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Dementia of depression or depression of dementia in stroke?
G Andersen1, K Vestergaard, J O Riis
1Department of Neurology, Aalborg Hospital, Denmark.
Insights
Post-stroke depression (PSD) improvement correlates with cognitive function, but some patients show no cognitive gains despite reduced distress. Findings suggest
Area of Science:
- Neurology
- Psychiatry
- Cognitive Science
Background:
- Post-stroke depression (PSD) is a common complication affecting stroke survivors.
- Intellectual impairment is frequently observed following a stroke.
Purpose of the Study:
- To investigate the correlation between mood symptom changes and intellectual impairment in stroke survivors.
- To compare the trajectory of intellectual impairment in PSD patients versus non-PSD patients.
- To explore the impact of antidepressant medication on cognitive function in PSD patients.
Main Methods:
- Assessed mood symptoms using the Hamilton Depression Rating Scale (HDRS).
- Evaluated intellectual impairment with the Brief Cognitive Rating Scale (BCRS) and Mattis Dementia Rating Scale (MDRS).
- Studied 166 one-year stroke survivors, comparing PSD and non-PSD groups.
Main Results:
- Improvement in mood symptoms generally correlated with improved intellectual function.
- A subset of 53 PSD patients showed no cognitive improvement despite reporting less distress.
- Antidepressant medication did not significantly improve Mattis Dementia Rating Scale scores.
- No evidence supported 'dementia of depression'; findings suggest 'depression of dementia'.
Conclusions:
- While mood improvement often aids cognitive function post-stroke, some PSD patients experience persistent intellectual impairment.
- The relationship between depression and cognitive decline in stroke survivors is complex, potentially indicating 'depression of dementia'.
Abstract:
This study describes the correlation between changes in mood symptoms assessed by the Hamilton Depression Rating Scale (HDRS) and intellectual impairment assessed by the Brief Cognitive Rating Scale (BCRS) and Mattis Dementia Rating Scale (MDRS) in 166 unselected 1-year survivors after stroke, in whom post-stroke depression (PSD) has previously been described and validated. The course of intellectual impairment associated with PSD was compared with the course of intellectual impairment in non-PSD patients. In general, improvement in mood symptoms was correlated with an improvement in intellectual function. However, in 53 PSD patients improvement in intellectual performance was absent, despite the fact that the patients reported being significantly less distressed by dementia symptoms. Antidepressive medication did not lead to any improvement in MDRS score. No evidence was found to support the hypothesis of 'dementia of depression'. To the contrary, the findings indicate 'depression of dementia'.