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The relationship between homocysteine and post-stroke depression in patients with spontaneous intracerebral

Chao Zhang1, Guojuan Chen1, Peng Ding1

  • 1Department of Neurology, Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Clinical College of Neurology, Neurosurgery, and Neurorehabilitation, Huanhu Hospital, Tianjin Medical University, 6 Jizhao Rd, Tianjin, 300350, China.

BMC Neurology
|May 8, 2026
PubMed

Insights

Post-stroke depression (PSD) is common after intracerebral hemorrhage. This study found PSD more frequent in patients with hyperhomocysteinemia (HHcy), with folic acid improving depression scores.

Area of Science:

  • Neurology
  • Psychiatry
  • Biochemistry

Background:

  • Post-stroke depression (PSD) is a frequent and burdensome complication following stroke.
  • This study investigates the relationship between PSD and homocysteine (HCY) levels in patients with spontaneous intracerebral hemorrhage (SICH).

Purpose of the Study:

  • To determine the association between post-stroke depression (PSD) and homocysteine (HCY) levels in patients with SICH.
  • To evaluate the impact of folic acid and antidepressant medications (ADM) on depression scores in patients with comorbid PSD and hyperhomocysteinemia (HHcy).

Main Methods:

  • Data from 1,852 hemorrhagic stroke (HS) patients were analyzed.
  • Demographic, clinical characteristics, HAM-D17 scores, and HCY levels at 3 months were recorded.
  • Treatment with ADM and folic acid was assessed in patients with PSD and HHcy.

Main Results:

  • PSD was observed in 34.7% and hyperhomocysteinemia (HHcy) in 32.3% of patients; 19.7% had both.
  • A significant link was found between depression and low HCY levels (OR, 1.549).
  • Left-sided stroke, anterior circulation stroke, intraventricular hemorrhage, paralysis, dysarthria, and higher NIHSS scores were associated with PSD. Folic acid plus ADM significantly reduced HAM-D17 scores compared to ADM alone.

Conclusions:

  • PSD is significantly more frequent in patients with HHcy following SICH.
  • Hemorrhage location and disease severity correlate with PSD incidence.
  • Folic acid combined with ADM demonstrated significant improvement in depression scores for patients with comorbid PSD and HHcy.
Abstract

Keywords:
Folic acidHomocysteineIntracerebral hemorrhagePost-stroke depressionTreatment

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