Camões Barbosa Alexandre, Sequeira Medeiros Luís, Duarte Nuno, Meneses Conceição
Área de Medicina Física e Reabilitação, Centro Hospitalar de Lisboa Central, Lisboa, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 2:175-80. Epub 2011 Dec 31.
Stroke can significantly limit functionality, a fact often not correlated with the neurological deficit itself. The psychiatric complications have been identified as key factors in post-stroke. Depression has shown to be the most common complication and the one associated with a worse prognosis. There is still uncertainty as to its etiology and risk factors. In the most recent systematic review, some factors are recognized: stroke severity, the degree of disability and cognitive impairment. Establishment of other factors wasn't possible due to methodological issues. Thus, it is urgent to define new factors that facilitate a timely diagnosis, which may lessen the negative effects on the rehabilitation process.
To determine the incidence of post-stroke depression (PSD) and to study variables described in the literature as possible predictors of PSD: sex, age, type of stroke, laterality, vascular territory and presence of aphasia. The study of the type of aphasia was defined as secondary endpoint.
Retrospective longitudinal study involving all patients admitted to a PMR ward, with the diagnosis of stroke de novo, between 1/1/2009 and 31/12/2009. Demographic and clinical data was collected from 74 patients' files.
'previous stroke', 'prior psychiatric illness with mood disturbance' and 'antidepressant medication at the time of stroke'. SPSS 11.5 was used for statistical analysis.
The incidence of PSD was 44.6%. Amongst possible predictor factors tested, only the presence of aphasia showed a significant association with depression (p = 0.02). There was no relation with the type of aphasia. The other predictors tested showed no statistically significant correlation. There seems to be a relationship between male sex and the PSD (p = 0.07), which did not reach significance with this sample size (n).
This study establishes aphasia as a predictive factor of PSD and excludes the remaining variables. The high incidence of PSD in this particular population agrees with the existing studies, but a different study is needed to justify the value found. Further studies are needed, not only to increase knowledge of risk factors for PSD, as to improve the outcomes of rehabilitation programs.
中风会严重限制功能,而这一事实往往与神经功能缺损本身并无关联。精神科并发症已被确认为中风后的关键因素。抑郁症已被证明是最常见的并发症,且与预后较差相关。其病因和危险因素仍不明确。在最近的系统评价中,一些因素得到了认可:中风严重程度、残疾程度和认知障碍。由于方法学问题,无法确定其他因素。因此,迫切需要确定有助于及时诊断的新因素,这可能会减轻对康复过程的负面影响。
确定中风后抑郁症(PSD)的发病率,并研究文献中描述的可能作为PSD预测因素的变量:性别、年龄、中风类型、病变侧别、血管分布区域和失语症的存在情况。失语症类型的研究被定义为次要终点。
回顾性纵向研究,纳入2009年1月1日至2009年12月31日期间入住物理医学与康复病房且初诊为中风的所有患者。从74份患者病历中收集人口统计学和临床数据。
“既往中风”、“既往有情绪障碍的精神疾病”和“中风时正在服用抗抑郁药物”。使用SPSS 11.5进行统计分析。
PSD的发病率为44.6%。在测试的可能预测因素中,只有失语症的存在与抑郁症有显著关联(p = 0.02)。与失语症类型无关。测试的其他预测因素均无统计学显著相关性。男性与PSD之间似乎存在关联(p = 0.07),但在该样本量(n)下未达到显著水平。
本研究确定失语症为PSD的预测因素,并排除了其余变量。该特定人群中PSD的高发病率与现有研究一致,但需要不同的研究来验证所发现的值。不仅需要进一步研究以增加对PSD危险因素的认识,还需要改善康复计划的结果。