The relationship between frontal lobe lesions, course of post-stroke depression, and 1-year prognosis in patients with first-ever ischemic stroke

Yu-Zhi Shi, Yu-Tao Xiang, Shuo-Lin Wu, Ning Zhang, Juan Zhou, Ying Bai, Shuo Wang, Yi-Long Wang, Xing-Quan Zhao, Gabor S Ungvari, Helen F K Chiu, Yong-Jun Wang, Chun-Xue Wang, Yu-Zhi Shi, Yu-Tao Xiang, Shuo-Lin Wu, Ning Zhang, Juan Zhou, Ying Bai, Shuo Wang, Yi-Long Wang, Xing-Quan Zhao, Gabor S Ungvari, Helen F K Chiu, Yong-Jun Wang, Chun-Xue Wang

Abstract

Background and purpose: Most studies on post-stroke depression (PSD) have focused on a certain time point after stroke instead of the time course of PSD. The aim of this study was to determine the relationship between frontal lobe lesions, course of PSD over a year following the stroke onset, and the 1-year prognosis in patients with first-ever ischemic stroke.

Methods: A total of 1067 patients from the prospective cohort study on the incidence and outcome of patients with post stroke depression in China who were diagnosed with first-ever ischemic stroke and attended 4 follow-up visits at 14±2 days, 3 months, 6 months, and 1 year after stroke onset, were enrolled in the study. PSD was diagnosed according to DSM-IV. The course of PSD was divided into the following two categories: persistent/recurrent depression and no/transient depression. Patients with any ischemic lesion responsible for the indexed stroke event located in the frontal lobe were defined as patients with frontal lobe lesions. Modified Rankin Scale (mRS) ≥2 at 1-year was considered to be poor prognosis.

Results: There were 109 patients with and 958 patients without frontal lobe lesions that formed the frontal lobe (FL) and no-frontal lobe (NFL) groups, respectively. After adjusting for confounding variables, frontal lobe lesion was significantly associated with persistent/recurrent PSD (OR 2.025, 95%CI 1.039-3.949). Overall, 32.7% of patients in the FL group had poor prognosis at 1- year compared with 22.7% in the NFL group (P = 0.021). Compared with no/transient depression, persistent/recurrent depression was found to be an independent predictor of poor prognosis at 1-year both in FL and NFL groups.

Conclusions: Long-term and periodical screening, evaluation and treatment are needed for PSD after the onset of ischemic stroke, particularly for patients with frontal lobe infarction.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Patients' inclusion chart.
Figure 1. Patients' inclusion chart.
Figure 2. Prevalence of PSD and PSD…
Figure 2. Prevalence of PSD and PSD course categories in the FL and NFL groups.
A. Prevalence of PSD in the FL and NFL groups at 14±2 days (33.9% vs 27.8%, p = 0.175), 3-month (29.6% vs 19.8%, p = 0.017), 6-month (22.6% vs 15.0%, p = 0.042) and 1-year (19.6% vs 14.3%, p = 0.138). B. Proportion of two courses of depression categories in the FL and NFL groups, 16.5% vs 9.4%, p = 0.028 for persistent/recurrent depression. FL Group, patients with frontal lobe lesions; NFL Group, patients without frontal lobe lesions.
Figure 3. 1-year prognosis of patients in…
Figure 3. 1-year prognosis of patients in the FL and NFL groups.
Comparison of the 1-year proportion of poor prognosis (mRS≥2) between two course of PSD categories in the FL and NFL groups after first-ever ischemic stroke. *p<0.001. FL Group, patients with frontal lobe lesions; NFL Group, patients without frontal lobe lesions.

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