Predictors of early-onset post-ischemic stroke depression: a cross-sectional study

Abstract

BackgroundPost-stroke depression (PSD) seriously affects the rehabilitation of nerve function and quality of life. However, the pathogenesis of PSD is still not clear. This study aimed to investigate the demographic, clinical, and biochemical factors in patients with PSD.MethodsPatients with an acute ischemic stroke, who met the inclusion criteria at Shanghai Tenth People’s Hospital from April 2016 to September 2016, were recruited for this study. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and the mental state was assessed using Mini-Mental State Examination (MMSE), Hamilton Depression Scale (HAMD), and Hamilton Anxiety Scale (HAMA) at 1 week of admission. The patients were divided into PSD and non-PSD groups. The demographic and clinical characteristics, as well as the biochemical factors, were compared between the two groups. A logistic regression analysis was performed to identify the risk factors for depression following stroke.ResultsA total of 83 patients with acute ischemic stroke were recruited. Of these, 36 (43.4%) developed depression. The multivariate logistic regression analysis indicated that high NIHSS [odds ratio (OR): 1.84, 95% confidence interval (CI): 1.09–3.12, P = 0.023] and high HAMD scores (OR: 2.38, 95% CI: 1.61–3.50, P < 0.001) were independent risk predictors for PSD and so were lower dopamine level (OR: 0.64, 95% CI: 0.45–0.91, P = 0.014), lower 5-hydroxytryptamine level (OR: 0.99, 95% CI: 0.98–1.00, P = 0.046), higher tumor necrosis factor-α level (OR: 1.05, 95% CI: 1.00–1.09, P = 0.044), and lower nerve growth factor level (OR: 0.06, 95% CI: 0.01–0.67, P = 0.022).ConclusionsThe identification of higher NIHSS scores, higher HAMD scores, lower dopamine level, lower 5-hydroxytryptamine level, higher tumor necrosis factor-α level, and lower nerve growth factor level might be useful for clinicians in recognizing and treating depression in patients after a stroke.

<p>Elevated Neutrophil-to-Lymphocyte Ratio Predicts Depression After Intracerebral Hemorrhage</p>

“…7 Higher levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-6 and IL-18 have been shown to be associated with PSD. 8,9 In another study, TNF-α and IL-1β genes polymorphism were reported to be correlated with increased risk for PSD. 10 A recent review also indicated that inflammation may promote the occurrence of depression after intracerebral hemorrhage through a series of signaling pathways.…”

Prescription and predictors of post-stroke antidepressant treatment: A population-based study

“…Stoke severity has previously been associated with the risk of PSD, but in small studies, in highly selected cohorts, or in restricted time periods after stroke. [23][24][25] Our findings could suggest that clinicians should have special focus on the more severe strokes with regard to identifying patients with symptoms requiring antidepressant treatment. Another possibility is that the more severe strokes were more likely to be treated with an antidepressant as they had longer hospital stays.…”

“…Stoke severity has previously been associated with the risk of PSD, but in small studies, in highly selected cohorts, or in restricted time periods after stroke [23][24][25]. Estimates in bold highlights statistically significant results.…”

Predictors of Early-Onset Depression after First-Ever Stroke

“…A more severe neurological deficit is most commonly the consequence of a larger cerebral lesion that affected the areas that are involved in cognitive functions and mood regulation. Most studies performed so far indicate that depressed patients have significantly more severe initial neurological deficit than non-depressed patients ( 18 , 24 ), and that the severity of neurological deficit is an independent predictor of PSD ( 12 , 43 , 44 ). This was also confirmed by our results recorded in patients having developed early-onset PSD.…”