Development of Post-Stroke Cognitive and Depressive Disturbances: Associations with Neurohumoral Indices

Abstract

Neuropsychiatric complications, in particular cognitive and depressive disorders, are common consequences of ischemic stroke (IS) and complicate the rehabilitation, quality of life, and social adaptation of patients. The hypothalamic–pituitary–adrenal (HPA) system, sympathoadrenal medullary system (SAMS), and inflammatory processes are believed to be involved in the pathogenesis of these disorders. This study aimed to explore these systems in IS patients, including those with post-stroke cognitive and depressive disorders, within a year after IS. Indices of the HPA axis, inflammatory system, and SAMS were measured in blood serum (cortisol, interleukin-6 (IL-6)), plasma (adrenocorticotropic hormone), and saliva (cortisol, α-amylase). During one year after mild/moderate IS (NIHSS score 5.9 ± 4.3), serum cortisol and salivary α-amylase levels remained elevated in the total cohort. In the group with further cognitive decline, serum and salivary cortisol levels were elevated during the acute period of IS. In the group with poststroke depressive disorder, salivary α-amylase was constantly elevated, while serum IL-6 was minimal during the acute period. The results suggest prolonged hyperactivation of the HPA axis and SAMS after IS. Specifically, post-stroke cognitive impairment was associated with hyperactivation of the HPA axis during the acute IS period, while post-stroke depressive disorder was associated with the chronic inflammatory process and hyperactivation of SAMS during the follow-up period.

Explainable Risk Prediction of Post-Stroke Adverse Mental Outcomes Using Machine Learning Techniques in a Population of 1780 Patients

“…The study population comprised 1780 patients who had been admitted for ischemic or hemorrhagic stroke to a tertiary care hospital, each of whom had completed an anxiety or depression screening assessment within 7–37 days from the time of stroke. The time window facilitated the inclusion of patients who had been stabilized after acute stroke management, and it was consistent with the 30-day window of prediction in the literature for identifying PSAMO during stroke recovery [ 27 , 28 , 29 , 30 ]. Baseline characteristics, including demographics, social information (e.g., occupation, educational level, etc.…”

Post-stroke arrhythmia could be a potential predictor for post-stroke depression

“…Plenty of studies focused on the association between lesion location and PSD, however the results are quite controversial and make the prediction of PSD based on the characteristics of infarctions on brain images quite unreliable 9 – 11 . Now it seems to be a consensus that PSD is not just a result of stroke in some special locations, but is caused by dysfunction of multiple networks involving the process of cognition, mood, immune and autonomic nervous system 12 , 13 .…”