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Post-stroke depression, anxiety, and stress symptoms and their associated factors: A cross-sectional study

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Abstract

Individuals post-stroke are subject to increased levels of mental health symptoms. This is a cross-sectional study explored levels of depression, anxiety, and stress symptoms and identified their predictors among Jordanian individuals with stroke. Outcome measures included Depression Anxiety Stress Scale, Fugl-Meyer assessment, goniometry, hand-held dynamometry, nine-hole peg test, Ashworth scale, Motor Activity Log, ten-meter walk test, and 12-item Short-Form health survey (SF-12). Descriptive analyses were used to describe prevalence of mental health symptoms and multiple variable linear regression models were used to identify their predictors. A total of 153 individuals participated in the study. Proportions of participants with mental health symptoms were 74.5% for depression, 52.9% for anxiety, and 68% for stress. Significant predictors of post-stroke mental health symptoms were SF-12 Mental Composite Score and grip strength for depression, anxiety, and stress. Depression and stress symptoms were significantly associated with discontinuation of rehabilitation services. Furthermore, self-reports of fewer sleep hours was significantly associated with anxiety and stress. Finally, Gender and self-reported physical diseases other than stroke were significantly associated with depression symptoms. We conclude that high proportions of Jordanian individuals’ post-stroke have suffered mental health symptoms. Future studies are required to design effective interventions to improve post-stroke mental health.

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... Anxiety and depression are common emotional symptoms among patients with life-threatening illnesses like stroke (2) . Recent studies estimated that 4 to 38% of patients with stroke developed post-stroke anxiety (PSA), up to 10 years after stroke (2)(3)(4)(5)(6) , and 25 to 79 % of them developed post-stroke depression (PSD) (2,(7)(8)(9)(10) . Post-stroke anxiety is a strong predictor of low quality of life, poor activity of daily living, poor mental and physical recovery, increased healthcare expenditure, and post-stroke depression (3,(11)(12)(13)(14)(15)(16) . ...
... In Jordan, stroke is the second leading cause of death among cardiovascular diseases that are the most common cause of death. Levels of psychiatric symptoms associated with stroke are high among Jordanian patients and might be considered as one of the highest rates in the world (10) . Indeed, 76 % of Jordanian patients with stroke experienced depression (9) , 53% experienced anxiety, and 68% showed stress symptoms (10) . ...
... Levels of psychiatric symptoms associated with stroke are high among Jordanian patients and might be considered as one of the highest rates in the world (10) . Indeed, 76 % of Jordanian patients with stroke experienced depression (9) , 53% experienced anxiety, and 68% showed stress symptoms (10) . Despite this, the Jordanian community has a deficit in basic knowledge regarding stroke and its disabling outcomes (23) ...
Article
Background: Anxiety is common emotional distress among patients with stroke, and it is a strong predictor of low quality of life, increased healthcare expenditure, poor rehabilitation and post-stroke depression. Objectives: Evaluate the prevalence and predictors of post-stroke anxiety among patients in Jordan. Methods: A cross-sectional, correlation design was utilized among 226 patients with stroke, recruited from nine randomly selected hospitals in Jordan. The validated Arabic version of the Hospital Anxiety and Depression scale was used to assess anxiety. Results: Almost 70% of the study participants were exhibited some levels of anxiety; of these, 46% had a clinically significant levels to be categorized as a definite case. Factors that significantly predicted being a definite case of anxiety were being a definite case of depression (OR = 5.86, 95% CI = 2.27-15.1, P < .001), being unable to perform self-care activities (OR = 5.29, 95% CI = 2.38-11.8, P < .001), having insufficient monthly income (OR =.447, 95% CI = .209-.957, P = .038), having visual problems due to stroke (OR = .330, 95% CI = .141-.769, P = .01), and having less duration since the stroke attack (OR= .254, 95% CI = .152-.423, P < .001). Conclusions: About half of the patients in this study had a clinically significant level of anxiety. The frequency of anxiety among stroke patients spots the light over the need for interventions of early detection and management. Patients who have any of the significant traits predicted anxiety required special attention.
... Overall scores are obtained by adding the scores of each item with a minimum possible score of 0 and a maximum score of 27. Higher the scores represent greater levels of depression, and based on the overall scores, the severity of depression is classified as minimal depression (0-4), mild depression (5-9), moderate depression (10)(11)(12)(13)(14), moderately severe depression (15)(16)(17)(18)(19), and severe depression (20)(21)(22)(23)(24)(25)(26)(27). The scale demonstrates excellent psychometric properties with high internal consistency reliability (Cronbach's alpha of 0.89) and high sensitivity for detecting PSD. ...
... Low self-esteem was experienced by 69 (45.7%) in several days. (15)(16)(17)(18)(19) 18 (11.9) Suicidal ideations were present in a minor proportion of stroke survivors. ...
... [3] On the contrary, a study by Almhdawi et al. found a high prevalence (74.5%) of depressive symptoms among individuals with stroke. [19] As per the treatment recommendations, a patient with moderate depression (PHQ score 10-14) requires counseling and or pharmacotherapy, those with moderately severe depression (PHQ score [15][16][17][18][19] require psychotherapy along with pharmacotherapy, and those with severe depression (PHQ score 20-27) would require immediate initiation of pharmacotherapy and referral to mental health specialists. [10] Even though 33.1% of the study sample would require either pharmacological or nonpharmacological measures to combat depression, it was alarming to note that only a small proportion of the study participants were receiving antidepressants. ...
Article
Background: Depression is a major neuropsychiatric complication of stroke. Poststroke depression (PSD) can lead to inadequate functional recovery, social withdrawal, poor quality of life, and suicidal ideations. Objective: The study explored the PSD among stroke survivors. Materials and Methods: A cross-sectional survey was conducted among 151, purposively selected rural stroke survivors of Kozhikode district, Kerala, India. Patient health questionnaire-9 (PHQ-9) was used to assess PSD. Results: The age of participants ranged from 28 to 80 years with a mean (standard deviation) age of 64.58 (10.3) years. The majorities of the participants were males (53.6%), had an ischemic stroke (76.2%), and had left-sided brain lesions (75.5%). The median (interquartile range) depression scores on PHQ-9 were 9 (12–6). Most of the participants had either mild (47%), moderate (21.2%), or moderately severe depression (11.9%). Low energy, sleep disturbances, low self-esteem, and anhedonia were the common depressive symptoms experienced by the stroke survivors. Conclusions: High prevalence of undiagnosed depression remains as a significant challenge to primary care. Keywords: Patient health questionnaire, poststroke depression, stroke
... There is no doubt that stroke can be detrimental to a person's life, while the psychological stress response will amplify and aggravate such negative effects (4,8,9). Furthermore, the psychological stress response, impacted by social factors and psychological comorbidities, has a similar or even more serious influence on mental health and the quality of life among survivors compared with physical disorders (10,11). Thus, it is crucial to explore which factors can predict the psychological stress response of patients and its impact on the prognosis of stroke. ...
... According to the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and the discussion of the three reviewers, 9 studies each were classified as having "Good" (8,11,15,17,19,20,(24)(25)(26) and "Fair" (2,4,7,9,16,18,(21)(22)(23) methodological qualities (Supplementary Tables 5, 6). The evaluation of the risk of bias revealed that the sample size justification was the weakest aspect, and only 6.67% of the studies reported how the sample size was determined; thus, it was not clear whether the sample size was sufficient in the studies. ...
... Poststroke psychological stress has been reported to be associated with clinical disease factors. At present, neurological deficits, chronic pain, functional independence, and grip strength have been shown to be relevant to perceived psychological stress (2,11,15,16,19,21). Worse neurological deficits, more severe chronic pain, lower functional independence, and weaker grip strength suggested higher psychological stress symptoms. ...
Article
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Background: Remarkable evidence indicates that psychological stress is significantly associated with stroke. However, a uniform recommendation to identify and alleviate poststroke psychological stress responses and improve postmorbid outcomes is not currently available. Thus, this systematic review aimed to summarize the types of poststroke psychological stress, measurement tools, contributing factors, and outcomes. Methods: This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A literature search was conducted in PubMed, Web of Science, Embase, CNKI, WanFangData, and CQVIP from database inception to November 2021. Cross-sectional and longitudinal studies were included in this research. Quality assessment was performed based on the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Eighteen quantitative, peer-reviewed studies were included for analysis. Selected articles mainly investigated perceived stress and posttraumatic stress disorder after stroke. We classified the contributing factors into four categories: sociodemographic factors, clinical disease factors, psychological factors, and behavioral and lifestyle factors. The postmorbid outcomes were divided into three categories: clinical disease outcomes, psychological outcomes, and behavioral and quality of life outcomes. Conclusions: Compared to common patients, stroke survivors with the following characteristics suffered an increased psychological stress response: younger age, the presence of caregivers, depression, unsuitable coping strategies, etc. Meanwhile, lower quality of life, worse drug compliance, worse functional independence, and more severe mental disorders were significantly associated with increased psychological stress symptoms. Further studies are required to provide more trustworthy and meaningful references for mitigating the damage caused by psychological stress after stroke.
... However, meta-analyses with large databases reported that approximately one-third of survivors developed PSD at any time point up to 5 years following stroke [11][12][13]. Surveys from the Middle East and North Africa (MENA) region also reported a wide prevalence of PSD (17-73%) [10], while previous surveys from Jordan reported a range from 25% to 76% [14][15][16][17]. Studies aiming to identify risk factors predisposing to PSD have also been inconsistent. ...
... Stroke symptoms were reported as motor, sensory, dysarthria, aphasia, and others. Stroke severity was assessed using NIHSS score, with stroke severity stratified as mild (NIHSS less than 6), moderate (NIHSS 6-15), severe (16)(17)(18)(19)(20)(21)(22)(23)(24)(25), and very severe (more than 25) [2,25]. Disability was assessed using the modified Rankin Score (mRS), and a favorable outcome was identified as having mRS score of 2 or less [2,25]. ...
... 6 Stroke Research and Treatment [16]. Similarly, Almhdawi et al. in 2020 evaluated 153 Jordanian stroke survivors with stroke chronicity of at least four months and who were receiving occupational therapy [17]. The investigators used the Depression Anxiety Stress Scale (DASS 21) and reported PSD in 74.5% of the cohort. ...
Article
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Poststroke depression (PSD) is common and remains a significant risk factor for poor outcomes. This prospective study is aimed at assessing the prevalence, severity, and predictors of PSD among Jordanian stroke survivors. A total of 151 patients who were consequently admitted to a tertiary teaching hospital with ischemic or hemorrhagic strokes were enrolled. Participants were screened on admission for premorbid depression using the PHQ-9 questionnaire; then, screening for PSD was repeated one and three months after stroke using the same tool. Depression prevalence at each screening was reported, and logistic regression analysis was conducted to evaluate for significant predictors. PHQ-9 scores suggestive of depression were reported by 15%, 24.83%, and 17.39% of respondents on admission and after one and three months, respectively. Scores suggesting severe depression were reported by 0.71%, 2.13%, and 6.52% of respondents, respectively. Significant predictors of PSD were having chronic kidney disease, current smoking status, moderate or severe disability (mRS score) at stroke onset, and severe dependence (BI) after one month (p values 0.007, 0,002, 0.014, and 0.031, respectively). Patients with secondary and high school education levels were less likely to get depression compared with illiterate patients (p 0.042). This study showed that nearly one in four Jordanian stroke survivors experienced PSD after one month. In contrast, while the overall PSD prevalence declined towards the end of follow-up period, patients who remained depressed showed a tendency towards higher PSD severity.
