AUTHOR=Huang Jing , Zhou Fu-Chun , Guan Boyuan , Zhang Ning , Wang Anxin , Yu Ping , Zhou Lei , Wang Chuan-Yue , Wang Chunxue 

TITLE=Predictors of Remission of Early-Onset Poststroke Depression and the Interaction Between Depression and Cognition During Follow-Up

JOURNAL=Frontiers in Psychiatry

VOLUME=9

YEAR=2019

URL=https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2018.00738

DOI=10.3389/fpsyt.2018.00738

ISSN=1664-0640

ABSTRACT=<p><bold>Objectives:</bold> This study aimed to examine the rate of remission in individuals experiencing early-onset poststroke depression (PSD) in China and to identify predictors of remission during a 3-month follow-up. This study also explored the interaction between cognitive impairment and depression.</p><p><bold>Methods:</bold> A total of 820 patients with PSD from a massive multicenter prospective cohort project in China (PRIOD) were included in the present study. Depressive symptoms were measured with the Hamilton Depression Rating Scale (17 Items, HDRS-17) at 2 weeks and the endpoint of the 3-month follow-up. The cut-off score of HDRS-17 (&lt; 8) was used to define remission of depression at the endpoint. The Mini-Mental State Exam (MMSE) was used to evaluate the cognitive impairment of the patients (at the 2-week follow-up and 3-month endpoint). The National Institutes of Health Stroke Scale (NIHSS) was used to measure the severity of stroke.</p><p><bold>Results:</bold> (1) Six hundred and forty-two patients completed the 3-month follow-up, and 332 (51.7%) patients remitted by the end of the study. Univariate analyses indicated that there was a higher proportion of patients who had hypertension, frontal lobe lesion, basal ganglia lesion, poor outcome at 2 weeks, high scores on the NIHSS at 2 weeks, major life events within 3 months, and major medical diseases within 3 months in the nonremission group. In stepwise multiple logistic regression analyses, remission was significantly predicted by lower NIHSS scores at 2 weeks (<italic>p</italic> = 0.001, <italic>OR</italic> = 1.086, 95% CI 1.035–1.139), fewer major life events (<italic>p</italic> = 0.036, <italic>OR</italic> = 5.195, 95% CI 1.111–27.283), fewer major medical comorbidities (<italic>p</italic> = 0.015, <italic>OR</italic> = 2.434, 95% CI 1.190–4.979), and fewer frontal lobe lesions (<italic>p</italic> = 0.042, <italic>OR</italic> = 1.717, 95% CI 1.019–2.891). (2) After controlling for confounding variables, repeated measures analysis of variance revealed a significant interaction between time (2 weeks vs. 3 months) and group (remitters vs. nonremitters) on MMSE scores [<italic>F</italic><sub>(1, 532)</sub> = 20.2, <italic>p</italic> &lt; 0.001].</p><p><bold>Conclusions:</bold> Early-onset PSD patients with milder neurological impairment, fewer major life events, fewer major medical comorbidities and no frontal lobe lesion at baseline were more likely to achieve remission 3 months after stroke. Only remitters of PSD improved significantly in cognitive impairment after stroke.</p><p>The PRIOD trial is registered at <ext-link ext-link-type="uri" xlink:href="http://www.isrctn.com/" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.isrctn.com/</ext-link>, number ISRCTN62169508.</p>