from ordinary cohorts in 14 studies [18][19][20][22][23][24][25]27,[29][30][31][33][34][35] and clinical trials in 4. 21,26,28,32 Most of the studies were from North American or European countries.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…One was conducted in Taiwan, and 3 were an international collaboration. The samples ranged from 401 to 30 959 par ticipants, and the follow-up duration ranged Study* de Moraes et al 18 Chi et al 19 Glymour et al 24 Liebetrau et al 25 O'Donnell et al 26 (e) O'Donnell et al 26 (e1) O'Donnell et al 26 (f) Ostir et al 27 Pettigrew et al 28 (e) Pettigrew et al 28 (f) Reitz et al 29 Sabayan et al 30 (e) Sabayan et al 30 (f) Shipley et al 31 Skoog et al 32 Weinstein et al 33 Wiberg et al 34 from 2.6 to 21 years. All but one of the studies included both men and women; the remaining study included only men.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Ten studies used the Mini-Mental State Examination to assess cognitive function, and 8 studies used other cognitive measures. Participants with a history of stroke were excluded in 12 studies; [18][19][20]22,24,25,27,29,30,[33][34][35] in the other studies, the proportion of participants with a history of stroke at baseline ranged from 4% 32 to 25%. 28 Seventeen studies used multivariable-adjusted analysis, and 1 study used propensity score matching.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…The estimates were similar between the fixed-effects model (RR 1.31, 95% CI 1.26-1.37) and the random-effects model. In the 3 studies with maximal adjustment for potential confounders, baseline cognitive impairment was associated with increased risk of future stroke (RR 1.28, 95% CI 1.18-1.38; random-effects model); 21,25,26 there was no heterogeneity among these studies (I 2 = 0%). When we pooled results from the studies that used a widely adopted definition of cognitive impairment (i.e., Mini-Mental State Examination score < 25 or nearest equivalent), the increased risk of future stroke among patients with cognitive impairment at baseline was still evident (RR 1.64, 95% CI 1.46-1.84; random-effects model) (Figure 3).…”

Section: Primary Analysismentioning

confidence: 97%

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Cognitive impairment and risk of future stroke: a systematic review and meta-analysis

Lee

Saver

Hong

et al. 2014

CMAJ

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C ognitive impairment is a major contributor to disability and dependence worldwide. Globally, stroke is the leading cause of long-term disability among adults and the second leading cause of death.1 The high cumulative risk of dementia or stroke or both conditions has been shown by the Framingham study, 2 and the urgent need to improve knowledge regarding cognition and vascular conditions has been emphasized in a specific meeting providing harmonized standards. 3Beyond their personal tolls, both of these conditions carry substantial social and economic burdens. These conditions also correlate strongly with increasing age. Given the projected substantial rise in the number of older people around the world, prevalence rates of cognitive impairment and stroke are expected to soar over the next several decades, especially in high-income countries. 4,5 Shared pathophysiologic mechanisms seem to exist between cognitive impairment and cerebrovascular disease.6 Indeed, risk factors for stroke (hypertension, hyperlipidemia, diabetes, obesity and physical inactivity) have been shown to play a role in the onset and progression of cognitive impairment, 7 and it is well established that stroke itself increases the risk of future cognitive impairment. 8 However, whether cognitive impairment increases the risk of future stroke remains unclear. Early identification and regular surveillance for cognitive impairment could potentially enable prompt initiation of treatment aimed at not only potentially limiting further deterioration of cognitive function (if mild), but also possibly reducing the risk of future stroke through timely and optimal control of risk factors.Several published studies have assessed the association between cognitive impairment and subsequent risk of stroke, but the results have not been consistent. We performed a systematic review and meta-analysis to determine the qualitative and quantitative association between baseline cognitive impairment and risk of future stroke. Methods Search strategyOur search strategy was based on the recommendations of the Meta-analysis of Observational Studies in Epidemiology group. 9 We searched MEDLINE via PubMed (1966 to November Background: Several studies have assessed the link between cognitive impairment and risk of future stroke, but results have been inconsistent. We conducted a systematic review and meta-analysis of cohort studies to determine the association between cognitive impairment and risk of future stroke.

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Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

Section: Primary Analysismentioning

confidence: 97%

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Cognitive impairment and risk of future stroke: a systematic review and meta-analysis

Lee

Saver

Hong

et al. 2014

CMAJ

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Depression and Risk of Stroke Morbidity and Mortality

Pan

Sun²,

Okereke

et al. 2011

JAMA

699

476

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Context Several studies have suggested that depression is associated with an increased risk of stroke; however, the results are inconsistent. Objective To conduct a systematic review and meta-analysis of prospective studies assessing the association between depression and risk of developing stroke in adults. Data Sources A search of MEDLINE, EMBASE, and PsychINFO databases (to May 2011) was supplemented by manual searches of bibliographies of key retrieved articles and relevant reviews. Study Selection We included prospective cohort studies that reported risk estimates of stroke morbidity or mortality by baseline or updated depression status assessed by self-reported scales or clinician diagnosis. Data Extraction Two independent reviewers extracted data on depression status at baseline, risk estimates of stroke, study quality, and methods used to assess depression and stroke. Hazard ratios (HRs) were pooled using fixed-effect or random-effects models when appropriate. Associations were tested in subgroups representing different participant and study characteristics. Publication bias was evaluated with funnel plots and Begg test. Results The search yielded 28 prospective cohort studies (n = 317540 participants) that reported 8478 stroke cases (morbidity and mortality) during a follow-up period ranging from 2 to 29 years. The pooled adjusted HRs were 1.45 (95% confidence interval [CI], 1.29–1.63; P-for-heterogeneity <0.001; random-effects model) for total stroke, 1.55 (1.25–1.93; P-for-heterogeneity = 0.31; fixed-effects model) for fatal stroke (8 studies), and 1.25 (1.11–1.40; P-for-heterogeneity = 0.34; fixed-effects model) for ischemic stroke (6 studies). The estimated absolute risk differences associated with depression were 106 cases for total stroke, 53 cases for ischemic stroke, and 22 cases for fatal stroke per 100 000 individuals per year. The increased risk of total stroke associated with depression was consistent across most subgroups. Conclusion Depression is associated with a significantly increased risk of stroke morbidity and mortality.

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Depressive spectrum states in a population‐based cohort of 70‐year olds followed over 9 years

Sigström

Wærn

Gudmundsson

et al. 2018

Int J Geriat Psychiatry

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In this population-based sample, over half experienced some degree of depression during their eighth decade of life. The findings give some support for the validity of a depressive spectrum in older adults. Most new episodes of major depression occurred in people who were in a depressive spectrum state already at baseline, which may have implications for late-life depression prevention strategies.

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Depression as a Risk Factor for the Incidence of First-Ever Stroke in 85-Year-Olds

Cited by 66 publications

References 33 publications

Cognitive impairment and risk of future stroke: a systematic review and meta-analysis

Cognitive impairment and risk of future stroke: a systematic review and meta-analysis

Depression and Risk of Stroke Morbidity and Mortality

Depressive spectrum states in a population‐based cohort of 70‐year olds followed over 9 years

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