Cognitive improvement after treatment of depressive symptoms in the acute phase of stroke

Abstract

-The outcome of antidepressant treatment for depressive symptoms and cognitive impairm e n t at the acute phase of stroke is controversial. We investigated 93 patients, treating with citalopram 36 with s e v e re depressive symptoms (HAM-D: Hamilton Depression Rating Scale ≥18), whilst 19 patients with mild d e p ressive symptoms, and 38 non-depressed patients, remained untreated. At baseline (two weeks after s t roke), patients with severe depressive symptoms had lower scores in total Dementia Rating Scale (DRS) and in the attention and memory DRS subscales, than the non-depressed patients (p≤0.001). At the end of the three-month follow-up period, these diff e rences had disappeared, but patients initially with mild d e p ressive symptoms had higher HAM-D scores than the non-depressed patients (p=0.015), and lower s c o res in DRS attention and memory subscales (p<0.01), than the patients treated with citalopram. Tre a t m e n t was associated with improved mood, memory and attention, and a placebo-controlled study on the tre a tment of mild depressive symptoms is warranted.KEY WORDS: post-stroke depression, treatment, vascular cognitive impairment, vascular dementia.Melhora cognitiva com tratamento antidepressivo na fase aguda do acidente vascular cere b r a l RESUMO -Os resultados do tratamento com antidepressivo para os sintomas depressivos e compro m e t imento cognitivo da fase aguda do acidente vascular cerebral não estão estabelecidos. Investigamos 93 pacientes, 36 com sintomas depressivos graves (HAM-D: Escala de Depressão de Hamilton ≥18) foram tratados com citalopram, enquanto 19 pacientes com sintomas depressivos leves e 38 não-deprimidos não foram tratados. Ao início do tratamento (duas semanas depois do icto), pacientes com sintomas depressivos graves tinham escores mais baixos na Escala de Avaliação de Demência (DRS) total e nas subescalas de atenção e de memória da DRS do que os pacientes não-deprimidos (p≤0,001). Ao fim de três meses de acompanhamento essas diferenças tinham desaparecido, mas pacientes que inicialmente tinham sintomas depre s s i v o s leves passaram a ter escores mais altos no HAM-D do que os não-deprimidos (p=0,015), e escores mais baixos nas subescalas de atenção e memória da DRS (p<0,01) do que os pacientes tratados com citalopram. O tratamento associou-se a melhora de humor, memória e atenção, e demonstra que é necessário um estudo controlado com placebo para o tratamento de sintomas depressivos leves.PA L AV R A S -C H AVE: acidente vascular cerebral, depressão, tratamento, comprometimento cognitivo vascular, demência vascular.

Effects of aquatic exercise on depression and anxiety in ischemic stroke subjects

“…However, there was no pharmacological support, which can be considered as a positive result. In the study of Simis and Nitrini [43], where pharmacological support was used, after three months of follow up, patients who initially had mild depressive symptoms began to have higher values, where treatment was associated with improved mood, memory and attention. A prospective study with 3525 subjects, aged between 65 and 84 years, in several Italian cities, showed that older people tend to an increased risk of depression caused mainly by declining physical condition [44], thus corroborating the results of this study where inactive people tend to have an increased rate of depression.…”

Management of patients with stroke: Is it time to expand treatment options?

“…70 Small clinical studies have tested the utility of the antidepressant medications to improve recovery of patients with recent stroke. 50,59,60,[71][72][73][74][75][76][77][78][79][80][81] Although data are not definitive, the results generally are positive. The most important data are from the FLAME study, which was a randomized, double-blind, placebo-controlled trial of fluoxetine (20mg daily) initiated within 5 to 10 days after stroke and continued for 3 months.…”

“…Small clinical studies have tested the utility of the antidepressant medications to improve recovery of patients with recent stroke . Although data are not definitive, the results generally are positive.…”

Electroconvulsive therapy: is there a role for treating older patients?

“…However, to understand the effect of ECT on cognition, it is important to consider the neuropsychological effects of depression itself. 30,31 It seems reasonable to assume that cognitive function should similarly improve with ECT treatment in patients with depression, with or without dementia. Clinical, epidemiological and neuroimaging evidence suggest that late-life depression is associated with structural changes in the frontostriatal network that form the basis for many of the neuropsychological deficits.…”