Functional and Neuroanatomic Correlations in Poststroke Depression

Abstract

Background and Purpose-The purpose of our study was to determine the functional and neuroanatomic correlates of poststroke depressive symptoms. Methods-Patients with consecutive admissions to a regional stroke center for new-onset unilateral hemispheric stroke who met World Health Organization and National Institute of Neurological and Communicative Disorders and Stroke criteria were eligible for inclusion in a longitudinal study. Acutely, patients underwent CT scanning, and at 3 months and 1 year after stroke, depressive symptoms were assessed by using both the Montgomery-Asberg Depression Rating Scale and the Zung Self-Rating Depression Scale. The Functional Independence Measure (FIM) served as an indication of functional outcome and was obtained at 1 month, 3 months, and 1 year after stroke, along with other demographic information. The Talairach and Tournoux stereotactic atlas was used for the primary determination of CT lesion localization. Lesion proximity to the anterior frontal pole was also measured. Results-Eighty-one patients participated in the longitudinal study. Stepwise linear regression analyses generated a highly significant model (F 3,76 ϭ9.8, R 2 ϭ28%, PϽ0.0005), with lower 1-month total FIM scores, living at home, and damage to the inferior frontal region predicting higher depression scores at 3 months. Similarly, lower 3-month total FIM scores correlated with higher 3-month depression scores, and lower 1-year total FIM scores correlated with higher 1-year depression scores. Conclusions-Functional measures correlated with poststroke depression across time and, together with neuroanatomic measures, predicted depressive symptoms longitudinally. Although inferior frontal lesion location, irrespective of side, appeared to play a role as a risk factor in this study, the degree of functional dependence after stroke imparted the greatest risk. (Stroke. 2000;31:637-644.)

Pre-morbid personality and depression following stroke

“…However, findings with respect to lesion location have been contradictory. Early findings by Robinson and colleagues, which demonstrated post-stroke depression occurred more commonly in patients with leftsided lesions , have not been replicated by later studies (Singh et al, 2000). A number of studies have shown that post-stroke depression shares risk factors in common with Major Depression occurring in other circumstances, including female gender and past personal and family history of depression (Gall, 2001).…”

Rehabilitation Programs monitored by Functional Independence Measure: An Observational Study

“…19 Additionally, it has been indicated that lower FIM scores correlate with higher depression scores. 20 There also are some critical voices indicating that a specific rehabilitation is not well represented by FIM such as the improvement of the upper limb function after stroke. 21 It has been suggested that the International Classification of Functioning, Disability and Health (ICF) is probably more comprehensive than FIM in describing both capacity and performance in stroke patients.…”

An association between the location of white matter changes and the behavioral and psychological symptoms of dementia in Alzheimer's disease patients

“…MRI studies reveal that major depressive disorder may involve pathological changes of the temporal and frontal lobes, including the superior temporal gyrus, the hippocampus, the amygdala, the anterior cingulate gyrus, and the orbitofrontal area [22] . Involvement of the frontal lobe and infarcts on frontal subcortical circuits are also an independent predictor of the development of post-stroke depression [23][24][25] . Medial pre-frontal networks that are connected to the medial pre-frontal cortex and the medial as well as the caudo-lateral orbital cortex are involved in the neural networks related to depressive episodes [26] .…”