Post-stroke depression and lesion location: A hospital based cross-sectional study

Depression is a common neuro-psychiatric consequence of stroke, affecting approximately 40% of the patients. Many studies show that in addition to the psychosocial stress, neurobiological factors such as site of infarct and brain atrophy may also be related to Post Stroke Depression (PSD). There are conflicting results in this area of research and paucity of such data in Indian literature. Thus the aim of this study is to weigh the importance of lesion location in PSD.

Sixty two subjects with their first ever stroke were interviewed using a semi-structured proforma and PSD diagnosed using MINI Plus interview. Scales of Beck Depression Inventory and Montgomery Asberg Depression Rating Scale were used to assess severity of depression. Mini mental state examination was used to assess cognitive impairment and Barthel Index to measure Activities of Daily Living. Neuro-imaging provided information on site and side of lesion. Collected data was analysed using SPSS version 15.0.

PSD was diagnosed in 28 subjects, amongst who 19 had left sided lesions. Left sided cortical infarcts and sub cortical infarcts showed statistically significant association with PSD.

Results are in keeping with previous landmark studies. Differences in emotional reactions depending on hemisphere and site of the infarct as shown in this study suggest organic biological basis for post stroke depression. Understanding the etiological basis would allow clinicians to monitor patients at risk of developing PSD, enabling early detection and treatment thus improving their quality of life and rehabilitation.