Association among depression, cognitive impairment and executive dysfunction after stroke

Terroni, Luisa; Sobreiro, Matildes F.M.; Conforto, Adriana B.; Adda, Carla C.; Guajardo, Valeri D.; Lucia, Mara Cristina S. de; Fráguas, Renério

doi:10.1590/S1980-57642012DN06030007

ABSTRACT

The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated.

Objective:

To review the relationship between post-stroke depression and cognitive impairment.

Methods:

We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke.

Results:

Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing.

Conclusion:

Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.

Key words:
stroke; depression; cognition impairment; cognition; executive function; dysfunction; neuropsychological assessment

RESUMO

A depressão e o déficit cognitivo são frequentes após o acidente vascular cerebral. A relação entre as duas condições é complexa e não tem sido suficientemente elucidada.

Objetivo:

Fazer uma revisão da relação entre a depressão pós-AVC e prejuízo cognitivo.

Métodos:

Foi realizada uma pesquisa no banco de dados PubMed nos últimos dez anos. Nosso foco foi estudos quantitativos originais que investigaram a relação entre depressão e comprometimento cognitivo em pacientes com AVC. Os termos depressão, disfunção cognitiva, comprometimento cognitivo e testes neuropsicológicos foram usados para pesquisa. Foram considerados artigos publicados em Inglês, Espanhol, Italiano e Português. Os critérios de seleção foram o uso de testes neuropsicológicos para avaliar a função cognitiva com também o uso de instrumentos para diagnosticar a depressão maior ou escalas para avaliar sintomas depressivos nos primeiros três meses após o AVC.

Resultados:

Seis estudos quantitativos originais preencheram os critérios de seleção. A prevalência de depressão pós-AVC nos primeiros três meses após o AVC variou de 22% a 31%. A incidência de depressão pós-AVC variou de 25% a 27% e foi avaliada apenas em dois estudos. A depressão pós-AVC esteve associada com comprometimento cognitivo mais acentuado. Disfunção cognitiva pós-AVC foi relatada em 35,2% a 87% dos pacientes. Déficits cognitivos pós-AVC foram encontrados principalmente em função executiva, memória, linguagem e velocidade de processamento.

Conclusão:

A disfunção executiva e a depressão ocorrem em pacientes de AVC, sendo frequentemente concomitantes e associadas a um pior prognóstico. Os profissionais de saúde devem diagnosticar e fornecer um tratamento adequado para a depressão e disfunção executiva nos primeiros três meses após o AVC. Mais estudos devem avaliar a efetividade de programas de detecção precoce e tratamento da depressão e disfunção executiva pós-AVC.

Palavras-chave:
acidente vascular cerebral; depressão; comprometimento cognitivo; cognição; função executiva; testes neuropsicológicos

