Depression-executive dysfunction syndrome in stroke patients.
OBJECTIVE
It has been suggested that executive dysfunction could be the core defect in patients with geriatric or vascular depression, and that this depression-dysexecutive syndrome (DES) might be related to frontal-subcortical circuit dysfunction. The authors tested this hypothesis in 158 poststroke patients, of whom 21 had both depression and executive dysfunction.


METHODS
In this cross-sectional cohort study, a neurological, psychiatric, and neuropsychological examination was carried out 3 months after ischemic stroke, and brain infarcts, white-matter changes, and brain atrophy were recorded by MRI.


RESULTS
The 21 patients with DES had significantly more brain infarcts affecting their frontal-subcortical circuit structures than the 137 patients without DES, or the 41 patients with depression but without executive dysfunction. Patients with DES also had more severe depressive symptoms and worse psychosocial functioning, and they coped less well in complex activities of daily living.


CONCLUSIONS
DES is a valid concept and may define a subgroup of poststroke patients with frontal-subcortical pathology and with distinct prognosis and treatment options.
Vataja
Risto
R
Memory Research Unit, Department of Neurology, Helsinki University Central Hospital, P.O. BOX 300, FIN-00029 HUS, Finland.
Pohjasvaara
Tarja
T
Mäntylä
Riitta
R
Ylikoski
Raija
R
Leskelä
Maarit
M
Kalska
Hely
H
Hietanen
Marja
M
Juhani Aronen
Hannu
H
Salonen
Oili
O
Kaste
Markku
M
Leppävuori
Antero
A
Erkinjuntti
Timo
T
D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000473:pathology / Q000503:physiopathology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000503:physiopathology; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000503:physiopathology*