Post-Stroke Depressive Symptoms Are Associated with Post-Stroke Characteristics

2,087

840

e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

Section: Poststroke Depression Including Emotional and Behavioral Statementioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

2,087

840

“…33 The associations between depression and stroke severity, impaired cognition, dependence, low activity levels, and social isolation had been observed only soon after stroke. 2,4 -12,33,34 Unlike many studies, [2][3][4][5][6][7][8][9][10][11][12][13][14]17,20 treatment for depression predicted depression 3 months and 5 years after stroke. Factors involved in the etiology of depression before stroke that are still present after the event may explain this association.…”

Section: Discussionmentioning

confidence: 99%

“…24 Demographic data included age, gender, ethnicity (white, black, and other ethnicity), employment status reported by patient (paid work full-time or part-time, unable to work because of disability, retired, and other), and living conditions before stroke (alone, with someone, or in an institution). Case severity measures included Glasgow coma scale score, categorized as severe (3)(4)(5)(6)(7)(8), moderate (9 -12), and mild (13)(14)(15) 25,26 Other variables assessed included dysphagia, hemianopia, neglect, dysphasia, dysarthria, hemiparesis, cerebellar symptoms, and type of stroke (infarct, primary intracranial hemorrhage, subarachnoid hemorrhage, and undefined). Activities of daily living were assessed 7 days after stroke using the Barthel Index; 27 severe disability is indicated by scores 0 to 14, moderate disability is indicated by scores 15 to 19, and score of 20 indicates the subject is independent.…”

Section: Methodsmentioning

confidence: 99%

Natural History, Predictors, and Associations of Depression 5 Years After Stroke

Ayerbe

Ayis

Rudd

et al. 2011

162

173

Background and Purpose-The longer-term natural history of depression after stroke is poorly understood. We estimate frequency, predictors, and associations of depression up to 5 years after stroke in a population-based study. Methods-Data from 3689 patients registered in the South London Stroke Register 1995 to 2006 were used. Baseline data included age, sex, ethnicity, socioeconomic status, and stroke severity. At 3 months and at 1, 3, and 5 years, survivors were assessed for depression (Hospital Anxiety and Depression; depression subscale score Ͼ7 indicates depression), cognition, disability, activity, accommodation, employment, and social networks. Associations with depression were investigated with logistic regression. Data are reported with OR and 95% CI. Results-Depression frequencies were 33% (30%-36%), 28% (25%-30%), 32% (30%-35%), and 31% (27%-34%) at 3 months and at 1, 3, and 5 years after stroke, respectively. Forty-eight percent of patients were not depressed at any time point; 49% to 55% of depressed patients at 1 assessment remained depressed at follow-up; and 15% to 20% of patients at each assessment were new cases. Predictors of depression included stroke severity, inability to work, and impaired cognition. Associations with depression at follow-up included impaired cognition, lack of family support, institutionalization, inability to work, functional dependence, and low activity level. Conclusions-Frequency of depression up to 5 years after stroke is 30%; however, it is a dynamic situation with recovery and new cases diagnosed over time. These findings support the need for regular assessment of depression and its associated factors and for the development of effective interventions to reduce depression after stroke.

“…19,20 Last, depression has been reported after transient ischemic attack and minor stroke (National Institutes of Health Stroke Scale score ≤5 at discharge). 21,22 Proposed biological factors contributing to PSD include lesion location, genetic susceptibility, inflammation, PSD and functional outcomes PSD is associated with poorer functional outcomes after stroke. Treatment with fluoxetine was associated with lower PSD occurrence rates and improvement in motor recovery in 1 RCT.…”

Section: February 2017mentioning

confidence: 99%

Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Towfighi¹,

Ovbiagele²,

Husseini³

et al. 2017

512

506

Abstract-Poststroke depression (PSD) is common, affecting approximately one third of stroke survivors at any one time after stroke. Individuals with PSD are at a higher risk for suboptimal recovery, recurrent vascular events, poor quality of life, and mortality. Although PSD is prevalent, uncertainty remains regarding predisposing risk factors and optimal strategies for prevention and treatment. This is the first scientific statement from the American Heart Association on the topic of PSD. Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee and the American Heart Association's Manuscript Oversight Committee. Members were assigned topics relevant to their areas of expertise and reviewed appropriate literature, references to published clinical and epidemiology studies, clinical and public health guidelines, authoritative statements, and expert opinion. This multispecialty statement provides a comprehensive review of the current evidence and gaps in current knowledge of the epidemiology, pathophysiology, outcomes, management, and prevention of PSD, and provides implications for clinical practice. (Stroke. 2017;48:e30-e43.