van de Port Ingrid G L, Kwakkel Gert, Bruin Margje, Lindeman Eline
Center of Excellence for Rehabilitation Medicine Utrecht, Rehabilitation Centre De Hoogstraat, Utrecht, The Netherlandz.
Disabil Rehabil. 2007 Mar 15;29(5):353-8. doi: 10.1080/09638280600787047.
The aim of the study was to identify factors that are significantly related to depression in chronic stroke patients.
Prospective cohort study of stroke patients admitted for rehabilitation. A total of 165 first ever stroke patients over 18 years of age were assessed at one and three years post stroke. Depression was determined by the Centre for Epidemiologic Studies Depression Scale (CES-D). Patients with scores >/=16 were classified as depressed. Bivariate and multivariate logistic regression analyses were used to identify prognostic factors for depression.
At three years post stroke, 19% of the patients were depressed. Bivariate analysis showed significant associations between post-stroke depression and type of stroke, fatigue, motor function of the leg and arm, activities of daily living (ADL) independency and instrumental ADL. Multivariate logistic regression analysis showed that depression was predicted by one-year instrumental ADL and fatigue. Sensitivity of the model was 63%, while specificity was 85%.
The present prospective cohort study showed that depression three years after stroke can be predicted by instrumental ADL and fatigue one year post stroke. Recognition of prognostic factors in patients at risk may help clinicians to apply interventions aimed at preventing depression in chronic stroke.
本研究旨在确定与慢性卒中患者抑郁显著相关的因素。
对入院接受康复治疗的卒中患者进行前瞻性队列研究。共对165例18岁以上的首次卒中患者在卒中后1年和3年进行评估。采用流行病学研究中心抑郁量表（CES-D）确定抑郁情况。得分≥16分的患者被归类为抑郁。采用双变量和多变量逻辑回归分析确定抑郁的预后因素。
卒中后3年，19%的患者出现抑郁。双变量分析显示，卒中后抑郁与卒中类型、疲劳、腿部和手臂运动功能、日常生活活动（ADL）独立性和工具性ADL之间存在显著关联。多变量逻辑回归分析显示，抑郁可由1年时的工具性ADL和疲劳预测。该模型的敏感性为63%，特异性为85%。
本前瞻性队列研究表明，卒中后1年的工具性ADL和疲劳可预测卒中后3年的抑郁。识别有风险患者的预后因素可能有助于临床医生应用旨在预防慢性卒中患者抑郁的干预措施。
