Frequency of anxiety after stroke: An updated systematic review and meta-analysis of observational studies

Knapp, Peter; Dunn-Roberts, Alexander; Sahib, Nimah; Cook, Liz; Astin, Felicity; Kontou, Eirini; Thomas, Shirley

doi:10.1177/1747493019896958

Cited by 108 publications

(90 citation statements)

References 98 publications

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“…The prevalence of anxiety after the stroke in our study was similar to what was previously observed, both in the acute phase of stroke [ 29 ] as well as over the 12 months post-stroke. We also observed that the anxiety prevalence decreased with time.…”

Section: Discussionsupporting

confidence: 91%

Delirium Post-Stroke: Short- and Long-Term Effect on Depression, Anxiety, Apathy and Aggression (Research Study—Part of PROPOLIS Study)

Kowalska

Droś

Mazurek

et al. 2020

JCM

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Background: Stroke patients are particularly vulnerable to delirium episodes, but very little is known about its subsequent adverse mental health outcomes. The author’s objective was to explore the association between in-hospital delirium and depression, anxiety, anger and apathy after stroke. Methods: A total of 750 consecutive patients with acute stroke or transient ischemic attack, were screened for delirium during hospitalization. Patients underwent mental health evaluation in hospital, 3 and 12 months post-stroke; depression, apathy, anxiety and anger were the outcomes measured at all evaluation check points. Results: Delirium was an independent risk factor for depression (OR = 2.28, 95%CI 1.15–4.51, p = 0.017) and aggression (OR = 3.39, 95%CI 1.48–7.73, p = 0.004) at the hospital, for anxiety 3 months post-stroke (OR = 2.83, 95%CI 1.25–6.39, p = 0.012), and for apathy at the hospital (OR = 4.82, 95%CI 2.25–10.47, p < 0.001), after 3 (OR = 3.84, 95%CI 1.31–11.21, p = 0.014) and 12 months (OR = 4.95, 95%CI 1.68–14.54, p = 0.004) post stroke. Conclusions: The results of this study confirm, that mental health problems are very frequent complications of stroke. Delirium in the acute phase of stroke influences mental health of patients. This effect is especially significant in the first months post-stroke and vanishes with time, which suggests that in-hospital delirium might not be a damaging occurrence in most measures of mental health problems from a long-term perspective.

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Section: Discussionsupporting

confidence: 91%

Delirium Post-Stroke: Short- and Long-Term Effect on Depression, Anxiety, Apathy and Aggression (Research Study—Part of PROPOLIS Study)

Kowalska

Droś

Mazurek

et al. 2020

JCM

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“…The statistics in this study show that the frequency of PSA is 33.16% evaluated by HADS-A, 33.67% by HAMA, and 30.38% by SAS, respectively. Our results are consistent with the findings in previous studies (Burton et al, 2013;Broomfield et al, 2014;Knapp et al, 2017Knapp et al, , 2020Rafsten et al, 2018), i.e., 18-36.7% of patients with acute ischemic stroke experienced anxiety 0-2 weeks after stroke onset.…”

Section: Discussionsupporting

confidence: 93%

“…A systematic review and metaanalysis shows that the prevalence of anxiety disorders is 29.3% post-stroke during the first year, with 36.7% in 2 weeks, 24.1% in 2 weeks to 3 months, and 23.8% in 3-12 months (Rafsten et al, 2018). Specifically, Knapp et al (2020) collect and analyze 53 studies and report 25.5% of stroke patients developed PSA within 1 month of stroke, 23.6% in 1 and 5 months, and 21.5% in 6 months to 1 year. A plethora of studies indicate that PSA significantly influences the living quality (Lincoln et al, 2013), which is associated with the delaying recovery of neurological function (Chun et al, 2018), and the interventions on anxiety disorders have a positive impact on the incidence of both coronary artery disease and stroke (Pérez-Piñar et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Post-stroke Anxiety Analysis via Machine Learning Methods

Wang

Zhao

Miao

et al. 2021

Front. Aging Neurosci.

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Post-stroke anxiety (PSA) has caused wide public concern in recent years, and the study on risk factors analysis and prediction is still an open issue. With the deepening of the research, machine learning has been widely applied to various scenarios and make great achievements increasingly, which brings new approaches to this field. In this paper, 395 patients with acute ischemic stroke are collected and evaluated by anxiety scales (i.e., HADS-A, HAMA, and SAS), hence the patients are divided into anxiety group and non-anxiety group. Afterward, the results of demographic data and general laboratory examination between the two groups are compared to identify the risk factors with statistical differences accordingly. Then the factors with statistical differences are incorporated into a multivariate logistic regression to obtain risk factors and protective factors of PSA. Statistical analysis shows great differences in gender, age, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level between PSA group and non-anxiety group with HADS-A and HAMA evaluation. Meanwhile, as evaluated by SAS scale, gender, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level differ in the PSA group and the non-anxiety group. Multivariate logistic regression analysis of HADS-A, HAMA, and SAS scales suggest that hypertension, diabetes mellitus, drinking, high NIHSS score, and low serum HDL-C level are related to PSA. In other words, gender, age, disability, hypertension, diabetes mellitus, HDL-C, and drinking are closely related to anxiety during the acute stage of ischemic stroke. Hypertension, diabetes mellitus, drinking, and disability increased the risk of PSA, and higher serum HDL-C level decreased the risk of PSA. Several machine learning methods are employed to predict PSA according to HADS-A, HAMA, and SAS scores, respectively. The experimental results indicate that random forest outperforms the competitive methods in PSA prediction, which contributes to early intervention for clinical treatment.