... Some patients will have dysphagia, nausea, coma and other serious conditions. This kind of patients with clinical manifestations will cause concern about their own situation, thus appeared restlessness, irritability, anxiety, as the extension of time, depression, approximately 60% of patients will experience post-stroke anxiety and depression [11]. Post-stroke anxiety and depression can easily affect the quality of life of patients and increase the burden on family and society [12]. ...
... This may be another reason for the lower prevalence of PSA and PSD in this series. The literature has shown that self-reported short sleep duration was significantly correlated with PSA (22), sleep loss, and experimental sleep deprivation are linked to increased negative emotions (such as depression, madness, and nervousness) (23), and treatment of insomnia helps relieve the symptoms of anxiety (24). In line with previous studies, we also found that short sleep duration (<6 h) significantly increased the risk of PSA at 3 months compared with sleep duration of >7 h. ...
Article
Background: Abnormal sleep duration predicts depression and anxiety. We seek to evaluate the impact of sleep duration before stroke on the occurrence of depression and anxiety at 3 months after acute ischemic stroke (AIS). Methods: Nationally representative samples from the Third China National Stroke Registry were used to examine cognition and sleep impairment after AIS (CNSR-III-ICONS). Based on baseline sleep duration before onset of stroke as measured by using the Pittsburgh Sleep Quality Index (PSQI), 1,446 patients were divided into four groups: >7, 6–7, 5–6, and <5 h of sleep. Patients were followed up with the General Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) for 3 months. Poststroke anxiety (PSA) was defined as GAD-7 of ≥5 and poststroke depression (PSD) as PHQ-9 of ≥5. The association of sleep duration with PSA and PSD was evaluated using multivariable logistic regression. Results: The incidences of PSA and PSD were 11.2 and 17.6% at 3 months, respectively. Compared to a sleep duration of >7 h, 5–6 h, and <5 h of sleep were identified as risk factors of PSA [odds ratio (OR), 1.95; 95% confidence interval (CI), 1.24–3.07; P < 0.01 and OR, 3.41; 95% CI, 1.94–6.04; P < 0.01) and PSD (OR, 1.47; 95% CI, 1.00–2.17; P = 0.04 and OR, 3.05; 95% CI, 1.85–5.02; P < 0.01), while 6–7 h of sleep was associated with neither PSA (OR, 1.09; 95% CI, 0.71–1.67; P = 0.68) nor PSD (OR, 0.92; 95% CI, 0.64–1.30; P = 0.64). In interaction analysis, the impact of sleep duration on PSA and PSD was not affected by gender (P = 0.68 and P = 0.29, respectively). Conclusions: Sleep duration of shorter than 6 h was predictive of anxiety and depression after ischemic stroke.
... Several predictors of poststroke depression (PSD) and anxiety (PSA) have been consistently reported in the literature including younger age, female gender, a previous history of mood and/or anxiety disorders, a previous history of stroke, stroke-induced severity of disability and aphasia, early depressive symptoms, and tobacco consumption (Almhdawi et al., 2020;Kutlubaev & Hackett, 2014;Perrain et al., 2020). The benefit of early selective serotonin reuptake inhibitor (SSRI) medication in the prevention of PSED has not been demonstrated unequivocally Villa et al., 2018). ...
Article
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Introduction Poststroke depression (PSD) and anxiety (PSA) are prevalent and have a strong impact on functional outcome. Beside stroke severity, little is known on their clinical determinants. This study investigated the association between stroke mechanism, neurological poststroke complications and remaining vascular risk factors and the presence of comorbid PSD and PSA, termed poststroke emotional distress (PSED). Methods This was a retrospective analysis of a prospectively compiled medical records database of consecutive patients evaluated during a follow‐up visit 3‐ to 4‐month poststroke. HAD scale was used to define PSED category (PSD+PSA vs. NoPSD+NoPSA). Stroke mechanism and poststroke complications were identified clinically or using appropriate scales. Their association with PSED was tested using a multivariate logistic regression model. Results The sample included 2,300 patients (male: 64.8%); 19% had a PSED and 56.39% were free of any depression or anxiety. The most frequent poststroke complications were fatigue/fatigability (58.4%), sleep problems (26.7%), and pain (20.4%). While no association was observed between PSED and stroke mechanism, higher functional disability (OR:1.572), lower cognitive abilities (OR:0.953), sleep problems (OR:2.334), pain (OR:1.478), fatigue/fatigability (OR:2.331), and abnormal movements (OR:2.380) were all independent risk factors. Persisting tobacco consumption (OR:1.360) was the only vascular significant risk factor. Conclusions The frequency of comorbid PSED remains high (1/5 patient) despite improved awareness of these conditions. The association between poststroke complications and the presence of PSED emphasizes the need for standardized neurological and psychological evaluations at follow‐up. These results foster the need to improve the management of addictive behaviors to reduce the burden of PSED.
... This study also revealed that patients with hypertension or diabetes mellitus are more prone to have PSA. A cross-sectional study also found that chronic physical diseases is an identified factor significantly associated with post-stroke mental health (Almhdawi et al., 2020). Interestingly, our study found that the level of HDL-C is independent protective factors for PSA. ...
Article
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Post-stroke anxiety (PSA) has caused wide public concern in recent years, and the study on risk factors analysis and prediction is still an open issue. With the deepening of the research, machine learning has been widely applied to various scenarios and make great achievements increasingly, which brings new approaches to this field. In this paper, 395 patients with acute ischemic stroke are collected and evaluated by anxiety scales (i.e., HADS-A, HAMA, and SAS), hence the patients are divided into anxiety group and non-anxiety group. Afterward, the results of demographic data and general laboratory examination between the two groups are compared to identify the risk factors with statistical differences accordingly. Then the factors with statistical differences are incorporated into a multivariate logistic regression to obtain risk factors and protective factors of PSA. Statistical analysis shows great differences in gender, age, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level between PSA group and non-anxiety group with HADS-A and HAMA evaluation. Meanwhile, as evaluated by SAS scale, gender, serious stroke, hypertension, diabetes mellitus, drinking, and HDL-C level differ in the PSA group and the non-anxiety group. Multivariate logistic regression analysis of HADS-A, HAMA, and SAS scales suggest that hypertension, diabetes mellitus, drinking, high NIHSS score, and low serum HDL-C level are related to PSA. In other words, gender, age, disability, hypertension, diabetes mellitus, HDL-C, and drinking are closely related to anxiety during the acute stage of ischemic stroke. Hypertension, diabetes mellitus, drinking, and disability increased the risk of PSA, and higher serum HDL-C level decreased the risk of PSA. Several machine learning methods are employed to predict PSA according to HADS-A, HAMA, and SAS scores, respectively. The experimental results indicate that random forest outperforms the competitive methods in PSA prediction, which contributes to early intervention for clinical treatment.
... In general, the DASS has been used to measure depression, anxiety, and stress in both clinical samples (Almhdawi et al., 2020;Joplin & Petar Vrklevski, 2017;Wang, You, Lin, Xu, & Leung, 2017) and the general population (Conley, Shapiro, Huguenel, & Kirsch, 2020;Negi, Khanna, & Aggarwal, 2019;Schnapp, O'Neal, & Vaughn, 2020). This is supported by the psychometric property information of DASS used in clinical samples (Le et al., 2017;Musa et al., 2007;Yohannes, Dryden, & Hanania, 2019) and the general population (Medvedev et al., 2018;Severino & Haynes, 2010;Sinclair et al., 2012). ...
Article
Full-text available
Measurement instruments that have satisfactory psychometric properties are needed to improve mental health research and services, especially in the effort to measure, identify, and monitor the psychological problems experienced by individuals. The purpose of this study is to examine the psychometric properties of the Indonesian version of the Depression Anxiety Stress Scale (DASS). The study involved 1,922 participants from Surabaya aged between 16 and 26. The data were obtained using the convenience sampling method. Testing of the factor structure, reliability, and measurement invariance of the Indonesian DASS was performed using a confirmatory factor, composite reliability, and multi-group analysis. It was found that a bifactor model consisting of specific (depression, anxiety, and stress) and general (psychological distress) factors was the best structure for the DASS. Furthermore, the model also showed satisfactory composite reliability and measurement invariance across genders. The results indicated that the Indonesian version of the DASS was a valid and reliable instrument for measuring and comparing depression, anxiety, stress, and psychological distress between genders in the Indonesian sample.
... Positive emotions, such as rehabilitation motivation, and self-efficacy, are observed to have a negative correlation (Fig. 3 b, c). The results thus obtained were identical to those reported in previous studies on depression, anxiety, rehabilitation motivation, and self-efficacy in stroke patients; negative and positive emotions were found to be the main factors affecting the SI of stroke patients; further, it was found that the two had opposite effects on each other [54][55][56] . ...
Article
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Currently, the identification of stroke patients with an increased suicide risk is mainly based on self‐report questionnaires, and this method suffers from a lack of objectivity. This study developed and validated a suicide ideation (SI) prediction model using clinical data and identified SI predictors. Significant variables were selected through traditional statistical analysis based on retrospective data of 385 stroke patients; the data were collected from October 2012 to March 2014. The data were then applied to three boosting models (Xgboost, CatBoost, and LGBM) to identify the comparative and best performing models. Demographic variables that showed significant differences between the two groups were age, onset, type, socioeconomic, and education level. Additionally, functional variables also showed a significant difference with regard to ADL and emotion (p < 0.05). The CatBoost model (0.900) showed higher performance than the other two models; and depression, anxiety, self-efficacy, and rehabilitation motivation were found to have high importance. Negative emotions such as depression and anxiety showed a positive relationship with SI and rehabilitation motivation and self-efficacy displayed an inverse relationship with SI. Machine learning-based SI models could augment SI prevention by helping rehabilitation and medical professionals identify high-risk stroke patients in need of SI prevention intervention.
... Previous studies have shown the importance of a regular post-stroke rehabilitation, as better 90-days mRS outcome and low rates of PSD were noted. 11,23 An interesting finding in our study was noticing that discontinuation of rehabilitation programs has had a negative relation with PSA. This was likely related to the fear of acquiring SARS-CoV-2 infection during regular hospital visits or stay. ...
Article
Introduction: Stroke is associated with a rise in post-stroke depression (PSD) and anxiety (PSA). In this study, we evaluated the impact of COVID-19 pandemic on the rates of PSD and PSA. Methods: All stroke admissions to two hospitals in Saudi Arabia during two months were prospectively evaluated for PSD and PSA. NIHSS and serum TSH assessed on admission. PSD and PSA were evaluated using Hospital Anxiety and Depression Scale (HADS). Post-stroke disability was assessed by mRS, while social support assessed by Multidimensional Scale of Perceived Social Support (MSPSS). Results: Among 50 participants (28 males), clinically significant PSD was found in 36%, while PSA in 32%. PSD associated with higher NIHSS (P < 0.001); lower MSPSS (P = 0.003); higher mRS (P = 0.001); and discontinuation of rehabilitation (P = 0.02). PSA was associated with higher TSH (P = 0.01); lower MSPSS (P = 0.03); while discontinuation of rehabilitation was related to less PSA (P = 0.034). Multivariate analysis showed that NIHSS (OR: 1.58, 95% CI: 742-3.37; P = 0.01); and MSPSS score (OR: 0.66, 95% CI: 0.47-0.94; P = 0.002) were associated with PSD; while PSA was related to TSH level (OR: 8.32, 95% CI:1.42-47.23; P = 0.02), and discontinuation of rehabilitation (OR: -0.96, 95% CI: -1.90-0.02; P = 0.04). Conclusions: Our research shows that the rise in PSD is related to stroke severity and this has not changed significantly during the pandemic; however, PSA showed a noticeable peak. Social deprivation and the lacking levels of rehabilitation related significantly to both.
