Post-Stroke Depression and Depression-Executive Dysfunction Syndrome Are Associated with Recurrence of Ischaemic Stroke

Abstract

Background: Depression and depression-executive dysfunction syndrome (DES) are common neuropsychiatric consequences of stroke. We hypothesized that if stroke as a cerebrovascular event causes depression, this so-called post-stroke depression will further increase the risk of recurrent stroke. The objective of the study was to investigate whether patients with post-stroke depression or DES have increased rates of stroke recurrence. Methods: We included 223 patients from the Helsinki Stroke Aging Memory cohort (n = 486) admitted to Helsinki University Central Hospital with a follow-up of 12 years. We included only patients with first-ever ischaemic stroke who were testable for depression and executive dysfunction. For follow-up, national register data were reviewed for all diagnosis codes of ischaemic stroke, survival data and causes of death. Neuropsychological and neuropsychiatric evaluations for depression and executive functions were performed 12-20 weeks after the index stroke. Univariate analysis was performed using χ², Mantel-Haenszel, ANOVA, and Kaplan-Meier log rank analyses. A Cox multivariable model with forced entry was used to adjust for stroke risk factors (age, gender, smoking, atrial fibrillation, hypertension, diabetes, peripheral arterial disease, hypercholesterolaemia). Results: The mean time to first recurrent stroke was shorter for the depressed patient group (8.15, 95% CI 7.11-9.19 vs. 9.63, 8.89-10.38 years) and even shorter for patients with DES (7.15, 5.55-8.75 vs. 9.75, 9.09-10.41 years) compared to the remaining groups, respectively. The cumulative risk for recurrent ischaemic stroke in the 12-year follow-up was higher for the depression group (log rank p = 0.04) and for the DES group (log rank p = 0.01) compared to the remaining groups, respectively. Cox multivariable analyses revealed that the older age of the patient (1.05; 1.01-1.08/year), the absence of hypercholesterolaemia (0.24; 0.09-0.59), depression (1.68; 1.07-2.63), and DES (1.95; 1.14-3.33) were all associated with recurrent stroke. Conclusions: Depression and especially DES are associated with a shorter interval to recurrence of ischaemic stroke but executive dysfunction alone is not associated with a more rapid stroke recurrence. Diagnosis and treatment of depressive syndromes should be considered as a part of secondary prevention in patients with ischaemic stroke.

Depression after minor stroke: the association with disability and quality of life – a 1‐year follow‐up study

“…; Sibolt, et al . ), limited involvement in the rehabilitation (Turner‐Stokes and Hassan ), or low activity levels due to PSD (Ayerbe, et al . ).…”

Vascular Cognitive Disorders and Depression After First-Ever Stroke: The Fogarty-Mexico Stroke Cohort

“…Sibolt et al [39 ]and Vataja et al [40] demonstrated that executive dysfunction is the core defect in patients with the depression-dysexecutive syndrome, resulting from stroke damage of frontal-subcortical circuits and are associated with a shorter interval to recurrence of ischemic stroke. In our cohort, we found 14.5% of patients with both depression and executive dysfunction.…”

Inflammation and the Silent Sequelae of Stroke

“…In addition, there is an increase in suicidal ideation and suicide after stroke, especially among those with PSD [20,21]. Studies also show that individuals with PSD experience a shorter interval to recurrent stroke [22]. And even in patients with minor stroke, PSD is independently associated with disability and poor physical and mental health 1 year after stroke [19].…”