title: Post-stroke depression and depression-executive dysfunction syndrome are associated with recurrence of ischaemic stroke.
abstract: BACKGROUND
  Depression and depression-executive dysfunction syndrome (DES) are common neuropsychiatric consequences of stroke. We hypothesized that if stroke as a cerebrovascular event causes depression, this so-called post-stroke depression will further increase the risk of recurrent stroke. The objective of the study was to investigate whether patients with post-stroke depression or DES have increased rates of stroke recurrence.
  
  
  METHODS
  We included 223 patients from the Helsinki Stroke Aging Memory cohort (n = 486) admitted to Helsinki University Central Hospital with a follow-up of 12 years. We included only patients with first-ever ischaemic stroke who were testable for depression and executive dysfunction. For follow-up, national register data were reviewed for all diagnosis codes of ischaemic stroke, survival data and causes of death. Neuropsychological and neuropsychiatric evaluations for depression and executive functions were performed 12-20 weeks after the index stroke. Univariate analysis was performed using χ(2), Mantel-Haenszel, ANOVA, and Kaplan-Meier log rank analyses. A Cox multivariable model with forced entry was used to adjust for stroke risk factors (age, gender, smoking, atrial fibrillation, hypertension, diabetes, peripheral arterial disease, hypercholesterolaemia).
  
  
  RESULTS
  The mean time to first recurrent stroke was shorter for the depressed patient group (8.15, 95% CI 7.11-9.19 vs. 9.63, 8.89-10.38 years) and even shorter for patients with DES (7.15, 5.55-8.75 vs. 9.75, 9.09-10.41 years) compared to the remaining groups, respectively. The cumulative risk for recurrent ischaemic stroke in the 12-year follow-up was higher for the depression group (log rank p = 0.04) and for the DES group (log rank p = 0.01) compared to the remaining groups, respectively. Cox multivariable analyses revealed that the older age of the patient (1.05; 1.01-1.08/year), the absence of hypercholesterolaemia (0.24; 0.09-0.59), depression (1.68; 1.07-2.63), and DES (1.95; 1.14-3.33) were all associated with recurrent stroke.
  
  
  CONCLUSIONS
  Depression and especially DES are associated with a shorter interval to recurrence of ischaemic stroke but executive dysfunction alone is not associated with a more rapid stroke recurrence. Diagnosis and treatment of depressive syndromes should be considered as a part of secondary prevention in patients with ischaemic stroke.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.
authors.forename: Gerli
authors.initials: G
authors.lastname: Sibolt
authors.forename: Sami
authors.initials: S
authors.lastname: Curtze
authors.forename: Susanna
authors.initials: S
authors.lastname: Melkas
authors.forename: Tarja
authors.initials: T
authors.lastname: Pohjasvaara
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Pekka J
authors.initials: PJ
authors.lastname: Karhunen
authors.forename: Niku K J
authors.initials: NK
authors.lastname: Oksala
authors.forename: Risto
authors.initials: R
authors.lastname: Vataja
authors.forename: Timo
authors.initials: T
authors.lastname: Erkinjuntti
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications*; D003863:Depression / Q000209:etiology*; D003866:Depressive Disorder / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D012307:Risk Factors; D055502:Secondary Prevention; D020521:Stroke / Q000150:complications*