The Prospective Cohort Study On Depression Incidence And 3-month Outcome In Stroke Survivors With And Without Aphasia

Objective To compare the incidence of depression between patients with or without aphasia following stroke.To explore the relationship between aphasia and PSD. To compare the functional outcome/quality of life between patients of aphasia group and of nonaphasia group.Methods Total 270 ischemic stroke patients within 14 days were recruited from the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University from April 2014 to October 2015. 1.Assessment in acute phase(14±2 days from onset)(1) Patients were collected of baseline information, including demographic data, past medical history, medication, personal history,evaluation of the National Institutes of Health Stroke Scale(NIHSS) by neurologists.(2) Two groups, with aphasia(WAB score≤93.8) and without aphasia(WAB score>93.8~100), according to the Western Aphasia Battery(WAB) assessed by trained specialists.(3) Diagnosis of depression will be performed by well-trained physicians according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition(DSM-Ⅳ).Stroke Aphasic Depression Questionnaire Hospital version(SADQ-H) in Chinese was used to rate all participants’ depression status. 2. Assessment at 3-month poststroke(90±7 days)(1) Stroke Aphasic Depression Questionnaire(SADQ) in Chinese was used to rate all participants’ depression status.(2) Barthel Index(BI) was used to measure the level of independence in the activity of daily living(ADL) and the modified Rankin Score(m RS) to determine participants’functional status at 3-month poststroke. m RS≤2 was defined as functional independence and favorable prognosis. Quality of life after stroke was evaluated by the Stroke and Aphasia Quality of life scale(SAQOL-39), 3.Statistical method SPSS statistical software, version 18.0 was used to establish a database and analyze data. The difference between groups was compared by t test or X 2 test. Univariate and multivariate logistic regression analysis was used to analyze the influence of aphasia and PSD on quality of life and functional outcome in 3 months. All variables of P<0.1 in single factor analysis were included in the multi factor logistic regression model. Respectively, the adjusted OR value and 95% confidence interval were calculated to obtain the corresponding independent risk factors. For all analyses, a two-tailed probability value of P<0.05 was considered statistically significant.Results A total of 270 patients with ischemic stroke were included in the analyses(aphasia:nonaphasia=160:110). Of these patients,248 patients were followed up at 3-month poststroke(aphasia:non-aphasia=148:100). 1.Comparison of baseline data The incidence of hypertension was higher in aphasic group(55.6% vs 74.5%,P<0.01) and lower of diabetes(28.8% vs 18.2%,P<0.05). 2.Comparison of variables in acute phase(1) The aphasic patients had higher score of SADQ-H(P<0.01) and incidence of PSD(47.5% vs 29.1%,P<0.01).Degrees of depression varied from different degrees of aphasia.Major aphasia patients suffered more severe depression(P<0.01). Depression was related with the type of aphasia(P<0.01);(2) The ratio of female,past stroke history,aphasia,NIHSS score were higher in depressive patients(38.9% vs 25.3%,P<0.05;32.4% vs 17.9%,P<0.01;70.4% vs 51.9%,P<0.01;P<0.01).The results of multi factor logistic regression showed aphasia,past stroke history and NIHSS score as independent risk factors of PSD(OR=1.74,95%CI:1.01-2.99,P﹤0.05;OR=2.04,95%CI:1.11-3.73,P﹤0.05;OR=1.12,95%CI:1.06-1.18,P﹤0.01);(3) In aphasic patients, the results of multi factor logistic regression showed NIHSS score as independent risk factors of PSD(OR=0.51,95%CI:0.25-1.07,P=0.07);(4) There were significant differences between the two groups in terms of complications(P<0.05). 3.Comparison of prognosis at 3-month poststroke(1) The aphasic patients had higher score of SADQ(P < 0.01) and incidence of PSD(41.5% vs 24.5%,P<0.01),but slightly lower than in acute phase.(2) The results of multi factor logistic regression showed female,diabetes and NIHSS score as independent risk factors of PSD after 3 months(OR=1.740,95%CI:1.011-2.994,P﹤0.05;OR=2.036,95%CI:1.111-3.732,P﹤0.05;OR=1.121,95%CI:1.063-1.183,P﹤0.01),as the same results in aphasic patients;(3) There were significant difference in poor outcome(55.4% vs 37.0%, P <0.01),whereas the rate of death and relapse were similar in two groups.Female,NIHSS score, pulmonary infection, deep venous thrombosis of lower extremity,PSD and aphasia in acute phase were related to the poor outcome. The results of multi factor logistic regression showed NIHSS score as independent risk factors of poor outcome after 3 months(OR=1.47,95%CI 1.34-1.62,P<0.01), whereas in aphasic patients,as well as female(OR=1.47,95%CI 1.28-1.64,P<0.01,OR=3.05,95%CI 1.12-8.34,P<0.01);(4) BI and SAQOL-39 were lower in patients with aphasia and in depressive patients(P<0.05).Conclusions 1. The incidence of PSD in acute phase and 3 months after stroke onset were 40% and 34.7%,respectively; 2. The incidence of PSD in acute phase and 3 months after stroke with aphasia were 47.5% and 41.5%,respectively,higher than total population and patients without aphasia.3.Degrees of depression varied from different degrees and types of aphasia.Major aphasia patients suffered more severe depression. Global and motor aphasia patients were susceptible more likely to PSD; 4. Aphasia,past stroke history and high NIHSS score were independent risk factors of PSD in acute phase.While female,diabetes before stroke and high NIHSS score in 3 months. 5. High NIHSS score was independent risk factors of poor outcome in 3 month after stroke,also women in patients with aphasia. 6. Aphasia greatly impacted the prognosis and compromised the activity of daily living and the quality of life of ischemic stroke patients,especially in depressive patients.