STROKE-DEPRESSION

SUMMARY

1. Organic etiology: catecholamine depletion through lesion-induced damage to the frontal noradrenergic, dopaminergic, and serotonergic projections (Heilman et al., 2012).

2. Reactive etiology: grief response to deficits, disability, incontinence, etc.

3. Prevalence of depression in stroke patients is 40% (25%-79%); occur in similar proportion in caregivers (Flick, 1999); 6 months to 2 years.

4. Higher risk for major depression in left frontal lesions (relationship still controversial).

5. Risk factors: prior psychiatric history, severe deficits & ADL impairments, female gender, non-fluent aphasia, cognitive impairment, lack of social supports.

6. Persistent depression correlates with delayed recovery and poorer outcome, assoc. with cognitive impairment, risk of developing dementia (including Alzheimer's dementia).

7. Pseudodementia: depression-related cognitive impairment mimicing the signs of dementia.

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].