Post-Stroke Apathy and Hypoperfusion in Basal Ganglia: SPECT Study

Onoda, Keiichi; Kuroda, Yoko; Yamämoto, Yasushi; Abe, Satoshi; Oguro, Hiroaki; Nagai, Atsushi; Bokura, Hirokazu; Yamaguchi, Shûhei

doi:10.1159/000319771

Cited by 63 publications

(46 citation statements)

References 77 publications

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“…[33][34][35][36][37][38][39][40][41][42] Assessment of the risk of bias per study is provided in Appendix SIII in the online-only Data Supplement.…”

Section: Poststroke Apathy 853mentioning

confidence: 99%

Poststroke Apathy

Dalen

Charante

Nederkoorn

et al. 2013

Stroke

131

123

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“…[33][34][35][36][37][38][39][40][41][42] Assessment of the risk of bias per study is provided in Appendix SIII in the online-only Data Supplement.…”

Section: Poststroke Apathy 853mentioning

confidence: 99%

Poststroke Apathy

Dalen

Charante

Nederkoorn

et al. 2013

Stroke

131

123

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“…Recent studies on post-stroke apathy were performed using validated apathy scales [4,5,6,7,8]. Post-stroke apathy is a disabling symptom present in 20-55% of stroke survivors [6,7,9,10,11,12,13,14,15].…”

Section: Introductionmentioning

confidence: 99%

Post-Stroke Apathy: An Exploratory Longitudinal Study

Caeiro

Ferro²,

Melo³

et al. 2013

Cerebrovasc Dis

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Introduction: Post-stroke apathy is a disturbance of motivation evidenced by low initiative, difficulties in starting, sustaining or finishing any goal-directed activity, low self-activation or self-initiated behavior and emotional indifference. Apathy is a common behavioral disturbance in stroke survivors. We aimed to analyze the relationship between post-stroke apathy at 1 year after stroke and (1) apathy in acute phase; (2) demographic, pre-stroke predisposing conditions (previous mild cognitive impairment, alcohol abuse, mood/anxiety disorder) and clinical features (stroke type and location, neurological symptoms); (3) post-stroke depression and post-stroke cognitive impairment, and (4) post-stroke functional outcome, quality of life and the perception of health. Methods: Consecutive stroke (infarct/intracerebral hemorrhage) patients without aphasia or consciousness disturbances were included in the acute phase of stroke and assessed at 1 year after stroke. We assessed apathy with the clinically rated version of the Apathy Evaluation Scale. We also assessed post-stroke depression (Montgomery Asberg Depression Rating Scale) and post-stroke cognitive impairment (attention, mental flexibility, verbal, motor and graphomotor initiative, and non-verbal and verbal abstract reasoning, and Mini-Mental State Examination), functional outcome (Barthel Index), quality of life and perception of health (EuroQol). Data were analyzed using bivariate associations (χ² and t test) and stepwise multivariate analysis. Results: We included 76 stroke patients [32.9% women, mean age 62.9 years (SD = 10.9) and a mean of 6.9 (SD = 4.3) years of education]. Apathy was present in 17 patients in the acute phase and in 18 (23.7%) patients at 1 year after stroke. At 1 year after stroke, 41% of the acute apathetic patients remained apathetic. Sixty-one percent of new cases of post-stroke apathy were detected. Post-stroke apathy was associated only with previous cognitive impairment, apathy in acute stroke, post-stroke cognitive impairment, verbal abstract reasoning and with worse Barthel Index scale scores. In the multivariate logistic regression model, verbal abstract reasoning (odds ratio, OR = 7.03) and apathy in acute stroke (OR = 3.8) were identified as independent factors for post-stroke apathy at 1 year. Apathetic patients did not report worse quality of life or health. Conclusion: Apathy in acute stroke phase was a reliable indicator of post-stroke apathy. Apathy should be assessed in both phases. Verbal abstract reasoning impairment was also an independent factor for post-stroke apathy impairing patients' ability to reason about goal-directed activity. Even though apathetic patients had worse post-stroke functional outcome, they did not report losing quality of life or having worse health.

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“…Research on PSD has primarily focused on determining its etiopathogenic factors [27] and prevalence [28]. Only a few studies have addressed the psychopathology and diagnosis of major depression (MD) for patients with depressive symptoms after stroke and fewer have compared the symptoms of PSD and MD in the absence of clinical comorbidity [29,30,31,32,33,34,35,36,37,38,39].…”

Section: Introductionmentioning

confidence: 99%

Is Poststroke Depression a Major Depression?

Silva

Brasil²,

Nascimento³

et al. 2013

Cerebrovasc Dis

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Background: Poststroke depression (PSD) is the most common neuropsychiatric consequence of stroke. A large number of studies have focused on the pathogenesis of PSD, but only a few aimed to characterize its psychopathology; these studies yielded results that are difficult to compare because of the different methods utilized. The current study aimed to characterize the symptom profile of PSD in an attempt to better understand the disease and allow a more accurate diagnosis. Methods: The study sample comprised 64 patients divided into three groups: stroke patients without diagnosis of depression (n = 33), stroke patients diagnosed with PSD (PSD group, n = 14) and patients diagnosed with major depression (MD) but with no clinical comorbidity (MD group, n = 17). All patients were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). The initial diagnostic interview was complemented by the Mini Mental State Examination (MMSE), the Rankin Scale, and four scales for the assessment of the intensity of symptoms of anxiety and depression: the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression General Scale (HADS), the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). The Star Plot, a graphical method of data visualization, was used to analyze the results. The t test was used for independent samples (two-tailed analysis). Results: As measured by the BDI, HAM-D and HAM-A scales and HADS depression subscale, the average total scores of symptoms for the sample of patients diagnosed with MD without clinical comorbidity was significantly higher than that of the PSD patients (p < 0.05). Similar results were obtained by plotting the BDI data on Star Plot. The PSD patients showed mild typical depressive symptoms such as less depressed mood, anhedonia, disinterest, guilt, negative thoughts, depreciation, suicidal ideation and anxiety, when evaluated by the HAM-A scale. Moreover, the somatic symptoms of depression did not lead to increased diagnosis of major depression in stroke patients. Conclusions: The results indicate that the PSD clinical picture comprised, in general, symptoms of mild/moderate intensity, especially those considered as pillars for the diagnosis of depression: depressed mood, loss of pleasure and lack of interest. Given the imprecision of boundaries that separate the clinical forms of depression from subclinical and nonpathological forms, or even from the concepts of demoralization and adjustment disorders, we situate PSD in a complex biopsychosocial context in which a better understanding of its psychopathological profile could provide diagnostic and therapeutic alternatives best suited to the difficult reality experienced by stroke patients.

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Post-Stroke Apathy and Hypoperfusion in Basal Ganglia: SPECT Study

Cited by 63 publications

References 77 publications

Poststroke Apathy

Poststroke Apathy

Post-Stroke Apathy: An Exploratory Longitudinal Study

Is Poststroke Depression a Major Depression?

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