Shiho Matsuzaki1, Mamoru Hashimoto2, Seiji Yuki3, Asuka Koyama3, Yoshifumi Hirata4, Manabu Ikeda3. 1. Department of Neuropsychiatry, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan. 2. Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan. Electronic address: m-hashi@kumamoto-u.ac.jp. 3. Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan. 4. Kumamoto Takumadai Rehabilitation Hospital, Kumamoto, Japan.
Abstract
BACKGROUND: Post-stroke depression (PSD) is a serious and common complication of stroke. In this prospective study on the relationship between clinical PSD and physical recovery, we focused on (1) distinguishing between depression and apathy, (2) issues in assessment of PSD, and (3) timing of assessment. METHODS: Japanese stroke patients (n=117) were studied. We used self-rating scales [Zung Self-Rating Depression Scale (SDS) for depression; Apathy Scale (AS) for apathy] and observer-rating scales [Montgomery-Åsberg Depression Rating Scale (MADRS) for depression; Neuropsychiatric Inventory-Nursing Home (NPI-NH) for apathy] to assess psychological state. We assessed physical disability using the Functional Independence Measurement (FIM). Two-way analysis of covariance was used to determine effects of depression and apathy on functional outcome. We evaluated PSD twice, within 10 days after hospitalization and four weeks later. RESULTS: Objective scales gave higher prevalence than subjective scales for both depression and apathy. A significant effect of apathy on FIM recovery was seen with objective scale assessment during hospitalization; there was a marginal effect of depression at the same time. LIMITATIONS: We did not consider the stroke size and location. In addition, we excluded patients with severe comprehension deficits or with a history of stroke. CONCLUSIONS: Our findings indicate that depression and apathy could occur independently after stroke and could individually influence functional recovery. We obtained more accurate estimates of functional recovery using objective measures. Furthermore, our findings suggest that depression and apathy should be assessed not only at admission but also during hospitalization to estimate and enhance the functional recovery of stroke patients.
BACKGROUND: Post-stroke depression (PSD) is a serious and common complication of stroke. In this prospective study on the relationship between clinical PSD and physical recovery, we focused on (1) distinguishing between depression and apathy, (2) issues in assessment of PSD, and (3) timing of assessment. METHODS: Japanese strokepatients (n=117) were studied. We used self-rating scales [Zung Self-Rating Depression Scale (SDS) for depression; Apathy Scale (AS) for apathy] and observer-rating scales [Montgomery-Åsberg Depression Rating Scale (MADRS) for depression; Neuropsychiatric Inventory-Nursing Home (NPI-NH) for apathy] to assess psychological state. We assessed physical disability using the Functional Independence Measurement (FIM). Two-way analysis of covariance was used to determine effects of depression and apathy on functional outcome. We evaluated PSD twice, within 10 days after hospitalization and four weeks later. RESULTS: Objective scales gave higher prevalence than subjective scales for both depression and apathy. A significant effect of apathy on FIM recovery was seen with objective scale assessment during hospitalization; there was a marginal effect of depression at the same time. LIMITATIONS: We did not consider the stroke size and location. In addition, we excluded patients with severe comprehension deficits or with a history of stroke. CONCLUSIONS: Our findings indicate that depression and apathy could occur independently after stroke and could individually influence functional recovery. We obtained more accurate estimates of functional recovery using objective measures. Furthermore, our findings suggest that depression and apathy should be assessed not only at admission but also during hospitalization to estimate and enhance the functional recovery of strokepatients.
Authors: Julianne Vermeer; Amanda McIntyre; Shannon Janzen; Danielle Rice; Laura Allen; David Ure; Robert Teasell Journal: Neurol Res Int Date: 2018-04-11
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