Dimensions of Poststroke Depression and Neuropsychological Deficits in Older Adults

Kanellopoulos, Dora; Wilkins, Victoria M.; Avari, Jimmy; Oberlin, Lauren E.; Arader, Lindsay; Chaplin, Merete; Banerjee, Samprit; Alexopoulos, George S.

doi:10.1016/j.jagp.2020.01.009

Cited by 18 publications

(17 citation statements)

References 57 publications

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“…These results are consistent with preliminary evidence that important correlates of post-stroke depression (eg, cognitive deficits, use of rehabilitation of services) may be specific to certain depressive symptoms. 12,13 There is also preliminary evidence that interventions targeting specific dimensions of post-stroke depression (eg, behavioral activation for anhedonia) may lead to improved therapeutic outcomes compared to usual care, 35,36 further supporting the potential benefit of examining dimensions of post-stroke depression rather than just total scale scores. According to studies applying the network theory of psychopathology to post-stroke depression, 37,38 biological, psychological, and social risk factors likely interact in complex and dynamic ways to contribute to and maintain post-stroke depressive symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 The multidimensionality of depression has been increasingly considered in studies of neurologically healthy individuals, 9 but has received less consideration in studies that investigate the natural course of post-stroke depression, which may obfuscate important differences between the longitudinal trajectories and/or interrelationships of depression symptom dimensions. For example, somatic symptoms such as fatigue may be more prominent and persistent than other depression symptoms after a stroke, 10,11 anhedonia/apathy may be uniquely associated with post-stroke cognitive deficits, 12 and negative affect and motivational deficits (eg, anhedonia) may be associated with less efficient use of rehabilitation services. 13 Elucidating how different symptom dimensions interact and change following a stroke can help elucidate different psychological mechanisms of depression, identify at-risk individuals, and highlight novel, more specific intervention targets.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal Trajectories of Post-Stroke Depression Symptom Subgroups

Ashaie

Funkhouser

Jabbarinejad

et al. 2022

Neurorehabil Neural Repair

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Background Post-stroke depressive symptoms are prevalent and impairing, and elucidating their course and risk factors is critical for reducing their public health burden. Previous studies have examined the course of post-stroke depression, but distinct depressive symptom dimensions (eg, somatic symptoms, negative affect [eg, sadness], anhedonia [eg, loss of interest]) may vary differently over time. Objective The present study examined within-person and between-person associations between depressive symptom dimensions across 3 timepoints in the year following discharge from in-patient rehabilitation hospitals, as well as the impact of multiple clinical variables (eg, aphasia). Methods Stroke survivors completed the Center for Epidemiologic Depression Scale (CES-D) at discharge from post-stroke rehabilitation (“T1”) and at 3-month (“T2”) and 12-month (“T3”) follow-ups. Scores on previously identified CES-D subscales (somatic symptoms, anhedonia, and negative affect) were calculated at each timepoint. Random intercept cross-lagged panel model analysis examined associations between symptom dimensions while disaggregating within-person and between-person effects. Results There were reciprocal, within-person associations between somatic symptoms and anhedonia from T1 to T2 and from T2 to T3. Neither dimension was predictive of, or predicted by negative affect. Conclusions The reciprocal associations between somatic symptoms and anhedonia may reflect a “vicious cycle,” and suggest these 2 symptom dimensions may be useful indicators of risk and/or intervention targets. Regularly assessing depression symptoms starting during inpatient rehabilitation may help identify stroke survivors at risk for depression symptoms and facilitate early intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Longitudinal Trajectories of Post-Stroke Depression Symptom Subgroups

Ashaie

Funkhouser

Jabbarinejad

et al. 2022

Neurorehabil Neural Repair

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“…7 In the context of this study, we tested the hypothesis that separating the MADRS into apathy and depression subscales would yield a better fit to the observed data compared to taking all the items on the MADRS to represent a unitary depressive construct. Previous studies have found support for a multi-factorial structure of the MADRS that included apathy in stroke patients, 8 but not in Parkinson's disease. 9 Importantly, CFA alone does not assess whether patients have apathy or depression per se, but rather identify whether patterns of responding on certain items are correlated.…”