Article
Objective To investigate the occurrence and the influencing factors of post-stroke depression (PSD) in first-episode stroke. Methods A total of 350 elderly stroke patients who were admitted to Wuxi Central Rehabilitation Hospital for the first time from January 2020 to December 2020 were enrolled in this study. The Hamilton Depression Scale (HAMD) was used to evaluate the depression status of stroke patients. The sociodemographic data, clinical symptoms, social environment and behavioral patterns of the patients were collected to analyze the related factors of depression after stroke through SPSS 20.0 software. Results The incidence of PSD was 45.71%. There were statistical differences among different gender, lesion nature, lesion location, smoking, hypertension, diabetes, hospitalization enpenses, season of onset, BMI index, NIHSS score, barthel index score, blood pressure variation coefficient and other factors (p=0.000). Post-stroke depression score was positively correlated with NIHSS score and coefficient of variation of systolic blood pressure (r=0.935, p=0.000; r=0.921, p=0.000), and negatively correlated with barthel index score (r=-0.964, p=0.000). Through multivariate Logistic regression analysis, it was found that male (OR=8.624, 95%CI: 5.672-11.715), cerebral infarction (OR=2.561, 95%CI: 1.256-3.567), and the right side lesion (OR=1.933, 95%CI: 1.024~3.026), smoking (OR=2.457, 95%CI: 1.611~3.625), onset in autumn and winter (OR=2.049, 95%CI: 1.201-2.919), high BMI (OR=2.461, 95%CI): 1.426-3.432) were risk factors for depression after stroke, and low SBPV (OR=0.567, 95%CI: 0.352-0.758) and low NISHH score (OR=0.256, 95%CI: 0.105-0.486) were the protective factor for subsequent depression of stroke. Conclusion Males, smoking, patients with onset in autumn and winter, lesions on the right side, high BMI, high NISHH score and high systolic blood pressure variation were closely related to PSD, which should be paid for attention for such patients to prevent the occurrence of PSD and take intervention measures.
Article
Background: Stroke is the second leading cause of death and a major cause of serious, long-term disability worldwide. The approximately 15 million people each year who experience stroke are at risk of developing depression. Poststroke depressive symptoms affect one third of survivors of stroke. Patients who develop poststroke depressive symptoms experience decreased functional independence, poor cognitive recovery, decreased quality of life, and increased mortality. Survivors of stroke use social support to deal with stress and defend against the adverse effects of negative stroke outcomes. Purpose: This study was designed to examine the influence of perceived social support (emotional and informational, tangible, affectionate, and positive social interaction), stress level, and functional independence on depressive symptoms in survivors of stroke. Methods: A cross-sectional observational study design in outpatient settings and rehabilitation centers was conducted. A convenience sample of 135 survivors of stroke completed the psychometrically valid instruments. Results: Most of the sample had mild or moderate depressive symptoms (26% and 29%, respectively). The mean score for perceived social support was 77.53 (SD = 21.44) on the Medical Outcomes Study Social Support Survey. A negative association was found between depressive symptoms and the social support total score (r = -.65, p < .01). All of the social support subcategories were negatively associated with depressive symptoms. Hierarchical multiple linear regression showed that social support, stress level, and literacy were associated with depressive symptoms (β = -.31, p < .001; β = .45, p < .001; and β = .16, p = .01, respectively) and partially mediated the association between depressive symptoms and functional independence. Conclusions/implications for practice: Poststroke depressive symptoms are common among survivors of stroke. Social support may improve health by protecting these individuals from the negative outcomes of stroke and enhance their recovery. Future research is required to examine how related interventions improve social support in caregivers and reduce depressive symptoms in stroke survivors.
Article
Background Stroke remains one of the major chronic illnesses worldwide that health care organizations will need to address for the next several decades. Individuals poststroke are subject to levels of cognitive impairment and mental health problems. Virtual reality (VR)-based therapies are new technologies used for cognitive rehabilitation and the management of psychological outcomes. Objective This study performed a meta-analysis to evaluate the effects of VR-based therapies on cognitive function and mental health in patients with stroke. Methods A comprehensive database search was performed using PubMed, MEDLINE (Ovid), Embase, Cochrane Library, and APA PsycINFO databases for randomized controlled trials (RCTs) that studied the effects of VR on patients with stroke. We included trials published up to April 15, 2021, that fulfilled our inclusion and exclusion criteria. The literature was screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. Results A total of 894 patients from 23 RCTs were included in our meta-analysis. Compared to traditional rehabilitation therapies, the executive function (standard mean difference [SMD]=0.88, 95% confidence interval [CI]=0.06-1.70, P=.03), memory (SMD=1.44, 95% CI=0.21-2.68, P=.02), and visuospatial function (SMD=0.78, 95% CI=0.23-1.33, P=.006) significantly improved among patients after VR intervention. However, there were no significant differences observed in global cognitive function, attention, verbal fluency, depression, and the quality of life (QoL). Conclusions The findings of our meta-analysis showed that VR-based therapies are efficacious in improving executive function, memory, and visuospatial function in patients with stroke. For global cognitive function, attention, verbal fluency, depression, and the QoL, further research is required. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021252788; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=252788
Article
Post-stroke depression (PSD) is a serious and common complication of stroke, which seriously affects the rehabilitation of stroke patients. To date, the pathogenesis of PSD is unclear and effective treatments remain unavailable. Here, we established a mouse model of PSD through photothrombosis-induced focal ischemia. By using a combination of brain imaging, transcriptome sequencing, and bioinformatics analysis, we found that the hippocampus of PSD mice had a significantly lower metabolic level than other brain regions. RNA sequencing revealed a significant reduction of miR34b-3p, which was expressed in hippocampal neurons and inhibited the translation of eukaryotic translation initiation factor 4E (eIF4E). Furthermore, silencing eIF4E inactivated microglia, inhibited neuroinflammation, and abolished the depression-like behaviors in PSD mice. Together, our data demonstrated that insufficient miR34b-3p after stroke cannot inhibit eIF4E translation, which causes PSD by the activation of microglia in the hippocampus. Therefore, miR34b-3p and eIF4E may serve as potential therapeutic targets for the treatment of PSD.
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Background: Repetitive transcranial magnetic stimulation (rTMS) is a promising intervention for stroke rehabilitation. Several studies have demonstrated the effectiveness of rTMS in restoring motor function. This meta-analysis aimed to summarize the current evidence of the effect of rTMS in improving upper limb function and fine motor recovery in stroke patients. Methods: Three online databases (Web of Science, PubMed, and Embase) were searched for relevant randomized controlled trials. A total of 45 studies (combined n = 2064) were included. Random effects model was used for meta-analysis and effect size was reported as standardized mean difference (SMD). Results: rTMS was effective in improving fine motor function in stroke patients (SMD, 0.38; 95% CI 0.19-0.58; P = 0). On subgroup analyses, for post-stroke functional improvement of the upper extremity, bilateral hemisphere stimulation was more effective than unilateral stimulation during the acute phase of stroke, and a regimen of 20 rTMS sessions produced greater improvement than <20 sessions. In the subacute phase of stroke, affected hemispheric stimulation with a 40-session rTMS regimen was superior to unaffected hemispheric stimulation or bilateral hemispheric stimulation with <40 sessions. Unaffected site stimulation with a 10-session rTMS regimen produced significant improvement in the chronic phase compared to affected side stimulation and bilateral stimulation with >10 rTMS sessions. For the rTMS stimulation method, both TBS and rTMS were found to be significantly more effective in the acute phase of stroke, but TBS was more effective than rTMS. However, rTMS was found to be more effective than TBS stimulation in patients in the subacute and chronic phases of stroke. rTMS significantly improved upper limb and fine function in the short term (0-1-month post-intervention) and medium term (2-5 months), but not for upper limb function in the long term (6 months+). The results should be interpreted with caution due to significant heterogeneity. Conclusions: This updated meta-analysis provides robust evidence of the efficacy of rTMS treatment in improving upper extremity and fine function during various phases of stroke. Systematic review registration: https://inplasy.com/inplasy-2022-5-0121/, identifier: INPLASY202250121.
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Background: Post-stroke anxiety (PSA) remains a challenging medical problem. Integrated rehabilitation involves a combination of traditional Chinese medicine (TCM) and Western conventional rehabilitation techniques. Theoretically, integrated rehabilitation is likely to have significant advantages in treating PSA. Nevertheless, the therapeutic effect of integrated rehabilitation needs to be verified based on large-scale trials with sound methodology. Thus, the aim of this trial is to assess the efficacy and safety of integrated rehabilitation on PSA. Methods: The study is a prospective, multicenter, randomized, controlled trial involving 188 PSA patients from four clinical centers in China. Eligible participants will be randomly divided into the integrated rehabilitation group or the standard care group. Participants in the integrated rehabilitation group will receive a combination of TCM and Western conventional rehabilitation methods, including acupuncture, repeated transcranial magnetic stimulation, traditional Chinese herbal medicine, and standard care. The primary outcome will be the Hamilton Anxiety Rating Scale (HAM-A). The secondary outcomes will include the Self-Rating Anxiety Scale (SAS), the Activities of Daily Living (ADL) scale, the Montreal Cognitive Assessment (MoCA) scale, the simplified Fugl-Meyer Assessment of motor function (FMA) scale, and the Pittsburgh Sleep Quality Index (PSQI). Outcome measurements will be performed at baseline, at the end of the 4-week treatment and the 8-week follow-up. Conclusion: Results of this trial will ascertain the efficacy and safety of integrated rehabilitation on PSA, thereby providing evidence regarding integrated rehabilitation strategies for treating PSA. It will also promote up-to-date evidence for patients, clinicians, and policy-makers. Trial registration: ClinicalTrials.gov NCT05147077.
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Background: Anxiety and depression are common post-stroke and impact quality-of-life (QoL). The EQ-5D three-level version (EQ-5D-3L) is increasingly used to routinely measure health-related QoL in stroke populations, but its potential value for detecting anxiety or depression is uncertain. We sought to examine the agreement and convergent validity of the EQ-5D-3L anxiety or depression domain in survivors of stroke. Methods: Cross-sectional survey data obtained from participants in the Australian Stroke Clinical Registry (AuSCR) between 90 and 180 days after stroke were used. Correlation, sensitivity, specificity, and the area under the curve were calculated for the EQ-5D-3L anxiety or depression domain against the Hospital Anxiety Depression Scale (HADS, reference standard), which has been validated as a screening measure following stroke. Results: Data were obtained from 245 respondents (median time post-stroke 143 days), median age 74 years; 42% female. Nearly 50% reported problems (43% moderate; 7% extreme) in the EQ-5D-3L anxiety or depression domain. The median HADS-Anxiety score was 6 (Q1:3, Q3:9), and the median HADS-Depression score was 5 (Q1:2, Q3:9). The EQ-5D-3L anxiety or depression scores were strongly correlated (r = 0.58) with scores of the HADS-Anxiety, but moderately correlated with HADS-Depression (r = 0.37), and combined HADS-Anxiety or HADS-Depression (r = 0.46). The EQ-5D-3L anxiety or depression domain had greater sensitivity and specificity in identifying cases with anxiety than in identifying depressive symptoms in survivors of stroke. Conclusions: The EQ-5D-3L appears to have value as a population level indicator of anxiety or depression following stroke. Further validation against “gold standard” clinical assessment is required for clinical applications.
