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STROKE: Post-Stroke Depression Common, Appears Related to Location of Lesion

By Cameron Johnston
Special to DG News


NEW ORLEANS, LA -- February 14, 2000 -- Studies show that not only is there a high prevalence of depression among patients who have had strokes, but the depression often does not wear off over time and is directly related to the position of the infarct within the brain. These results were presented at the 25th American Stroke Association's International Conference, in New Orleans, LA, yesterday (Feb. 13).


In the first study, conducted at the University of Kansas Medical Center, approximately one-third of the people who had strokes experienced some form of depression, and that depression did not resolve within six months of the event. Patients who were no longer able to carry out the basic activities of daily living were two-and-a-half times more likely to be depressed after their stroke than matched patients who were able to carry out those activities.

The patients were also more depressed as their ability to move around was restricted. Fewer than one in three patients were able to get around freely without restrictions or limitations. Patients whose ability to move was restricted following the stroke were 80 percent more likely to be depressed than those whose movements were not restricted, said Dr. Sue Min-Lai, a resident in neurology at the University of Kansas Medical Center, in Kansas City.

Patients who were able to prepare their own meals were less likely to be depressed and, similarly, only half of the patients were depressed as a result of having to take daily medications. Nonetheless, those two groups did experience some depression. Those who were not able to prepare their own meals were 60 percent more likely to be depressed, and those who had to take daily medications were 20 percent more likely to be depressed.

In a second study, researchers from the department of neurology at Indiana University School of Medicine and at the Roudebush Veteran’s Affairs Medical Center noted that the severity of depression is related to the proximity of the lesion to the frontal pole.

The researchers looked at CT scans for 85 patients (39 percent depressed and 61 percent not depressed) who were recruited from two different hospitals. Dr. Linda Williams, a neurologist in Indiana University School of Medicine’s department of medicine, said those patients whose lesions were within 40 percent of the frontal pole had a 60 percent depression rate, patients whose lesions were in the intermediate range had a 21 percent depression rate, and those whose lesions were more than 60 percent from the frontal pole had a 33 percent rate of depression.

There were no significant differences in whether the lesion was in the left or right hemisphere. Patients whose lesions were closer to the frontal pole also had markedly worse Stroke Specific Quality of Life (SS-QOL) scores -- 3.7 versus 4.2 -- regardless of whether they were depressed. The SS-QOL ranks quality of life on as 0 = very poor to 5 = very good.

Dr. Williams said this study is important because it demonstrates that there is a trend toward more depression as the lesion is closer to the frontal pole, but there is a more definite correlation between quality of life and the position of the lesion with respect to the frontal pole.

"Patients with anterior frontal stroke may be at increased risk of poor post-stroke quality of live, mediated not only by mood changes, but perhaps by the effect the frontal injury has on the patient's cognitive and social behavior", she said.

There were limitations to the study, however, in that patients whose strokes were considered severe and those who were left with significant speech defects as a result of the stroke were excluded from the patient groups.

It’s also interesting to note, Dr. Williams said, that there were no differences between the depressed and non-depressed patients as to age, stroke severity, size of the lesion, National Institutes of Health stroke scores, length of hospital stay and past history of depression.

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Aggiornato il: 27 February 2001