Herrmann N, Black S E, Lawrence J, Szekely C, Szalai J P
Department of Psychiatry, Sunnybrook Health Science Centre and University of Toronto, North York, Ontario, Canada.
Stroke. 1998 Mar;29(3):618-24. doi: 10.1161/01.str.29.3.618.
To assess the prevalence of depressive symptoms, their clinical correlates, and the effects of depressive symptoms on stroke recovery, a relatively unselected, well-diagnosed cohort of consecutive stroke survivors was followed prospectively.
Consecutive admissions to a regional stroke center who met World Health Organization and National Institute of Neurological Disorders and Stroke criteria for stroke were eligible. Subarachnoid hemorrhage and brain stem strokes were excluded. Patients underwent CT, single-photon emission CT, and standardized neurological and cognitive examinations at entry. At 3 months and 1 year after stroke, depressive symptoms were assessed with the Montgomery Asberg Depression Rating Scale (MADRS) and the Zung Self-Rating Depression Scale (SDS). Functional outcome was measured with the Functional Independence Measure, and handicap was assessed by the Oxford Handicap Scale.
We assessed 436 patients at entry (mean +/- SD age, 74.9 +/- 11.6 years). There were 150 patients available for assessment at 3 months and 136 at 1 year. Marked depressive symptoms were noted in 22% (SDS) to 27% (MADRS) at 3 months and 21% (SDS) to 22% (MADRS) at 1 year. Patents with marked depressive symptoms had more neurological impairment (P<.008), were more likely to be female (P<.05), and were more likely to have previous histories of depression (P<.03). There was no relationship between depressive symptoms and age, lesion volume, or side of lesion. Depressive symptoms were correlated with functional outcome (r = -.31, P<.0001) and handicap (r = .41, P<.0001) at 3 months and 1 year (r= -.28, P<.001; r = .35, P<.0001).
Depressive symptoms and functional outcome are correlated. In view of the prevalence of depressive symptoms in this population, diagnosis and treatment of depression are important in optimizing recovery.
为评估抑郁症状的患病率、其临床相关因素以及抑郁症状对中风恢复的影响，我们对一组相对未经筛选、诊断明确的连续性中风幸存者队列进行了前瞻性随访。
符合世界卫生组织及美国国立神经疾病与中风研究所中风标准的连续入住某地区中风中心的患者符合条件。蛛网膜下腔出血和脑干中风患者被排除。患者入院时接受了CT、单光子发射CT以及标准化的神经和认知检查。在中风后3个月和1年，使用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）和zung自评抑郁量表（SDS）评估抑郁症状。使用功能独立性测量量表测量功能结局，并通过牛津残疾量表评估残疾情况。
我们在入院时评估了436例患者（平均年龄±标准差为74.9±11.6岁）。3个月时150例患者可供评估，1年时136例可供评估。3个月时，22%（SDS）至27%（MADRS）的患者有明显抑郁症状；1年时，21%（SDS）至22%（MADRS）的患者有明显抑郁症状。有明显抑郁症状的患者神经功能损害更严重（P<0.008），更可能为女性（P<0.05），且更可能有抑郁症病史（P<0.03）。抑郁症状与年龄、病变体积或病变部位无关。抑郁症状与3个月和1年时的功能结局（r=-0.31，P<0.0001）和残疾情况（r=0.41，P<0.0001）相关（3个月时r=-0.28，P<0.001；1年时r=0.35，P<0.0001）。
抑郁症状与功能结局相关。鉴于该人群中抑郁症状的患病率，抑郁症的诊断和治疗对于优化恢复情况很重要。