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REFERENCES

Robinson RG, Starr LB, Lipsey JR, et al. A two-year longitudinal study of post-stroke mood disorders: dynamic changes in associated variables over the first six months of follow-up. Stroke 1984;15:510-517.
Astrom M, Adolfsson R, Asplund K. Major depression in stroke patients. A 3-year longitudinal study. Stroke 1993;24:976-982.
Spalletta G, Ripa A, Caltagirone C. Symptom profile of DSM-IV major and minor depressive disorders in first-ever stroke patients. Am J Geriatr Psychiatry 2005;13:108-115.
Terroni L, Leite CC, Tinone G, et al. [Poststroke depression: risk factors and antidepressant treatment]. Rev Assoc Med Bras 2003;49:450-459.
Hackett ML, Anderson CS. Frequency, management, and predictors of abnormal mood after stroke: the Auckland Regional Community Stroke (ARCOS) study, 2002 to 2003. Stroke 2006;37:2123-2128.
Vataja R, Pohjasvaara T, Leppavuori A, et al. Magnetic resonance imaging correlates of depression after ischemic stroke. Arch Gen Psychiatry 2001;58:925-931.
Aben I, Verhey F, Strik J, et al. A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction. J Neurol Neurosurg Psychiatry 2003;74:581-585.
Robinson RG, Price TR. Post-stroke depressive disorders: a follow-up study of 103 patients. Stroke 1982;13:635-641.
Provinciali L, Paolucci S, Torta R, et al. Depression after first-ever ischemic stroke: the prognostic role of neuroanatomic subtypes in clinical practice. Cerebrovasc Dis 2008;26:592-599.
Gainotti G, Azzoni A, Marra C. Frequency, phenomenology and anatomical-clinical correlates of major post-stroke depression. Br J Psychiatry 1999;175:163-167.
Terroni L, Fraguas R, Lucia M, et al. Importance of retardation and fatigue/interest domains for the diagnosis of major depressive episode after stroke: a four months prospective study. Rev Bras Psiquiatr 2009; 31:202-207.
Parikh RM, Robinson RG, Lipsey JR, et al. The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. Arch Neurol 1990;47:785-789.
Burvill PW, Johnson AK, Jamrozik KD, et al. Prevalence of Depression After Stroke: The Perth Community Stroke Study. Br J Psychiatry 1995;166:320-327.
King RB. Quality of life after stroke. Stroke 1996;27:1467-1472.
Andersen G, Vestergaard K, Ingemann-Nielsen M, et al. Risk factors for post-stroke depression. Acta Psychiatr Scand 1995;92:193-198.
Robinson RG, Kubos KL, Starr LB, et al. Mood disorders in stroke patients. Importance of location of lesion. Brain 1984;107 ( Pt 1):81-93.
Aben I, Verhey F. Depression after a cerebrovascular accident. The importance of the integration of neurobiological and psychosocial pathogenic models. Panminerva Med 2006;48:49-57.
Tatemichi TK, Desmond DW, Stern Y, et al. Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry 1994;57:202-207.
Hoffmann M. Stroke in the young: The multiethnic prospective durban stroke data bank results. J Stroke Cerebrovasc Dis 1998;7:404-413.
Hoffmann M, Schmitt F, Bromley E. Vascular cognitive syndromes: relation to stroke etiology and topography. Acta Neurol Scand 2009; 120:161-169.
Barker-Collo S, Feigin V. The impact of neuropsychological deficits on functional stroke outcomes. Neuropsychol Rev 2006;16:53-64.
Farner L, Wagle J, Engedal K, et al. Depressive symptoms in stroke patients: a 13 month follow-up study of patients referred to a rehabilitation unit. J Affect Disord 2010;127:211-218.
Hobson P, Meara J. Cognitive function and mortality in a community-based elderly cohort of first-ever stroke survivors and control subjects. J Stroke Cerebrovasc Dis 2010;19:382-387.
O'Brien JT, Erkinjuntti T, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol 2003;2:89-98.
Madureira S, Guerreiro M, Ferro JM. Dementia and cognitive impairment three months after stroke. Eur J Neurol 2001;8:621-627.
