| Objective To investigate the changes of post-stroke apathy at the acute phase,3 months,6 months and 1 year after acute ischemic stroke,as well as the related risk factors of apathy in actue phase and 1 year after stroke.Methods 1.A total of 156 patients with acute ischemic stroke admitted to Department of Neurology,Affiliated Hospital of Southwest Medical University from January 2016 to February 2017 were selected as the observation group.70 cases of physical examination during the same period were selected as the control group,There were no significant difference in age,gender,educational level,hypertension,diabetes,coronary heart diseases,smoking or alcohol abused between two groups.2.The Modified Apathy Evaluation Scale(MAES)was used to assess apathy in the observation and the control groups.3.Basic information and clinical features of the observation group were collected,including demographic data,vascular risk factors,biochemical indicators,imaging data,a follow-up study on the incidence of post-stroke apathy was conducted.The first follow-up study was performed at the acute phase of stroke(14d ± 2d).MAES,National Institutes of Health Stroke Scale(NIHSS),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA)and Montreal Cognitive Assessment Scale(MoCA)were used to assess all the enrolled patients.At the third month(90 d ± 7d)and the 6th month(180 d ± 7d)after stroke,the second and third follow-up study were conducted by outpatient referral,telephone interview or home visit,MAES was used to assess the incidence of apathy.At 1 year(365d ± 14d)after stroke,the fourth follow-up study was implemented through outpatient referral,MAES,modified Rankin scale(mRs),HAMD,HAMA,MoCA and Pittsburgh Sleep Quality Index(PSQI)were uesd to assess the enrolled patients.4.According to the MAES scores in the follow-up study,the observation group was divided into apathy group and non-apathy group(MAES> 14 was defined as apathy),the incidence and changes of apathy were explored in different time points after stroke(14 days,3 months,6 months,1 year).Besides,the basic information and clinical features of two groups were compared to analyze the related risk factors of apathy in acute phase and 1 year after ischemic stroke.Results 1.In 156 patients with ischemic stroke,the incidence of apathy in acute phase was 32.7%(51/156);while the incidence of apathy found in control group was 7.1%(5/70),the difference was statistically significant between the two groups(P<0.05).2.In the acute phase of stroke,the blood homocysteine(Hcy)level was 15.08 ± 9.29μmol / l in the apathy group,it was higher than 10.82 ± 5.02μmol / l in the non-apathy group,the difference was statistically significant(P<0.05).3.In the apathy group of post-stroke acute phase,there were 31 cases(60.8%)of lesions located on the right side,15 cases(29.4%)on the brainstem,8 cases(15.7%)on the frontal lobe and 35 cases(68.6%)exist white matter lesions;while there were 46 cases(43.8%)on the right side,11 cases(10.5%)on the brainstem,6 cases(5.7%)on the frontal lobe,and 46 cases(43.8%)exist white matter lesions in the non-apathy group.The differences were statistically significant(P<0.05).4.NIHSS score was 5(3,6)and HAMD was 6(4,10)in the apathy group of post-stroke acute phase;while NIHSS score was 4(3,4)and HAMD was 5(3,8)in the non-apathy group,the differences were statistically significant(P<0.05).5.Multivariate Logistic analysis showed that the Hcy(OR: 1.201,95% CI: 1.101-1.311,P = 0.000),NIHSS score(OR: 1.602,95% CI: 1.218-2.106,P = 0.001),right lesion(OR: 2.575,95% CI: 1.053-6.297,P = 0.038),frontal lobe lesion(OR: 16.313,95% CI: 3.789-70.232,P = 0.000),brainstem lesion(OR: 5.026,95% CI: 1.747-14.461,P = 0.003)and exist white matter lesions(OR: 3.296,95% CI: 1.344-8.087,P = 0.009)were related to apathy in acute phase after ischemic stroke.6.The incidence of apathy were 36.8%,40.4% and 33.6% respectively at 3 months,6 months and 1 year after ischemic stroke,there was no significant difference among each incidence of apathy(P> 0.05).7.There were 7 cases(15.6%)stroke attacked again,29 cases(64.4%)mRs score > 1 in the apathy group of 1 year after ischemic stroke onset,while there were 3 cases(3.4%)who stroke attacked again and mRs score> 1 was 27cases(30.3%)in the non-apathy group.The differences were statistically significant(P<0.05).8.PSQI score was 6(5,10)and HAMD score was 6(5,12)in the apathy group of 1 year after ischemic stroke onset,which were higher than the PSQI score 5(4,6)and HAMD score 5(4,9)in the non-apathy group.MoCA score was 18(16.5,21)in the apathy group,which was lower than 21(15.5,25)in the non-apathy group.The differences were statistically significant(P<0.05).9.Multivariate Logistic analysis showed that the mRs score(OR: 7.626,95% CI: 2.256-25.773,P = 0.001),PSQI score(OR: 1.627,95% CI: 1.270-2.083,P = 0.000),and HAMD score(OR: 1.192,95% CI: 1.023-1.390,P = 0.024)were related to apathy in 1 year after ischemic stroke onset.Conclusions 1.Apathy is a common psychiatric symptom after ischemic stroke,the incidence of which changes over time,but remains relatively stable in the first year after stroke.2.There are many influencing factors of apathy after ischemic stroke,and different periods of stroke may have different influencing factors.3.Blood homocysteine,neurological deficits,lesions located on the right side hemisphere,frontal lobe,brain stem and exist white matter lesions may be the related risk factors of apathy in acute phase after ischemic stroke.4.Patients with apathy at 1 year after ischemic stroke are more likely to get recurrence of stroke and disability.5.Physical disability,sleep disorders and depression may be the related risk factors of apathy in chronic phase after ischemic stroke onset. |
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