Elles Douven

Co-occurrence of depressive symptoms and executive dysfunction after stroke: associations with brain pathology and prognosis

Objective To examine, first, whether the co-occurrence of executive dysfunction (ED) and poststroke depression (PSD) shows different associations with neuroimaging markers and the course of depression and executive function, and second, whether it is associated with a different course on other cognitive domains and quality of life. Methods The present study included 245 stroke patients (35.9% female, mean age 67.5 years (SD=11.9). All patients completed neuropsychological and neuropsychiatric assessment 3 months poststroke, which were repeated at 6-month and 12-month follow-up. A subset (n=186) received 3-Tesla brain MRI at baseline to evaluate lesion-related imaging markers, white matter hyperintensity volume, global brain atrophy and total cerebral small vessel disease burden. Results Patients with ‘depression–executive dysfunction syndrome’ (DES) showed higher white matter hyperintensity volumes compared with all other groups and more frequently showed left-sided lesions compared with ED only and PSD only. They also had more frequently old infarcts and higher total cerebral small vessel disease burden compared with PSD only and patients with neither ED nor PSD, and more global brain atrophy compared with PSD only. Longitudinal analyses showed that patients with DES had a more chronic course of depressive symptoms relative to PSD only, and a stable pattern of worse cognitive performance similar to patients with ED only. Conclusions The co-occurrence of ED and PSD is associated with a worse prognosis of depression, persistent cognitive impairment and a higher amount of vascular and degenerative brain pathology. Future studies are needed to examine whether these patients represent a more severe subtype within the PSD spectrum. Clinical trial registration NCT02585349;Results.

Baseline Vascular Cognitive Impairment Predicts the Course of Apathetic Symptoms After Stroke: The CASPER Study

OBJECTIVE To examine the influence of vascular cognitive impairment (VCI) on the course of poststroke depression (PSD) and poststroke apathy (PSA). METHODS Included were 250 stroke patients who underwent neuropsychological and neuropsychiatric assessment 3 months after stroke (baseline) and at a 6- and 12-month follow-up after baseline. Linear mixed models tested the influence of VCI in at least one cognitive domain (any VCI) or multidomain VCI (VCI in multiple cognitive domains) at baseline and domain-specific VCI at baseline on levels of depression and apathy over time, with random effects for intercept and slope. RESULTS Almost half of the patients showed any VCI at baseline, and any VCI was associated with increasing apathy levels from baseline to the 12-month follow-up. Patients with multidomain VCI had higher apathy scores at the 6- and 12-month follow-up compared with patients with VCI in a single cognitive domain. Domain-specific analyses showed that impaired executive function and slowed information processing speed went together with increasing apathy levels from baseline to 6- and 12-month follow-up. None of the cognitive variables predicted the course of depressive symptoms. CONCLUSION Baseline VCI is associated with increasing apathy levels from baseline to the chronic stroke phase, whereas no association was found between baseline VCI and the course of depressive symptoms. Health professionals should be aware that apathy might be absent early after stroke but may evolve over time in patients with VCI.

Personality traits and course of symptoms of depression and apathy after stroke: Results of the CASPER study

OBJECTIVE Post-stroke depression (PSD) and post-stroke apathy (PSA) are both associated with adverse outcome after stroke. This study aimed to examine whether personality traits predict the course of PSD and PSA. METHODS In this prospective cohort study, 240 stroke patients completed the NEO Five Factor Inventory, Montgomery-Åsberg Depression Rating Scale, and Apathy Evaluation Scale at 3 months post-stroke. Neuropsychiatric assessment was repeated at 6- and 12-month follow-up after initial testing. RESULTS Linear mixed models showed that high neuroticism scores were associated with higher depression levels at baseline, and this association remained stable at follow-up. High extraversion scores and high conscientiousness scores were associated with lower apathy levels at baseline. For neuroticism, a significant interaction with time was found, with higher neuroticism scores at baseline being associated with an increase in apathy scores from 6-month to 12-month follow-up. Prospective analyses showed that high extraversion predicted low apathy levels at 6-month and 12-month follow-up independent of its relations with baseline depression and apathy. High neuroticism predicted high apathy levels at 12-month follow-up, whereas high agreeableness and high openness predicted high apathy levels and low apathy levels, respectively, at 6-month follow-up. None of the personality traits predicted depression scores at follow-up. CONCLUSION Personality traits are associated with the development and sustainability of PSD and PSA. The traits associated with PSD and PSA were different, providing support for the independence of these constructs. The findings highlight the importance to take personality traits into account as a potential vulnerability factor for PSD and PSA.

Imaging Markers of Post-Stroke Depression and Apathy : a Systematic Review and Meta-Analysis

Several brain imaging markers have been studied in the development of post-stroke depression (PSD) and post-stroke apathy (PSA), but inconsistent associations have been reported. This systematic review and meta-analysis aims to provide a comprehensive and up-to-date evaluation of imaging markers associated with PSD and PSA. Databases (Medline, Embase, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews) were searched from inception to July 21, 2016. Observational studies describing imaging markers of PSD and PSA were included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated to examine the association between PSD or PSA and stroke lesion laterality, type, and location, also stratified by study phase (acute, post-acute, chronic). Other imaging markers were reviewed qualitatively. The search retrieved 4502 studies, of which 149 studies were included in the review and 86 studies in the meta-analyses. PSD in the post-acute stroke phase was significantly associated with frontal (OR 1.72, 95% CI 1.34–2.19) and basal ganglia lesions (OR 2.25, 95% CI 1.33–3.84). Hemorrhagic stroke related to higher odds for PSA in the acute phase (OR 2.58, 95% CI 1.18–5.65), whereas ischemic stroke related to higher odds for PSA in the post-acute phase (OR 0.20, 95% CI 0.06–0.69). Frequency of PSD and PSA is modestly associated with stroke type and location and is dependent on stroke phase. These findings have to be taken into consideration for stroke rehabilitation programs, as this could prevent stroke patients from developing PSD and PSA, resulting in better clinical outcome.

