Clinically Relevant Depressive Symptoms in Young Stroke Patients - Results of the sifap1 Study

Abstract

Background: Although post-stroke depression is widely recognized, less is known about depressive symptoms in the acute stage of stroke and especially in young stroke patients. We thus investigated depressive symptoms and their determinants in such a cohort. Methods: The Stroke in Young Fabry Patients study (sifap1) prospectively recruited a large multinational European cohort (n = 5,023) of patients with a cerebrovascular event aged 18-55. For assessing clinically relevant depressive symptoms (CRDS, defined by a BDI-score ≥18) the self-reporting Beck Depression Inventory (BDI) was obtained on inclusion in the study. Associations with baseline parameters, stroke severity (National Institutes of Health Stroke Scale, NIHSS), and brain MRI findings were analyzed. Results: From the 2007 patients with BDI documentation, 202 (10.1%) had CRDS. CRDS were observed more frequently in women (12.6 vs. 8.2% in men, p < 0.001). Patients with CRDS more often had arterial hypertension, diabetes mellitus, and hyperlipidemia than patients without CRDS (hypertension: 58.0 vs. 47.1%, p = 0.017; diabetes mellitus: 17.9 vs. 8.9%, p < 0.001; hyperlipidemia: 40.5 vs. 32.3%, p = 0.012). In the subgroup of patients with ischemic stroke or TIA (n = 1,832) no significant associations between CRDS and cerebral MRI findings such as the presence of acute infarcts (68.1 vs. 65.8%, p = 0.666), old infarctions (63.4 vs. 62.1%, p = 0.725) or white matter hyper-intensities (51.6 vs. 53.7%, p = 0.520) were found. Conclusion: Depressive symptoms were present in 10.1% of young stroke patients in the acute phase, and were related to risk factors but not to imaging findings.

Imaging Markers of Post-Stroke Depression and Apathy: a Systematic Review and Meta-Analysis

“…Based on full-text evaluation of the remaining articles, 135 articles met inclusion criteria. Reasons for exclusion were: conference abstract (Akiashvili et al 2013 ), research protocol (Toso et al 2004 ), review article (Beckson and Cummings 1991 ; Robinson and Starkstein 1989 ), small sample size (Beblo et al 1999 ; Grasso et al 1994 ; Lassalle-Lagadec et al 2012 , 2013 ; Matsuoka et al 2015 ; Mayberg et al 1988 ; Paradiso et al 2013 ; Ramasubbu et al 1999 ), other outcome than depression or apathy (Astrom 1996 ; Downhill and Robinson 1994 ; Vataja et al 2005 ), study population other than stroke or no separate results available for stroke subpopulation (Bella et al 2010 ; Grool et al 2013 ; O’Brien et al 2006 ; Ojagbemi et al 2013 ; Sachdev et al 2007 ; Tanislav et al 2015 ; Wu et al 2014 ), and no evaluation of imaging markers (Eriksen et al 2016 ). Fourteen additional studies found in reference lists and fulfilling eligibility criteria were included, resulting in a total of 149 studies.…”

Accelerated development of cerebral small vessel disease in young stroke patients

“…A large MRI study in patients younger than 55 with a stroke found no association between depression and MRI characteristics of SVD. 29 However, both MRI and assessment of depression took place within 10 days after stroke. Patients may develop both SVD and depression during follow-up, which determines poststroke functioning.…”

Frequency and predictors of acute ischaemic lesions on brain magnetic resonance imaging in young patients with a clinical diagnosis of transient ischaemic attack

“…The multinational sifap1 study (47 centres in 15 European countries) prospectively recruited (between April 2007 and January 2010) 5023 patients aged 18 to 55 years with a CVE to establish the prevalence of Fabry disease. Details of this study have been published previously . The study was approved by the ethics committees at the leading centre and at each study site.…”

“…The following vascular risk factors were considered: diabetes, arterial hypertension, dyslipidaemia, tobacco use and cardiovascular disease. Cardiovascular disease was considered when one of the following conditions was fulfilled: ischaemic coronary artery disease, myocardial infarctions, peripheral artery occlusive disease, congestive heart failure and valvular heart disease . The following parameters documented in the case report form were included in the analysis: presenting symptoms, ultrasound data from brain supplying arteries (including stenoses and occlusions), previous CVE, prior TIA, atrial fibrillation, snoring and obstructive sleep apnoea .…”

“…This risk might increase dramatically in those TIA patients with acute ischaemic lesions, as observed on diffusion‐weighted imaging (DWI) on brain magnetic resonance imaging (MRI) . Recent studies on young stroke patients provided detailed information on age and gender distribution, risk factors, aetiological factors and imaging findings . They emphasized the limitation in translating knowledge from general stroke populations to the specific subgroup of younger stroke patients .…”