Nys GM, van Zandvoort MJ, de Kort PL, et al. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cerebrovasc Dis 2007;23:408-416.
Pohjasvaara T, Leskela M, Vataja R, et al. Post-stroke depression, executive dysfunction and functional outcome. Eur J Neurol 2002;9:269-275.
Ballard C, Stephens S, Kenny R, et al. Profile of neuropsychological deficits in older stroke survivors without dementia. Dement Geriatr Cogn Disord 2003;16:52-56.
Lesniak M, Bak T, Czepiel W, et al. Frequency and prognostic value of cognitive disorders in stroke patients. Dement Geriatr Cogn Disord 2008;26:356-363.
Bolla-Wilson K, Robinson RG, Starkstein SE, et al. Lateralization of dementia of depression in stroke patients. Am J Psychiatry 1989;146:627-634.
Vataja R, Pohjasvaara T, Mantyla R, et al. Depression-executive dysfunction syndrome in stroke patients. Am J Geriatr Psychiatry 2005; 13:99-107.
Kauhanen M, Korpelainen JT, Hiltunen P, et al. Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke 1999;30:1875-1880.
Nys GM, van Zandvoort MJ, van der Worp HB, et al. Early depressive symptoms after stroke: neuropsychological correlates and lesion characteristics. J Neurol Sci 2005;228:27-33.
Barker-Collo SL. Depression and anxiety 3 months post stroke: prevalence and correlates. Arch Clin Neuropsychol 2007;22:519-531.
Alexopoulos GS, Meyers BS, Young RC, et al. Clinically defined vascular depression. Am J Psychiatry 1997;154:562-565.
Nys GM, van Zandvoort MJ, van der Worp HB, et al. Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke. J Neurol Sci 2006;247:149-156.
Verdelho A, Henon H, Lebert F, et al. Depressive symptoms after stroke and relationship with dementia: A three-year follow-up study. Neurology 2004;62:905-911.
Kimura M, Robinson RG, Kosier JT. Treatment of cognitive impairment after poststroke depression: a double-blind treatment trial. Stroke 2000; 31:1482-1486.
Simis S, Nitrini R. Cognitive improvement after treatment of depressive symptoms in the acute phase of stroke. Arq Neuropsiquiatr 2006;64:412-417.
Bueno VF, Brunoni AR, Boggio PS, et al. Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression. Neurocase 2011;17:318-322.
Sato S, Yamakawa Y, Terashima Y, et al. Efficacy of milnacipran on cognitive dysfunction with post-stroke depression: preliminary open-label study. Psychiatry Clin Neurosci 2006;60:584-589.
Spalletta G, Guida G, Caltagirone C. Is left stroke a risk-factor for selective serotonin reuptake inhibitor antidepressant treatment resistance? J Neurol 2003;250:449-455.
Narushima K, Chan KL, Kosier JT, et al. Does cognitive recovery after treatment of poststroke depression last? A 2-year follow-up of cognitive function associated with poststroke depression. Am J Psychiatry 2003;160:1157-1162.
Murata Y, Kimura M, Robinson RG. Does cognitive impairment cause post-stroke depression? Am J Geriatr Psychiatry 2000;8:310-317.
Jorge RE, Acion L, Moser D, et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry 2010;67:187-196.
Schubert DS, Taylor C, Lee S, et al. Detection of depression in the stroke patient. Psychosomatics 1992;33:290-294.
Edwards DF, Hahn MG, Baum CM, et al. Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines. Neurorehabil Neural Repair 2006;20:42-48.
Miotto EC, Sato J, Lucia MC, et al. Development of an adapted version of the Boston Naming Test for Portuguese speakers. Rev Bras Psiquiatr 2010;32:279-282.
Zhou B, Zhao Q, Teramukai S, et al. Executive function predicts survival in Alzheimer disease: a study in Shanghai. J Alzheimers Dis 2010;22:673-682.
Johnson JK, Lui LY, Yaffe K. Executive function, more than global cognition, predicts functional decline and mortality in elderly women. J Gerontol A Biol Sci Med Sci 2007;62:1134-1141.
Melkas S, Vataja R, Oksala NK, et al. Depression-executive dysfunction syndrome relates to poor poststroke survival. Am J Geriatr Psychiatry 2010;18:1007-1016.