IMAGING MARKERS ASSOCIATED WITH THE DEVELOPMENT OF POST-STROKE DEPRESSION AND APATHY: RESULTS OF THE CASPER STUDY

P3-310 IMAGING MARKERS ASSOCIATEDWITH THE DEVELOPMENT OF POST-STROKE DEPRESSION AND APATHY: RESULTS OF THE CASPER STUDY Elles Douven, Julie Staals, Syenna H. J. Schievink, Whitney M. Freeze, Danique Hellebrekers, Robin Wolz, Jacobus F. A. Jansen, Robert J. van Oostenbrugge, Frans R. J. Verhey, Sebastiaan Koehler, Pauline Aalten, Alzheimer Center Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands; Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands; Imperial College London, London, United Kingdom. Contact e-mail: p.aalten@ maastrichtuniversity.nl

Depression and apathy after stroke : The influence of risk factors on their development and course

Depression and apathy are common symptoms after a stroke and can negatively affect the rehabilitation process. This dissertation examined the influence of biological and psychosocial risk factors on the development and progression of depression and apathy after a stroke. The results reveal differences in the risk factors associated with depression and apathy, which supports the hypothesis that apathy can develop independent of depression. The findings in this dissertation improve our understanding of the etiology of these syndromes and help clinicians make a diagnostic distinction between depression and apathy, which in turn helps to develop more targeted treatment strategies.

Temporal Associations between Fatigue, Depression, and Apathy after Stroke: Results of the Cognition and Affect after Stroke, a Prospective Evaluation of Risks Study

Background: Poststroke fatigue (PSF) is a form of pathological fatigue that can develop after stroke and has a negative impact on functional outcome. PSF is associated with poststroke depression (PSD), which in turn shows similarities with poststroke apathy (PSA). This study aimed at disentangling the temporal associations between PSF and PSD and between PSF and PSA. Methods: A total of 250 stroke patients were included, of which 243 completed the Fatigue Severity Scale, Montgomery-Åsberg Depression Rating Scale, and Apathy Evaluation Scale at 3 months poststroke, with follow-up measurements at 6 and 12 months after initial testing. Linear mixed models and linear regressions were performed to evaluate the temporal associations between PSF and PSD, and between PSF and PSA. Results: PSF was present in 119 patients (49%), of whom 62 patients also had PSD (26%), and 21 patients (9%) also had PSA. At baseline, PSF patients showed higher depression levels, which remained stable at follow-up. PSD patients had higher fatigue levels compared with no-PSD patients at baseline, which remained stable at follow-up. No association between apathy and fatigue was found at baseline and no interaction with time was found. Change in fatigue from baseline to 12-month follow-up was associated with change in depression and with change in apathy. Conclusions: Bidirectional associations were found between PSF and PSD. In treatment and rehabilitation programs, early focus on the presence of PSD and PSF is important, since these conditions tend to persist. As there are currently more treatment options for PSD, attention for PSD is important and might also have a beneficial effect on PSF.

EARLY VASCULAR COGNITIVE IMPAIRMENT PREDICTS THE COURSE OF DEPRESSION AND APATHY AFTER STROKE: THE CASPER STUDY

Sweden. A representative sample of 800 women was examined at baseline 1968 (aged 38 to 54 years), and re-examinations (n1⁄46) were done until 2012. Both dementia and depression was diagnosed according to DSM-III-R criteria, and based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. For thosewho had an episode of depression before baseline hospital registers were used. Sub-type of AD dementia was diagnosed according to NINCDS-ADRDA criteria. Results:During the 44-years of follow-up, 133 women developed AD and 598 died. Sixty-seven percent of the women had anytype depression during life-span (44% had major depression). Mean age of first depressive episode was 42 years. History of major depression increased the risk of developing AD with above 90%, compared to those without depression. Minor depression was not associated to AD. The risk of AD was related to age of onset of depression. Compared to women without depression, HR (95% CI) for AD was 3.35 (1.70-6.59) in women with first depressive episode before age twenty, 1.66 (1.06-2.59) in women with first episode in early midlife (20-49 years), and 2.16 (1.22-3.79) in women with first episode after age 70. Those with depression onset in late midlife (50-69 years) had no increased risk of AD. Depression was not associated with vascular dementia or other types of dementia. All analyses were adjusted for age, education and ApoE genotype. Conclusions:We found that major depression, early-life depression, early midlife depression, and late-life depression were associations with higher incidence of AD.

Neuropsychiatrische syndromen na een beroerte

SamenvattingBeroerte is wereldwijd een van de meest voorkomende doodsoorzaken met een hoge ziektelast. Naast fysieke en cognitieve beperkingen kunnen er na een beroerte neuropsychiatrische syndromen ontstaan, waarvan depressie, apathie, angst, vermoeidheid en emotionele labiliteit het meest voorkomen. Minder vaak voorkomende syndromen na een beroerte zijn persoonlijkheids-veranderingen, psychose en manie. Al deze syndromen hebben een grote impact op de kwaliteit van leven van de patiënt en op diens familie, en zijn van invloed op het herstel. Individuele symptomen kunnen deel uitmaken van verschillende neuropsychiatrische syndromen, wat een adequate diagnose en mogelijke behandeling bemoeilijkt. Dit review geeft een overzicht van definities, prevalenties, beloop en behandelingsopties van de neuropsychiatrische syndromen en hun bijbehorende symptomen. Daarnaast worden er aanbevelingen aangedragen voor toekomstig onderzoek.