Academic journal article Indian Journal of Psychiatry

Post-Stroke Depression and Lesion Location: A Hospital Based Cross-Sectional Study

Academic journal article Indian Journal of Psychiatry

Post-Stroke Depression and Lesion Location: A Hospital Based Cross-Sectional Study

Article excerpt

Byline: Pooja. Rajashekaran, Keshava. Pai, Ravish. Thunga, B. Unnikrishnan

Background: Depression is a common neuro-psychiatric consequence of stroke, affecting approximately 40% of the patients. Many studies show that in addition to the psychosocial stress, neurobiological factors such as site of infarct and brain atrophy may also be related to Post Stroke Depression (PSD). There are conflicting results in this area of research and paucity of such data in Indian literature. Thus the aim of this study is to weigh the importance of lesion location in PSD. Materials and Methods: Sixty two subjects with their first ever stroke were interviewed using a semi-structured proforma and PSD diagnosed using MINI Plus interview. Scales of Beck Depression Inventory and Montgomery Asberg Depression Rating Scale were used to assess severity of depression. Mini mental state examination was used to assess cognitive impairment and Barthel Index to measure Activities of Daily Living. Neuro-imaging provided information on site and side of lesion. Collected data was analysed using SPSS version 15.0. Results: PSD was diagnosed in 28 subjects, amongst who 19 had left sided lesions. Left sided cortical infarcts and sub cortical infarcts showed statistically significant association with PSD. Conclusion: Results are in keeping with previous landmark studies. Differences in emotional reactions depending on hemisphere and site of the infarct as shown in this study suggest organic biological basis for post stroke depression. Understanding the etiological basis would allow clinicians to monitor patients at risk of developing PSD, enabling early detection and treatment thus improving their quality of life and rehabilitation.

Introduction

Stroke as the third leading cause of death and one of the most common disabling diseases, has an enormous emotional impact on both patients and their family members. [sup][1] Depression is a common neuro-psychiatric consequence of stroke with quoted rates of post-stroke depressive disorders ranging from 18% to 61%.

Post-stroke depression (PSD) may affect a patient's ability to participate in therapy and is associated with a slower progress in the rehabilitation and increased length of hospital stay. [sup][2] One etiological theory for depression after stroke is that it is a psychological reaction to the clinical consequences of stroke. [sup][3] Another theory was of the biological model proposed by Robinson and co-workers. They hypothesized that the depletion of monoaminergic amines occurring after stroke plays a role in PSD. [sup][4] Norepinephrinergic and serotoninergic pathways are disrupted in the basal ganglia and frontal lobe lesions - sites that are shown to be associated with PSD.

The association between the vascular changes and depression [sup][5] and more specifically the location of brain lesion as a result of stroke and depression has been the topic of much research. Pooling previous results, Morris et al. , [sup][6] identified specific relationships between the locations of brain injury and the character and severity of post-stroke mood disturbances. He suggested that left anterior cerebral lesions were associated with significantly higher depression scores than left posterior lesions and more specifically left frontal lesions. [sup][7] Magnetic resonance imaging (MRI) studies of depressed patients have revealed structural abnormalities in areas related to limbic-cortical-striatal-pallidal-thalamic-cortical pathways, including the frontal lobes, caudate, and putamen. [sup][8],[9]

There is paucity of data in this area of research from India. Correlation between the mood changes and the type, location and severity of stroke may provide useful information for improving patient management, including the prediction of functional evaluation and prognosis.

Clinicians need to be watchful and recognize symptoms of depression early, before it interferes with therapy and the patients' well-being. …

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