Dataset Information

Temporal Associations between Fatigue, Depression, and Apathy after Stroke: Results of the Cognition and Affect after Stroke, a Prospective Evaluation of Risks Study.

ABSTRACT: Poststroke fatigue (PSF) is a form of pathological fatigue that can develop after stroke and has a negative impact on functional outcome. PSF is associated with poststroke depression (PSD), which in turn shows similarities with poststroke apathy (PSA). This study aimed at disentangling the temporal associations between PSF and PSD and between PSF and PSA.A total of 250 stroke patients were included, of which 243 completed the Fatigue Severity Scale, Montgomery-Åsberg Depression Rating Scale, and Apathy Evaluation Scale at 3 months poststroke, with follow-up measurements at 6 and 12 months after initial testing. Linear mixed models and linear regressions were performed to evaluate the temporal associations between PSF and PSD, and between PSF and PSA.PSF was present in 119 patients (49%), of whom 62 patients also had PSD (26%), and 21 patients (9%) also had PSA. At baseline, PSF patients showed higher depression levels, which remained stable at follow-up. PSD patients had higher fatigue levels compared with no-PSD patients at baseline, which remained stable at follow-up. No association between apathy and fatigue was found at baseline and no interaction with time was found. Change in fatigue from baseline to 12-month follow-up was associated with change in depression and with change in apathy.Bidirectional associations were found between PSF and PSD. In treatment and rehabilitation programs, early focus on the presence of PSD and PSF is important, since these conditions tend to persist. As there are currently more treatment options for PSD, attention for PSD is important and might also have a beneficial effect on PSF.

SUBMITTER: Douven E

PROVIDER: S-EPMC5804825 | biostudies-other | 2017

REPOSITORIES: biostudies-other

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Temporal Associations between Fatigue, Depression, and Apathy after Stroke: Results of the Cognition and Affect after Stroke, a Prospective Evaluation of Risks Study.

Douven Elles E Köhler Sebastian S Schievink Syenna H J SHJ van Oostenbrugge Robert J RJ Staals Julie J Verhey Frans R J FRJ Aalten Pauline P

Cerebrovascular diseases (Basel, Switzerland) 20171026 5-6

<h4>Background</h4>Poststroke fatigue (PSF) is a form of pathological fatigue that can develop after stroke and has a negative impact on functional outcome. PSF is associated with poststroke depression (PSD), which in turn shows similarities with poststroke apathy (PSA). This study aimed at disentangling the temporal associations between PSF and PSD and between PSF and PSA.<h4>Methods</h4>A total of 250 stroke patients were included, of which 243 completed the Fatigue Severity Scale, Montgomery- ...[more]

PMID: 29073590

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Project description:Cognitive impairment and neuropsychiatric syndromes, like depression and apathy, are frequent residual consequences of stroke. These have a large impact on quality of life and long-term prognosis. Several factors are involved in the development of these residual syndromes, although their exact role and their interrelationships remain still rather unclear. The Cognition and Affect after Stroke: a Prospective Evaluation of Risks (CASPER) study has been primarily designed to examine whether stroke-specific (e.g. lesion location, volume, type, severity), cerebrovascular and neurodegenerative (e.g. white matter changes, atrophy, microbleeds, perivascular spaces), inflammatory, endothelial, and (epi)genetic markers are associated with cognitive impairment, post-stroke depression, and post-stroke apathy, and whether they predict their course over 12 months. The secondary aims are to investigate how the above-mentioned markers interact with each other, and to determine if patients with apathy and depression after stroke differ in pathogenesis, course, and outcome (e.g. functional outcome, neurocognitive performance, quality of life).CASPER is a 1-year prospective clinical cohort follow-up study in 250 stroke patients recruited at the neurological in- and outpatient services at Maastricht University Medical Center (MUMC+, Maastricht, The Netherlands), and Zuyderland Medical Center (Sittard and Heerlen, The Netherlands). At baseline (3 months post-stroke), a neuropsychological assessment, neuropsychiatric interview, blood sample, and brain magnetic resonance imaging (MRI) scan are conducted. Assessment of neuropsychiatric and neurocognitive status are repeated 6 and 12 months later.The CASPER study investigates stroke-specific, vascular, neurodegenerative, inflammatory, and genetic markers of the development of vascular cognitive impairment, depression, and apathy after stroke. This creates the possibility to study not only the contribution of these individual markers but also their joint contribution, which differentiates this study from earlier stroke cohorts who lacked long-term follow-up data, a large sample size, an extensive MRI protocol, and markers from the blood. The knowledge we derive from this study might help in identifying markers that are associated with, or can predict the onset, maintenance, and progression of vascular cognitive impairment, depression, and apathy after stroke, and could provide new insights into possibilities for treatment and rehabilitation that result in better functional outcome after stroke.ClinicalTrials.gov NCT02585349.

Project description:BackgroundAlthough many cardiovascular risk factors for stroke have been reported before, it has not been investigated comprehensively for all major stroke types in large datasets. This study aimed to evaluate the associations of healthy behaviors, biological phenotypes and cardiovascular health (CVH) with long-term risks of strokes events, overall and stroke subtypes (ischemic stroke [IS], intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH], and unspecified stroke).MethodsBetween 2006 and 2010, a total of 354,976 participants (age 40-70 years) in the UK Biobank free of stroke and coronary heart disease were examined and thereafter followed up to 2020. According to American Heart Association guideline, the global CVH included four behavioral (smoking, diet, physical activity, body mass index) and three biological (blood glucose, blood cholesterol, blood pressure) metrics. The behavioral, biological and global CVH score was the sum of four, three, and seven metrics, respectively, and then was categorized into poor, intermediate and ideal group. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of stroke events.FindingsA total of 5804 incident stroke cases, including 3664 IS, 714 ICH and 453 SAH, were documented over a median follow-up of 11 years. The risk of stroke decreased significantly and linearly with both increasing behavioral CVH score and biological CVH score. Ideal behavioral CVH group was significantly associated with lower risks of all stroke subtypes, biological CVH was related to stroke events except for SAH. Additionally, the 1-point increment in global CVH score was associated with 11%,13%, 8% and 13% lower risks of stroke, IS, ICH and unspecified stroke, however, there was no significant dose-dependent association between global CVH and SAH.InterpretationOur findings suggest inverse linear associations of behavioral, biological and global CVH with long-term risks of stroke and stroke subtypes, except for SAH, highlighting the benefits of maintaining better CVH status as a primordial prevention strategy of stroke.FundingThe National Natural Science Foundation of China (71,910,107,004, 91,746,205).

Dataset Information

Temporal Associations between Fatigue, Depression, and Apathy after Stroke: Results of the Cognition and Affect after Stroke, a Prospective Evaluation of Risks Study.

Publications

Temporal Associations between Fatigue, Depression, and Apathy after Stroke: Results of the Cognition and Affect after Stroke, a Prospective Evaluation of Risks Study.

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