Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands.
Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
J Neurol Neurosurg Psychiatry. 2018 Aug;89(8):859-865. doi: 10.1136/jnnp-2017-317548. Epub 2018 Feb 8.
To examine, first, whether the co-occurrence of executive dysfunction (ED) and poststroke depression (PSD) shows different associations with neuroimaging markers and the course of depression and executive function, and second, whether it is associated with a different course on other cognitive domains and quality of life.
The present study included 245 stroke patients (35.9% female, mean age 67.5 years (SD=11.9). All patients completed neuropsychological and neuropsychiatric assessment 3 months poststroke, which were repeated at 6-month and 12-month follow-up. A subset (n=186) received 3-Tesla brain MRI at baseline to evaluate lesion-related imaging markers, white matter hyperintensity volume, global brain atrophy and total cerebral small vessel disease burden.
Patients with 'depression-executive dysfunction syndrome' (DES) showed higher white matter hyperintensity volumes compared with all other groups and more frequently showed left-sided lesions compared with ED only and PSD only. They also had more frequently old infarcts and higher total cerebral small vessel disease burden compared with PSD only and patients with neither ED nor PSD, and more global brain atrophy compared with PSD only. Longitudinal analyses showed that patients with DES had a more chronic course of depressive symptoms relative to PSD only, and a stable pattern of worse cognitive performance similar to patients with ED only.
The co-occurrence of ED and PSD is associated with a worse prognosis of depression, persistent cognitive impairment and a higher amount of vascular and degenerative brain pathology. Future studies are needed to examine whether these patients represent a more severe subtype within the PSD spectrum.
NCT02585349;Results.
首先考察执行功能障碍（ED）和卒中后抑郁（PSD）同时存在是否与神经影像学标志物以及抑郁和执行功能的病程有不同的关联，其次考察其是否与其他认知领域和生活质量的不同病程相关。
本研究纳入了 245 名卒中患者（35.9%为女性，平均年龄 67.5 岁（SD=11.9）。所有患者在卒中后 3 个月接受神经心理学和神经精神病学评估，在 6 个月和 12 个月的随访时重复评估。一个亚组（n=186）在基线时接受 3-Tesla 脑部 MRI 检查，以评估与病变相关的影像学标志物、脑白质高信号体积、全脑萎缩和总脑小血管疾病负担。
“抑郁-执行功能障碍综合征”（DES）患者的脑白质高信号体积高于其他所有组，且与 ED 仅和 PSD 仅相比，更常出现左侧病变。与 PSD 仅和无 ED 或 PSD 的患者相比，他们也更常出现陈旧性梗死和更高的总脑小血管疾病负担，与 PSD 仅相比，他们的全脑萎缩更明显。纵向分析显示，与 PSD 仅相比，DES 患者的抑郁症状病程更慢性，认知表现更稳定，且与 ED 仅患者相似。
ED 和 PSD 同时存在与 PSD 预后更差、持续认知障碍以及更多血管和退行性脑病理有关。未来的研究需要检验这些患者是否代表 PSD 谱内更严重的亚型。
NCT02585349；结果。
