Predictors of cerebrovascular event reoccurrence in patients with depression: a retrospective cohort study

Abstract

ObjectivesTo identify predictors of recurrent cerebrovascular morbidity in a cohort of patients with depression and a cerebrovascular disease (CBVD) history.MethodsWe used the Maudsley Biomedical Research Centre Case Register to identify patients aged 50 years or older with a diagnosis of depressive disorder between 2008 and 2017 and a previous history of hospitalised CBVD. Using depression diagnosis as the index date we followed patients until first hospitalised CBVD recurrence or death due to CBVD. Sociodemographic data, symptom and functioning scores of Health of the Nation Outcome Scales, medications and comorbidities were extracted and modelled in multivariate survival analyses to identify predictors of CBVD reoccurrence.ResultsOf 1292 patients with depression and CBVD (mean age 75.6 years; 56.6% female), 264 (20.4%) experienced fatal/non-fatal CBVD recurrence during a median follow-up duration of 1.66 years. In multivariate Cox regression models, a higher risk of CBVD recurrence was predicted by older age (HR, 1.02; 95% CI, 1.01 to 1.04) (p=0.002), physical health problems (moderate to severe HR, 2.47; 95% CI, 1.45 to 4.19) (p=0.001), anticoagulant (HR, 1.40; 95% CI, 1.01 to 1.93) (p=0.041) and antipsychotic medication (HR, 0.66; 95% CI 0.44 to 0.99) (p=0.047). Neither depression severity, mental health symptoms, functional status, nor antidepressant prescribing were significantly associated with CBVD recurrence.ConclusionsApproximately one in five patients with depression and CBVD experienced a CBVD recurrence over a median follow-up time of 20 months. Risk of CBVD recurrence was largely dependent on age and physical health rather than on severity of depressive symptoms, co-morbid mental health or functional problems, or psychotropic prescribing.

Prediction Model of Ischemic Stroke Recurrence Using PSO-LSTM in Mobile Medical Monitoring System

“…However, this method only analyzes the characteristics after the early onset of the disease, which has some limitations. Reference [ 12 ] took patients with depression and cerebrovascular diseases as the research object and used the diagnosis of depression as the index date to track and record the recurrence of cerebrovascular diseases. The results showed that the risk of cerebrovascular diseases recurrence mainly depends on age and physical health but had little relationship with depression and psychotropic drugs.…”

Clinical factors associated with progression to dementia in people with late-life depression: a cohort study of patients in secondary care

“…17 Although it has been shown that precision and recall are relatively high for the medication natural language processing application, 17 there remains a risk underestimating or overestimating the true prescribing prevalence, especially as adherence to medication cannot be established. 53 Lastly, although we incorporated a wide range of potential confounders in our analysis, causal inferences cannot readily be drawn in an observational study of this nature.…”

The efficacy and safety of Jin's three-needle therapy vs. placebo acupuncture on anxiety symptoms in patients with post-stroke anxiety: A study protocol for a randomized controlled trial

“…The activated HPA axis promoted a “systemic anti-inflammatory response” that negatively affects function recovery and anxiety generation ( 31 ). Besides, anxiety and depression are recognized to be associated with dysregulation of the HPA axis, which accentuates inflammation, consequently increasing the risk of stroke recurrence ( 32 ). Dysfunction of the HPA axis is suspected to be one of the main mechanisms connecting stroke with anxiety ( 33 ).…”