Imaging Markers of Post-Stroke Depression and Apathy: a Systematic Review and Meta-Analysis

Elles Douven, Sebastian Köhler, Maria M F Rodriguez, Julie Staals, Frans R J Verhey, Pauline Aalten, Elles Douven, Sebastian Köhler, Maria M F Rodriguez, Julie Staals, Frans R J Verhey, Pauline Aalten

Abstract

Several brain imaging markers have been studied in the development of post-stroke depression (PSD) and post-stroke apathy (PSA), but inconsistent associations have been reported. This systematic review and meta-analysis aims to provide a comprehensive and up-to-date evaluation of imaging markers associated with PSD and PSA. Databases (Medline, Embase, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews) were searched from inception to July 21, 2016. Observational studies describing imaging markers of PSD and PSA were included. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated to examine the association between PSD or PSA and stroke lesion laterality, type, and location, also stratified by study phase (acute, post-acute, chronic). Other imaging markers were reviewed qualitatively. The search retrieved 4502 studies, of which 149 studies were included in the review and 86 studies in the meta-analyses. PSD in the post-acute stroke phase was significantly associated with frontal (OR 1.72, 95% CI 1.34-2.19) and basal ganglia lesions (OR 2.25, 95% CI 1.33-3.84). Hemorrhagic stroke related to higher odds for PSA in the acute phase (OR 2.58, 95% CI 1.18-5.65), whereas ischemic stroke related to higher odds for PSA in the post-acute phase (OR 0.20, 95% CI 0.06-0.69). Frequency of PSD and PSA is modestly associated with stroke type and location and is dependent on stroke phase. These findings have to be taken into consideration for stroke rehabilitation programs, as this could prevent stroke patients from developing PSD and PSA, resulting in better clinical outcome.

Keywords: Apathy; Depression; Imaging; Meta-analysis; Stroke; Systematic review.

Conflict of interest statement

Conflict of Interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Financial Disclosure

Funding was received from Maastricht University, Health Foundation Limburg, and the Adriana van Rinsum Ponsen Stichting.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flowchart of study selection and review. PSA post-stroke apathy, PSD post-stroke depression
Fig. 2
Fig. 2
Forest plot of the relationship between post-stroke depression and lesion laterality. Subanalyses on acute stroke phase are presented. CI confidence interval, OR odds ratio
Fig. 3
Fig. 3
Forest plot of the relationship between post-stroke depression and lesion laterality. Subanalyses on post-acute stroke phase (upper panels) and chronic stroke phase (lower panels) are presented. CI confidence interval, OR odds ratio
Fig. 4
Fig. 4
Forest plot of the relationship between post-stroke apathy and lesion laterality/type. In panel a, the results of the meta-analysis on lesion laterality are presented. In panel b, the results of the meta-analysis on lesion type are presented. Apart from the overall analysis, the subanalyses on acute stroke phase (upper panels) and post-acute stroke phase (lower panels) are presented. CI confidence interval, OR odds ratio
Fig. 5
Fig. 5
Forest plot of the relationship between post-stroke depression and lesion type. Apart from the overall analysis, the subanalyses on acute stroke phase (upper panels), post-acute stroke phase (middle panels), and chronic stroke phase (lower panels) are presented. CI confidence interval, OR odds ratio
Fig. 6
Fig. 6
Forest plot of the relationship between post-stroke depression and frontal/anterior lesions. Apart from the overall analysis, the subanalyses on acute stroke phase (upper panels) and post-acute stroke phase (lower panels) are presented. CI confidence interval, OR odds ratio
Fig. 7
Fig. 7
Forest plot of the relationship between post-stroke depression and subcortical/basal ganglia lesions. In panel a, the results of the meta-analysis on subcortical lesion location are presented. Apart from the overall analysis, the subanalyses on acute stroke phase (upper panels), post-acute stroke phase (middle panels), and chronic stroke phase (lower panels) are presented. In panel b, the results of the meta-analysis on basal ganglia lesions are presented. Apart from the overall analysis, the subanalyses on acute stroke phase (upper panels) and post-acute stroke phase (lower panels) are presented. CI confidence interval, OR odds ratio
Fig. 8
Fig. 8
Forest plot of the relationship between post-stroke apathy and lesion location. In panel a, the results of the meta-analysis on frontal lesion location are presented. In panel b, the results of the meta-analysis on subcortical lesion location are presented. In panel c, the results of the meta-analysis on basal ganglia lesions are presented. Apart from the overall analysis, the subanalyses on acute stroke phase (upper panels) and post-acute stroke phase (lower panels) are presented. CI confidence interval, OR odds ratio

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