Post‐stroke depression, executive dysfunction and functional outcome

European Journal of Neurology - Tập 9 Số 3 - Trang 269-275 - 2002
Tarja Pohjasvaara1,2, Maarit Virta3,2, Risto Vataja2, Hely Kalska2, Raija Ylikoski2, Marja Hietanen2, Antero Leppävuori4, Markku Kaste5, Timo Erkinjuntti2
1Lohja District Hospital, Helsinki, Finland,
2Memory Research Unit, Department of Clinical Neuroscience, Helsinki University Central Hospital, Helsinki, Finland,
3Haaga Neurological Research Centre Neuro, Helsinki, Finland,
4Psychiatric Consultation Unit, Department of Psychiatry, Helsinki, Finland,
5Stroke Unit, Department of Clinical Neuroscience, Helsinki University Central Hospital, Helsinki, Finland

Tóm tắt

The early diagnosis of vascular cognitive impairment has been challenged and executive control function has been suggested to be a rational basis for the diagnosis of vascular dementia. We sought to examine the correlates of executive dysfunction in a well‐defined stroke cohort. A group of 256 patients from a consecutive cohort of 486 patients with ischaemic stroke, aged 55–85 years, was subjected to a comprehensive neuropsychological examination 3–4 months after ischaemic stroke and 188 of them in addition to detailed psychiatric examination. Basic and complex activities of daily living (ADLs) (bADLs and cADLs) post‐stroke were assessed. The DSM‐III‐R criteria were used for the diagnosis of the depressive disorders. Altogether 40.6% (n=104) of the patients had executive dysfunction. The patients with executive dysfunction were older, had lower level of education, were more often dependent, did worse in bADLs and cADLs, had more often DSM‐III dementia, had worse cognition as measured by Mini Mental State Examination (MMSE) and were more depressed as measured by the BECK depression scale, but not with the more detailed psychiatric evaluation. They had more often stroke in the anterior circulation and less often in the posterior circulation. The independent correlates of executive dysfunction were cADLs (OR 1.1, 95% CI 1.03–1.16), each point of worsening in cognition by MMSE (OR 1.7, 95% CI 1.42–1.97) and stroke in the posterior circulation area (OR 0.4, 95% CI 0.18–0.84). Clinically significant executive dysfunction is frequent after ischaemic stroke and is closely connected with cADLs and to overall cognitive status but could be distinguished from depression by detailed neuropsychological examination. Executive measures may detect patients at risk of dementia and disability post‐stroke.

Từ khóa


Tài liệu tham khảo

10.1161/01.STR.24.1.35

Agency for Health Care and Policy Research (AHCPR)(1996).Early identification of Alzheimer's disease and related dementias. In:Quick Reference Guide for CliniciansNumber 19. AHCPR Publication No. 97‐0703. Department of Health and Human Services Washington DC.

American Psychiatric Association Committee on Nomenclature and Statistics(1980).Diagnostic and Statistical Manual of Mental Disorders(DSM‐III) 3rd edn. APA Washington DC.

American Psychiatric Association Committee on Nomenclature and Statistics(1987).Diagnostic and Statistical Manual of Mental Disorders(DSM‐III‐R) 3rd edn. revised. APA Washington DC.

American Psychiatric Association Committee on Nomenclature and Statistics(1994).Diagnostic and Statistical Manual of Mental Disorders(DSM‐IV) 4th edn. APA Washington DC.

Arbuthnott K, 2000, Trail making test, part B as a measure of executive control: validation using set‐switching paradigm, J Clin Exp Neuropsychol, 22, 518, 10.1076/1380-3395(200008)22:4;1-0;FT518

10.1212/WNL.44.3_Part_1.420

10.1017/S135561779800513X

BaddeleyAD(1990).Human Memory: Theory and Practice. Hove and London: LEA.

Beck AT, 1982, Screening depressed patients in family practice, Postgraduate Med J, 11, 561

BMDP(1994).New System for Windows. BMDP Los Angeles CA.