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Background: Allied health professions (AHP) students are subject to critical levels of study-related stressors including mental health symptoms (MHS) and musculoskeletal pain. Few studies recruited AHP students of multiple academic majors simultaneously. Objectives: This study investigated and compared the prevalence of MHS severity and their associated factors among students of nine AHP majors. Methods: A cross-sectional design was used with a sample of nine AHP academic majors (n = 838). Participants completed a validated self-administered questionnaire that included demographics and life style, the Depression Anxiety Stress Scale (DASS 21), and the Nordic Musculoskeletal Questionnaire. MHS scores were statistically compared between males and females and between majors. A general linear model (GLM) multivariate procedure was used to assess the statistical associations between MHS and their correlates. Results: Mild to extremely severe MHS levels were found in 62.2% of the participants for depression, 65.3% for anxiety, and 54.2% for stress. Compared to males, females showed significantly higher levels of stress (p < 0.01) and depression (p = 0.018). MHS were statistically associated with gender, physical health, diet quality, study difficulty, satisfaction with academic major, academic major and musculoskeletal pain. University GPA demonstrated negative significant correlations with MHS. Conclusions: MHS in AHP students are prevalent and should be accounted for by AHP educators. More studies are encouraged to assess actual mechanisms causing MHS among AHP students, and effective treatment programs are needed.
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Objective: To update the evidence surrounding the presence of anxiety after stroke. Data sources: A search was conducted in EMBASE, MEDLINE, PsycINFO, Cochrane Library, AMED and CINAHL in May 2015 and repeated in April 2017. Study selection: Clinical diagnosis of stroke and assessed for anxiety symptoms on a rating scale in the first year after stroke. Data extraction: One reviewer screened and identified studies against the inclusion criteria. A second reviewer conducted a random check of approximately 10% of titles and abstracts. Two authors independently performed the final full-text review. Data synthesis: Overall pooled prevalence of anxiety disorders was 29.3% ((95% confidence interval 24.8-33.8%), (I2 = 97%, p< 0.00001)) during the first year. Frequency 0-2 weeks post-stroke was 36.7%, 2 weeks to 3 months 24.1%, and 3-12 months 23.8%. There was a statistically high heterogeneity in this estimate (I2 = 97%, p < 0.00001). Conclusion: Anxiety is common during the first year post-stroke. Since anxiety significantly influences quality of life and is a predictor for depression, it may be worth considering further routine screening post-stroke.
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The aim of this study was to analyse the changes in psychological stress and identify its basal predictors among elderly stroke survivors after 6 months following discharge from hospital to home directly, rather than to a rehabilitation facility. The sample comprised 50 elderly stroke survivors. Data were collected at 2 weeks (T1), at 3 months (T2), and at 6 months (T3) after hospital discharge. The following instruments were applied: Perceived Stress Scale-10 items (PSS-10), National Institute of Health Stroke Scale, Functional Independence Measure, and Geriatric Depression Scale-15 items. Study records indicated that the age of the study participants ranged from 60 to 87 years old (mean = 70.3; standard deviation = 7.6). The number of male and female participants was similar. The PSS-10 score decreased almost 6 points between T1 (mean = 15.1) and T3 (mean = 9.7; p < .001). Both Functional Independence Measure (p = .025) and Geriatric Depression Scale-15 (p = .017) scores at T1 predicted the PSS-10 score at T3. The study thus demonstrated that elderly stroke survivors experienced significant stress after hospital discharge, which tended to improve over the next 6 months. Depression and lower functional independence 2 weeks after discharge were predictors of a greater level of psychological stress at 6 months following discharge.
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The health survey, the 12-Item Short-Form (SF-12) survey instrument, was developed as a shorter alternative to the SF-36 for use in scale studies. The aim of our study was to adapt this instrument into Moroccan Arabic and to examine its psychometric properties. The SF-12 was translated from English to dialectical Moroccan Arabic following the International Quality of Life Assessment translation procedure. The psychometric properties were tested in September 2007. Testing involved a sample of families and friends of patients ( 16 years old) in the diagnostic centre of the Fez University hospital, Morocco. The SF-12 was assessed by examining item-level characteristics, estimates of scale reliability (internal consistency) and construct validity. The study was conducted on 141 subjects. The physical component summary (PCS-12) and the mental health component summary (MCS-12) of the SF-12 demonstrated good internal consistency reliability, with alpha coefficients of 0.80 and 0.79, respectively. Multitrait analysis showed that the subscales of the SF-12 had good convergent and discriminant validity. Construct validity, assessed by the method of extreme groups, determined that the SF-12 summary scores varied for individuals who differed according to age and medical conditions. The Moroccan Arabic version of the SF-12 appears to be a valid tool with which to for assess the health status of the general Moroccan population. On the other hand, issues such as test-retest reliability, longitudinal construct validity and responsiveness were not addressed in this study and should be considered in future ones.
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Background: Post-stroke depression is among the most frequent neuropsychiatric complications of stroke, and it is associated with poor prognosis and outcomes. This study aimed to assess the prevalence of depression; its correlates, and predictors among patients with stroke in Jordan. Methods: A cross-sectional, descriptive correlation design was used among 198 patients with stroke admitted to 9 hospitals all over Jordan. Depression was assessed using the validated hospital depression subscale (HDS) of the Hospital Anxiety and Depression scale. Results: Study patients (mean age 56.62 years [SD = 14.2], 53% were males) experienced high prevalence of depression (76%); of these, 51.6% were categorized as higher depression category (a case of depression; HDS = 11-21). Factors that correspondingly predicted higher depression categories were low level of education (odds ratio [OR] = 3.347, 95% confidence interval [CI] = 2.920-23.949, P < .001), having a preparatory level of education (OR = 8.363, 95% CI = 1.24-9.034, P = .017), having comorbid chronic diseases (OR = .401, 95% CI = .190-.847), being a smoker (OR = 2.488, 95% CI = 1.105-5.604, P = .028), patients who reported inability to perform daily activities by themselves (OR = 3.688, 95% CI = 1.746-7.790, P = .001), and patients with comorbid dysphasia (OR = 12.884, 95% CI = 4.846-34.25, P < .001). Conclusions: Post-stroke depression is a significant health problem among Jordanian patients with stroke and warrants serious attention. Clinicians need to consider these important predictors when assessing and managing depression among patients at risk.
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Aim: The aim of this paper was to investigate whether the extent of neurological impairment, the location of ischemic lesions due to stroke are associated with the severity of post-stroke depression. Materials and methods: The study included 82 patients, who were diagnosed with acute ischemic stroke and post-stroke depression and were admitted to the Neurology Clinic of Cluj-Napoca County Emergency Hospital between 2009 and 2011. A head MRI was performed with a 1.5 Tesla. Psychometric assessment was performed by using several scales, including the Beck Depression Inventory and the Mini-Mental State Examination. The National Institutes of Health Stroke Scale (NIHSS) and the Barthel Index of Activities of Daily Living were used to produce a complete neurological assessment. Results: Patients with severe depression had a lower score on the Quality of Life Scale (QOLS) and higher scores for the Barthel index, NIHSS and MMSE. A stroke located in the basal nuclei increased the probability of severe depression. The patients with fewer lesions (1-2) had a greater chance of developing mild or moderate depression compared to the patients with 3-4 lesions. A frontal localization of the stroke was almost twice as common in patients with severe depression. If the stroke affected the left hemisphere, there was a higher probability of severe depression. In multivariate analysis, a basal nuclei lesion, a left hemisphere stroke location, and an NIHSS score >11 were all independently associated with severe depression. Conclusion: The location of the stroke and the NIHSS score could be related to the severity of post-stroke depression. Abbreviations: NIHSS = The National Institutes of Health Stroke Scale; QQL = Quality of life Scale; BDI = Beck Depression Inventory; MMSE = Mini-Mental State Examination; PSD = Post-stroke depression; MRI = Magnetic resonance imaging
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Objectives To assess the internal consistency, latent structure and convergent validity of the Depression, Anxiety and Stress Scale-21 (DASS-21) among adolescents in Vietnam. Method An anonymous, self-completed questionnaire was conducted among 1,745 high school students in Hanoi, Vietnam between October, 2013 and January, 2014. Confirmatory factor analyses were performed to assess the latent structure of the DASS-21. Factorial invariance between girls and boys was examined. Cronbach alphas and correlation coefficients between DASS-21 factor scores and the domain scores of the Duke Health Profile Adolescent Vietnamese validated version (ADHP-V) were calculated to assess DASS-21 internal consistency and convergent validity. Results A total of 1,606/ 1,745 (92.6%) students returned the questionnaire. Of those, 1,387 students provided complete DASS-21 data. The scale demonstrated adequate internal consistency (Cronbach α: 0.761 to 0.906). A four-factor model showed the best fit to the data. Items loaded significantly on a common general distress factor, the depression, and the anxiety factors, but few on the stress factor (p<0.05). DASS-21 convergent validity was confirmed with moderate correlation coefficients (-0.47 to -0.66) between its factor scores and the ADHP-V mental health related domains. Conclusions The DASS-21 is reliable and suitable for use to assess symptoms of common mental health problems, especially depression and anxiety among Vietnamese adolescents. However, its ability in detecting stress among these adolescents may be limited. Further research is warrant to explore these results.
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[Purpose] The purpose of this study was to investigate the effects of hand strength on upper extremity function and activities of daily living in patients with right hemiplegia, as well as to provide important fundamental data for rehabilitation after stroke. [Subjects and Methods] This study was conducted from May 1 to December 30, 2013, at the Department of Rehabilitation of P Hospital in Seoul and included subjects hospitalized with a diagnosis of stroke. Patients with right hemiplegia were selected, and their hand strength, upper extremity function, and activities of daily living were evaluated. Hand strength was measured by grip, lateral pinch, and three-point pinch strength. [Results] The effects of hand strength on upper extremity function were evaluated. The results showed that all types of hand strength significantly influenced upper extremity function. However, only grip strength influenced activities of daily living. [Conclusion] In rehabilitation of stroke patients, it is necessary to first improve their general physical condition and basic activities of daily living, and then improve hand movement and hand muscle strength for instrumental activities of daily living training, which requires detailed hand movements. © 2016 The Society of Physical Therapy Science. Published by IPEC Inc.
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Aims: Population surveys have become a frequently used method to explore stigma, help-seeking and illness beliefs related to mental illness. Methodological quality however differs greatly between studies, and our current knowledge seems heavily biased towards high-income countries. A critical appraisal of advances and shortcomings of psychiatric attitude research is missing. This review summarises and appraises the state of the art in population-based attitude research on mental health. Methods: Systematic review of all peer-reviewed papers reporting representative population studies on beliefs and attitudes about mental disorders published between January 2005 and December 2014 (n = 478). Results: Over the decade covered by this review considerably more papers on psychiatric attitude research have been published than over the whole time period before. Most papers originated in Europe (36.3%), North America (23.2%) and Australia (22.6%), only 14.6% of all papers included data from low- or middle income countries. The vast majority of papers (80.1%) used correlational cross-sectional analyses, only 4% used experimental or quasi-experimental designs. Data in 45.9% of all papers were obtained with face-to-face interviews, followed by telephone (34.5%), mail (7.3%) and online surveys (4.0%). In almost half of papers (44.6%) case-vignettes served as stimulus for eliciting responses from interviewees. In 20.7% instruments meeting established psychometric criteria were used. The most frequently studied disorder was depression (44.6% of all paper), followed by schizophrenia (33%). 11.7% of papers reported time trend analyses of attitudes and beliefs, 7.5% cross-cultural comparisons. The most common focus of research was on mental health literacy (in total 63.4% of all papers, followed by various forms of stigma (48.3%).There was a scarcity of papers (12.1%) based on established theoretical frameworks. Conclusions: In the current boom of attitude research, an avant-garde of studies uses profound and innovative methodology, but there are still blind spots and a large proportion of conventional studies. We discuss current and future methodological challenges that psychiatric attitude research needs to embrace. More innovative and methodologically sound studies are needed to provide an empirical basis for evidence-based interventions aimed at reducing misconceptions about mental disorders and improve attitudes towards those afflicted.
