Parikh R M, Lipsey J R, Robinson R G, Price T R
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21205.
Int J Psychiatry Med. 1988;18(1):45-56. doi: 10.2190/lw46-3e9f-kyjm-wxgq.
In a prospective study of mood disorders in 103 stroke patients, we examined the predictive value of affective, cognitive, social and neurologic variables obtained in-hospital and at six months poststroke in terms of outcome as determined by the same measures at one and two years follow-up. The following factors were found to have prognostic significance: 1) Lesion Location: proximity of the lesion on CT scan to the frontal pole in patients with left anterior infarcts showed a strong positive relationship with severity of depression at one year but not at two years poststroke. 2) Affective Status: depression (in-hospital and at 6 months) strongly predicted depression at one year but not at two years poststroke. Additionally, in-hospital depression significantly correlated with physical impairment at two years, while depression at six months bore a moderate relationship to physical impairment at one year. 3) Physical Impairment: impairment in activities of daily living in-hospital bore a modest relationship to depression at one year while such impairment at six months correlated strongly with depression at both one and two years. These findings may reflect the natural course of major depression which remits between one and two years poststroke. Although stroke lesion location is the strongest predictor of subsequent depression, there appears to be a reciprocal relationship between physical impairment and depression (i.e., depression predicts impairment and impairment predicts depression). Since poststroke depressions are amenable to therapeutic intervention, these prognostic factors may have implications for the treatment and rehabilitation of stroke patients.
在一项针对103名中风患者情绪障碍的前瞻性研究中，我们考察了住院时及中风后6个月时获取的情感、认知、社会和神经学变量对于随访1年和2年时采用相同测量指标所确定的结果的预测价值。发现以下因素具有预后意义：1）病变位置：在左前脑梗死患者中，CT扫描显示病变与额极的接近程度与中风后1年时的抑郁严重程度呈强正相关，但与中风后2年时无关。2）情感状态：（住院时及6个月时的）抑郁强烈预测中风后1年时的抑郁，但不能预测中风后2年时的抑郁。此外，住院时的抑郁与2年时的身体损伤显著相关，而6个月时的抑郁与1年时的身体损伤呈中度相关。3）身体损伤：住院时日常生活活动的损伤与1年时的抑郁呈适度相关，而6个月时的此类损伤与1年和2年时的抑郁均密切相关。这些发现可能反映了中风后1至2年期间缓解的重度抑郁症的自然病程。虽然中风病变位置是后续抑郁的最强预测因素，但身体损伤与抑郁之间似乎存在相互关系（即抑郁预测损伤，损伤预测抑郁）。由于中风后抑郁可通过治疗干预，这些预后因素可能对中风患者的治疗和康复具有启示意义。
