Saxena S K, Ng T-P, Koh G, Yong D, Fong N P
National Disease Registries Office, Health Promotion Board, Singapore.
Acta Neurol Scand. 2007 May;115(5):339-46. doi: 10.1111/j.1600-0404.2006.00751.x.
Depression and cognitive impairment after stroke are associated with physical functional outcomes, but there are limited data on whether depressive symptoms and cognitive status and improvements independently influence functional status and recovery.
In a 6-month prospective cohort study of 141 post-acute stroke patients, demographic and clinical data on admission, and neurological, cognitive, depressive symptoms and functional variables on admission and at 6 months after stroke were measured using the National Institute of Health Stroke Scale (NIHSS), Abbreviated Mental Test (AMT), Geriatric Depression Scale (GDS) and Barthel Index (BI).
On multivariate analysis, severe activities of daily living (ADL) dependence at 6 months was significantly less likely associated with higher baseline AMT score denoting better cognitive status (OR=0.68, 95% CI 0.48-0.97 per score point) and with greater AMT change score denoting greater cognitive improvement (OR=0.61, 95% CI 0.41-0.91 per change score point); it was also more likely with higher baseline NIHSS scores denoting severe neurological impairment, (OR=1.74, 95% CI 1.13-2.63 per point score), NIHSS change score [denoting lesser neurological improvement (OR = 1.83, 95% CI 1.13-2.93 per unit change score)], but was not associated with baseline or change scores of GDS. Greater magnitudes of functional recovery [BI change score (standardized beta)] were associated with better baseline depressive symptoms (-0.21) and improvement (-0.31), but not with cognitive status or improvement, in the presence of other significant variables, neurological status (-0.89) and improvement (-0.65), lower baseline physical functional status (-0.85) and younger age (-0.23).
These data suggest that improving depressive symptoms in stroke patients may accelerate functional recovery, but the level of physical functioning achieved post-stroke is determined by neurological and cognitive factors, consistent with the evidence that improvement of depressive symptoms through therapeutic intervention is limited by cognitive impairment.
中风后的抑郁和认知障碍与身体功能结局相关，但关于抑郁症状、认知状态及其改善是否独立影响功能状态和恢复的数据有限。
在一项对141例急性中风后患者进行的为期6个月的前瞻性队列研究中，使用美国国立卫生研究院卒中量表（NIHSS）、简易精神状态检查表（AMT）、老年抑郁量表（GDS）和巴氏指数（BI）测量入院时的人口统计学和临床数据，以及中风后入院时和6个月时的神经、认知、抑郁症状和功能变量。
多变量分析显示，6个月时严重的日常生活活动（ADL）依赖与表示更好认知状态的较高基线AMT评分（每分OR=0.68，95%CI 0.48-0.97）以及表示更大认知改善的更大AMT变化评分（每变化分OR=0.61，95%CI 0.41-0.91）显著相关可能性较小；与表示严重神经功能缺损的较高基线NIHSS评分（每分OR=1.74，95%CI 1.13-2.63）、NIHSS变化评分[表示较小神经功能改善（每单位变化分OR = 1.83，95%CI 1.13-2.93）]相关可能性较大，但与GDS的基线或变化评分无关。在存在其他显著变量（神经状态（-0.89）和改善（-0.65）、较低的基线身体功能状态（-0.85）和较年轻的年龄（-0.23））的情况下，更大程度的功能恢复[BI变化评分（标准化β）]与更好的基线抑郁症状（-0.21）和改善（-0.31）相关，但与认知状态或改善无关。
这些数据表明，改善中风患者的抑郁症状可能会加速功能恢复，但中风后达到的身体功能水平由神经和认知因素决定，这与通过治疗干预改善抑郁症状受认知障碍限制的证据一致。
