Imaging Markers of Post-Stroke Depression and Apathy: a Systematic Review and Meta-Analysis

Abstract

Several brain imaging markers have been studied in the development of post-stroke depression (PSD) and post-stroke apathy (PSA), but inconsistent associations have been reported. This systematic review and meta-analysis aims to provide a comprehensive and up-to-date evaluation of imaging markers associated with PSD and PSA. Databases (Medline, Embase, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews) were searched from inception to July 21, 2016. Observational studies describing imaging markers of PSD and PSA were included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated to examine the association between PSD or PSA and stroke lesion laterality, type, and location, also stratified by study phase (acute, post-acute, chronic). Other imaging markers were reviewed qualitatively. The search retrieved 4502 studies, of which 149 studies were included in the review and 86 studies in the meta-analyses. PSD in the post-acute stroke phase was significantly associated with frontal (OR 1.72, 95% CI 1.34–2.19) and basal ganglia lesions (OR 2.25, 95% CI 1.33–3.84). Hemorrhagic stroke related to higher odds for PSA in the acute phase (OR 2.58, 95% CI 1.18–5.65), whereas ischemic stroke related to higher odds for PSA in the post-acute phase (OR 0.20, 95% CI 0.06–0.69). Frequency of PSD and PSA is modestly associated with stroke type and location and is dependent on stroke phase. These findings have to be taken into consideration for stroke rehabilitation programs, as this could prevent stroke patients from developing PSD and PSA, resulting in better clinical outcome.Electronic supplementary materialThe online version of this article (doi:10.1007/s11065-017-9356-2) contains supplementary material, which is available to authorized users.

Depression and the Use of Selective Serotonin Reuptake Inhibitors in Patients with Acute Intracerebral Hemorrhage

“…We did not find any correlation between the location of hemorrhage on neuroimaging studies and depressive symptoms (p: 0.55). These findings are in agreement with previous reports [5,7,26]. However, some studies have found a significant association between PSD and left- hemisphere lesions [27].…”

Subjective Stroke Impact and Depressive Symptoms: Indications for a Moderating Role of Health-Related Locus of Control

“…Results may have been different if based, for example, on functional testing and examination by a psychologist like in other studies. It must be also kept in mind that further subjective and objective factors such as type and location of stroke play a role in the development of depressive symptoms after stroke (24). The prevalence of depression found in the present study was relatively low but still in a range that was reported in a previous systematic review (2).…”

Lobar microbleeds are associated with cognitive impairment in patients with lacunar infarction

“…In this study, we did not evaluate these factors. According to a meta-analysis, poststroke depression in the acute stroke phase is significantly associated with frontal and basal ganglia lesions, and poststroke apathy is related to hemorrhagic stroke 38 . In this study, we only included patients with first-ever acute stroke diagnosed with lacunar infarction.…”