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

Elles Douven, Pauline Aalten, Julie Staals, Syenna H. J. Schievink, Robert J. van Oostenbrugge, Frans R. J. Verhey, Sebastian Kohler*

*Corresponding author for this work

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Abstract

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 P atients 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.
Original languageEnglish
Pages (from-to)859-865
Number of pages7
JournalJournal of Neurology Neurosurgery and Psychiatry
Volume89
Issue number8
DOIs
Publication statusPublished - 1 Aug 2018

Keywords

  • VASCULAR RISK-FACTORS
  • SMALL-VESSEL DISEASE
  • LATE-LIFE DEPRESSION
  • QUALITY-OF-LIFE
  • COGNITIVE IMPAIRMENT
  • GERIATRIC DEPRESSION
  • TREATMENT RESPONSE
  • NATURAL-HISTORY
  • NORMATIVE DATA
  • PARTICIPANTS

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