Depression after stroke and lesion location: a systematic review

Carson, Alan; MacHale, Siobhan; Allen, Katherine A.; Lawrie, Stephen M.; Dennis, Martin; House, Allan; Sharpe, Michael

doi:10.1016/s0140-6736(00)02448-x

Cited by 572 publications

(360 citation statements)

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“…Carson et al. (2000) have indicated that PSD is not associated with stroke lesion location. Narushima, Kosier, & Robinson (2003) have reported that the occurrence of PSD is associated with left frontal and left basal ganglia lesions when depression was assessed within 2 months after stroke.…”

Section: Discussionmentioning

confidence: 99%

“…Recent systematically review studies have also not identified the association between the presence or absence of PSD and the stroke lesion location. Two systematical review and meta‐analyses suggest that there is no relationship between risk of PSD and a specific location of stroke (Carson et al., 2000; Hadidi, Treat‐Jacobson, & Lindquist, 2009). Bhogal and colleagues conduct a systematic review and maintain that PSD is associated with the left brain hemispheric lesion after stroke onset (Bhogal, Teasell, Foley, & Speechley, 2004), while Yu and colleagues report a weak association between PSD and right brain hemispheric lesion after stroke onset (Yu et al., 2004).…”

Section: Introductionmentioning

confidence: 99%

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The association between lesion location, sex and poststroke depression: Meta‐analysis

et al. 2017

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BackgroundPoststroke depression (PSD) is a common form of stroke patients. Whether the risk of PSD is influenced by the stroke lesion location and sex remains a matter of debate. The objective of this study was to examine the association between the risk of PSD and the stroke lesion location and sex by performing a systematic meta‐analysis.MethodsSubgroup analyses were performed according to the time interval after stroke onset to assessment for PSD. A total of 31 reports involving 5,309 subjects (for lesion location analysis) and 5,489 subjects (for sex analysis) suffering from stroke were included in this meta‐analysis.ResultsThe pooled odds ratio (OR) of PSD after a left‐hemisphere stroke, compared with a right‐hemisphere stroke was 1.11 (95% confidence interval [CI] 0.82–1.49) and OR of PSD after a male stroke, compared with a female stroke was 0.68 (95% CI 0.58–0.81). Subacute poststroke subgroup (1–6 months) significantly favored PSD occurring after a left hemisphere stroke (OR = 1.50, 95% CI 1.21–1.87). Furthermore, there was a statistically significant association between PSD and female stroke for studies with acute poststroke group (OR = 0.73, 95% CI 0.62–0.86) and subacute poststroke stroke phase (OR = 0.69, 95% CI 0.56–0.86).ConclusionsThis systematic review suggests that patients with left hemisphere stroke may be more susceptible to PSD during subacute phase of stroke and female stroke may be more susceptible to PSD during acute and subacute phase of stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The association between lesion location, sex and poststroke depression: Meta‐analysis

et al. 2017

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“…Duas revisões sistemáticas concluíram que não é possível estabelecer um consenso quanto à associação da DPAVC e a localização do AVC até o momento 71,72 . Embora haja divergências entre os resultados das pesquisas sobre os correlatos neuroanatômicos, há uma tendência em aceitar que os infartos localizados no pólo frontal esquerdo e nos gânglios da base do hemisfério esquerdo estão associados a uma maior frequência e maior gravidade de depressão no período agudo pós-AVC 73 .…”

Section: Localização Do Avcunclassified

Depressão pós-AVC: aspectos psicológicos, neuropsicológicos, eixo HHA, correlato neuroanatômico e tratamento

Terroni

Mattos

Sobreiro³

et al. 2009

Rev. psiquiatr. clín.

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ResumoContexto: A depressão pós-AVC (DPAVC) possui uma prevalência elevada. Apesar disso, ela é pouco detectada e tratada. Muitos fatores de risco e repercussões negativas na recuperação dos pacientes estão associados à DPAVC. Objetivo: Revisar alguns aspectos da DPAVC como: qualidade de vida, prejuízos cognitivos, eixo HHA, localização do AVC e tratamento. Métodos: Pesquisa dos últimos 10 anos da base de dados MedLine/PubMed usando as palavraschave post-stroke depression, stroke, quality of life, hypercortisolism, cogntitive dysfunction e treatment. Resultados: A prevalência de DPAVC é de 23% a 60%. Há poucos estudos sobre a incidência de DPAVC. A DPAVC está associada a pior prognóstico e evolução, agravo das disfunções cognitivas e redução da qualidade de vida. O hipercortisolismo está associado à DPAVC que ocorre tardiamente ao AVC. AVC em gânglios da base, região frontal esquerda e estruturas do circuito prefrontosubcortical está relacionado à frequência e à gravidade da DPAVC. Conclusões: É necessário melhoria na metodologia dos estudos para maior esclarecimento sobre a fisiopatologia da incidência da DPAVC. Programas objetivando o aumento das taxas de detecção dos pacientes deprimidos se fazem necessários inclusive para a redução dos impactos negativos na recuperação desses pacientes.Terroni LMN, et al. / Rev Psiq Clín. 2009;36(3):100-8 Palavras-chave: depressão pós-AVC, acidente vascular cerebral, qualidade de vida, disfunção cognitiva, hipercortisolismo, tratamento. AbstractBackground: The prevalence of post-stroke depression (PSD) is elevated. Some risk factors and poor outcome have been associated with PSD. The treatment of PSD reduced the negative impact in patients recovery. Appart from these data the PSD has been under diagnosed and under treated. Objective: Review some aspects such as quality of life, cognitive dysfunction, hypercortisolism, stroke localization and treatment of PSD. Methods: MedLine/PubMed database search using the terms post-stroke depression, stroke, quality of life, hypercortisolism, cognitive dysfunction and treatment, published in MedLine in the last 10 years. Results: PSD has a high rate of prevalence, from 23% to 60%. Few incidence rates are investigated. PSD is associated with poor outcome, increase of cognitive dysfunction and reduced quality of life. The hypercortisolism seems to be associated with PSD in the latter period of stroke. Stroke in the left frontal region, basal ganglia and some structures of prefrontosubcortical circuits have been related with

