Depression and Apathy After Transient Ischemic Attack or Minor Stroke: Prevalence, Evolution and Predictors

Area of Science:

• Neurology
• Psychiatry
• Neuroimaging

Background:

• Affective impairments like depression and apathy are understudied following transient ischemic attack (TIA) and minor stroke.
• Understanding their prevalence, progression, and predictors is crucial for patient care.

Purpose of the Study:

• To determine the prevalence, evolution, and predictors of post-stroke depression (PSD) and post-stroke apathy (PSA) in TIA and minor stroke patients over 12 months.
• To identify clinical and neuroimaging factors associated with PSD and PSA.

Main Methods:

• Prospective study of TIA and minor stroke patients (NIHSS ≤4) with early MRI.
• Diagnosis of PSD using DSM-5 criteria; PSA defined by Apathy Evaluation Scale-Community (AES-C) score ≥37.
• 12-month follow-up assessing clinical and neuroimaging variables.

Main Results:

• Early prevalence: 43.9% for PSD and 34.1% for PSA at 10 days.
• At 12 months, PSD decreased to 8.6%, while PSA remained significant at 35.7%.
• Predictors for PSD included Beck Depression Inventory-II, MMSE, and prior depression/anxiety history. PSA predictors included MMSE, Montgomery Asberg Depression Rating Scale, prior stroke, acute basal ganglia lesions, and leukoaraiosis patterns.

Conclusions:

• PSD and PSA are common early after TIA and minor stroke, even with mild symptoms.
• PSA demonstrates greater persistence than PSD over the 12-month follow-up period.
• Specific neuroimaging findings and patient history are associated with the development of PSD and PSA.