Center for Clinical and Epidemiological Research, Hospital Universitário, University of São Paulo, Brazil.
Institute of Psychiatry, Hospital das Clínicas, Medical School, University of São Paulo, Brazil; Laboratory of Medical Investigations of Psychopharmacology and Clinical Psychophysiology (LIM23), Medical School, University of São Paulo, Brazil.
Prog Neuropsychopharmacol Biol Psychiatry. 2019 Aug 30;94:109639. doi: 10.1016/j.pnpbp.2019.109639. Epub 2019 May 7.
Depression and cognitive impairment are common conditions following stroke. We aimed to evaluate stroke laterality as predictor of post-stroke depression (PSD) and cognitive impairment (PCI) in a stroke cohort. Major depression (Patient Health Questionnaire-9, score ≥ 10) and cognitive impairment (Modified Telephone Interview for Cognitive Status, score < 14) were evaluated at 6 months and yearly up to 2 years. Survival analyses were performed by Kaplan-Meier curves and Cox logistic regression models, adjusted for potential confounders (cumulative hazard ratio, HR; 95% confidence interval, CI), for the likelihood of subsequent PSD or PCI progression at 6 months and 2 years, according to stroke laterality (right hemisphere-reference). Among 100 stroke patients, we found 19% had PSD and 38% had PCI 2 years after stroke. Most participants (53%) presented right-sided stroke. However, right-sided stroke was not associated with PSD or PCI. Overall, left-sided stroke was an independent and long-term predictor of PCI, but not of major depression. Left-sided stroke was associated with a high probability of PCI (42.6% and 53.2%, respectively at 6 months and 2 years, p-log-rank: 0.002). The HR of PCI due to left-sided stroke was 3.25 (95%CI, 1.30-8.12) at 6 months and remained almost the same at 2 years (HR,3.22;95%CI, 1.43-7.28). The risk of having worse cognition status increased by >3 times, 2 years after stroke. The results support the hypothesis that involvement of networks in the left, but not in the right hemisphere, contribute to long-term cognitive impairment. Lesion laterality did not influence the risk of PSD.
抑郁和认知障碍是中风后的常见病症。我们旨在评估中风的偏侧性是否可预测中风后抑郁（PSD）和认知障碍（PCI）。在中风队列中，分别在 6 个月和 2 年时使用患者健康问卷（PHQ-9，得分≥10）和改良电话访谈认知状态量表（MoCA-T，得分<14）评估主要抑郁和认知障碍。采用 Kaplan-Meier 曲线和 Cox 逻辑回归模型进行生存分析，调整了潜在混杂因素（累积风险比，HR；95%置信区间，CI），评估了 6 个月和 2 年后 PSD 或 PCI 进展的可能性，其依据是中风的偏侧性（右侧半球作为参考）。在 100 名中风患者中，我们发现 19%的患者在中风后 2 年内出现 PSD，38%的患者出现 PCI。大多数参与者（53%）为右侧中风，但右侧中风与 PSD 或 PCI 无关。总体而言，左侧中风是 PCI 的独立且长期预测因素，但不是 PSD 的预测因素。左侧中风与 PCI 具有高度相关性（分别为 6 个月和 2 年时的 42.6%和 53.2%，p-log-rank：0.002）。由于左侧中风导致 PCI 的 HR 为 3.25（95%CI，1.30-8.12），2 年后基本保持不变（HR，3.22；95%CI，1.43-7.28）。中风后 2 年，认知状态恶化的风险增加了 3 倍以上。结果支持了以下假说：左侧半球（而不是右侧半球）的网络参与有助于长期认知障碍。病变偏侧性不影响 PSD 的风险。