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Objective: To quantitatively define levels of upper extremity movement impairment using cluster analysis of Fugl-Meyer upper extremity (FM-UE) with and without reflex items. Design: Secondary analysis of FM-UE individual item scores compiled from baseline testing of 5 studies with consistent testing procedures. Setting: University and VA research centers. Participants: Individuals (N=-247) with chronic stroke (>6 months post-stroke). Interventions: Not applicable. Main outcome measures: Cut-off scores defined by total FM-UE scores of clusters identified by two hierarchical cluster analyses run on full sample of FM-UE individual item scores (with/without reflexes). Patterns of motor function defined by aggregate item scores of clusters. Results: FM-UE scores ranged from 2-63 (mean=26.9±15.7) with reflex items and 0-57 (mean=22.1 ±15.3) without reflex items. Three clusters were identified. The distributions of the FM-UE scores revealed considerable overlap between the clusters, therefore four distinct stroke impairment levels were also derived. Conclusions: For chronic stroke, the cluster analyses of the upper extremity FM support either a three or a four impairment level classification scheme.
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Objective: To investigate the relationship between grip and pinch strength and independence in activities of daily living (ADL) in stroke patients. Methods: Medical records of 577 stroke patients from January 2010 to February 2013 were retrospectively reviewed. Patients' grip and pinch strength of both hemiplegic and non-hemiplegic hands and the Korean version of Modified Barthel Index (K-MBI) score were collected. These patients were divided into three groups: group A (onset duration: ≤3 months), group B (onset duration: >3 months and <2 years), and group C (onset duration: ≥2 years). The correlation between grip and pinch strength and the K-MBI score was analyzed. Results: In group A (95 patients), the K-MBI score was significantly (p<0.05) correlated with the grip and pinch strength of both hands in patients with right hemiplegia. Significant (p<0.05) correlation between the K-MBI score and the grip and pinch strength of the hemiplegic hand was shown in patients with left hemiplegia. In group B (69 patients) and group C (73 patients), the K-MBI score was significantly (p<0.05) correlated with the grip and pinch strength of the hemiplegic hand. Conclusion: Stroke patients in subacute stage mainly performed activities of daily living using their dominant hand. However, independence in ADL was associated with the strength of the affected dominant hand. For stroke patients in chronic and late chronic stages, their hand power of the affected hand was associated with independence in ADL regardless whether the dominant hand was affected.
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Background: Grip strength, commonly evaluated with the handgrip dynamometer, is a good indicator of upper limb (UL) function in stroke subjects and may reflect the global strength deficits of the whole paretic UL. The Modified Sphygmomanometer Test (MST) also provides objective and adequate measures at low-cost. Objective: To assess whether grip strength values obtained by using the MST and those obtained by using a handgrip dynamometer would present similar correlations with the global strength and motor function of the paretic UL in subjects with stroke, both in the subacute and chronic phases. Method: Measures of grip strength (MST and handgrip dynamometer), UL global strength (MST and hand-held dynamometer), and UL motor function (Fugl-Meyer motor assessment scale) were obtained with 33 subacute and 44 chronic stroke subjects. Pearson and Spearman correlation coefficients were calculated and Stepwise multiple regression analyses were performed to investigate predictor variables of grip strength (α=0.05). Results: Significant correlations of similar magnitude were found between measures of global strength of the paretic UL and grip strength assessed with both the MST (0.66≤r≤0.78) and handgrip dynamometer (0.66≤r≤0.78) and between UL motor function and grip strength assessed with both the MST (0.50≤rs≤0.51) and hand-held dynamometer (0.50≤rs≤0.63) in subacute and chronic stroke subjects. Only global strength remained as a significant predictor variable of grip strength for the MST (0.43≤R2≤0.61) and for the handgrip dynamometer (0.44≤R2≤0.61) for both stroke subgroups. Conclusion: Grip strength assessed with the MST could be used to report paretic UL global strength.
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Background: Epidemiological research on post-stroke affective disorders has been mainly focusing on post-stroke depression (PSD). In contrast, research on post-stroke anxiety (PSA) is in its early stages. The present study proposes a broad picture on post-stroke affective disorders, including PSD and PSA in German stroke in-patients during rehabilitation. In addition, we investigated whether lifetime affective disorders predict the emergence of PSD and PSA. Methods: 289 stroke patients were assessed in the early weeks following stroke for a range of mood and anxiety disorders by means of the Structured Clinical Interview relying on the Diagnostic and Statistical Manual of Mental Disorders IV. This assessment was conducted for two periods: for post-stroke and retroactively for the period preceding stroke (lifetime). The covariation between PSD and PSA was investigated using Spearman-ρ correlation. Predictors of PSD and PSA prevalence based on the respective lifetime prevalence were investigated using logistic regression analyses. Results: PSD prevalence was 31.1%, PSA prevalence was 20.4%. We also found significant correlations between depression and anxiety at post-stroke and for the lifetime period. Interestingly, lifetime depression could not predict the emergence of PSD. In contrast, lifetime anxiety was a good predictor of PSA. Conclusions: We were able to highlight the complexity of post-stroke affective disorders by strengthening the comorbidity of depression and anxiety. In addition, we contrasted the predictability of PSA based on its lifetime history compared to PSD which was not predictable based on lifetime depression.
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[Purpose] This study investigated the primary factors behind changes in depressive symptoms among stroke patients after 8 weeks of rehabilitation (physical, occupational, and cognitive therapy). [Methods] This study was conducted using a literature review, and electronic medical records from January, 2008 to December, 2009. Data were collected for 120 subjects with chronic stroke. [Results] Cardiac disorder, left-brain lesion, early-stage depression, activities of daily living, and cognitive function were significant predictors of the changes in depression in chronic stroke patients. [Conclusion] Post-stroke depression can be controlled by rehabilitation. Also, clinicians should comprehend and share the psychological and physical affliction, develop back-up programs, and make them comprehensively available to support the psychological and physical health of subjects with chronic stroke.
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Background Apathy and depression are important neuropsychiatric disorders that can occur after a stroke but the etiology and risk factors are not well understood. The purpose of this study was to identify risk factors for apathy and depression following a stroke. Methods Patients with an acute stroke who met the inclusion criteria were recruited from our hospital, and general information was recorded from patient charts. The Apathy Evaluation Scale, Clinician Version (AES-C) was used to evaluate these patients within 2 weeks after the stroke. The Montreal Cognitive Assessment (MoCA), mini-mental state examination (MMSE), Hamilton Depression Scale (HAMD), Mattis Dementia Rating Scale Initiation/Perseveration subset (MDRS I/P), Frontal Assessment Battery (FAB) and Stroop Color-Word Association Test were employed to evaluate emotion, cognitive function and executive function. The patients were divided into two groups: the apathy group and the non-apathy group. We also divided the patients into two groups based on whether or not they had post-stroke depression. The clinical characteristics and scores on the MoCA, MMSE, HAMD and MDRS I/P were compared between the apathy and non-apathy groups as well as between patients with and without depression. Logistic regression analysis was performed to identify risk factors for apathy and depression following a stroke. Results A total of 75 patients with acute stroke were recruited. Of these, 25 (33.3%) developed apathy and 12 (16%) developed depression. Multivariate logistic regression analysis indicated that a history of cerebrovascular disease (OR: 6.45, 95% CI: 1.48-28.05, P = 0.013), low HbA1c (OR: 0.31, 95% CI: 0.12-0.81, P = 0.017) and a low MDRS I/P score (OR: 0.84, 95% CI: 0.74, 0.96, P = 0.010) were risk factors for post-stroke apathy. Additionally, multivariate logistic regression indicated that a low MDRS I/P (OR: 0.85, 95% CI: 0.75, 0.97, P = 0.015) was associated with post-stroke depression. Conclusions Three risk factors for post-stroke apathy were identified as a history of cerebrovascular disease, low HbA1c and lower MDRS I/P scores. A low MDRS I/P score was also identified as a risk factor for post-stroke depression. These results may be useful to clinicians in recognizing and treating apathy and depression in patients after a stroke.
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Background. Depression after stroke may have great burden on the likelihood of functional recovery and long-term outcomes. Objective. To estimate the association between depression after stroke and subsequent mortality. Methods. A systematic search of articles using PubMed and Web of Science databases was performed. Odds ratios (ORs) and hazard ratios (HRs) were used as association measures for pooled analyses, based on random-effects models. Results. Thirteen studies, involving 59,598 subjects suffering from stroke (6,052 with and 53,546 without depression), had data suitable for meta-analysis. The pooled OR for mortality at followup in people suffering from depression after stroke was 1.22 (1.02-1.47). Subgroups analyses highlighted that only studies with medium-term followup (2-5 years) showed a statistically significant association between depression and risk of death. Four studies had data suitable for further analysis of pooled HR. The meta-analysis revealed a HR for mortality of 1.52 (1.02-2.26) among people with depression after stroke. Conclusions. Despite some limitations, this paper confirms the potential role of depression on post stroke mortality. The relationship between depression and mortality after stroke seems to be related to the followup duration. Further research is needed to clarify the nature of the association between depression after stroke and mortality.
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Objective: Functional impairment resulting from a stroke frequently requires the care of a family caregiver, often the spouse. This change in the relationship can be stressful for the couple. Thus, this study examined the longitudinal, dyadic relationship between caregivers' and stroke survivors' mutuality and caregivers' and stroke survivors' perceived stress. Method: This secondary data analysis of 159 stroke survivors and their spousal caregivers utilized a cross-lagged, mixed models analysis with the actor-partner interdependence model to examine the dyadic relationship between mutuality and perceived stress over the first year post-discharge from inpatient rehabilitation. Results: Caregivers' mutuality showed an actor effect (β = -3.82, p < 0.0001) but not a partner effect. Thus, caregivers' mutuality influenced one's own perceived stress but not the stroke survivors' perceived stress. Stroke survivors' perceived stress showed a partner effect and affected caregivers' perceived stress (β = 0.13, p = 0.047). Caregivers' perceived stress did not show a partner effect and did not significantly affect stroke survivors' perceived stress. Conclusion: These findings highlight the interpersonal nature of stress in the context of caregiving for a spouse. Caregivers are especially influenced by perceived stress in the spousal relationship. Couples should be encouraged to focus on positive aspects of the caregiving relationship to mitigate stress.
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Depression after stroke is a distressing problem that may be associated with other negative health outcomes. To estimate the natural history, predictors and outcomes of depression after stroke. Studies published up to 31 August 2011 were searched and reviewed according to accepted criteria. Out of 13 558 references initially found, 50 studies were included. Prevalence of depression was 29% (95% CI 25-32), and remains stable up to 10 years after stroke, with a cumulative incidence of 39-52% within 5 years of stroke. The rate of recovery from depression among patients depressed a few months after stroke ranged from 15 to 57% 1 year after stroke. Major predictors of depression are disability, depression pre-stroke, cognitive impairment, stroke severity and anxiety. Lower quality of life, mortality and disability are independent outcomes of depression after stroke. Interventions for depression and its potential outcomes are required.
