شیوع و عوامل پیش بینی کننده افسردگی پس از سکته مغزی خفیف

Objective : Severity of stroke and disability after stroke are major predictors of post-stroke depression (PSD). The prevalence of PSD in patients with minor stroke is expected to be low because minor stroke is characterized by mild neurological dysfunction. The aim of this study is to investigate the prevalence and predictors of PSD in patients with minor ischemic stroke. Methods : Patients with first-ever minor ischemic stroke (n=757) were followed up at 14±2 days, 3 months, 6 months, and 1 year after stroke. Depression status was assessed at each follow-up. Patients had PSD at follow-ups were classified into two groups according to the time point of the diagnosis of PSD: patients diagnosed at 14±2 days were formed the early-onset PSD group; those who were diagnosed at any subsequent follow-ups constituted the late-onset PSD group. Results : The 1-year prevalence of PSD in patients with minor stroke was 29.0% (95% CI, 25.2-32.8). Female gender, current smoking at stroke onset, mild global cognitive impairment at 14±2 days and stroke recurrence were independently associated with a high risk of PSD over the 1-year follow-up. Predictors of early-onset PSD included female gender, current smoking and mild global cognitive impairment at 14±2 days, while predictors of late-onset PSD were current smoking and stroke recurrence. Conclusion : Approximately three in ten patients with first-ever minor ischemic stroke may develop depression during the first year after stroke. Female gender, smoking, mild global cognitive impairment and stroke recurrence predict early-onset or late-onset PSD after minor ischemic stroke.

Post-stroke depression (PSD) is a common complication that occurs in approximately 33% of stroke survivors during the first year after stroke [1] and negatively associated with survival, functional independence and quality of life in stroke patients [2-6]. PSD in patients with minor stroke was usually studied combining with transient ischemic attack (TIA) patients in previous studies and found that the prevalence of PSD after TIA or minor stroke was 18-32% [7]. In these studies, the definition of minor stroke and diagnostic criteria of depression were diverse [7]. Severity of stroke and disability after stroke are major predictors of PSD in stroke in general [8]. Minor stroke is characterized by mild, short-lasting symptoms and relatively low rate of disability [9]. For the distinctly different conditions between minor stroke and TIA, and stroke in general, PSD after minor stroke should be studied separately. Disability after stroke, cognitive impairment, stroke severity, lesion sites and locations and some vascular risk factors all have been reported to be associated with PSD [1]. The natural courses of PSD is dynamic, that the frequency of PSD was relatively high during the acute stage of stroke and to decrease over time [1, 7]. Due to the dynamic course of PSD, discrepancies in the predictors of PSD reported in previous studies [1] may be related to the time of depression assessment which suggests that PSD has different predictors in the acute and chronic stages of stroke. For this reason, the predictors of PSD should be studied at the acute and chronic stages of stroke separately. The study investigated the prevalence of PSD during a year follow-up in patients with minor ischemic stroke and explored predictors of PSD in the acute (early-onset PSD) and chronic (late-onset depression) stages of minor stroke.

In conclusion, approximately three in ten patients with minor ischemic stroke developed PSD over the first year after stroke. Although the incidence of PSD decreased steeply 3 months after stroke, new cases were diagnosed even at the 1-year follow-up. The course of PSD after minor ischemic stroke suggests that the monitoring of patients’ moods should begin in the acute stage and be undertaken regularly during the chronic stage after minor ischemic stroke. Current smoking at stroke onset was a predictor of both early-onset and late-onset PSD after minor stroke. Mild global cognitive impairment independently associated with a high risk of PSD in its acute stage. For that reason, more attention should be paid to the cognitive status at the acute stage of minor stroke. Stroke recurrence was the most important predictor of late-onset PSD. Secondary prevention of stroke may represent an effective way to decrease the risk of PSD at the chronic stage of minor stroke.