Brodaty Henry, Withall Adrienne, Altendorf Annette, Sachdev Perminder S
School of Psychiatry, University of New South Wales, Academic Department for Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia.
Am J Geriatr Psychiatry. 2007 Jun;15(6):477-86. doi: 10.1097/JGP.0b013e3180590bca.
To investigate the frequency and correlates of depression at 3 and 15 months after stroke.
A total of 164 consecutive eligible stroke patients and 100 comparison subjects received extensive medical, psychiatric, and neuropsychological assessments; a subset also received magnetic resonance imaging scans. Comprehensive assessments included ratings for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition major or minor depression at 3-6 months (index assessment) and 15 months (follow-up assessment) after stroke. The comparison subjects, who were similar in age and sex, were similarly assessed twice, 12 months apart.
Major or minor depression was present in 12.0% of stroke patients at index assessment and in 20.7% at follow-up which included 18 new cases (13.4%). By follow-up, stroke patients with depression had significantly greater impairment of functional ability and global cognition than nondepressed stroke patients or comparison subjects. Depression was not associated with age, intellectual decline prior to stroke or side or severity of stroke. Patients who experienced a TIA or stroke during the follow-up, who had developed dementia by three months or who were not living with a relative or partner were more likely to be depressed at follow-up. Dementia at 3 months predicted depression, but the reverse did not hold.
Depression may be less frequent after stroke than previously reported and is related to cumulative vascular brain pathology rather than side and severity of single strokes. Clinicians should strive to slow the progression of cerebrovascular disease and encourage greater social support.
调查卒中后3个月和15个月时抑郁症的发生率及其相关因素。
共有164例连续入选的符合条件的卒中患者和100例对照受试者接受了全面的医学、精神科和神经心理学评估；部分患者还接受了磁共振成像扫描。综合评估包括对《精神障碍诊断与统计手册》第四版中卒中后3至6个月（索引评估）和15个月（随访评估）时重度或轻度抑郁症的评定。年龄和性别匹配的对照受试者同样接受了两次评估，间隔12个月。
在索引评估时，12.0%的卒中患者存在重度或轻度抑郁症，随访时这一比例为20.7%，其中包括18例新发病例（13.4%）。到随访时，与未患抑郁症的卒中患者或对照受试者相比，患抑郁症的卒中患者在功能能力和整体认知方面的损害明显更大。抑郁症与年龄、卒中前智力衰退、卒中部位或严重程度无关。在随访期间经历短暂性脑缺血发作或卒中、在3个月时已发展为痴呆症或未与亲属或伴侣同住的患者在随访时更有可能患抑郁症。3个月时的痴呆症可预测抑郁症，但反之则不成立。
卒中后抑郁症的发生率可能低于先前报道，且与累积性脑血管病变有关，而非与单次卒中的部位和严重程度有关。临床医生应努力减缓脑血管疾病的进展，并鼓励提供更多社会支持。