Publication Dates

Publication in this collection
Jul-Sep 2012

History

Received
20 Jan 2012
Accepted
02 Apr 2012

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Robinson RG, Starr LB, Lipsey JR, et al. A two-year longitudinal study of post-stroke mood disorders: dynamic changes in associated variables over the first six months of follow-up. Stroke 1984;15:510-517.

[2] Astrom M, Adolfsson R, Asplund K. Major depression in stroke patients. A 3-year longitudinal study. Stroke 1993;24:976-982.

[3] Spalletta G, Ripa A, Caltagirone C. Symptom profile of DSM-IV major and minor depressive disorders in first-ever stroke patients. Am J Geriatr Psychiatry 2005;13:108-115.

[4] Terroni L, Leite CC, Tinone G, et al. [Poststroke depression: risk factors and antidepressant treatment]. Rev Assoc Med Bras 2003;49:450-459.

[5] Hackett ML, Anderson CS. Frequency, management, and predictors of abnormal mood after stroke: the Auckland Regional Community Stroke (ARCOS) study, 2002 to 2003. Stroke 2006;37:2123-2128.

[6] Vataja R, Pohjasvaara T, Leppavuori A, et al. Magnetic resonance imaging correlates of depression after ischemic stroke. Arch Gen Psychiatry 2001;58:925-931.

[7] Aben I, Verhey F, Strik J, et al. A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction. J Neurol Neurosurg Psychiatry 2003;74:581-585.

[8] Robinson RG, Price TR. Post-stroke depressive disorders: a follow-up study of 103 patients. Stroke 1982;13:635-641.

[9] Provinciali L, Paolucci S, Torta R, et al. Depression after first-ever ischemic stroke: the prognostic role of neuroanatomic subtypes in clinical practice. Cerebrovasc Dis 2008;26:592-599.

[10] Gainotti G, Azzoni A, Marra C. Frequency, phenomenology and anatomical-clinical correlates of major post-stroke depression. Br J Psychiatry 1999;175:163-167.

[11] Terroni L, Fraguas R, Lucia M, et al. Importance of retardation and fatigue/interest domains for the diagnosis of major depressive episode after stroke: a four months prospective study. Rev Bras Psiquiatr 2009; 31:202-207.

[12] Parikh RM, Robinson RG, Lipsey JR, et al. The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. Arch Neurol 1990;47:785-789.

[13] Burvill PW, Johnson AK, Jamrozik KD, et al. Prevalence of Depression After Stroke: The Perth Community Stroke Study. Br J Psychiatry 1995;166:320-327.

[14] King RB. Quality of life after stroke. Stroke 1996;27:1467-1472.

[15] Andersen G, Vestergaard K, Ingemann-Nielsen M, et al. Risk factors for post-stroke depression. Acta Psychiatr Scand 1995;92:193-198.

[16] Robinson RG, Kubos KL, Starr LB, et al. Mood disorders in stroke patients. Importance of location of lesion. Brain 1984;107 ( Pt 1):81-93.

[17] Aben I, Verhey F. Depression after a cerebrovascular accident. The importance of the integration of neurobiological and psychosocial pathogenic models. Panminerva Med 2006;48:49-57.

[18] Tatemichi TK, Desmond DW, Stern Y, et al. Cognitive impairment after stroke: frequency, patterns, and relationship to functional abilities. J Neurol Neurosurg Psychiatry 1994;57:202-207.

[19] Hoffmann M. Stroke in the young: The multiethnic prospective durban stroke data bank results. J Stroke Cerebrovasc Dis 1998;7:404-413.

[20] Hoffmann M, Schmitt F, Bromley E. Vascular cognitive syndromes: relation to stroke etiology and topography. Acta Neurol Scand 2009; 120:161-169.

[21] Barker-Collo S, Feigin V. The impact of neuropsychological deficits on functional stroke outcomes. Neuropsychol Rev 2006;16:53-64.

[22] Farner L, Wagle J, Engedal K, et al. Depressive symptoms in stroke patients: a 13 month follow-up study of patients referred to a rehabilitation unit. J Affect Disord 2010;127:211-218.

[23] Hobson P, Meara J. Cognitive function and mortality in a community-based elderly cohort of first-ever stroke survivors and control subjects. J Stroke Cerebrovasc Dis 2010;19:382-387.

[24] O'Brien JT, Erkinjuntti T, Reisberg B, et al. Vascular cognitive impairment. Lancet Neurol 2003;2:89-98.

[25] Madureira S, Guerreiro M, Ferro JM. Dementia and cognitive impairment three months after stroke. Eur J Neurol 2001;8:621-627.

[26] Nys GM, van Zandvoort MJ, de Kort PL, et al. Cognitive disorders in acute stroke: prevalence and clinical determinants. Cerebrovasc Dis 2007;23:408-416.

[27] Pohjasvaara T, Leskela M, Vataja R, et al. Post-stroke depression, executive dysfunction and functional outcome. Eur J Neurol 2002;9:269-275.

[28] Ballard C, Stephens S, Kenny R, et al. Profile of neuropsychological deficits in older stroke survivors without dementia. Dement Geriatr Cogn Disord 2003;16:52-56.

[29] Lesniak M, Bak T, Czepiel W, et al. Frequency and prognostic value of cognitive disorders in stroke patients. Dement Geriatr Cogn Disord 2008;26:356-363.