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Background: In Spain, stroke is a major public health concern, but large population-based studies are scarce and date from the 1990s. We estimated the incidence and in-hospital mortality of stroke through a multicentered population-based stroke register in 5 geographical areas of Spain, i.e. Lugo, Almería, Segovia, Talavera de la Reina and Mallorca, representing north, south, central (×2) and Mediterranean areas of Spain, respectively, the aim and novelty being that all methodologies were standardized, and diagnoses were verified by a neurologist using neuroimaging techniques. Methods: The register identified subjects >17 years of age who suffered a first-ever stroke or transient ischemic attack (TIA) between 1 January and 31 December 2006. Stroke and TIA were defined according to the WHO criteria. The Lausanne Stroke Registry definitions were used to classify ischemic stroke subtypes, as follows: (1) large-artery atherosclerosis (LAA); (2) cardioembolism (CE); (3) lacunar stroke or small-artery occlusion (SAO); (4) stroke of other infrequent cause (SIC), and (5) stroke of undetermined cause (UND). We used several complementary data sources such as hospital discharge registers, emergency room registers and primary care surveillance systems. Results: In the 1-year study period, we identified 2,700 first-ever cerebrovascular episodes (53% men; 2,257 strokes + 443 TIA episodes). Brain CT in the acute stage was performed in 99% of cases. Of a total of 2,257 stroke patients, 1,817 (81%) had cerebral infarction, 350 (16%) had intracerebral hemorrhage, 59 (3%) had subarachnoid hemorrhage (SAH) and 31 (1%) had unclassifiable stroke. The overall unadjusted annual incidence for all cerebrovascular events was 187 per 100,000 [95% confidence interval (CI) 180-194; incidence for men: 202, 95% CI 189-210; incidence for women: 187, 95% CI 180-194]. The subtype of ischemic stroke could be determined in 1,779 patients and was classified as LAA in 624 (35%), CE in 352 (20%), SAO in 316 (18%), SIC in 56 (3%) and UND in 431 (24%). The incidence rates per 100,000 (95% CI) standardized to the 2006 European population were as follows: all cerebrovascular events, 176 (169-182); all stroke (non-TIA), 147 (140-153); TIA, 29 (26-32); ischemic stroke, 118 (112-123); intracerebral hemorrhage, 23 (21-26), and SAH, 4.2 (3.1-5.2). Incidence rates clearly increased with age in both genders, with a peak at or above 85 years of age. The in-hospital mortality was 14%. Conclusions: Our results show that the incidence of stroke and TIA in Spain is moderate compared to other Western and European countries. However, it is expected that these figures will change due to progressively aging populations.
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Examined the validity and reliability and established adult norms for the Nine Hole Peg Test of finger dexterity. 26 20–39 yr old female occupational therapy students were administered the Nine Hole Peg Test and the Purdue Pegboard. An additional 618 20–94 yr old volunteers were administered the Nine Hole Peg Test to establish adult norms. The results indicate that the Nine Hole Peg Test is a valid measure of finger dexterity but not as reliable as the Purdue Pegboard. (9 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Background and purpose: Negative psychological outcomes occur frequently after stroke; however, there is uncertainty regarding the occurrence of anxiety disorders and anxiety symptoms after stroke. A systematic review of observational studies was conducted that assessed the frequency of anxiety in stroke patients using a diagnostic or screening tool. Summary of review: Databases were searched up to March 2011. A random effects model was used to summarize the pooled estimate. Statistical heterogeneity was assessed using the I(2) statistic. Forty-four published studies comprising 5760 stroke patients were included. The overall pooled estimate of anxiety disorders assessed by clinical interview was 18% (95%confidence interval 8-29%, I(2) = 97%) and was 25% (95% confidence interval 21-28%, I(2) = 90%) for anxiety assessed by rating scale. The Hospital Anxiety and Depression Scale-Anxiety subscale 'probable' and 'possible' cutoff scores were the most widely used assessment criteria. The combined rate of anxiety by time after stroke was: 20% (95% confidence interval 13-27%, I(2) = 96%) within one-month of stroke; 23% (95% confidence interval 19-27%, I(2) = 84%) one to five-months after stroke; and 24% (95% confidence interval 19-29%, I(2) = 89%) six-months or more after stroke. Conclusion: Anxiety after stroke occurs frequently although methodological limitations in the primary studies may limit generalizability. Given the association between prevalence rates and the Hospital Anxiety and Depression Scale-Anxiety cutoff used in studies, reported rates could in fact underrepresent the extent of the problem. Additionally, risk factors for anxiety, its impact on patient outcomes, and effects in tangent with depression remain unclear.
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The longer-term natural history of depression after stroke is poorly understood. We estimate frequency, predictors, and associations of depression up to 5 years after stroke in a population-based study. Data from 3689 patients registered in the South London Stroke Register 1995 to 2006 were used. Baseline data included age, sex, ethnicity, socioeconomic status, and stroke severity. At 3 months and at 1, 3, and 5 years, survivors were assessed for depression (Hospital Anxiety and Depression; depression subscale score >7 indicates depression), cognition, disability, activity, accommodation, employment, and social networks. Associations with depression were investigated with logistic regression. Data are reported with OR and 95% CI. Depression frequencies were 33% (30%-36%), 28% (25%-30%), 32% (30%-35%), and 31% (27%-34%) at 3 months and at 1, 3, and 5 years after stroke, respectively. Forty-eight percent of patients were not depressed at any time point; 49% to 55% of depressed patients at 1 assessment remained depressed at follow-up; and 15% to 20% of patients at each assessment were new cases. Predictors of depression included stroke severity, inability to work, and impaired cognition. Associations with depression at follow-up included impaired cognition, lack of family support, institutionalization, inability to work, functional dependence, and low activity level. Frequency of depression up to 5 years after stroke is 30%; however, it is a dynamic situation with recovery and new cases diagnosed over time. These findings support the need for regular assessment of depression and its associated factors and for the development of effective interventions to reduce depression after stroke.
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Cognitive neuroscience continues to build meaningful connections between affective behavior and human brain function. Within the biological sciences, a similar renaissance has taken place, focusing on the role of sleep in various neurocognitive processes and, most recently, on the interaction between sleep and emotional regulation. This review surveys an array of diverse findings across basic and clinical research domains, resulting in a convergent view of sleep-dependent emotional brain processing. On the basis of the unique neurobiology of sleep, the authors outline a model describing the overnight modulation of affective neural systems and the (re)processing of recent emotional experiences, both of which appear to redress the appropriate next-day reactivity of limbic and associated autonomic networks. Furthermore, a rapid eye movement (REM) sleep hypothesis of emotional-memory processing is proposed, the implications of which may provide brain-based insights into the association between sleep abnormalities and the initiation and maintenance of mood disturbances.
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This study describes levels of stress in stroke survivors and spousal caregivers and identifies predictors of stress in couples during their first year at home. The Perceived Stress Scale (PSS) was administered to 159 stroke survivors and caregivers at discharge and at 3, 6, 9, and 12 months. Other variables tested included stroke survivor function (FIM), health status, mutuality, stroke impact (SIS), caregiver coping (F-COPES), support (MOS Social Support Survey), and preparedness. Repeated measures analyses of PSS scores were conducted with linear mixed models for stroke survivors and caregivers. PSS scores for stroke survivors and caregivers were positively correlated (p<.01). Scores decreased significantly over the year, but caregivers had higher scores initially and decreased less. Stroke survivor function was a significant predictor of stress for both survivors and caregivers. Preparation was the most powerful predictor of stress in caregivers, whereas mutuality was the strongest predictor for stroke survivors. Good health, social support, and coping were associated with less stress. Stress is increased by poor function and mediated by internal and external buffers including health, the dyadic relationship, coping ability, and social support. More research using a dyadic research approach is needed to better understand stress within couples.
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This study investigated and compared the responsiveness and validity of the Fugl-Meyer Assessment (FMA), the Action Research Arm Test (ARAT), and the Wolf Motor Function Test (WMFT) for patients after stroke rehabilitation. A total of 57 patients with stroke received 1 of 3 rehabilitation treatments for 3 weeks. At pretreatment and posttreatment, the 3 outcome measures, as well as the Functional Independence Measure (FIM) as the external criterion, were administered. The standardized response mean (SRM) and the Wilcoxon signed rank test were used to examine the responsiveness. Construct validity and predictive validity were examined by the Spearman correlation coefficient (rho). The responsiveness of the FMA, ARAT, and WMFT functional ability scores was large (SRM=0.95-1.42), whereas the WMFT performance time score was small (SRM=0.38). The responsiveness of the FMA was significantly larger than those of the ARAT and the WMFT-TIME, but not the WMFT functional ability scores. With respect to construct validity, correlations between the FMA and other measures were relatively high (rho=0.42-0.76). The FMA and the WMFT performance time scores at pretreatment had moderate predictive validity with the FIM scores at posttreatment (rho=0.42-0.47). In addition, the ARAT and the WMFT functional ability scores revealed a low predictive validity with the FIM (rho=0.17-0.26). The results support the FMA and the WMFT-FAS are suitable to detect changes over time for patients after stroke rehabilitation. While simultaneously considering the responsiveness and validity attributes, the FMA may be a relatively sound measure of motor function for stroke patients based on our results. Further research based on a larger sample is needed to replicate the findings.
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Background It has been proposed that vascular disease is the mechanism linking depression and cognition, but prospective studies have not supported this hypothesis. This study aims to investigate the inter-relationships between depressive symptoms, cognition and cerebrovascular disease using a well-characterised prospective cohort. Method Data came from waves 1 (2005–2007) and 2 (2007–2009) of the Sydney Memory and Ageing Study ( n = 462; mean age = 78.3 years). Results At wave 1, there was an association between depressive symptoms and white matter hyperintensity (WMH) volume [ b = 0.016, t(414) = 2.34, p = 0.020]. Both depressive symptoms [ b = −0.058, t(413) = −2.64, p = 0.009] and WMH volume [ b = −0.011, t(413) = −3.77, p < 0.001], but not stroke/transient ischaemic attack (TIA) [ b = −0.328, t(413) = −1.90, p = 0.058], were independently associated with lower cognition. Prospectively, cerebrovascular disease was not found to predict increasing depressive symptoms [stroke/TIA: b = −0.349, t(374.7) = −0.76, p = 0.448; WMH volume: b = 0.007, t(376.3) = 0.875, p = 0.382]. Depressive symptoms predicted increasing WMH severity [ b = 0.012, t(265.9) = −3.291, p = 0.001], but not incident stroke/TIA (odds ratio = 0.995; CI 0.949–1.043; p = 0.820). When examined in separate models, depressive symptoms [ b = −0.027, t(373.5) = −2.16, p = 0.032] and a history of stroke/TIA [ b = −0.460, t(361.2) = −4.45, p < 0.001], but not WMH volume [ b = 0.001, t(362.3) = −0.520, p = 0.603], predicted declines in cognition. When investigated in a combined model, a history of stroke/TIA remained a predictor of cognitive decline [ b = −0.443, t(360.6) = −4.28, p < 0.001], whilst depressive symptoms did not [ b = −0.012, t(359.7) = −0.96, p = 0.336]. Conclusions This study is contrasted with previous prospective studies which indicate that depressive symptoms predict cognitive decline independently of vascular disease. Future research should focus on further exploring the vascular mechanisms underpinning the relationship between depressive symptoms and cognition.