10.1017/S1355617798466037

10.1016/0165-0327(96)00027-4

10.1136/jnnp.66.2.162

ChristensenA‐L(1975).Luria's Neuropsychological Investigation: Text.Munksgaard Copenhagen Denmark.

10.1080/01688639208402832

10.1001/archneur.1993.00540080076020

10.1111/j.1600-0447.1998.tb09985.x

10.1016/0022-3956(75)90026-6

10.1080/01688639008400995

GoodglassH KaplanE(1983).The Assessment of Aphasia and Related Disorders. Lea and Febiger Philadelphia PA.

10.1016/s0140-6736(99)90438-5

10.1111/j.1532-5415.1998.tb01075.x

10.1016/0140-6736(92)92177-H

10.1161/01.STR.30.9.1875

10.3109/14015439309101353

10.1111/j.1532-5415.2007.01590.x

10.1093/ageing/30.3.251

10.1097/00001199-199303000-00004

LezakMD(1995).Neuropsychological Assessment. Oxford University Press New York.

10.1097/00019442-200008000-00004

LoweC RabbittP(1997).Cognitive models of ageing and frontal lobe deficits. In: Rabbit P ed.Methodology of Frontal and Executive Functions.Psychological Press East Sussex UK pp. 39–60.

10.1037/0033-2909.109.2.163

10.1017/S0033291700035339

10.1016/S0010-9452(76)80035-4

NyrkköH(1999).Cognitive Deficits in Postacute Stroke. Kela the Social Insurance Institution Finland. Studies in social security and health 40. Kelan omatarvepaino.

10.1017/S1355617798005128

10.1016/0028-3932(74)90047-5

10.1080/01688639308402571

10.1093/geronj/37.3.323

10.1161/01.STR.28.4.785

10.1161/01.STR.29.1.75

10.1161/01.STR.29.11.2311

10.1159/000015863

RabbitP(1997).Introduction: methodolgies and models in the study of executive function. In: Rabbit P ed.Methodology of Frontal and Executive Functions. Psychological Press East Sussex UK.

10.2466/pms.1958.8.3.271

Roman GC, 1999, Executive control function: a rational basis for the diagnosis of vascular dementia, Alzheimer Disease and Associated Disorders, 13, 69, 10.1097/00002093-199912001-00012

SAS(1990).SAS Procedures Guide Version 6 3rd edn. SAS Institute Cary NC.

10.1161/01.STR.16.5.885

ShalliceT(1988).From Neuropsyschology to Mental Structure. Cambridge University Press Cambridge.

ShalliceT BurgessPW(1991).Higher order cognitive impairments and frontal lobe lesions in man. In: Levin HS Eisenberg HM Benton AL eds.Frontal Lobe Function and Dysfunction. Oxford University Press New York pp. 125–138.

10.1007/s004269900007

StussDT BensonDF(1986).The Frontal Lobes. Raven Press New York.

TabachnickBG FidellLS(1996).Using Multivariate Statistics. Harper Collins Publishers New York.

10.1136/jnnp.57.2.202

TranelD AndersonSW BentonA(1994).Development of the concept of `executive function' and its relationship to the frontal lobes. In: Boller F Spinnler H eds.Handbook of Neuropsychology Vol. 9. Elsevier Science B.V. Amsterdam.

10.1080/01688639708403745

10.1037/0894-4105.14.3.409

10.1016/S0733-8619(18)30170-1

10.1037/0894-4105.11.3.421

WilsonBAet al. (1997).Behavioral assessment of dysexecutive syndrome. In: Rabbit P ed.Methodology of Frontal and Executive Function. Psychology Press UK.

10.1001/archpsyc.1990.01810180089012

WingJK CooperJE SartoriusN(1974).Measurement and classification of psychiatric symptoms. In:Instruction Manual for the PSE. Cambridge University Press London pp. 2311–2317.

World Health Organization(1989).The International Classification of Diseases 10th Revision(ICD‐10). World Health Organization Geneva: Switzerland pp. 25–31. WHO typescript document MNH/MEP/87.1.

10.1207/s15324826an0501_1