The Analysis Of Incidence,Related Risk Factors And Prognosis Of Ischemic Post-Stroke Digpression

Objective:To study the incidence of post-stroke depression(PSD)after stroke onset and analyze related risk factors.The prognosis of PSD patients and the clinical features of remission of early-onset post-stroke depression were also observed.Methods:152 patients with acute ischemic stroke were collected continuously and followed up to 3 months after stroke onset.All patients were evaluated according to diagnostic criteria of post-stroke depression and the Hamilton Depression Scale 17 version(HAMD-17)at 2 weeks and 3 months.Based on the results,the case group were divided into post-stroke depression group(PSD group)and no post-stroke depression group(non-PSD group,NPSD),the PSD group were divided into mild PSD group and moderate or major PSD group according to HAMD scores.We defined patients diagnosed PSD at 2 weeks,whose HAMD score<7 at 3 months as remission of PSD,and patients whose HAMD score≥7 at 3 months as non-remission of PSD.PSD patients at 2 weeks were divided into remission group and non-remission group.All patients were performed NIHSS,BI scores after stroke onset and MMSE,Hamilton Anxiety Scale14 version(HAMA-14)at 2 weeks.We calculated incidence rate of PSD at 2 weeks,3 months and within 3 months after stroke onset.Sociodemographic,cerebrovascular risk factors,related biochemical indicators,imaging features and above scores were compared in PSD and non-PSD group to understand the related factors of PSD.Hospitalization and modified Rankin Scale(mRS)at 3 months were used to evaluate prognosis of ischemic stroke patients.We also analyzed related factors that influencing remission of early-onset PSD.Results:1)A total of 152 patients with acute ischemic stroke were collected,56 cases were diagnosed PSD at 2 weeks after stroke onset,the incidence of PSD was 36.8%.39 cases were diagnosed PSD at 3 months,the incidence of PSD was 25.7%.There were 30 patients diagnosed PSD at 2 weeks and got remitted at 3 months,26 patients diagnosed PSD both at 2 weeks and 3 months and 13 new patients diagnosed PSD at 3 months,the remission rate of early-onset PSD within 3 months was 53.6%.There were 69 patients diagnosed PSD within 3 months.The cumulative incidence of depression within 3 months was 45.4%,with mild depression accounting for 38.2%and moderate depression accounting for 7.2%.2)Sociodemographic data showed that patients living in rural areas and living alone were more likely to have poststroke depression(P=0.007,P<0.001).3)The lymphocytes and eosinophils counts of PSD patients were lower than those of NPSD patients(P=0.026,P=0.007).4)Patients with lesion in frontal lobe,temporal lobe,bigger cerebral infarction volume and multifocal ischemic stroke were more likely to have PSD(P=0.008,P=0.002,P=0.007,P=0.006).5)The MMSE scores and BI scores of the mild PSD group were significantly lower than those of the NPSD group(P<0.001,for all),while the NIHSS and HAMA scores were significantly higher than the NPSD group(P<0.001,for all).The MMSE scores and BI scores of the moderate PSD group were significantly lower than those of the NPSD group(P=0.019,P=0.025),and the HAMA scores was significantly higher than the NPSD(P<0.001).The HAMA scores in the moderate PSD group was significantly higher than that in the mild PSD group(P=0.009).6)NIHSS,HAMA scores,hospitalization and infarction volume were positively correlated with HAMD scores in ischemic stroke patients(r=0.327,r=0.523,r=0.311,=0.206,P<0.05,for all),while MMSE scores,BI Scores,lymphocyte count,eosinophil count were negatively correlated with HAMD scores(r=-0.306,r=-0.296,r=-0.162,r=-0.219,P<0.05,for all).7)Multivariate logistic regression analysis showed that higher HAMA scores and multifocal ischemic stroke may be risk factors for acute ischemic poststroke depression.Patients with PSD have a longer hospitalization period and a higher mRS score than patients with NPSD.8)The PSD remission group had lower fasting blood glucose and HAMD scores than the non-remission group,and the anxiety disorder in remission group was not common,(P=0.007,P<0.001,P=0.013).Conclusions:1)The cumulative incidence of PSD within 3 months after stroke onset reaching 45.4%and mainly composed of mild poststroke depression.The remission rate of early-onset PSD within 3 months was 53.6%.2)PSD was closely related to living area,living with offspring,lymphocyte count,eosinophil count,lesion location,multifocal ischemic stroke,lesion volume,the extent of neurological deficit,daily life ability damage,cognitive dysfunction and anxiety disorder.3)Anxiety disorder and multifocal ischemic stroke may be risk factors for PSD.PSD group had a longer hospitalization period and worse prognosis.4)Early-onset PSD patients who get remitted easily have lower fasting blood glucose,anxiety and depression symptoms.