Factors that influence the severity of post-stroke depression

Aim: The aim of this paper was to investigate whether the extent of neurological impairment, the location of ischemic lesions due to stroke are associated with the severity of post-stroke depression. Materials and methods: The study included 82 patients, who were diagnosed with acute ischemic stroke and post-stroke depression and were admitted to the Neurology Clinic of Cluj-Napoca County Emergency Hospital between 2009 and 2011. A head MRI was performed with a 1.5 Tesla. Psychometric assessment was performed by using several scales, including the Beck Depression Inventory and the Mini-Mental State Examination. The National Institutes of Health Stroke Scale (NIHSS) and the Barthel Index of Activities of Daily Living were used to produce a complete neurological assessment. Results: Patients with severe depression had a lower score on the Quality of Life Scale (QOLS) and higher scores for the Barthel index, NIHSS and MMSE. A stroke located in the basal nuclei increased the probability of severe depression. The patients with fewer lesions (1-2) had a greater chance of developing mild or moderate depression compared to the patients with 3-4 lesions. A frontal localization of the stroke was almost twice as common in patients with severe depression. If the stroke affected the left hemisphere, there was a higher probability of severe depression. In multivariate analysis, a basal nuclei lesion, a left hemisphere stroke location, and an NIHSS score >11 were all independently associated with severe depression. Conclusion: The location of the stroke and the NIHSS score could be related to the severity of post-stroke depression. Abbreviations: NIHSS = The National Institutes of Health Stroke Scale; QQL = Quality of life Scale; BDI = Beck Depression Inventory; MMSE = Mini-Mental State Examination; PSD = Post-stroke depression; MRI = Magnetic resonance imaging