Center for Clinical and Epidemiological Research, Hospital Universitario, Universidade de Sao Paulo, Brazil; Laboratory of Psychiatric Neuroimaging (LIM21), Departamento de Psiquiatria, Universidade de Sao Paulo, Medical School, Brazil.
Institute of Psychiatry, Hospital das Clinicas, Universidade de Sao Paulo, Medical School, Brazil; Laboratory of Medical Investigations of Psychopharmacology and Clinical Psychophysiology (LIM23), Universidade de Sao Paulo, Medical School, Brazil.
J Affect Disord. 2019 Feb 15;245:72-81. doi: 10.1016/j.jad.2018.10.003. Epub 2018 Oct 12.
Post-stroke depression (PSD) and cognitive impairment (PCI) are common conditions. This study aims to describe the protocol and preliminary findings of an investigation into factors associated with PSD and PCI 1-3 months after stroke (subacute phase) in survivors from the Study of Stroke Mortality and Morbidity (EMMA study).
Stroke patients underwent to clinical and neurological evaluations on admission to hospital. Cerebral magnetic resonance and biomarkers (serotonin, BDNF, IL-6 and IL-18) were carried out in the subacute phase. DSM-IV major depression for the diagnosis of PSD, cognitive functioning for the diagnosis of PCI and functional disability were also recorded at same time.
Of the 103 eligible patients, 85.4% had ischemic stroke and 73.7% had first-ever stroke. In the subacute phase, 27.2% had PCI and 13.6% had current PSD (5.8% with 'first episode' and 7.8% with 'recurrent' depression). PCI was associated with low education (0-7 years of formal education: 75%) and ageing (median age: 70; interquartile range: 59-75 y-old). Left-sided stroke was more frequently associated with increased PCI than right-sided stroke (71.4% vs. 28.4%, p = 0.005). PSD was neither associated with stroke laterality nor tentorial area. Overall, biomarkers levels were not alterated in patients with PSD and PCI.
Findings are based on small sample and less disabled stroke participants, e.g. those without aphasia and deafness.
Findings reinforce the need of early recognition and rehabilitation of PCI and PSD, mainly among those less educated and with left-sided stroke. PSD might occur through a pathophysiological pathway other than classical depression.
卒中后抑郁（PSD）和认知障碍（PCI）是常见病症。本研究旨在描述一项研究的方案和初步结果，该研究调查了卒中后 1-3 个月（亚急性期）幸存者中与 PSD 和 PCI 相关的因素，该研究来自卒中死亡率和发病率研究（EMMA 研究）。
卒中患者在入院时接受临床和神经学评估。在亚急性期进行磁共振和生物标志物（血清素、BDNF、IL-6 和 IL-18）检测。同时还记录了 DSM-IV 重性抑郁诊断的 PSD、认知功能诊断的 PCI 和功能残疾。
在 103 名符合条件的患者中，85.4%为缺血性卒中，73.7%为首次卒中。在亚急性期，27.2%有 PCI，13.6%有当前 PSD（5.8%为“首发”，7.8%为“复发性”抑郁）。PCI 与低教育程度（0-7 年正规教育：75%）和年龄老化（中位数年龄：70；四分位间距：59-75 岁）相关。与右侧卒中相比，左侧卒中更常与 PCI 增加相关（71.4%比 28.4%，p=0.005）。PSD 与卒中侧或天幕区无关。总的来说，在 PSD 和 PCI 患者中，生物标志物水平没有改变。
研究结果基于小样本和较少残疾的卒中参与者，例如没有失语症和耳聋的患者。
研究结果强调了需要早期识别和康复 PCI 和 PSD，特别是在那些教育程度较低和有左侧卒中的患者中。PSD 可能通过不同于经典抑郁的病理生理途径发生。
