Neuropsychiatric Symptoms and Interleukin-6 Serum Levels in Acute Stroke

Spalletta, Gianfranco; Cravello, Luca; Imperiale, Francesca; Salani, Francesca; Bossù, Paola; Picchetto, Livio; Cao, Marina; Rasura, Maurizia; Pazzelli, Floriana; Orzi, Francesco; Caltagirone, Carlo; Robinson, Robert G.; Cacciari, Claudia

doi:10.1176/appi.neuropsych.12120399

Cited by 52 publications

(32 citation statements)

References 53 publications

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“…We found that vitamin D and IL‐6 were associated with the development of PSD. Similar to our result, low level of vitamin D has been considered as an important predicting factor for PSD (Han et al., ; Kaloglu et al., ) and IL‐6 has been showed to play a vital role in pathophysiology of PSD (Spalletta et al., ). Researchers have advanced one hypothesis that anti‐inflammatory role of vitamin D may play a role in the pathophysiology of PSD (Han et al., ).…”

Section: Discussionsupporting

confidence: 90%

Relationship between serum vitamin D levels and inflammatory markers in acute stroke patients

et al. 2018

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IntroductionLow serum vitamin D levels are associated with the development of poststroke depression (PSD). Inflammatory markers play an important role in pathophysiology of PSD. The relationship between vitamin D levels and inflammatory markers has been discussed in nonstroke individuals. The purposes of this study were to explore the relationship between vitamin D levels and inflammatory markers in acute stroke patients and examine the effect of vitamin D and inflammatory markers on PSD.MethodsA total of 152 acute stroke patients were recruited. Serum levels of 25‐hydroxyvitamin D and inflammatory markers were measured by standardized laboratory methods. Depression symptoms were assessed with the 17‐item Hamilton Depression Scale (HAMD‐17). Patients with the HAMD‐17 scores ≥7 were identified to have depression symptoms.ResultsSerum vitamin D levels were negatively correlated with serum levels of interleukin‐6 and high‐sensitivity C‐reactive protein (hsCRP) (r = −.244, p = .002; r = −.231, p = .004). Multiple regression analysis showed that interleukin‐6 and hsCRP levels were associated with vitamin D levels (B = −0.355, p = .003; B = −2.085, p = .006), whereas age, height, weight, leukocyte count, neutrophil ratio, and lymphocyte rate could be omitted without changing the results. In multivariate analyses, the serum levels of vitamin D and interleukin‐6 were associated with the development of PSD after adjusted possible variables (OR = 0.976, 95% CI: 0.958–0.994, p = .009; OR = 1.029, 95% CI: 1.003–1.055, p = .027).ConclusionsSerum vitamin D levels are inversely associated with the levels of interleukin‐6 and hsCRP, suggesting a potential anti‐inflammatory role for vitamin D in stroke individuals.

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Section: Discussionsupporting

confidence: 90%

Relationship between serum vitamin D levels and inflammatory markers in acute stroke patients

et al. 2018

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“…67–69 Elevated Il-6 is also implicated as an underlying mechanism for late-life depression; 70–72 however, its role in late life apathy has yet to be examined. One study looking at depression among post-stroke individuals found that higher levels of Il-6 were associated with severity of apathetic-depressive symptoms, 73 indicating some evidence of an apathy-inflammatory link. Future studies should further explore this connection by examining apathy and inflammatory markers in the context of age-related motoric and functional decline.…”

Section: Discussionmentioning

confidence: 99%

Symptoms of Apathy Independently Predict Incident Frailty and Disability in Community-Dwelling Older Adults

Ayers

Shapiro

Holtzer

et al. 2017

J. Clin. Psychiatry

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Objective Although depressive symptoms are widely recognized as a predictor of functional decline among older adults, little is known about the predictive utility of apathy in this population. We prospectively examined apathy symptoms as predictors of incident slow gait, frailty and disability among non-demented, community-dwelling older adults. Methods We examined two independent prospective cohort studies - the LonGenity study (N = 625, 53% women, mean age 75.2 years) and the Central Control of Mobility in Aging (CCMA) study (N = 312, 57% women, mean age 76.4 years). Individuals were recruited from 2008 to 2014. Apathy was assessed using 3 items from the Geriatric Depression Scale. Slow gait was defined as 1 standard deviation or more below age and sex-adjusted mean values, frailty was defined using the Cardiovascular Health Study criteria, and disability was assessed with a well-validated disability scale. Results The prevalence of apathy was 20% in LonGenity cohort and 26% in the CCMA cohort. The presence of apathy at baseline, independent of depressive symptoms (besides apathy), increased risk of developing incident slow gait (hazard ratio [HR] = 2.10; CI = 1.36–3.24; p = .001), frailty (HR = 2.86; CI = 1.96–4.16; p < .001), and disability (HR = 3.43; CI = 1.73–6.79; p < .001) in the pooled sample. These associations remained significant when accounting for demographics, medical illnesses, and cognitive function. Conclusions Apathy is associated with increased risk of developing slow gait, frailty, and disability, independent of other established risk factors, in non-demented older adults. Apathy should be screened as a potentially preventable cause of functional decline in clinical psychiatric settings.

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“…Two review papers [90,91] provided evidence that proinflammatory cytokines, such as IL-1beta, TNF-alpha, or IL-18, resulting from stroke may lead to an amplification of the inflammatory process, widespread activation of 2,3-dioxygenase, and to a subsequent depletion of serotonin. Spalletta et al [92] performed an extensive neuropsychiatric evaluation of 48 ischemic stroke patients 72 h after the presentation of stroke symptoms and collected fasting peripheral blood for measurement of IL-6 at the same time point. Elevated serum IL-6 levels were associated with depressed mood, loss of interest, loss of weight/appetite, and insomnia.…”

Section: Post-stroke Fatigue and Depressionmentioning

confidence: 99%

Inflammatory Signaling in Post-Stroke Fatigue and Depression

et al. 2018

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Background: In the United States, stroke continues to be the cause for long-term disability. Of the patients with a first stroke, up to 75% will experience post-stroke fatigue (PSF) in the first year following stroke. PSF is one of the most disabling symptoms in stroke survivors; it decreases quality of life, increases mortality, and is a barrier to stroke rehabilitation. Given the incidence of stroke and the prevalence and detrimental impact of PSF on quality of life, independent living, and overall survival, efficient management of PSF must be a priority in stroke rehabilitation. The cause of PSF remains unknown. The burden of fatigue in stroke survivors is influenced by other stroke-related symptoms, most notably post-stroke depression (PSD). It is well known that stroke induces a systemic inflammatory response that is the trigger for sickness behavior, of which fatigue and depression are predominant symptoms. Summary: To date, only a handful of studies have sought to explore the relationship between stroke-induced inflammation and PSF and PSD. In this review, we describe this evidence, highlight the strengths and weaknesses of these existing studies, and suggest further experiments that may further support the association between stroke-related inflammatory processes and stroke-related symptoms. Key Messages: The current concept and further research are important for a more specific therapeutic intervention for PSF and PSD.

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Neuropsychiatric Symptoms and Interleukin-6 Serum Levels in Acute Stroke

Cited by 52 publications

References 53 publications

Relationship between serum vitamin D levels and inflammatory markers in acute stroke patients

Relationship between serum vitamin D levels and inflammatory markers in acute stroke patients

Symptoms of Apathy Independently Predict Incident Frailty and Disability in Community-Dwelling Older Adults

Inflammatory Signaling in Post-Stroke Fatigue and Depression

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