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Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up

Objectives: This study aimed to examine the rate of remission in individuals experiencing early-onset poststroke depression (PSD) in China and to identify predictors of remission during a 3-month follow-up. This study also explored the interaction between cognitive impairment and depression. Methods...

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Autores principales: Huang, Jing, Zhou, Fu-Chun, Guan, Boyuan, Zhang, Ning, Wang, Anxin, Yu, Ping, Zhou, Lei, Wang, Chuan-Yue, Wang, Chunxue
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331416/
https://www.ncbi.nlm.nih.gov/pubmed/30670990
http://dx.doi.org/10.3389/fpsyt.2018.00738
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author Huang, Jing
Zhou, Fu-Chun
Guan, Boyuan
Zhang, Ning
Wang, Anxin
Yu, Ping
Zhou, Lei
Wang, Chuan-Yue
Wang, Chunxue
author_facet Huang, Jing
Zhou, Fu-Chun
Guan, Boyuan
Zhang, Ning
Wang, Anxin
Yu, Ping
Zhou, Lei
Wang, Chuan-Yue
Wang, Chunxue
author_sort Huang, Jing
collection PubMed
description Objectives: This study aimed to examine the rate of remission in individuals experiencing early-onset poststroke depression (PSD) in China and to identify predictors of remission during a 3-month follow-up. This study also explored the interaction between cognitive impairment and depression. Methods: A total of 820 patients with PSD from a massive multicenter prospective cohort project in China (PRIOD) were included in the present study. Depressive symptoms were measured with the Hamilton Depression Rating Scale (17 Items, HDRS-17) at 2 weeks and the endpoint of the 3-month follow-up. The cut-off score of HDRS-17 (< 8) was used to define remission of depression at the endpoint. The Mini-Mental State Exam (MMSE) was used to evaluate the cognitive impairment of the patients (at the 2-week follow-up and 3-month endpoint). The National Institutes of Health Stroke Scale (NIHSS) was used to measure the severity of stroke. Results: (1) Six hundred and forty-two patients completed the 3-month follow-up, and 332 (51.7%) patients remitted by the end of the study. Univariate analyses indicated that there was a higher proportion of patients who had hypertension, frontal lobe lesion, basal ganglia lesion, poor outcome at 2 weeks, high scores on the NIHSS at 2 weeks, major life events within 3 months, and major medical diseases within 3 months in the nonremission group. In stepwise multiple logistic regression analyses, remission was significantly predicted by lower NIHSS scores at 2 weeks (p = 0.001, OR = 1.086, 95% CI 1.035–1.139), fewer major life events (p = 0.036, OR = 5.195, 95% CI 1.111–27.283), fewer major medical comorbidities (p = 0.015, OR = 2.434, 95% CI 1.190–4.979), and fewer frontal lobe lesions (p = 0.042, OR = 1.717, 95% CI 1.019–2.891). (2) After controlling for confounding variables, repeated measures analysis of variance revealed a significant interaction between time (2 weeks vs. 3 months) and group (remitters vs. nonremitters) on MMSE scores [F((1, 532)) = 20.2, p < 0.001]. Conclusions: Early-onset PSD patients with milder neurological impairment, fewer major life events, fewer major medical comorbidities and no frontal lobe lesion at baseline were more likely to achieve remission 3 months after stroke. Only remitters of PSD improved significantly in cognitive impairment after stroke. The PRIOD trial is registered at http://www.isrctn.com/, number ISRCTN62169508.
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spelling pubmed-63314162019-01-22 Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up Huang, Jing Zhou, Fu-Chun Guan, Boyuan Zhang, Ning Wang, Anxin Yu, Ping Zhou, Lei Wang, Chuan-Yue Wang, Chunxue Front Psychiatry Psychiatry Objectives: This study aimed to examine the rate of remission in individuals experiencing early-onset poststroke depression (PSD) in China and to identify predictors of remission during a 3-month follow-up. This study also explored the interaction between cognitive impairment and depression. Methods: A total of 820 patients with PSD from a massive multicenter prospective cohort project in China (PRIOD) were included in the present study. Depressive symptoms were measured with the Hamilton Depression Rating Scale (17 Items, HDRS-17) at 2 weeks and the endpoint of the 3-month follow-up. The cut-off score of HDRS-17 (< 8) was used to define remission of depression at the endpoint. The Mini-Mental State Exam (MMSE) was used to evaluate the cognitive impairment of the patients (at the 2-week follow-up and 3-month endpoint). The National Institutes of Health Stroke Scale (NIHSS) was used to measure the severity of stroke. Results: (1) Six hundred and forty-two patients completed the 3-month follow-up, and 332 (51.7%) patients remitted by the end of the study. Univariate analyses indicated that there was a higher proportion of patients who had hypertension, frontal lobe lesion, basal ganglia lesion, poor outcome at 2 weeks, high scores on the NIHSS at 2 weeks, major life events within 3 months, and major medical diseases within 3 months in the nonremission group. In stepwise multiple logistic regression analyses, remission was significantly predicted by lower NIHSS scores at 2 weeks (p = 0.001, OR = 1.086, 95% CI 1.035–1.139), fewer major life events (p = 0.036, OR = 5.195, 95% CI 1.111–27.283), fewer major medical comorbidities (p = 0.015, OR = 2.434, 95% CI 1.190–4.979), and fewer frontal lobe lesions (p = 0.042, OR = 1.717, 95% CI 1.019–2.891). (2) After controlling for confounding variables, repeated measures analysis of variance revealed a significant interaction between time (2 weeks vs. 3 months) and group (remitters vs. nonremitters) on MMSE scores [F((1, 532)) = 20.2, p < 0.001]. Conclusions: Early-onset PSD patients with milder neurological impairment, fewer major life events, fewer major medical comorbidities and no frontal lobe lesion at baseline were more likely to achieve remission 3 months after stroke. Only remitters of PSD improved significantly in cognitive impairment after stroke. The PRIOD trial is registered at http://www.isrctn.com/, number ISRCTN62169508. Frontiers Media S.A. 2019-01-08 /pmc/articles/PMC6331416/ /pubmed/30670990 http://dx.doi.org/10.3389/fpsyt.2018.00738 Text en Copyright © 2019 Huang, Zhou, Guan, Zhang, Wang, Yu, Zhou, Wang and Wang. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Huang, Jing
Zhou, Fu-Chun
Guan, Boyuan
Zhang, Ning
Wang, Anxin
Yu, Ping
Zhou, Lei
Wang, Chuan-Yue
Wang, Chunxue
Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up
title Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up
title_full Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up
title_fullStr Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up
title_full_unstemmed Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up
title_short Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up
title_sort predictors of remission of early-onset poststroke depression and the interaction between depression and cognition during follow-up
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331416/
https://www.ncbi.nlm.nih.gov/pubmed/30670990
http://dx.doi.org/10.3389/fpsyt.2018.00738
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