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Front. Aging Neurosci. | doi: 10.3389/fnagi.2018.00046

Cerebral Small Vessel Disease Burden Is Associated with Poststroke Depressive Symptoms: A 15-month Prospective Study

 Yannis, Yan Liang1, Yang-kun Chen2,  Vincent C. Mok3,  Defeng Wang4, Gabor S. Ungvari5, Chiu-wing W. Chu4, Hee-Ju Kang6 and  Wai-Kwong Tang1, 7*
  • 1Psychiatry, The Chinese University of Hong Kong, Hong Kong
  • 2Neurology, Dongguan People’s Hospital, China
  • 3Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
  • 4Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong
  • 5Marian Centre, University of Notre Dame Australia, Australia
  • 6Psychiatry, Chonnam National University Hospital, South Korea
  • 7Shenzhen Research Institute, The Chinese University of Hong Kong, Hong Kong

Objective: All types of cerebral small vessel disease (SVD) markers including lacunae, white matter hyperintensities, cerebral microbleeds and perivascular spaces were found to be associated with poststroke depressive symptoms (DS). This study explored whether the combination of the four markers constituting an overall SVD burden was associated with DS after stroke.

Methods: A selected cohort of 563 patients with acute ischemic stroke were followed over 15-month period after index stroke. A score of ≥ 7 on the 15-item Geriatric Depression Scale (GDS) was defined as clinically significant DS. Scores of the four SVD markers ascertained on magnetic resonance imaging were summed up to represent the total SVD burden. The association between SVD burden and poststroke DS was assessed with generalized estimating equations models.

Results: The study sample had a mean age of 67.0 years and mild-moderate stroke (National Institutes of Health Stroke Scale score: 3, interquartile, 1-5). DS were found in 18.3%, 11.6% and 12.3% of the sample at 3-, 9- and 15 months after stroke, respectively. After adjusting for demographic characteristics, stroke severity, physical and cognitive functions, and size and locations of stroke, the SVD burden was associated with an increased risk of DS (odds ratio=1.30; 95% confidence interval=1.07-1.58; p=0.010). Other significant predictors of poststroke DS were time of assessment, female sex, smoking, number of acute infarcts, functional independence and social support.

Conclusions: SVD burden was associated with poststroke DS examined over 15 months follow-up in mild to moderate acute ischemic stroke.

Keywords: depressive symptoms, Stroke, Poststroke depression, Cerebral small vessel disease (CSVD), white matter hyperintensities (WMH), lacune, cerebral microbleeds, enlarged perivascular spaces

Received: 28 Nov 2017; Accepted: 12 Feb 2018.

Edited by:

Aurel Popa-Wagner, Department of Neurology, University Hospital Essen, Germany

Reviewed by:

Danny J. Wang, University of Southern California, United States
Raluca Sandu Vintilescu, University of Medicine and Pharmacy of Craiova, Romania  

Copyright: © 2018 Liang, Chen, Mok, Wang, Ungvari, Chu, Kang and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Wai-Kwong Tang, The Chinese University of Hong Kong, Psychiatry, Hong Kong, Hong Kong, tangwk@cuhk.edu.hk