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“…Post stroke cognitive impairment has been reported over 50% ( which is still a gross underestimation) of stroke survivors with worsened disability and quality of life (110). Frequency of anxiety after stroke very high at 24.2% (21.5%-26.9%) by rating scales (111) with likely increased risk of further stroke and downward spiral from the PNI point of view. Post stroke depression (PSD) is reported at 18%-33% (112) ( gross under estimation again, see the comprehensive review on pathobiology of PSD Pascoe & Crewther (113)).…”

Section: Discussionmentioning

confidence: 99%

Scoping Review of Existing Stroke Guidelines; Argument for a Value-Added Change

Wijeratne

Sales

Jakovljević

et al. 2021

Preprint

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Background and Purpose: Stroke represents one of the most important causes of morbidity (eighty million patients with disabling of ongoing effects of stroke at a given time, globally) and mortality (the second leading cause of death) worldwide. Innovative systems biology-based approach is likely to increase the understanding of the underpinning of acute stroke promise to enhance stroke prevention, acute treatment, and neurorehabilitation. Recent growing body of evidence with shared pathobiology with COVID-19 and the critically important role of inflammation in the context of stroke points to far-reaching consequences of acute stroke, just as in the case of COVID-19 ( post-acute event issues as well as long term issues ). So far, stroke typically defined by late-appearing disease manifestation by the range of stroke subtypes as defined by the WHO or American Stroke Association. This definition neglects the underlying pathobiological mechanisms such as low-grade chronic inflammation and already compromised vascular system. Diseases such as stroke is hardly a simple result of a single problem, but rather a complex cascade of pathobiological processes and interactions in a complex biochemical environment. The evidence of changes in innate immunity and adaptive immunity during the index event of acute stroke and recovery over next 3-12 months can be easily elicited with simple bedside blood tests such as neutrophil-lymphocyte ratio (NLR) with well over 300 published papers including several systematic reviews and meta-analyses confirming this. Global standard operating procedures (SOP) of stroke care dictated by the national and international stroke guidelines at present. It is imperative to explore the evidence of systems biology approach in current stroke guidelines. This is likely to be a key turning point in managing stroke across the continuum (prevention, management of acute event and rehabilitation). Methods: We systematically searched for guideline recommendation on the day-to-day use of peripheral inflammatory markers such as NLR published in the English language between January 1, 2005, and December 2020. Any other evidence of systems biology-based approach or recommendation was explored within the selected guidelines for this scoping review. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 4 authors to determine clinical scenarios explained/given, scientific evidence used, and recommendations presented in the context of systems biology. Results: The scoping review found 3,830 (3830) titles with 119 guidelines from 46 countries included for this review (Figure 1; PRISMA diagram). Stroke-related organizations wrote Sixty-five per cent of the guidelines while national ministries wrote a fewer number of guidelines. We were primarily interested in recommendations for acute management in AIS published in the English language. Fifteen eligible guidelines were identified from 15 different countries/regions. None of the guidelines recommended the routine use of peripheral markers of inflammation, such as NLR, among their acute assessment and management recommendations. None of the existing guidelines explored the systems biology approach to one of the most complex diseases affecting the human brain, stroke. Conclusions: This systematic review has identified a significant evidence-practice gap in all existing national stroke guidelines published in English medium as of October 2020. These guidelines included the only current living stroke guidelines, Stroke Guidelines from Australia with a real opportunity to modernize the living stroke guidelines with systems biology approach and provide 2020 vision towards better stroke care globally. Investigation of complex disease such as stroke is best served through a systems biology approach. One of the easiest places to start is simple blood tests such as total white cell count and NLR. Systems biology approach point us towards simple tools such immune-inflammatory index (SII), Sunshine Prognostic Score (SPS) which should pave the way for the stroke physician community address the challenges in systems biology approach in stroke care. These challenges include translating bench research to the bedside, managing big data ( continuous pulse, blood pressure, sleep, Oxygen saturation, progressive changes in NLR, SII, SPS, etc.). Working with an interdisciplinary team is also provide a distinct advantage.

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Frequency of anxiety after stroke: An updated systematic review and meta-analysis of observational studies

Cited by 108 publications

References 98 publications

Delirium Post-Stroke: Short- and Long-Term Effect on Depression, Anxiety, Apathy and Aggression (Research Study—Part of PROPOLIS Study)

Delirium Post-Stroke: Short- and Long-Term Effect on Depression, Anxiety, Apathy and Aggression (Research Study—Part of PROPOLIS Study)

Post-stroke Anxiety Analysis via Machine Learning Methods

Scoping Review of Existing Stroke Guidelines; Argument for a Value-Added Change

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