Depression in stroke rehabilitation

Abstract

Despite recent advances in understanding the pathophysiology of poststroke depression, major questions remain. They include the relative importance of lesion location and size and the confounding effects of time since stroke, age, prior history of depression, and cerebral atrophy. To evaluate these issues, we systematically assessed depressive features, functional status, and brain structure with computer tomography scans in 91 men undergoing stroke rehabilitation. Forty percent met DSM-III criteria for major depressive disorder. Mood disturbance was more severe for patients with right than with left hemisphere lesions, correlated with functional disability and lesion size, and was associated with previous history of depression. Age, time since stroke, and atrophy did not correlate with mood. Depression is common in delayed stroke recovery, regardless of lesion location. Because there are no demographic or anatomic features that predict the absence of depression, depression screening should be part of the assessment of all patients undergoing stroke rehabilitation.

Correlation analysis between depressive manifestations and morphological lesion characteristics in patients with stroke

“…The positive correlation between depression and the size of the right hemisphere lesion and the intensity Stojanovi} Zlatan, Vukadinovi} Stojanovi} Sanja of the neurological deficit was confirmed by various studies (19,24,25). The studies (21,26,27) also confirmed the existence of the correlation between the lesion extent, neurological deficit and intensity of depression, while the studies (20,28) deny it.…”

“…The study Starkstein et al determines major depression in acute phase of stroke in 18.3% of patients, and minor depression in 11.8% of cases (18). It is interesting to mention the study Schwartz et al which finds depression in men in the period of acute post-stroke rehabilitation in 40% of patients (19). One year (fifteen months) after stroke Brodaty et al determine depression in 20.7% of patients (20).…”

Examination of Sleep Quality, Anxiety and Depression in Stroke Patients

“…Post-stroke depression affects disability level, cognitive status and vice versa. The frequency of major depression seems to increase during the first year (4,5,6,7).…”

Depression and apathy after stroke

“…PSD was associated with total, 89,119 deep, 119 frontal, 89,118 and periventricular WMH. 119 Also, cerebral microbleeds are associated with PSD, [121][122][123][124] and several studies showed that PSD is more prevalent in patients with a large lesion volume, 9,68,72,83,87,106,[125][126][127][128] or large number of lesions. 83,89,98,119,124,129 More recently, advanced diffusion tensor imaging (DTI) techniques have been used to investigate the association between microstructural abnormalities in white matter (WM) and PSD.…”

“…The Fazekas visual rating scale is used to score deep and periventricular WMH. 87 In addition, a semiautomatic brain tissue segmentation program, based on the program used in the Rotterdam scan study, 88 is used to measure WMH volumes and to calculate the volume of global brain atrophy, corrected for total intracranial volume. The accuracy of this semi-automated method appeared to be within the range of the inter-observer variability of fully manual segmentations but is less timeconsuming while still requiring some manual correcting.…”