ABSTRACT
To investigate the time-dependent effects of traditional risk factors on functional disability in all-cause mortality post-stroke, we evaluated data from a long-term stroke cohort. Baseline cerebrovascular risk factors (CVRF) and functionality at 1 and 6 months were evaluated in survivors from a prospective stroke cohort using the modified Rankin scale (m-RS), which classifies participants as improvement of disability, unchanged disability (at least moderate), and worsening disability. Cox regression models considering baseline risk factors, medication use, and functionality 6 months after stroke were fitted to identify their time-dependent effects up to 12 years of follow-up. Adjusted hazard ratios (HR) with 95% confidence intervals (CI) are presented. Among 632 survivors (median age 68, 54% male, 71% first-ever episode), age and functional disability (unchanged and worsening) 6 months after ischemic stroke had time-dependent effects on all-cause mortality risk up to 12 years of follow-up. The most impacting risk factors were unchanged (at least moderate) (HR, 2.99; 95%CI: 1.98-4.52) and worsening disability (HR, 2.85; 95%CI: 1.26-6.44), particularly in the first two years after a stroke event (Time 1: ≥6 mo to <2.5 y). Worsening disability also impacted mortality in the period from ≥2.5 to <7.5 years (Time 2) of follow-up (HR, 2.43 (95%CI: 1.03-5.73). Other baseline factors had a fixed high-risk effect on mortality during follow-up. Post-stroke and continuous medication use had a fixed protective effect on mortality. Functional disability was the main contributor with differential risks of mortality up to 12 years of follow-up.
ABSTRACT
OBJECTIVES: The aims of this study were to identify the frequency and severity of white matter lesions on MRIs of late-life depression and deppression due to cerebrovascular diseases (vascular depression), to evaluate the relation with cerebrovascular risk factors, and finally to understand an important cause of late-life depression. DESIGN: The frequency and severity of the periventricular hyperintensity and the deep white matter hyperintensity were measured on the brain MRIs in the patients with major depression, vascular depression and neurotic controls over 50 yrs of age. The association of the white matter lesions with cerebrovascular risk factors were evaluated. MATERIALS AND METHODS: The MRI films of 32 patients (15 males & 17 females) with major depression over 50 yrs of age, 25 patients (17 males & 8 females) with vascular depression, and 25 neurotic controls (6 males & 19 females) were analyzed for the white matter lesions according to the modified Fazekas criteria. The cerebrovascular risk factors including hypertension, arteriosclerosis, obesity, smoking, diabetes mellitus, thyroid function abnoramlities, EKG abnormality, stroke, etc were also assessed. RESULTS: 1) The frequency of periventricular lesions or deep white matter lesions were significantly higher in patients with vascular depression and major depression than in neurotic controls. 2) The intracerebral hyperintensities or classical infarctions were prevalent in frontal cortex (32.0%) and in basal ganglia (40.0%). 3) Among cerebrovascular risk factors, stroke (p<0.005), hypertension (p<0.025), EKG abnormality (p<0.005) and smoking (p<0.05) were significantly prevalent in the patients with vascular depression and major depression as compared with neurotic controls. 4) The severity of white matter lesions were significantly associated with the cerebrovascular risk factors (p<0.005) in patients with major depression over 50 yrs of age. CONCLUSIONS: The white matter hyperintensities on brain MRIs of patients with major depression over 50 yrs of age were significantly associated with cerebrovascular risk factors, which suggested a vascular origin of pathogenesis of late-life depression.