Relationship between apathy/post-stroke depression and gait training in patients with stroke

We examined the effect of gait training on apathy/post-stroke depression (PSD) in patients with walking disorders after stroke, and the effect of apathy/PSD on gait reacquisition in subacute stroke.

Fifty-five participants with gait disorders after stroke underwent gait training for 6 weeks. Outcome measurements included Apathy Scale (AS), Center for Epidemiologic Studies Depression Scale (CES-D), Mini-Mental State Examination, Lower Extremity Function of Stroke Impairment Assessment Set, and Functional Independence Measure-TRANSFER and -WALK scores. These scores of the participants were divided into groups with or without apathy based on AS scores for statistical analysis.

Both groups showed significant differences in all outcomes after gait training. In addition, even if the participants had apathy at baseline, there were no significant differences in outcomes other than AS/CES-D between the two groups after gait training. Logistic regression analysis showed that only Mini-Mental State Examination and Lower Extremity Function of Stroke Impairment Assessment Set scores affected the reacquisition of independent walking (odds ratio: 1.332, P = 0.015; odds ratio: 1.364, P = 0.005, respectively). AS and CES-D scores had no effects on gait reacquisition.

Gait training may be beneficial for both physical impairment and psychiatric symptoms in patients with stroke and may prevent poor functional recovery caused by apathy and PSD. As opposed to previous studies that have shown a negative impact of apathy and PSD on functional recovery, our results suggest that apathy/PSD may not negatively affect functional recovery when gait training is conducted in subacute stroke.