Journal of the International Neuropsychological Society

Table of Contents - 2003 - Volume 9, Issue 03  

Journal of the International Neuropsychological Society (2003), 9:3:429-439 Cambridge University Press
Copyright © 2003 The International Neuropsychological Society
doi:10.1017/S1355617703930086

Ischemic stroke and depression

DAVID W.  DESMOND  a1 c1, ROBERT H.  REMIEN  a2, JOAN T.  MORONEY  a3, YAAKOV  STERN  a4, MARY  SANO  a4 and JANET B.W.  WILLIAMS  a2
a1 Departments of Neurology and Pathology, SUNY Downstate Medical Center, Brooklyn, New York
a2 Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
a3 Department of Clinical Neurosciences, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
a4 Departments of Neurology and Psychiatry and the Gertrude H. Sergievsky Center, Columbia University College of Physicians and Surgeons, New York, New York

Abstract

Previous studies of depression after stroke have reported widely variable findings, possibly due to differences between studies in patient characteristics and methods for the assessment of depression, small sample sizes, and the failure to examine stroke-free reference groups to determine the base rate of depression in the general population. In an effort to address certain of those methodologic issues and further investigate the frequency and clinical determinants of depression after stroke, we administered the Structured Interview Guide for the Hamilton Depression Rating Scale (SIGH–D) and neurological, neuropsychological, and functional assessments to 421 patients (age = 71.5 ± 8.0 years) 3 months after ischemic stroke and 249 stroke-free control subjects (age = 70.8 ± 6.7 years). We required a SIGH–D total score > 11 for the identification of depression. We found that depression was less frequent (47/421 patients, or 11.2%, and 13/249 control subjects, or 5.2%), less severe, and less persistent in our stroke cohort than previously reported, possibly due to the underrepresentation of patients with a premorbid history of affective illness. Depression was associated with more severe stroke, particularly in vascular territories that supply limbic structures; dementia; and female sex. SIGH–D item analyses suggested that a reliance on nonsomatic rather than somatic symptoms would result in the most accurate diagnoses of depression after ischemic stroke. (JINS, 2003, 9, 429–439.)

(Received February 20 2002)
(Revised April 29 2002)
(Accepted May 28 2002)


Key Words: Stroke; Cerebrovascular disease; Depression; Dementia.

Correspondence:
c1 Reprint requests to: Dr. David W. Desmond, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 25, Brooklyn, NY 11203. E-mail: dwdesmond@usa.net

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