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脳卒中後のうつ病と病変の位置:体系的なレビュー
A J Carson1, S MacHale, K Allen
1University Department of Psychiatry, Royal Edinburgh Hospital, UK. A.Carson@ed.ac.uk
Lancet (London, England)
|August 30, 2000
まとめ
脳卒中の後の脳損傷の位置は,うつ病を発症するリスクに影響を与えないようです. この体系的なレビューでは,特定の脳損傷の位置が脳卒中後のうつ病リスクを増加させるという仮説を支持する証拠は見つかりませんでした.
科学分野:
- 神経科学は神経科学である.
- 精神科医は精神病を患っている.
- 臨床神経学 臨床神経学
背景:
- 脳卒中後のうつ病リスクに対する脳損傷の位置の影響について,矛盾する証拠が存在する.
- 以前の研究では,左半球または左前頭部の病変が脳卒中後のうつ病とより強く関連しているかどうかを明確に確立できませんでした.
研究 の 目的:
- 脳卒中の後のうつ病のリスクは,病変の位置によって影響されるという仮説を体系的に見直し,検証する.
- 左半球の脳卒中や左前頭脳損傷が,他の領域と比較してうつ病とよりよく関連しているかどうかを調査する.
主な方法:
- 複数のデータベース (MEDLINE,BIDS ISI,PsychLit) の包括的なコンピュータ支援および手動検索が行われました.
- 脳卒中の病変の位置とうつ病との関連に関する適格な報告は,2人の独立した研究者によって体系的にレビューされました.
- 収集されたデータに対して,固定効果とランダム効果のメタ解析が行われました.
主要な成果:
- 特定された143件の報告のうち,48件が含まれていましたが,すべてのオリジナルのデータが含まれていませんでした.
- 仮説を裏付けるのは2つのオリジナルのデータ報告のみで,7つは明らかにそうではなかった.
- メタアナリシスは,左半球と右半球の脳卒中におけるうつ病リスクの有意な違いを示さなかった (RR 0.95,95%CI 0.83-1.10).
- 他の脳領域と比較して,左側前頭部の病変によるうつ病リスクにおいて有意な差異は認められなかった (RR 1.17,95%CI 0.87-1.62).
- 高品質の研究,重度のうつ病,または脳卒中後の時間によって層分化された分析は,これらの発見を変更しませんでした.
結論:
- この体系的レビューは,脳損傷の位置が脳卒中後のうつ病のリスクに影響を与えるという仮説を支持するものではありません.
- この発見は,病変の位置が,脳卒中後のうつ病の有意な予測要因ではないことを示唆している.
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