Section: Clinical Measures and Confirmatory Factor Analysismentioning

confidence: 98%

Does fluoxetine reduce apathetic and depressive symptoms after stroke? An analysis of the Efficacy oF Fluoxetine—a randomized Controlled Trial in Stroke trial data set

Tay

Mårtensson

Markus

et al. 2022

International Journal of Stroke

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Objective. Apathy is a common and disabling symptom after stroke with no proven treatments. Selective serotonin reuptake inhibitors are widely used to treat depressive symptoms post stroke but whether they reduce apathetic symptoms is unknown. We determined the effect of fluoxetine on post stroke apathy in a post-hoc analysis of the EFFECTS (Efficacy oF Fluoxetine - a randomisEd Controlled Trial in Stroke) trial. Methods. EFFECTS enrolled patients >=18 years between 2-15 days after stroke onset. Participants were randomly assigned to receive oral fluoxetine 20 mg once daily or matching placebo for 6 months. The Montgomery-Åsberg Depression Rating Scale (MADRS) was administered at baseline and 6 months. Individual items on this scale were divided into those reflecting symptoms of apathy and depression. Symptoms were compared between fluoxetine and placebo groups. Results. Of 1500 participants enrolled, complete MADRS data was available for 1369. The modified intention-to-treat population included 681 patients in the fluoxetine group and 688 in the placebo group. Confirmatory factor analysis revealed that apathic, depressive, and anhedonic symptoms were dissociable. Apathy scores increased in both fluoxetine and placebo groups (both P≤0.00001). In contrast fluoxetine was associated with a reduction in depressive scores, (P=0.002) Conclusions. Post-stroke apathetic and depressive symptoms respond differently to fluoxetine treatment. Our analysis suggests fluoxetine is ineffective in preventing post-stroke apathy.

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“…It is estimated that nearly 1% of the world's population lives with the sequelae of cerebrovascular events [ 38 ]. Impaired motor control [ 39 ], general cognitive deficits [ 40 – 42 ], difficulties with speech production or processing [ 43 ], and altered mood states [ 44 ] are common debilitating effects of stroke [ 45 ]. For patients with poststroke motor dysfunction, rehabilitation interventions fall into two categories.…”

Section: Bci Applications In Nerve Rehabilitation After Strokementioning

confidence: 99%

Exploring the Use of Brain-Computer Interfaces in Stroke Neurorehabilitation

Yang

et al. 2021

BioMed Research International

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With the continuous development of artificial intelligence technology, “brain-computer interfaces” are gradually entering the field of medical rehabilitation. As a result, brain-computer interfaces (BCIs) have been included in many countries’ strategic plans for innovating this field, and subsequently, major funding and talent have been invested in this technology. In neurological rehabilitation for stroke patients, the use of BCIs opens up a new chapter in “top-down” rehabilitation. In our study, we first reviewed the latest BCI technologies, then presented recent research advances and landmark findings in BCI-based neurorehabilitation for stroke patients. Neurorehabilitation was focused on the areas of motor, sensory, speech, cognitive, and environmental interactions. Finally, we summarized the shortcomings of BCI use in the field of stroke neurorehabilitation and the prospects for BCI technology development for rehabilitation.

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Dimensions of Poststroke Depression and Neuropsychological Deficits in Older Adults

Cited by 18 publications

References 57 publications

Longitudinal Trajectories of Post-Stroke Depression Symptom Subgroups

Longitudinal Trajectories of Post-Stroke Depression Symptom Subgroups

Does fluoxetine reduce apathetic and depressive symptoms after stroke? An analysis of the Efficacy oF Fluoxetine—a randomized Controlled Trial in Stroke trial data set

Exploring the Use of Brain-Computer Interfaces in Stroke Neurorehabilitation

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