Norwegian Centre for Ageing and Health, Vestfold Mental Health Care Trust, Norway.
J Affect Disord. 2010 Dec;127(1-3):211-8. doi: 10.1016/j.jad.2010.05.025. Epub 2010 Oct 8.
Although depression is known to be frequently associated with stroke, it is nonetheless underdiagnosed and under-treated in this patient population. Its effect on outcome for stroke patients is thought to be substantial, but prediction is complicated by other pre- and post stroke factors. The aims of this study was to describe changes in depressive symptoms in elderly stroke patients across a timespan of one year, to examine risk factor for such changes and to explore whether depressive symptoms have any independent impact upon one year mortality and nursing home placement.
194 patients diagnosed with an ischaemic or hemorrhagic stroke was recruited from the Stroke Rehabilitation Unit, Ullevaal University Hospital, Oslo, Norway during the period between March 2005 and August 2006 and followed up for a period of 13 months. Pre-stroke assessment was accomplished by means of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), the Frenchay Activities Index (FAI), the Barthel ADL Index and patient's medical history. Post-stroke assessment at inclusion and follow-up examination was performed with the Mini Mental State Examination (MMSE), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Star Cancellation Test, the Barthel ADL Index, the modified Rankin Scale (mRS) and the National Institute of Health Stroke Scale (NIHSS). Information was collected from the patients' records.
Institutionalization at 13 months was predicted by more depression (MADRS) and cognitive impairment (RBANS) at baseline, together with lower pre-stroke social activity levels (FAI). Two factors predicted death at 13 months: Cognitive impairment (MMSE) and greater age. The prevalence of depression was relatively unchanged from baseline (56%) to 13 month follow-up (48%). Among the patients who were depressed at baseline 55% still had MADRS score above six (persistent depression) at 13 months, while 35% in the non-depressed group at baseline had developed depression (incident depression). Persistent depression was significantly predicted by lower pre-stroke social activity levels (FAI) together with a more severe stroke (NIHSS) and worse overall function (mRS) at baseline. Incident depression was predicted by receipt of municipal home help before the stroke and a lower score on the delayed memory tasks on RBANS at baseline.
虽然抑郁与中风密切相关，但在这一患者群体中，抑郁的诊断和治疗仍不充分。人们认为抑郁对中风患者的预后有重大影响，但由于其他中风前后的因素，预测变得复杂。本研究的目的是描述老年中风患者在一年时间内抑郁症状的变化，检查这些变化的危险因素，并探讨抑郁症状是否对一年死亡率和入住养老院有任何独立影响。
2005 年 3 月至 2006 年 8 月期间，我们从挪威奥斯陆乌勒瓦尔大学医院的中风康复病房招募了 194 名诊断为缺血性或出血性中风的患者，并对其进行了为期 13 个月的随访。在中风前，通过认知下降询问表（IQCODE）、Frenchay 活动指数（FAI）、巴氏量表（Barthel ADL Index）和患者病史进行评估。在纳入和随访检查时，采用简易精神状态检查（MMSE）、重复性成套神经心理状态测验（RBANS）、星号删除测验、巴氏量表（Barthel ADL Index）、改良 Rankin 量表（mRS）和国立卫生研究院中风量表（NIHSS）进行评估。从患者的病历中收集信息。
13 个月时，患者入院治疗是由基线时的抑郁（MADRS）和认知障碍（RBANS）程度更高，以及更低的中风前社会活动水平（FAI）预测的。有两个因素可以预测 13 个月时的死亡：认知障碍（MMSE）和更高的年龄。从基线（56%）到 13 个月随访（48%），抑郁的患病率相对不变。在基线时抑郁的患者中，55%的患者仍有 MADRS 评分高于 6 分（持续性抑郁），而基线时无抑郁的患者中，有 35%出现了抑郁（新发抑郁）。持续性抑郁与较低的中风前社会活动水平（FAI）、更严重的中风（NIHSS）和基线时更差的整体功能（mRS）显著相关。新发抑郁与中风前接受市立家庭帮助和 RBANS 延迟记忆任务得分较低有关。
