Types of affective response to stroke.

Most studies of depression after stroke have included heterogeneous samples of patients. These studies have generally not qualified patients as to age, absence of neurologic, psychiatric, and substance abuse histories, and other complicating factors. Of 155 inpatient rehabilitation admissions after acute unilateral cerebrovascular accident, only 26 met the following strict criteria for inclusion: age older than 55 years, no history of or concomitant brain disease or injury, and no history of major affective, thought, or substance abuse disorder. Two examiners independently administered the Hamilton Depression Rating Scale, a mood adjective checklist, and a modified Mini-Mental State Examination to 20 subjects who agreed to participate. They also rated subjects on research diagnostic criteria for depression and obtained a dexamethasone suppression test for each subject. Eighteen subjects completed neuropsychologic evaluation. All evaluations were completed within six weeks of the patient's stroke. Subjects fell into four distinct clinical groups based on averaged data: (1) no affective symptoms, (2) verbal distress only, (3) vegetative symptoms only, and (4) a combined disorder with both distress and vegetative symptoms. The presence of verbal reports of distress, vegetative signs, or both were associated with longer hospital stays and greater neuropsychologic impairment.