Early apathetic, but not depressive, symptoms are associated with poor outcome after stroke
Early apathetic, but not depressive, symptoms are associated with poor outcome after stroke
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DOI：
10.1111/ene.14785
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发表时间：
2021-03-09
影响因子：
5.1
通讯作者：
Dziedzic, Tomasz
中科院分区：
文献类型：
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作者：
Lopatkiewicz, Anna Maria;Pera, Joanna;Dziedzic, Tomasz
背景和目的抑郁和冷漠是中风后常见的神经精神障碍，并且可能同时出现。尽管中风后抑郁和冷漠的症状有重叠，但这两种综合征可能与不同的疾病有关，并从不同的治疗中获益。我们的目的是解开早期抑郁和冷漠的症状和中风后outcomeafterstrok.Methods的698例登记缺血性中风患者之间的关系，我们包括443名参与者（中位年龄= 69岁，51%的女性）进行抑郁和冷漠的症状评估中风后第8天。我们将患者分为四组：结果在校正年龄和卒中严重程度后，第2组和第4组患者3个月预后不良的风险增加，第1组患者无严重抑郁和冷漠症状，第2组患者仅有冷漠症状，第3组患者仅有抑郁症状，第4组患者抑郁和冷漠症状均存在（比值比[OR] = 1.98，95%置信区间[CI] = 1.16-3.38，p = 0.01和OR = 1.58，95% CI = 1.24-2.01，p < 0.01）。第2组和第4组12个月预后不良的风险也增加（OR = 3.85，95%CI = 2.19-6.78，p < 0.01和OR = 1.54，95%CI = 1.22-1.96，p < 0.01）和死亡率（风险比[HR] = 2.76，95%CI = 1.19-6.41，p = 0.02和HR = 1.77，95%CI = 1.32-2.38，p < 0.01）。与第1组相比，第3组并没有增加风险的不利outcomes.Conclusions早期冷漠，但不抑郁，症状与中风后更糟糕的结果。我们的研究强调了独立于抑郁症状识别冷漠症状的重要性。
Background and purpose Depression and apathy are frequent neuropsychiatric disturbances after stroke and may appear together. Despite the overlap in symptoms between poststroke depression and apathy, these two syndromes might be associated with different prognoses and benefit from different treatments. We aimed to disentangle the relationship between early depressive and apathetic symptoms and outcome after stroke.Methods Of 698 enrolled patients with ischemic stroke, we included 443 participants (median age = 69 years, 51% female) who underwent depressive and apathetic symptom assessment on Day 8 after stroke. We divided patients into four groups: without greater depressive and apathetic symptoms (Group 1), with only apathetic symptoms (Group 2), with only depressive symptoms (Group 3), and with both depressive and apathetic symptoms (Group 4).Results After adjusting for age and stroke severity, Group 2 and Group 4 had an increased risk of poor 3-month outcome (odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.16-3.38, p = 0.01 and OR = 1.58, 95% CI = 1.24-2.01, p < 0.01, respectively). Group 2 and Group 4 also had an increased risk of poor 12-month outcome (OR = 3.85, 95% CI = 2.19-6.78, p < 0.01 and OR = 1.54, 95% CI = 1.22-1.96, p < 0.01, respectively) and mortality (hazard ratio [HR] = 2.76, 95% CI = 1.19-6.41, p = 0.02 and HR = 1.77, 95% CI = 1.32-2.38, p < 0.01, respectively). Compared with Group 1, Group 3 did not have an increased risk of unfavorable outcomes.Conclusions Early apathetic, but not depressive, symptoms are related to worse outcomes after stroke. Our study underscores the importance of recognizing apathetic symptoms independently from depressive symptoms.