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Title: Association of depressive and apathetic symptoms with outcome after ischemic stroke
Abstract:
The aim of the first study was to determine whether the functional outcome varies in patients with different trajectories of post-stroke depressive symptoms. Of 698 patients with ischemic stroke or transient ischemic attack (TIA) who participated in the Prospective Observational Polish Study on post-stroke delirium (PROPOLIS), we included 335 patients (median age: 68, 48% female). Depressive symptoms were assessed on day 8 and 3 months after stroke using the Patient Health Questionnaire (PHQ-9). Greater depressive symptoms were defined as a score >9. Patients were divided into 4 groups: without depressive symptoms (Group 1), depressive symptoms only on day 8 (Group 2), depressive symptoms only 3 months after stroke (Group 3), depressive symptoms both on day 8 and 3 months after stroke (Group 4). The endpoints were functional disability defined as the Rankin Scale score 3-5 at 3 and 12 moth after stroke. Group 2 was predominantly female and had the highest rate of previous stroke or TIA. Group 3 was more likely to suffer from delirium and more severe stroke. Group 4 had the highest frequency of vascular risk factors, pre-morbid psychiatric symptoms and cognitive decline. In multivariate logistic analysis, Group 3 had the increased risk of disability at month 3 (OR: 2.59, 95%CI: 1.64-4.07, PO.Ol) and month 12 (OR: 3.97, 95%CI: 2.32-6.76, PO.Ol) compared with Group 1. The risk of ; unfavourable functional outcome did not differ significantly between Group 2 and Group 1 (adjusted OR: 1.97, 95%CI: 0.765.12, P=0.16 at month 3 and 0.67, 95%CI: 0.182.47, PO.54 at month 12), and between Group 4 and Group 1 (adjusted OR: 1.24, 95%CI: 0.87-1.76, PO.23 at month 3 and 0.94, 95%CI: 0.61-1.46, P=0.81 at month 12). The results suggest that different trajectories of post-stroke depressive symptoms are related to different outcomes. Patients who only have later depressive symptoms also have the worst functional prognosis. The aim of the second study was to investigate the association between early depressive and apathetic symptoms and functional outcome and mortality after ischemic stroke or TIA. Four hundred forty-three patients participating in PROPOLIS were included to analysis (median age: 69 years, 51% female). Depressive symptoms were assessed on day 8 after stroke using PHQ-9 (cut-off >9) and apathetic symptoms using the Apathy Evaluation Scale (cut-off >37). Patients were divided into 4 groups: without depressive and apathetic symptoms (Group 1), with only apathetic symptoms (Group 2), with only depressive symptoms (Group 3), with both apathetic and depressive symptoms (Group 4). The endpoints of the study were 3- and 12-month disability and 12-month mortality. After adjusting for age and stroke severity, Group 2 (OR: 1.98, 95%CI: 1.16-3.38, P-0.01) and Group 4 ; (OR: 1.58, 95%CI: 1.242.01, PcO.Ol) had higher risk of disability 3 months after stroke compared with Group 1. Similarly, these groups had increased risk of unfavourable functional outcome and death at month 12 (OR: 3.85, 95%CI: 2.19-6.78, P<0.01 and HR: 2.76, 95%CI: 1.19-6.41, P-0.02 for Group 2; OR: 1.54, 95%CI: 1.22-1.96, P<0.01 and HR: 1.77,95%CI: 1.32-2.38, P<0.01 for Group 4). Comparing with Group 1, Group 3 did not have increased risk of poor outcomes. These results suggest that early apathetic, but not depressive symptoms, are related to worse outcomes after stroke and underscore the importance of recognizing apathetic symptoms independently from depressive symptoms. The purpose of the third study was to determine whether pre-morbid and early post-stroke apathy predicts dementia 3 months after stroke. One hundred and four patients with ischemic stroke or TIA were included (mean age: 67.5 ± 12.3; 45.9% female). Pre-stroke apathetic and depressive symptoms were evaluated using the Neuropsychiatrie Inventory. Early apathetic and depressive symptoms were assessed on day 8 using the Apathy Evaluation Scale and PHQ-9, respectively. Patients underwent neuropsychological examination 3 months after stroke. Dementia was diagnosed in 21.6% of patients. Patients with dementia had higher apathy scores before stroke (mean: 0.9 ± 1.7 vs 0.2 ± 0.9, P<0.01) and on day 8 (mean: 37.2 ± 9. ; 3 vs 29.0 ± 9.6, P<0.01). Depressive symptoms did not differ between groups. In multivariate analysis adjusted for age, diabetes mellitus, stroke severity and in-hospital delirium, apathy symptoms before stroke and on day 8 after stroke predicted post-stroke dementia (adjusted OR: 1.59, 95%CI: 1.13-2.26, P=0.0 land OR: 1.06,95%CI: 1.01-1.11,P-0.03, respectively). Pre-stroke apathy had sensitivity of 0.31 and specificity of 0.94 whereas early post-stroke apathy had sensitivity of 0.96 and specificity of 0.40 for predicting dementia. In conclusion, pre-stroke and early post-stroke apathy independently from age, stroke severity and delirium predicted dementia 3 months after stroke. Thus, apathy might be useful in identifying at-risk patients.
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Rada Dyscypliny Nauki medyczne
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Last modified:
May 23, 2025
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May 23, 2025
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http://dl.cm-uj.krakow.pl:8080/publication/5259
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| Edition name | Date |
|---|---|
| ZB-142612 | May 23, 2025 |
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