Early depressed mood after stroke predicts long-term disability: the Northern Manhattan Stroke Study (NOMASS).
Early depressed mood after stroke predicts long-term disability: the Northern Manhattan Stroke Study (NOMASS).
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DOI：
10.1161/strokeaha.110.583997
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发表时间：
2010-09
期刊：
影响因子：
8.3
通讯作者：
Wright CB
中科院分区：
文献类型：
--
作者：
Willey JZ;Disla N;Moon YP;Paik MC;Sacco RL;Boden-Albala B;Elkind MS;Wright CB
中风后抑郁症非常普遍，可能会影响恢复。我们的目的是确定卒中后急性抑郁情绪是否能预测随后的残疾和死亡率。作为北方曼哈顿卒中研究的一部分，在多种族城市人群中进行了一项基于人群的卒中事件病例随访研究，参与者被问及卒中后7-10天内的抑郁情绪。参与者在前2年每6个月随访一次，此后每年随访5年，通过Barthel指数（BI）测量死亡和残疾。我们使用典型链接拟合多分类logistic回归模型，以检查中风后抑郁情绪与残疾之间的关系，比较中度（BI 60-95）和重度（BI < 60）残疾与无残疾（BI ≥ 95）。Cox比例风险模型被用来研究抑郁情绪和死亡率之间的关系。在655名入选的缺血性卒中患者中，有340名患者被问及卒中后7-10天内的抑郁情绪，其中139名患者报告他们感到抑郁。在控制了社会人口统计学因素、卒中严重程度和医疗条件的多变量分析中，与卒中后1年（OR 2.91，95%CI 1.07-7.91）和2年（OR 3.72，95%CI 1.29-10.71）无残疾相比，抑郁情绪与严重残疾的几率更大相关。抑郁情绪与全因死亡率或血管性死亡无关。卒中后抑郁情绪与卒中后残疾相关，但与死亡率无关。中风后情绪障碍的早期筛查和干预可能会改善预后，需要进一步研究。
Depression is highly prevalent after stroke, and may influence recovery. We aimed to determine whether depressed mood acutely after stroke predicts subsequent disability and mortality. As part of the Northern Manhattan Stroke Study, a population-based incident stroke case follow-up study performed in a multiethnic urban population, participants were asked about depressed mood within 7–10 days after stroke. Participants were followed every 6 months the first 2 years, and yearly thereafter for 5 years, for death and disability measured by the Barthel Index (BI). We fitted polytomous logistic regression models using canonical link to examine the association between depressed mood after stroke and disability, comparing moderate (BI 60–95) and severe (BI < 60) disability to no disability (BI ≥ 95). Cox-proportional hazards models were created to examine the association between depressed mood and mortality. A question about depressed mood within 7–10 days after stroke was asked in 340 of 655 ischemic stroke patients enrolled, and 139 reported that they felt depressed. In multivariate analyses controlling for socio-demographic factors, stroke severity, and medical conditions, depressed mood was associated with a greater odds of severe disability compared to no disability at one (OR 2.91, 95% CI 1.07–7.91) and two years (OR 3.72, 95% CI 1.29–10.71) after stroke. Depressed mood was not associated with all cause mortality or vascular death. Depressed mood after stroke is associated with disability but not mortality after stroke. Early screening and intervention for mood disorders after stroke may improve outcomes and requires further research.