Depression, anxiety, and cognitive functioning after intracerebral hemorrhage
Depression, anxiety, and cognitive functioning after intracerebral hemorrhage
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DOI：
10.1111/ane.12367
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发表时间：
2015-09-01
影响因子：
3.5
通讯作者：
Putaala, J.
中科院分区：
文献类型：
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作者：
Koivunen, R. -J.;Harno, H.;Putaala, J.
背景与目的脑卒中后抑郁（Post-stroke depression，PSD）是脑卒中的重要并发症。我们研究了长期PSD脑出血（ICH）后，在年轻的时候，以及焦虑，和认知功能的survivers.MethodsWe收集了336个年轻的ICH患者的临床和影像学数据，年龄在16岁和49岁之间的治疗赫尔辛基大学中心医院。经过中位9.7（7.0-12.0）年的随访，我们对130名幸存者进行了结构性问卷调查，包括贝克抑郁量表II（BDI-II）、医院焦虑和抑郁量表（HADS）、疼痛焦虑症状量表（PASS）、简明疼痛量表（BPI）和蒙特利尔认知评估量表（莫卡）。进行单变量和多变量分析以确定与PSD相关的因素（BDI-II评分>13）。结果30例（23.1%）患者存在PSD，52例（40.0%）患者存在焦虑（HADS评分>6分）。残疾程度越高，抑郁症状（BDI-II评分越高，P=0.001）、情绪困扰（HADS评分越高，P=0.004）和疼痛（PASS评分越高，P=0.008，BPI评分越高，P=0.003）越明显。与PSD相关的唯一基线因素是脑积水（P=0.014）。PASS评分中位数为9（IQR 0-25），BPI评分中位数为5（0-23），莫卡评分中位数为26（22-28），提示正常或轻度认知功能障碍。抗抑郁药使用率为9.2%。结论4例年轻脑出血幸存者中有1例发生长期PSD。残疾程度越高，预示PSD的发生。抑郁症的治疗似乎是年轻ICH幸存者未满足的需求。
Background and PurposePost-stroke depression (PSD) is an important complication of stroke. We studied long-term PSD after intracerebral hemorrhage (ICH) at young age, as well as anxiety, and cognitive functioning of the survivors.MethodsWe gathered clinical and imaging data of 336 young ICH patients between age 16 and 49 treated in the Helsinki University Central Hospital. After a median follow-up of 9.7 (7.0-12.0) years, we interviewed 130 survivors with structural questionnaires including Beck Depression Inventory II (BDI-II), Hospital Anxiety and Depression Scale (HADS), Pain Anxiety Symptoms Scale (PASS), Brief Pain Inventory (BPI), and Montreal Cognitive Assessment (MoCA). Univariate and multivariate analysis was performed to identify factors associated with PSD (BDI-II score >13). Degree of disability was measured by modified Rankin Scale score (mRS).ResultsPSD was present among 30 (23.1%) and anxiety among 52 (40.0%) patients (HADS score >6). Higher degree of disability was associated with symptoms of depression (higher BDI-II scores, P=0.001), emotional distress (higher HADS scores, P=0.004), and pain (higher PASS scores, P=0.008, and higher BPI scores, P=0.003). The only baseline factor identified to associate with PSD was hydrocephalus (P=0.014). Median PASS score was 9 (IQR 0-25), median BPI score was 5 (0-23), and median MoCA score was 26 (22-28) hinting to normal or mild cognitive dysfunction. Antidepressants were used by 9.2%.ConclusionsOne of four survivors of ICH at young age suffers long-term PSD. Higher degree of disability predicted occurrence of PSD. Treatment of depression appears as an unmet need in young ICH survivors.