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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a sample of ninety-nine patients seen two months post-stroke, 18 percent were diagnosed as having minor depression and 14 percent major depression. At follow-up, fifteen months later, the prevalence of depressive disorder had declined substantially, to 12 percent overall. Major depression was characterized by an average duration of thirty-nine weeks, a mortality rate of 23 percent and was associated with positive family history of affective or anxiety disorder. Among patients with left hemisphere lesions, major depression was associated with cognitive impairment. Minor depression had a shorter average duration (twelve weeks) and was more common in males. These two syndromes may define distinct types of post-stroke depression with implications for treatment interventions.
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PMID:Prevalence and course of depressive disorders in hospitalized stroke patients. 208 22

The prevalence, diagnosis, clinical presentation, evolution, and treatment of depression and mania following stroke are discussed. Among the many studies presented in the review is one that indicates major depression following right hemisphere lesions is associated with a positive family history of psychiatric disorder and lesions involving the parietal cortex. The co-occurrence of major depression and generalized anxiety disorder is associated with cortical lesions, while depression alone is associated with subcortical lesions. A recent study has also shown a strong association between mania and direct or indirect dysfunction of the basotemporal cortex in the right hemisphere. Possible mechanisms for both mania and depression following stroke are presented, and ideas for future directions in research are suggested.
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PMID:Current research in affective disorders following stroke. 213 55

Depressive disorder is a common complication of stroke. Although somatic symptoms of stroke may be mistaken for depression, DSM-III criteria for major depression are appropriate for use in this clinical setting. The etiology of poststroke depression can be viewed from a number of perspectives. Evidence from examining lesion characteristics and depression suggests that a disease model is suitable for some cases of poststroke depression. Alternatively, adequacy of social support and gender differences influence the occurrence of poststroke depression. Poststroke depression can be effectively treated with tricyclic antidepressants, and the use of these agents may also enhance physical and cognitive recovery.
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PMID:Depression and cerebrovascular disease. 200 83

In a community-based study of patients with a first-ever stroke, intellectual impairment (as defined by scores on a common screening test for dementia, the Mini-Mental State Examination) was found in 26% at 1 month post-stroke, and in 21% at 6 and 12 month follow-up. Low scores on the screening test were associated with greater age, physical disability before the stroke, larger stroke lesion volumes as measured on CT scan, and non-stroke changes such as atrophy and white matter low attenuation on the CT scan. There was a negative correlation between scores on the Mini-Mental State Examination and symptom levels on two measures of mood disorder. However, there was no evidence of a specific relationship between major depression and low scores on the Mini-Mental State. We examined various aspects of the relationship between mood symptoms and low scores on the Mini-Mental State, but found no evidence to support the suggestion that this relationship represented an example of depressive pseudodementia. We discuss the significance of our findings for clinical psychiatry and neuropsychology.
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PMID:The relationship between intellectual impairment and mood disorder in the first year after stroke. 228 89

Sixty surviving patients from a community-based stroke register who had CT scan evidence of a single brain lesion and neurological signs appropriate to it were interviewed three to five years following their first-ever stroke. Mood disorder (anxiety and depression), physical disability, and intellectual impairment were assessed using standardized measures. The position and volume of the brain lesion was determined from CT scans performed soon after the stroke. The prevalence of depressive disorder was lower in this sample than that reported in previous studies (DSM-IIIR major depression 8.3%; all DSM-IIIR depressive disorders 18.3%). Reports by other workers for an association of depressive disorder either with left-sided brain lesions, or with anteriorly placed lesions in the left cerebral hemisphere, were not supported. Neither was there evidence of a correlation between symptom score and proximity of the lesion to the anterior pole of the left cerebral hemisphere. Psychiatric symptom scores were however greater with larger volume brain lesions. Anxiety disorders, especially agoraphobia, were relatively common (20% if diagnosed in the presence of depressive disorder), but were not related to lesion location or volume.
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PMID:Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume. 228 90