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Objective This study aimed to examine the validity of the Arabic version of the Depression Anxiety Stress Scale-21 (DASS-21) in 149 illicit drug users. Methods We calculated α coefficient, inter-tem and item-total correlations, coefficients of reproducibility and scalability (CR and CS), item difficulty and discrimination indices. Results The DASS-21 had an acceptable reliability; but values of the CR and the CS were less than acceptable. Items varied in difficulty and discrimination; some items are candidates for elimination. Conclusion The DASS-21 is a probabilistic and not a deterministic measure of distress; it has problematic items and needs further investigations.
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Objectives: Studies considering emotional disturbances in the setting of stroke have primarily focused on depression and been conducted in high-income countries. Anxiety in stroke survivors, which may be associated with its own unique sets of risk factors and clinical parameters, has been rarely investigated in sub-Saharan Africa (SSA). We assess the characteristics of anxiety and anxiety-depression comorbidity in a SSA sample of recent stroke survivors. Materials and methods: We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤1 month) stroke survivors in SSA. Anxiety in this patient population was measured using the Hospital Anxiety and Depression Scale (HADS), while the community screening instrument for dementia was used to evaluate cognitive functioning. Independent associations were assessed using logistic regression analysis. Results: Among 391 participants, clinically significant anxiety (HADS anxiety score≥11) was found in 77 (19.7%). Anxiety was comorbid with depression in 55 (14.1%). Female stroke survivors were more likely than males to have anxiety (OR=2.4, 95% CI=1.5-4.0). Anxiety was significantly associated with the presence of cognitive impairment after adjusting for age, gender and education (OR=6.8, 95% CI=2.6-18.0). Conclusions: One in five recent stroke survivors in SSA has clinically significant anxiety, and well over 70% of those with anxiety also have depression. Future studies will need to determine what specific impact post-stroke anxiety may have on post-stroke clinical processes and outcomes.
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Background: Community ambulation is essential for patients with stroke. Apart from treatments, an assessment with a quantitative target criterion is also important for patients to clearly demonstrate their functional alteration and determine how close they are to their goal, as well as for therapists to assess the effectiveness of the treatments. The existing quantitative target criteria for community ambulation were all derived from participants in a developed country and ability was assessed using a single-task test. To explore cutoff scores of the single-task and dual-task 10-meter walk test (10MWT) in ambulatory patients with stroke from rural areas of a developing country. Methods: Ninety-five participants with chronic stroke were interviewed concerning their community ambulation ability, and assessed for their walking ability using the single- and dual-task 10MWT. Results: A walking speed of at least 0.47 m/s assessed using the single-task 10MWT, and at least 0.30 m/s assessed using the dual-task 10MWT, could determine the community ambulation ability of the participants. Conclusion: Distinct contexts and anthropometric characteristics required different target criteria for community walking. Thus, when establishing a target value for community ambulation, it needs to be specific to the demographics and geographical locations of the patients.
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This second edition, published in 2006, covers the range of neuropsychiatric syndromes associated with stroke, including cognitive, emotional and behavioural disorders such as depression, anxiety and psychosis. There is growing recognition among a wide range of clinicians and allied healthcare staff that post-stroke neuropsychiatric syndromes are common and serious. Such complications can have a negative impact on recovery and even survival; however, there is now evidence suggesting that pre-emptive therapeutic intervention in high-risk patient groups can prevent the initial onset of the conditions. This opportunity for primary prevention marks a huge advance in the management of this patient population.
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Background and objective: Depression, imbalance, and physical disability are among the serious stroke sequels. The objective of this study was to examine the correlation between depression, balance, and self-reported physical performance in patients post stroke. Methods: The Arabic versions of the Beck Depression Inventory (BDI), Dynamic Gait Index (A-DGI), and physical Stroke Impact Scale-16 version 3 were administered to a convenience sample of patients post stroke. The correlation between the mentioned measures was calculated using the Pearson coefficient. Additionally, the Kruskal-Wallis test was used to find out if the distribution of measurement scores differs among BDI levels of depression intensity or among Orpington Prognostic Scale (OPS) levels of stroke severity. Results: Sixty-one patients with stroke (mean age [standard deviation] = 64 [12] years, 39 male) were recruited. Significant moderate correlations were found between BDI and A-DGI, BDI and Stroke Impact Scale (SIS), and A-DGI and physical SIS. Additionally, the distribution of the A-DGI and the physical SIS scores showed significant differences among BDI levels of depression intensity. Moreover, the distribution of the BDI, A-DGI, and physical SIS scores showed significant differences among OPS levels of stroke severity. Conclusions: Depressive symptoms were found frequent among people post stroke and were associated with balance and self-reported physical performance.
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Context. —Preventive health programs may mitigate against the health risks of older adulthood.Objective. —To evaluate the effectiveness of preventive occupational therapy (OT) services specifically tailored for multiethnic, independent-living older adults.Design. —A randomized controlled trial.Setting. —Two government subsidized apartment complexes for independentliving older adults.Subjects. —A total of 361 culturally diverse volunteers aged 60 years or older.Intervention. —An OT group, a social activity control group, and a nontreatment control group. The period of treatment was 9 months.Main Outcome Measures. —A battery of self-administered questionnaires designed to measure physical and social function, self-rated health, life satisfaction, and depressive symptoms.Results. —Benefit attributable to OT treatment was found for the quality of interaction scale on the Functional Status Questionnaire (P=.03), Life Satisfaction Index-Z (P=.03), Medical Outcomes Study Health Perception Survey (P=.05), and for 7 of 8 scales on the RAND 36-Item Health Status Survey, Short Form: bodily pain (P=.03), physical functioning (P=.008), role limitations attributable to health problems (P=.02), vitality (P=.004), social functioning (P=.05), role limitations attributable to emotional problems (P=.05), and general mental health (P=.02).Conclusions. —Significant benefits for the OT preventive treatment group were found across various health, function, and quality-of-life domains. Because the control groups tended to decline over the study interval, our results suggest that preventive health programs based on OT may mitigate against the health risks of older adulthood.
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Rapidly emerging evidence continues to describe an intimate and causal relationship between sleep and emotional brain function. These findings are mirrored by long-standing clinical observations demonstrating that nearly all mood and anxiety disorders co-occur with one or more sleep abnormalities. This review aims to (a) provide a synthesis of recent findings describing the emotional brain and behavioral benefits triggered by sleep, and conversely, the detrimental impairments following a lack of sleep; (b) outline a proposed framework in which sleep, and specifically rapid-eye movement (REM) sleep, supports a process of affective brain homeostasis, optimally preparing the organism for next-day social and emotional functioning; and (c) describe how this hypothesized framework can explain the prevalent relationships between sleep and psychiatric disorders, with a particular focus on posttraumatic stress disorder and major depression. Expected final online publication date for the Annual Review of Clinical Psychology Volume 10 is March 20, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
Article
To examine the impact of anxiety on the health-related quality of life (HRQoL) of stroke survivors. Cross-sectional study. An acute stroke unit in a regional hospital in Hong Kong. Patients (N=374) from an acute stroke unit. Not applicable. The presence of anxiety was defined as a score of 8 or above on the Anxiety subscale of the Hospital Anxiety Depression Scale (HADSA). HRQoL was measured by the total score and 12 domain scores of the Stroke Specific Quality of Life (SSQoL) scale. The demographic characteristics and history of medical conditions were also recorded. Clinical characteristics were obtained using the following scales: National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), Mini-Mental State Examination (MMSE), and Geriatric Depression Scale (GDS). Eighty-six (23%) stroke survivors had anxiety. The anxiety group had significantly more female subjects (62.8% vs. 35.1%), higher GDS scores (7.5±4.5 vs. 3.5±3.6), and lower scores for total SSQoL (3.9±0.6 vs. 4.5±0.6) and the SSQoL domains of energy (2.0±1.2 vs. 3.4±1.4), mood (3.6±1.5 vs. 4.6±0.9), personality (3.4±1.7 vs. 4.4±1.1), and thinking (2.4±1.2 vs. 3.5±1.4), after adjustment for gender and GDS score. In subsequent multivariate regression analysis, the HADSA score was negatively associated with the SSQoL total score (r=-0.154) and 4 of the 12 domain scores, namely energy (r=-0.290), mood (r=-0.102), personality (r=-0.195), thinking (r=-0.136), and work/productivity (r=-0.096). Anxiety has a negative effect on the HRQoL of stroke survivors independent from depression. Interventions for anxiety should improve stroke survivors' quality of life.
Article
A principal objective of this paper is to discuss a class of biased linear estimators employing generalized inverses. A second objective is to establish a unifying perspective. The paper exhibits theoretical properties shared by generalized inverse estimators, ridge estimators, and corresponding nonlinear estimation procedures. From this perspective it becomes clear why all these methods work so well in practical estimation from nonorthogonal data.
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Background and purpose: Iceland is an island in the North Atlantic with ≈319 000 inhabitants. The study determines the incidence of first stroke in the adult population of Iceland during 12 months, which has not been previously reported in the entire Icelandic population. Methods: The study population consisted of all residents of Iceland, aged ≥ 18 years, during the 12-month study period. Cases were identified by multiple overlapping approaches. Medical records were reviewed to verify diagnosis, to determine stroke subtype and to determine selected risk factors. Results: A total of 343 individuals, aged ≥ 18 years, had a first stroke during the study period. Incidence was 144 per 100 000 person years; 81% ischemic infarction; 9% intracerebral hemorrhage; 7% subarachnoid hemorrhage; and 3% unknown. Fifty percent of the individuals were men. Mean age for ischemic infarction and intracerebral hemorrhage was 71 years for men and 73 years for women. Atrial fibrillation was previously known in 18% with first ischemic stroke or intracerebral hemorrhage and another 6% were diagnosed on routine admission ECG. Long-term ECG study (24 hours) found that 12% (18/154) of the remaining individuals had paroxysmal atrial fibrillation. Conclusions: Incidence of first stroke in Iceland is similar to other Western countries. The high number of paroxysmal atrial fibrillation found during the 24-hour ECG suggests that atrial fibrillation may be underdiagnosed in patients with stroke.
Article
Objective: To determine the validity of the Montreal Cognitive Assessment (MoCA) and the Mini-Mental State Examination (MMSE) as screening tools for cognitive impairment after stroke. Materials and methods: Cognitive assessments were administered over 2 sessions (1 week apart) at 3 months post-stroke. Scores on the MoCA and MMSE were evaluated against a diagnosis of cognitive impairment derived from a comprehensive neuropsychological battery (the criterion standard). Results: Sixty patients participated in the study [mean age 72.1 years (SD = 13.9), mean education 10.5 years (SD = 3.9), median acute NIHSS score 5 (IQR 3-7)]. The MoCA yielded lower scores (median = 21, IQR = 17-24; mean = 20.0, SD = 5.4) than the MMSE (median = 26, IQR = 22-27; mean = 24.2, SD = 4.5). MMSE data were more skewed towards ceiling than MoCA data (skewness = -1.09 vs -0.73). Area under the receiver operator curve was higher for MoCA than for MMSE (0.87 vs 0.84), although this difference was not significant (χ(2) = 0.48, P = 0.49). At their optimal cut-offs, the MoCA had better sensitivity than the MMSE (0.92 vs 0.82) but poorer specificity (0.67 vs 0.76). Conclusions: The MoCA is a valid screening tool for post-stroke cognitive impairment; it is more sensitive but less specific than the MMSE. Contrary to the prevailing view, the MMSE also exhibited acceptable validity in this setting.