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“…17,19 In both PSD (which the DSM would categorize as depression secondary to a general medical illness [stroke]) and poststroke anxiety, a relationship to the anatomical location of the lesion has been proposed. 33 Some studies have linked PSD with left-sided anterior lesions and lesions to the left basal ganglia, 14 whereas others have found that some emotional reactions to stroke are correlated with right-sided lesions. 31 Others have found that a relationship between PSD and lesions of the anterior frontal cortex is independent of laterality or size of the lesion.…”

Section: How Do We Distinguish Psychological Reactions From Neuropsycmentioning

confidence: 99%

“…15,33,36,37 In a study comparing cognitive behavioral therapy (CBT) 38 and paroxetine as treatments for depression, Goldapple and colleagues 36 found that CBT and psychotropic medications may initially affect similar brain pathways.…”

Section: How Do We Distinguish Psychological Reactions From Neuropsycmentioning

confidence: 99%

The Recognition and Management of Psychological Reactions to Stroke

Chriki¹,

Bullain²,

Stern³

2006

Prim. Care Companion CNS Disord.

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ROUNDS IN THE GENERAL HOSPITALPrimwho is likely to cope poorly with physical impairments? Have you wondered how you can distinguish psychological reactions from neuropsychiatric and neurologic reactions? If you have, then the following case vignette (of a man who developed poststroke depression) should provide the forum for answers to these and other questions related to the psychological sequelae of stroke and comorbid neuropsychiatric syndromes. Cerebrovascular accidents (CVAs) disable thousands of people each year and are a major cause of death in this country. 1 CVAs lead to physical limitations in daily living and to psychological disorders, expressed in alterations to an individual's behavior and emotion. 2 However, in the recovery process after stroke, many patients and their caregivers focus on the patient's physical disabilities and fail to appreciate that the psychological complications of stroke can hinder a patient's recovery. Psychological reactions to stroke are manifested in myriad ways in the days, months, and years after a stroke. [2][3][4][5][6][7] Although not every patient develops intense emotional responses to stroke, those who do often have risk factors that make them more vulnerable to psychological consequences. 3,4,[8][9][10][11] Attention paid to those patients who may benefit from psychotherapeutic treatments as well as from psychotropic medications can facilitate effective treatment.The patient we present sustained a stroke and had severe psychological reactions to it. We will highlight symptom recognition, review the risk factors for distress and dysfunction, and discuss the treatment of psychological reactions to stroke. Case VignetteMr. B, a previously healthy, right-handed, 60-year-old man, suffered a CVA in his sleep. A sudden noise awakened him; his head ached, and he realized that he could barely move his right arm. Despite this, he managed to call for an ambulance. On arrival at the emergency room, his vital signs revealed a heart rate of 120 beats per minute, a respiratory rate of 26 breaths per minute, and a blood pressure reading of 172/112 mm Hg. The physical examination revealed decreased muscle tone, 1/5 muscle strength, and hyperreflexia in the right arm. A noncontrast computed tomography scan of Mr. B's head confirmed the diagnosis of stroke. Results of the rest of his examination were within normal limits. After 4 days in the hospital, Mr. B was discharged to his home and began a course of physical therapy as arranged by his family practitioner. Mr. B struggled to carry out the basic activities of daily living (ADLs); he had difficulty dressing himself and preparing his own food, and he was unable to write.

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Depression after stroke and lesion location: a systematic review

Cited by 572 publications

References 32 publications

The association between lesion location, sex and poststroke depression: Meta‐analysis

The association between lesion location, sex and poststroke depression: Meta‐analysis

Depressão pós-AVC: aspectos psicológicos, neuropsicológicos, eixo HHA, correlato neuroanatômico e tratamento

The Recognition and Management of Psychological Reactions to Stroke

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