Siotto Mariacristina, Germanotta Marco, Santoro Massimo, Cipollini Valeria, Guardati Giulia, Papadopoulou Dionysia, Bray Elisa, Mastrorosa Alessia, Aprile Irene
IRCCS Fondazione Don Carlo Gnocchi ONLUS, 50143 Florence, Italy.
Division of Health Protection Technologies ENEA-Italian National Agency for New Technologies, Energy and Sustainable Economic Development, 00123 Rome, Italy.
Brain Sci. 2021 May 15;11(5):642. doi: 10.3390/brainsci11050642.
Post-stroke depression and cognitive impairment are common conditions affecting patients after stroke. Serotonin is a neurotransmitter involved in modulating, among others, mood, cognition, learning, and memory. Sub-optimal serotonin activity may be in part responsible for cognitive deficits seen in depression. In this pilot study serotonin levels were evaluated in 29 patients with sub-acute stroke before and after a rehabilitation treatment (consisting of a program of upper limb robotic rehabilitation in addition to conventional physical therapy treatment). We employed the Back Depression Inventory scale to evaluate symptoms of depression, and specific tools to evaluate cognitive functions. We found a significant reduction of the serotonin levels after rehabilitation in the whole group (T0: 85.9 ± 92.4 ng/mL; T1: 61.9 ± 58.4 ng/mL; = 0.0018), as well as in the subgroup of patients untreated with Selective Serotonin Reuptake Inhibitors (SRRI), (mean serotonin at T0: 154.0 ± 102.3 ng/mL; mean serotonin at T1: 92.9. ± 68.7 ng/mL at T1; = 0.005). We also found a correlation with cognitive assessment: in particular, the change from baseline of the serotonin (ΔSerotonin) was correlated with the changes from baseline of the Rey's Figure (ΔROCF) ( = 0.535; < 0.05), the Tower of London (ΔToL) (subscore point: = 0.621; < 0.005; subscore time: r = -0.619; < 0.005) meaning that a serotonin levels decrease is associated with a worsening of cognitive functions. Considering patients treated and untreated with SSRIs separately, in patients treated with SSRIs ( = 16) we found only a positive correlation between ∆Serotonin and ∆ToL (subscore point: = 0.587; = 0.045), whereas in patients untreated with SSRIs ( = 13) we found a positive correlations between ΔSerotonin and ΔROCF ( = 0.700; = 0.036), ∆Stroop (subscore time: = 0.750; = 0.020) and ∆Tol (subscore point: = 0.740; = 0.023) and a negative correlation between ΔSerotonin and ∆Tol (subscore time: = -0.833; = 0.005). These results suggest that variation of serotonin levels should be monitored in patients during a rehabilitation program, not only for their relationship with depression symptoms, but also for the correlation with cognitive performance.
中风后抑郁和认知障碍是影响中风患者的常见病症。血清素是一种神经递质，尤其参与调节情绪、认知、学习和记忆。血清素活性欠佳可能部分导致了抑郁症中出现的认知缺陷。在这项初步研究中，对29例亚急性中风患者在康复治疗前后（康复治疗包括上肢机器人康复计划以及传统物理治疗）的血清素水平进行了评估。我们采用贝克抑郁量表来评估抑郁症状，并使用特定工具来评估认知功能。我们发现，整个组康复后血清素水平显著降低（T0：85.9±92.4纳克/毫升；T1：61.9±58.4纳克/毫升；P = 0.0018），在未接受选择性血清素再摄取抑制剂（SRRI）治疗的患者亚组中也是如此（T0时血清素均值：154.0±102.3纳克/毫升；T1时血清素均值：92.9±68.7纳克/毫升；P = 0.005）。我们还发现血清素水平与认知评估之间存在相关性：特别是，血清素的基线变化（Δ血清素）与雷伊图形的基线变化（ΔROCF）相关（r = 0.535；P < 0.05），与伦敦塔测试（ΔToL）相关（子评分点：r = 0.621；P < 0.005；子评分时间：r = -0.619；P < 0.005），这意味着血清素水平降低与认知功能恶化有关。分别考虑接受和未接受SSRIs治疗的患者，在接受SSRIs治疗的患者（n = 16）中，我们仅发现Δ血清素与ΔToL之间存在正相关（子评分点：r = 0.587；P = 0.045），而在未接受SSRIs治疗的患者（n = 13）中，我们发现Δ血清素与ΔROCF（r = 0.700；P = 0.036）、ΔStroop（子评分时间：r = 0.750；P = 0.020）和ΔTol（子评分点：r = 0.740；P = 0.023）之间存在正相关，以及Δ血清素与ΔToL（子评分时间：r = -0.833；P = 0.005）之间存在负相关。这些结果表明，在康复计划期间应对患者的血清素水平变化进行监测，不仅因为其与抑郁症状的关系，还因为其与认知表现的相关性。