[30] Bolla-Wilson K, Robinson RG, Starkstein SE, et al. Lateralization of dementia of depression in stroke patients. Am J Psychiatry 1989;146:627-634.

[31] Vataja R, Pohjasvaara T, Mantyla R, et al. Depression-executive dysfunction syndrome in stroke patients. Am J Geriatr Psychiatry 2005; 13:99-107.

[32] Kauhanen M, Korpelainen JT, Hiltunen P, et al. Poststroke depression correlates with cognitive impairment and neurological deficits. Stroke 1999;30:1875-1880.

[33] Nys GM, van Zandvoort MJ, van der Worp HB, et al. Early depressive symptoms after stroke: neuropsychological correlates and lesion characteristics. J Neurol Sci 2005;228:27-33.

[34] Barker-Collo SL. Depression and anxiety 3 months post stroke: prevalence and correlates. Arch Clin Neuropsychol 2007;22:519-531.

[35] Alexopoulos GS, Meyers BS, Young RC, et al. Clinically defined vascular depression. Am J Psychiatry 1997;154:562-565.

[36] Nys GM, van Zandvoort MJ, van der Worp HB, et al. Early cognitive impairment predicts long-term depressive symptoms and quality of life after stroke. J Neurol Sci 2006;247:149-156.

[37] Verdelho A, Henon H, Lebert F, et al. Depressive symptoms after stroke and relationship with dementia: A three-year follow-up study. Neurology 2004;62:905-911.

[38] Kimura M, Robinson RG, Kosier JT. Treatment of cognitive impairment after poststroke depression: a double-blind treatment trial. Stroke 2000; 31:1482-1486.

[39] Simis S, Nitrini R. Cognitive improvement after treatment of depressive symptoms in the acute phase of stroke. Arq Neuropsiquiatr 2006;64:412-417.

[40] Bueno VF, Brunoni AR, Boggio PS, et al. Mood and cognitive effects of transcranial direct current stimulation in post-stroke depression. Neurocase 2011;17:318-322.

[41] Sato S, Yamakawa Y, Terashima Y, et al. Efficacy of milnacipran on cognitive dysfunction with post-stroke depression: preliminary open-label study. Psychiatry Clin Neurosci 2006;60:584-589.

[42] Spalletta G, Guida G, Caltagirone C. Is left stroke a risk-factor for selective serotonin reuptake inhibitor antidepressant treatment resistance? J Neurol 2003;250:449-455.

[43] Narushima K, Chan KL, Kosier JT, et al. Does cognitive recovery after treatment of poststroke depression last? A 2-year follow-up of cognitive function associated with poststroke depression. Am J Psychiatry 2003;160:1157-1162.

[44] Murata Y, Kimura M, Robinson RG. Does cognitive impairment cause post-stroke depression? Am J Geriatr Psychiatry 2000;8:310-317.

[45] Jorge RE, Acion L, Moser D, et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry 2010;67:187-196.

[46] Schubert DS, Taylor C, Lee S, et al. Detection of depression in the stroke patient. Psychosomatics 1992;33:290-294.

[47] Edwards DF, Hahn MG, Baum CM, et al. Screening patients with stroke for rehabilitation needs: validation of the post-stroke rehabilitation guidelines. Neurorehabil Neural Repair 2006;20:42-48.

[48] Miotto EC, Sato J, Lucia MC, et al. Development of an adapted version of the Boston Naming Test for Portuguese speakers. Rev Bras Psiquiatr 2010;32:279-282.

[49] Zhou B, Zhao Q, Teramukai S, et al. Executive function predicts survival in Alzheimer disease: a study in Shanghai. J Alzheimers Dis 2010;22:673-682.

[50] Johnson JK, Lui LY, Yaffe K. Executive function, more than global cognition, predicts functional decline and mortality in elderly women. J Gerontol A Biol Sci Med Sci 2007;62:1134-1141.

[51] Melkas S, Vataja R, Oksala NK, et al. Depression-executive dysfunction syndrome relates to poor poststroke survival. Am J Geriatr Psychiatry 2010;18:1007-1016.

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