The interaction between anxiety disorder and major depressive disorder in patients with cerebrovascular lesions was examined in a controlled, 2 x 2 study design. A consecutive series of 24 patients who met criteria for major depression only were compared with 6 patients who met criteria for both major depression and generalized anxiety disorder, and 45 patients who did not meet criteria for either major depression of generalized anxiety. Among patients with positive computed tomographic scans, the anxious-depressed group (n = 19) showed a significantly higher frequency of cortical lesions, while patients with major depression only (n = 15) had a significantly higher frequency of subcortical (basal ganglia) strokes. No significant between-group differences were found in other variables, such as demographic variables, familial and personal history of psychiatric disorders, and neurologic deficits. These findings suggest that, in this mostly black, low-socioeconomic-status population, cortical vs subcortical lesion location may play an important role in determining whether severe anxiety occurs in patients with post-stroke major depression.
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PMID:Relationship between anxiety disorders and depressive disorders in patients with cerebrovascular injury. 230 66

The impact of clinically diagnosed depression on recovery in activities of daily living over a 2-year follow-up was examined in a prospective study of 63 stroke patients. Although impairment in activities of daily living, neurologic diagnoses and findings, lesion location and volume as measured on computed tomographic scan, demographic variables, cognitive impairment, and social functioning were comparable between depressed (n = 25) and nondepressed (n = 38) patients during their acute hospitalization, the two groups had different patterns of recovery in activities of daily living. At 2 years after suffering a stroke, patients with an in-hospital diagnosis of depression (either major or minor depression) were significantly more impaired in both physical activities and language functioning than were non-depressed patients. Among patients with major depression, this disparity in the recovery profile was present even after the depression had remitted. This study emphasizes the need for early recognition and treatment of poststroke depression.
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PMID:The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. 235 59

In a community-based study of stroke survivors, we identified 73 consecutive patients with a stroke, the first ever in a lifetime, who had a CT scan which showed a neurologically appropriate single stroke lesion, and who did not have a psychiatric disorder in the year preceding the stroke. A detailed follow-up study of these patients using standardized psychiatric assessments failed to confirm a number of recent claims about poststroke depressive disorders. We found no evidence that left-sided lesions were associated with more severe or persistent depressive symptoms, or that right-sided lesions were associated with hypomania. The DSM III syndrome of major depression was much less common than has previously been reported, and was not specifically associated with lesions placed anteriorly in the left hemisphere. There was a weak correlation between mood symptom scores and the proximity of the stroke lesion to the frontal pole of the hemisphere, but no evidence of a difference between right and left hemisphere strokes in the nature of the relationship between lesion distribution and mood symptoms. We suggest that previous studies have different findings because of differences in the conventions applied to the definition and measurement of psychiatric disorders after stroke, and because other studies have concentrated on selected inpatient populations.
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PMID:Mood disorders after stroke and their relation to lesion location. A CT scan study. 239 85

Using the dexamethasone suppression test, we studied the activity of the hypothalamic-pituitary-adrenal axis within the first week after onset in 62 patients with acute ischemic stroke. Compared with two control groups (one comprising 25 elderly patients with various acute medical disorders and the other comprising 33 80-year-old volunteers), stroke patients had higher postdexamethasone cortisol levels (p = 0.08 and p = 0.001, respectively). By multiple regression analysis, high postdexamethasone cortisol levels in the stroke patients were significantly associated with proximity of the lesion to the frontal pole of the brain (p = 0.008) and with disorientation (p = 0.03), whereas no association with major depression was seen. Many stroke patients are exposed to hypercortisolism, which may have negative consequences upon organ functions. The extent to which dexamethasone administration suppresses cortisol levels seems to be determined mainly by the site of brain lesion and cannot be used as an indicator of major depression early after stroke.
Stroke 1989 Dec
PMID:Hypercortisolism revealed by the dexamethasone suppression test in patients [corrected] with acute ischemic stroke. 259 30

Ninety-three patients with acute stroke lesions restricted to the right hemisphere were examined for the presence of mood changes. While 46 patients showed no mood changes, 19 were unduly cheerful, 17 had developed major depression, and 11 had developed minor depression. Although there were no significant between-groups differences in other demographic variables, neurological deficits, activities of daily living, cognitive impairment, or quality of social support, patients with major depression had a significantly higher frequency of familial history of psychiatric disorder and lesions of the parietal cortex than patients with either no mood change or major depression following left-hemisphere lesions. On the other hand, undue cheerfulness was significantly associated with lesions of the right frontal operculum. These findings suggest that major depression following right-hemisphere lesions may have a different aetiology and mechanism than major depression following left frontal or basal ganglia lesions.
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PMID:Mood changes after right-hemisphere lesions. 260 36


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