School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
Cerebrovasc Dis. 2011;32(4):354-60. doi: 10.1159/000330350. Epub 2011 Sep 15.
Little is known about post-stroke depression in patients with lacunar stroke due to cerebral small vessel disease. Our objectives were to describe the prevalence of depression, its correlates and to examine the course of depression over time in a cohort of patients with lacunar stroke, the majority of whom had mild functional disability.
Depression was determined in participants in the international Secondary Prevention of Small Subcortical Strokes (SPS3) trial which is testing antiplatelet therapies and targets of blood pressure control in patients with lacunar strokes and assessing stroke recurrence and cognitive decline. Depression was evaluated using the Patient Health Questionnaire. Multivariable logistic regression models were fitted to examine the relationship between the covariates of interest and depression. Generalized estimating equations were used to examine the likelihood of depression over time, while accounting for the multiple measurements within each subject.
The prevalence of depression in 2,477 participants at approximately 4 months after stroke was 19%. Older age (OR 0.97; 95% CI 0.96-0.99), male gender (OR 0.62; 95% CI 0.48-0.80) and less cognitive impairment (OR 0.99; 95% CI 0.98-1.00) were independently associated with a lower risk of depression. Functional disability (OR 1.8; 95% CI 1.3-2.4), living with a spouse/family (OR 1.6; 95% CI 1.1-2.3) and risk factors for stroke (OR 1.2; 95% CI 1.0-1.3) were each independently associated with a higher risk of depression. Longitudinal modeling indicated that the likelihood of depression decreased by 1.12 times (95% CI 1.06-1.17) for each 1-year increase in time.
One fifth of those in the SPS3 trial cohort reported depression that is sustained over time. Although this is lower than the prevalence reported for stroke in general, these results underscore the importance of early screening for post-stroke depression, treatment and follow-up to minimize the negative consequences associated with depression.
由于脑小血管疾病，腔隙性卒中患者的卒中后抑郁知之甚少。我们的目的是描述腔隙性卒中患者中抑郁的患病率、相关因素，并检查抑郁随时间的变化过程，这些患者大多数存在轻度的功能残疾。
在国际腔隙性卒中二级预防（SPS3）试验的参与者中评估抑郁，该试验正在测试抗血小板治疗和血压控制目标，以评估腔隙性卒中患者的卒中复发和认知能力下降。抑郁使用患者健康问卷进行评估。多变量逻辑回归模型用于检查感兴趣的协变量与抑郁之间的关系。使用广义估计方程来检查随时间发生抑郁的可能性，同时考虑每个受试者内的多次测量。
大约 4 个月后卒中时，2477 名参与者中抑郁的患病率为 19%。年龄较大（OR 0.97；95%CI 0.96-0.99）、男性（OR 0.62；95%CI 0.48-0.80）和认知障碍较轻（OR 0.99；95%CI 0.98-1.00）与抑郁风险较低独立相关。功能障碍（OR 1.8；95%CI 1.3-2.4）、与配偶/家人同住（OR 1.6；95%CI 1.1-2.3）和卒中风险因素（OR 1.2；95%CI 1.0-1.3）与抑郁风险较高独立相关。纵向建模表明，随时间增加 1 年，抑郁的可能性降低 1.12 倍（95%CI 1.06-1.17）。
SPS3 试验队列中有五分之一的人报告了持续存在的抑郁。虽然这低于一般卒中报告的患病率，但这些结果强调了早期筛查卒中后抑郁、治疗和随访的重要性，以尽量减少与抑郁相关的负面影响。
