Early depressive symptoms after stroke: neuropsychological correlates and lesion characteristics.
OBJECTIVE
To examine the relation between depressive symptoms and specific cognitive functions in patients with a recent stroke and to examine associations with lesion characteristics.


METHODS
We studied 126 of 183 consecutive patients within 3 weeks after a first-ever symptomatic stroke (mean interval, 8.3+/-4.3 days). Presence and severity of depressive symptoms was assessed with the Montgomery Asberg Depression Rating Scale. Neuropsychological functioning was examined by means of a detailed neuropsychological examination covering six cognitive domains. We included a healthy control group (N=75) to obtain normative data for the neuropsychological examination. Functional impairment was measured with the modified Barthel Index and the modified Rankin Scale. Symptomatic and preexistent lesion characteristics were determined on CT or MRI.


RESULTS
Of the included patients, 40% demonstrated mild and 12% moderate to severe depressive symptoms. Severity of depressive symptoms was related to lesion volume (p=0.008), functional impairment (all p<0.004), and degree of overall cognitive impairment (p=0.005). After adjustment for lesion size, a specific neuropsychological profile emerged in patients with moderate to severe depressive symptoms, affecting primarily memory, visual perception, and language (all p<0.05). No association was found between severity of depressive symptoms and lesion location, presence of preexistent lesions (white matter lesions and silent infarcts), and demographic factors (age, education, and gender).


CONCLUSIONS
Moderate or severe symptoms of depression in the early stage poststroke are associated with a specific pattern of cognitive impairment, lesion size, and functional status. We suggest that depressive symptoms early after stroke are, at least in part, a reactive phenomenon secondary to severe cognitive and functional deficits.
Nys
G M S
GM
Psychological Laboratory, Helmholtz Instituut, Utrecht University, 3584 CS, The Netherlands. g.nys@fss.uu.nl
van Zandvoort
M J E
MJ
van der Worp
H B
HB
de Haan
E H F
EH
de Kort
P L M
PL
Kappelle
L J
LJ
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001288:Attention / Q000502:physiology; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000473:pathology* / Q000503:physiopathology; D003863:Depression / Q000209:etiology* / Q000473:pathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008568:Memory / Q000502:physiology; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D011340:Problem Solving / Q000502:physiology; D011569:Psychiatric Status Rating Scales; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014796:Visual Perception / Q000502:physiology