Correlative analysis of long-term post-stroke depression and characteristics of infarcted lesions in elderly patients with first-episode ischemic stroke / 中国医师进修杂志

ABSTRACT

Objective To explore the correlation between long-term post-stroke depression (PSD) and characteristics of infarcted lesions in elderly patients with first-episode ischemic stroke (IS). Methods The clinical data of 118 elderly patients with first-episode IS from January 2013 to March 2016 were retrospectively analyzed. All patients underwent MRI examination to measure the location, side, volume and number of infarcted lesions. The patients were followed up for at least 2 years. The evaluation of PSD based on the 4th edition of American Psychiatric Association Diagnostic Manual for Mental Disorders (DSM-Ⅳ) standard and 17-item Hamilton Depression Scales (HAMD), and the HAMD score ≥ 7 scores was classified as depression. The correlation between long-term PSD and infarcted lesions was analyzed by unconditional multivariate Logistic regression analysis. Results Among 118 elderly patients with IS, 49 cases had long-term PSD (PSD group), of which 25 cases were mild, 15 cases moderate and 9 cases severe (infarcted lesion in frontal lobe in 5 cases); 69 cases had no long-term depression (non-PSD group). The proportion of frontal lobe and temporal lobe infarction, number of infarcted lesions and volume of infarcted lesions in PSD group were significantly higher than those in non-PSD group:40.8％(20/49) vs. 15.9％(11/69), 28.6％(14/49) vs. 8.7％(6/69), (2.6 ± 0.6) lesions vs. (1.7 ± 0.3) lesions and (3.6 ± 1.3) ml vs. (2.4 ± 1.2) ml, and there were statistical differences (P<0.05);there was no significant difference in lesion side between 2 groups (P>0.05). In PSD group, the numbers of infarcted lesions in mild, moderate and severe PSD patients were (1.7 ± 0.6), (2.2 ± 0.7) and (2.8 ± 1.0) lesions respectively, and the volume of infarcted lesions were (2.5 ± 1.0), (3.4 ± 1.1) and (3.8 ± 1.3) ml respectively, and there were significant differences among the 3 groups (F=6.462 and 7.391, P=0.025 and 0.022). Unconditional multivariate Logistic regression analysis result showed that frontal lobe and temporal lobe infarctions were independent risk factors for the occurrence of PSD in elderly patients with first-episode IS (OR = 2.935 and 3.581, 95％ CI 1.191 to 6.717 and 1.244 to 10.395, P = 0.020 and 0.018). Conclusions The frontal lobe and temporal lobe infarctions are independent risk factors for long-term PSD in elderly patients with IS. Long-term PSD is more severe in more frontal lobe, more infarcted lesions, and larger volume of infarcted lesions.