Department of Neurology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China; Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.
Department of Neurology, Dongguan People's Hospital, Dongguan, Guangdong, China.
J Affect Disord. 2019 Jun 15;253:218-223. doi: 10.1016/j.jad.2019.04.092. Epub 2019 Apr 22.
Cerebral small vessel diseases (SVD) are associated with poststroke depressive symptoms (PDS). The mechanisms underlying the association between SVD burden and PDS are unclear. This study investigated the clinical pathways linking SVD burden to PDS.
A cohort of 563 patients with acute ischemic stroke were examined at three and fifteen months after stroke. PDS was measured with the 15-item Geriatric Depression Scale (GDS). Cognitive and physical functions were assessed with the Mini-Mental State Examination and the modified Rankin Scale, respectively. All patients received MRI scans at baseline. Infarct volumes and the four SVD markers (lacunae, white matter hyperintensities, cerebral microbleeds, and perivascular spaces) were assessed on magnetic resonance imaging. SVD burden was defined as a latent variable encompassing the information about all four SVD markers in structural equation modeling (SEM). SEM was further employed to examine the direct and indirect linking pathways between SVD burden, infarct volumes, stroke severity, poststroke cognitive and physical dysfunctions, and PDS.
The latent SVD burden was directly associated with more severe PDS at the 3-month follow-up (path coefficient=0.11), while SVD burden and PDS at the 15-month were mainly linked through PDS at the 3-month follow-up (path coefficient=0.48). The volume of acute infarcts and impaired physical functions predominantly mediated the association between SVD burden and PDS at 3-month follow-up. Physical and cognitive functions 15 months after stroke mainly bridged the link between SVD burden and the PDS at the 15-month follow-up.
The study included patients with mild stroke, which reduced the generalizability of the findings.
SVD burden not only directly determines poststroke depressive symptoms, but also worsens acute stroke lesions, stroke severity, and poststroke neurological deficits, thereby contributing further to the development of PDS over the first 15 months after stroke.
脑小血管病（SVD）与卒中后抑郁症状（PDS）有关。SVD 负担与 PDS 之间关联的潜在机制尚不清楚。本研究探讨了 SVD 负担与 PDS 相关的临床途径。
对 563 例急性缺血性卒中患者在卒中后 3 个月和 15 个月进行了检查。使用 15 项老年抑郁量表（GDS）测量 PDS。使用简易精神状态检查和改良 Rankin 量表分别评估认知和身体功能。所有患者在基线时均接受 MRI 扫描。在磁共振成像上评估梗死体积和 4 种 SVD 标志物（腔隙、脑白质高信号、脑微出血和血管周围间隙）。SVD 负担被定义为结构方程模型（SEM）中包含所有 4 种 SVD 标志物信息的潜在变量。SEM 进一步用于研究 SVD 负担、梗死体积、卒中严重程度、卒中后认知和身体功能障碍与 PDS 之间的直接和间接联系途径。
潜在的 SVD 负担与 3 个月随访时更严重的 PDS 直接相关（路径系数=0.11），而 SVD 负担和 15 个月时的 PDS 主要通过 3 个月随访时的 PDS 联系（路径系数=0.48）。急性梗死体积和身体功能障碍主要介导了 SVD 负担与 3 个月随访时 PDS 之间的关联。卒中后 15 个月的身体和认知功能主要桥接了 SVD 负担与 15 个月随访时 PDS 之间的联系。
该研究纳入了轻度卒中患者，降低了研究结果的普遍性。
SVD 负担不仅直接决定了卒中后抑郁症状，而且还加重了急性卒中病灶、卒中严重程度和卒中后神经功能缺损，从而在卒中后 15 个月内进一步导致 PDS 的发展。
