Treating Depression and Enhancing Locomotor Recovery Post-stroke

抑郁症是中风后最常见的神经精神症状，目前的治疗方法是 大部分无效。抑郁症对康复治疗的反应有直接和间接的影响;因此， 卒中后抑郁（PSD）患者通常被排除在康复试验和治疗之外， 这些人的选择极为有限。我们建议确定两种已知的抗抑郁药的影响， 对非中风相关抑郁症有效的治疗-有氧运动训练（AET） 和重复经颅磁刺激（rTMS）-中风后抑郁症状。此外，我们将 确定抑郁症是否限制了治疗后行走功能的增加， 抑郁症状有助于改善行走。 这个项目是基于这样一个前提，即抑郁症会对大脑适应环境的潜力产生负面影响。 对治疗的反应，使康复可能不会产生相同的大脑变化，它在非抑郁症 个体我们认为，有效的治疗PSD将导致一个良性循环， 减少抑郁会促进大脑的变化，从而促进功能的改善。即有效治疗 抑郁症会使大脑更好地从中风中恢复过来。此外，除了其有益的 对抑郁症的影响，AET已知可改善中风后行走，因此为治疗中风提供了一个有吸引力的选择。 治疗抑郁症以及建立车辆，以研究PSD对运动反应的影响 康复活动. 作为本项目的一部分，提出的实验旨在解决与以下方面相关的关键问题：1） AET和/或rTMS对抑郁症状的影响; 2）PSD可能限制运动功能的改善 功能; 3）AET和rTMS联合治疗的影响;和4）基线受试者之间的关系 属性和对治疗的反应。该项目的成功完成将为 更大规模的治疗试验，以确定AET和/或rTMS对卒中后抑郁的有效性， 步行以及识别可能负责响应于 治疗

Depression is the most common neuropsychiatric manifestation following stroke and current treatments are largely ineffective. Depression has both direct and indirect effects on response to rehabilitation treatment; thus subjects with post-stroke depression (PSD) are routinely excluded from rehabilitation trials and treatment options for these individuals are extremely limited. We propose to determine the impact of two known anti-depressive treatments shown to be effective in non-stroke related depression - aerobic exercise training (AET) and repetitive transcranial magnetic stimulation (rTMS) - on post-stroke depressive symptoms. Further, we will determine if depression limits gains in walking function in response to treatment and if successful reduction in depressive symptoms facilitates improved walking. This project is based on the premise that depression negatively affects the potential for the brain to adapt in response to treatment such that rehabilitation may not produce the same brain changes that it does in non-depressed individuals. We propose that effective treatment for PSD would result in a virtuous cycle where reducing depression enhances brain changes, thereby facilitating functional gains. That is, effectively treating depression will make the brain better able to recover from stroke. Furthermore, in addition to its beneficial effects on depression, AET is known to improve post-stroke walking, thus providing an attractive option for treating depression as well as an established vehicle to study the effects of PSD on response to locomotor rehabilitation. The experiments proposed as part of this project are designed to address critical questions related to the: 1) effects of AET and/or rTMS on depressive symptoms; 2) potential for PSD to limit improvements in locomotor function; 3) impact of combining AET and rTMS treatments; and 4) relationship between baseline subject attributes and response to treatment(s). Successful completion of this project will provide a foundation for larger scale therapeutic trials to establish the effectiveness of AET and/or rTMS on post-stroke depression and walking as well as identify the mechanisms that may be responsible for the changes that occur in response to treatment.