Article
Scores on the SF-36 and SF-12 scales range from 0–100, with higher scores indicating better health. On the physical functioning scale, low scores are typical of someone who experiences many limitations in physical activities, including bathing or dressing, while high scores represent someone who is able to perform these types of activities without limitations. Low scores on the role physical scale represent someone who experiences many limitations in work or other daily activities, and high scores characterize someone who has no difficulties with these activities. Low scores on the social functioning typify a person who experiences a great deal of difficulties in normal social activities due to physical and emotional health problems, and high scores represent someone who is able to perform normal social activities without interference due to physical or emotional health. Low scores on the bodily pain scale are typical of a person who has very severe and extremely limiting pain, and high scores represent individuals who have no pain or pain-related limitations. On the mental health scale, low scores represent high levels of nervousness and depression, while high scores characterize someone who feels peaceful, happy, and calm. Low scores on the role emotional scale represent someone who experiences many problems with work or other daily activities as a result of emotional ill health, and high scores represent those who have no problems with work or other daily activities as a result of emotional health. On the vitality scale, low scores are typical of someone who feels tired and worn out all of the time, while high scores characterize those who feel full of pep and energy. Low scores on the general health scale represent a person who believes their health to be poor and likely to get worse, and high scores represent someone who sees their health as excellent (1).
Article
Purpose: The aim was to document the prevalence and predictors of anxiety and depression 5 years after stroke, across four European centres. Method: A cohort of 220 stroke patients was assessed at 2, 4 and 6 months and 5 years after stroke. Patients were assessed on the Hospital Anxiety and Depression Scale and measures of motor function and independence in activities of daily living. Results: At 5 years, the prevalence of anxiety was 29% and depression 33%, with no significant differences between centres. The severity of anxiety and depression increased significantly between 6 months and 5 years. Higher anxiety at 6 months and centre were significantly associated with anxiety at 5 years, but not measures of functional recovery. Higher depression scores at 6 months, older age and centre, but not measures of functional recovery, were associated with depression at 5 years. Conclusions: Anxiety and depression were more frequent at 5 years after stroke than at 6 months. There were significant differences between four European centres in the severity of anxiety and depression. Although the main determinant of anxiety or depression scores at 5 years was the level of anxiety or depression at 6 months, this accounted for little of the variance. Centre was also a significant predictor of mood at 5 years. There needs to be greater recognition of the development of mood disorders late after stroke and evaluation of variation in management policies across centres.
Article
Post-stroke depression (PSD) is one of the most frequent complications of stroke, with a prevalence ranging 20-60%. As PSD seems to be related to stroke severity, we hypothesized that the prevalence of PSD would be lower in patients with minor stroke. We investigated the prevalence and predictors of PSD over a 30-month follow-up period in a cohort of patients with minor ischaemic stroke (NIHSS≤5). We enrolled 105 patients (mean age 64.38±11.2years, M/F 69/36). PSD was diagnosed in 43 (41%) patients, 40 (93%) of whom had dysthymia; 22% of patients were already depressed at 1month. The most frequent depressive symptoms (DSs) were working inhibition, indecisiveness, and fatigability. Patients who developed PSD were less educated (P=0.044) and diabetic (P=0.006). After excluding patients that were already depressed at 1month, we performed a logistic regression model to detect predictors of PSD. Crying (P=0.012, OR 1.067, CI 0.269-4.553) and guilt (P=0.007, OR 0.037, CI 0.02ì03-0.401) at baseline were two DSs found to be significantly correlated with PSD. Higher educational level (P=0.022, OR 0.084, CI 0.010-0.698) and diabetes (P=0.007, OR 14.361, CI 2.040-101.108) were the risk factors significantly correlated with PSD. Post-stroke depression is frequent even in patients with minor stroke. Early detection of DSs might help to predict long-term development of PSD. No correlation was observed between lesion site or side and the development of PSD.
Article
To evaluate (1) the prevalence of operationally defined depressive disorder (ICD-10) in chronic stroke subjects and (2) the relationship of post-stroke depression (PSD) with disability. Cross-sectional, descriptive study. Neurological rehabilitation unit of a tertiary care university research center. Participants were those with first episode of supratentorial stroke of more than 3 months' duration with impaired balance and gait who had been referred for rehabilitation. Data were collected on demographic data, stroke data (side and type of lesion and post-stroke duration), cognition (mini mental state examination), depressive ideation (Hamilton Depression Rating Scale - HRDS), impairment (Scandinavian Stroke Scale), balance (Berg Balance Scale), ambulatory status (Functional Ambulation Category), walking ability (speed), and independence in activities of daily living (Barthel Index). Statistical analysis was done using SPSS 13.0. We carried out the chi-square test for ordinal variables and the independent t test for continuous variables. Fifty-one patients (M:F: 41:10) of mean age 46.06 +/- 11.19 years and mean post-stroke duration of 467.33 +/- 436.39 days) were included in the study. Eighteen of the 51 participants (35.29%) met the criteria for depression. Demographic variables like male gender, being married, living in a nuclear family, urban background, and higher HRDS score were significantly correlated with PSD (P < 0.05). Depression was related to functional disability after stroke but to a statistically insignificant level (P > 0.05) and was unrelated to lesion-related parameters. Depression occurs in one-third of chronic stroke survivors and is prevalent in subjects referred for rehabilitation. PSD is related primarily to demographic variables and only to a lesser extent to functional disability following stroke.
Article
The Depression Anxiety Stress Scale (Lovibond & Lovibond, 1995) is used to assess the severity of symptoms in child and adolescent samples although its validity in these populations has not been demonstrated. The authors assessed the latent structure of the 21-item version of the scale in samples of 425 and 285 children and adolescents on two occasions, one year apart. On each occasion, parallel analyses suggested that only one component should be extracted, indicating that the test does not differentiate depression, anxiety, and stress in children and adolescents. The results provide additional evidence that adult models of depression do not describe the experience of depression in children and adolescents.
Article
Stroke is an important neurological problem and a leading cause of death in clinical practice. Among survivors, over half have significant disabilities; and/ or psychiatric complications most especially Post-stroke depression (PSD). The study aimed to establish prevalence and risk factors for post stroke depression. A prospective study carried out among selected stroke survivors in Lagos University Teaching Hospital (LUTH). Subjects included those who satisfied the WHO definition of stroke. The necessary socio-demographic data was obtained from each subject; the Depression Anxiety Stress Scale-21 (DASS-21) and Modified Motor Assessment Scale (MMAS) were administered. Risk factors of PSD studied were gender, laterality of stroke, post stroke functional impairment and post stroke duration before clinical presentation. A total of 51 stroke survivors were studied, made up of 31 (60.8%) males and 20 (39.2% ) females. The mean age was 52.5+/-5.9 years; and age range of 40-64 years. From assessment with the depression subscale of DASS-21, 38 (74.5% ) of the subjects were normal and the rest 13 (25.5% ) had depression. Risk factors found to be statistically significant for PSD in the study included: gender (X(2)=10.3 at p=0.001) and stroke laterality ( X (2)=6.1 at p = 0.013). However, there were no statistically significant differences for mean post-stroke duration before clinical presentation and PSD ( "t" =3.5 and p= 0.073) ; and post-stroke disability as shown by mean MMAS scores and PSD ( "t" =7.6 and p= 0.084). Depression was found to be an important complication among stroke survivors in our study. Important risk factors found for PSD included gender and laterality. The findings emphasized a need for appropriate health facilities and for stroke survivors to present early for treatment to attenuate stroke complications.
Article
Mild cognitive impairment (MCI) is a clinical label which includes elderly subjects with memory impairment and with no significant daily functional disability. MCI is an important target for Alzheimer's dementia prevention studies. Data on the prevalence and incidence of MCI varies greatly according to cultural difference. The first aim of this study was to assess the reliability and validity of Montreal Cognitive Assessment (MoCA) Arabic version in MCI detection. The second was to determine the prevalence of MCI among apparently healthy elderly people attending geriatric clubs in Cairo. In stage I reliability & validity of MoCA Arabic version were assessed in reference to Cambridge Cognitive Examination (CAMCOG). In stage II prevalence of MCI was estimated using Arabic MoCA among apparently healthy elderly attending geriatric clubs. These geriatric clubs were randomly selected from different regions in Cairo governorate. Test-retest reliability data of the Arabic MoCA were collected approximately 35.0 +/- 17.6 days apart. The mean change in Arabic MoCA scores from the first to second evaluation was 0.9 +/- 2.5 points, and correlation between the two evaluations was high (correlation coefficient = 0.92, P < 0.001). The internal consistency of the Arabic MoCA was good, yielding a Cronbach's alpha on the standardized items of 0.83. In diagnosing mild cognitive impairment, the Arabic MoCA showed 92.3% sensitivity and 85.7% specificity. The prevalence of MCI among elderly subjects attending geriatric clubs in Cairo is 34.2% and 44.3% of healthy men and women, respectively. Older age, female sex and less education are the independent risk factors for MCI among apparently healthy elderly subjects attending geriatric clubs in Cairo.
Article
A system for evaluation of motor function, balance, some sensation qualities and joint function in hemiplegic patients is described in detail. The system applies a cumulative numerical score. A series of hemiplegic patients has been followed from within one week post-stroke and throughout one year. When initially nearly flaccid hemiparalysis prevails, the motor recovery, if any occur, follows a definable course. The findings in this study substantiate the validity of ontogenetic principles as applicable to the assessment of motor behaviour in hemiplegic patients, and foocus the importance of early therapeutic measures against contractures.
Article
The psychometric properties of the Depression Anxiety Stress Scales (DASS) were evaluated in a normal sample of N = 717 who were also administered the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The DASS was shown to possess satisfactory psychometric properties, and the factor structure was substantiated both by exploratory and confirmatory factor analysis. In comparison to the BDI and BAI, the DASS scales showed greater separation in factor loadings. The DASS Anxiety scale correlated 0.81 with the BAI, and the DASS Depression scale correlated 0.74 with the BDI. Factor analyses suggested that the BDI differs from the DASS Depression scale primarily in that the BDI includes items such as weight loss, insomnia, somatic preoccupation and irritability, which fail to discriminate between depression and other affective states. The factor structure of the combined BDI and BAI items was virtually identical to that reported by Beck for a sample of diagnosed depressed and anxious patients, supporting the view that these clinical states are more severe expressions of the same states that may be discerned in normals. Implications of the results for the conceptualisation of depression, anxiety and tension/stress are considered, and the utility of the DASS scales in discriminating between these constructs is discussed.
Article
A much debated question is whether sex differences exist in the functional organization of the brain for language. A long-held hypothesis posits that language functions are more likely to be highly lateralized in males and to be represented in both cerebral hemispheres in females, but attempts to demonstrate this have been inconclusive. Here we use echo-planar functional magnetic resonance imaging to study 38 right-handed subjects (19 males and 19 females) during orthographic (letter recognition), phonological (rhyme) and semantic (semantic category) tasks. During phonological tasks, brain activation in males is lateralized to the left inferior frontal gyrus regions; in females the pattern of activation is very different, engaging more diffuse neural systems that involve both the left and right inferior frontal gyrus. Our data provide clear evidence for a sex difference in the functional organization of the brain for language and indicate that these variations exist at the level of phonological processing.