Post-stroke Emotional Disturbances Screening And Predictive Factors Analysis

Objective: ①Investigate morbidity and predictive factors of post-stroke depression(PSD), post-stroke fatigue(PSF) and post-stroke emotional incontinence(PSEI)through emotional disturbances screening at acute and subacute stages of stroke. ②Explore some single nucleotide polymorphisms(SNPs) within the COMT, TPH2 and CACNA1 C genes. Try to associate SNPs with post-stroke emotional disturbances to explain the pathogenesis.Methods: We evaluated 368 consecutive patients who were admitted to Tianjin Medical University General Hospital(Tianjin, China) with a diagnosis of acute stroke,between Jan 2012 and Jun 2014. Inclusion criteria: ①The diagnosis was confirmed based on CT or MRI findings within 7 days after stroke onset. ②Age between 18 and 85 years old. ③Patients who can accepted interview and follow-up. ④All the subjects were right-handed. Exclusion criteria: ①Those with communication problems(decreased consciousness, confusion, aphasia, dementia, or dysarthria)severe enough to preclude a reliable interview. ②Those with very severe neurologic or medical conditions(such as metastatic cancer). ③Patients who did not undergo a complete follow-up. Clinical and socio-demographic information was taken and recorded at admission. To ensure that the evaluation was reliable, the patients were asked to take the interview with the caregiver who lived with him/her. The caregiver was present to verify the information and assist the patient, but could not take part in the assessment. Neurologic and psychological assessments(including NIH Stroke Scale, Beck Depression Inventory, Fatigue Severity Scale, Social Support Rating Scale, Medical Coping Modes Questionnaire, Fazeka’s scale and symptom observation) were completed by doctors assigned specifically for that purpose.Mini-Mental State Examination was used for cognition screening, excluding dementia.The second patient interview was performed 3 months after the onset of stroke.Neurologic and psychological assessments were completed by the same doctors who conducted the first interview. The Rankin scale(m RS) replaced NIH Stroke Scale(NIHSS) to record neurologic dysfunction. Investigate morbidity and predictive factors of post-stroke depression, post-stroke fatigue and post-stroke emotional incontinence. Use mass spectrometry genotyping to associate SNPs(rs1006737、rs4680、rs4818、rs1386494、rs4570625、rs17110747) with post-stroke emotional disturbances.Results: ①A total of 368 participants was enrolled within 7 days after the onset of stroke and completed their second interview at 3 months after the stroke. PSD was present in 19.3% of patients at admission and in 23.6% at 3 months. PSEI was present in10.9% of patients at admission and in 15.2% at 3 months. PSF was present in23.4% of patients at admission and in 29.6% at 3 months. ②A high NIHSS score(P<0.01) was highly correlated with PSD at admission. Both motor and sensory dysfunction at admission(P<0.01) compared with only motor or only sensory dysfunction was related to PSD at admission. Patients who had resignation styles(MCMQ; P<0.01) were prone to PSD at admission. In addition, patients who had PSD at admission had a poor prognosis, as evident from their m RS score(P<0.01).Three months later, none of the above risk factors for PSD changed significantly. In addition, the patients who manifested a lower degree of social utilization(SSRS; P<0.05) and took avoidance styles(MCMQ; P<0.01) were more prone to PSD. We also found that the patients who had only sensory dysfunction at admission(P<0.05)were not susceptible to PSD. ③Patients with a high NIHSS score and with both motor and sensory dysfunction(P<0.01) were more susceptible to PSF at admission compared to individuals with a low NIHSS score and only motor or only sensory dysfunction(P <0.01). Moreover, resignation(MCMQ; P<0.01) styles, low objective support(SSRS; P<0.05) and degree of social utilization(SSRS; P<0.05)were also predictive factors for PSF. In addition, the patients who had PSF at admission had a poor prognosis as evident from their m RS scores 3 months later.Meanwhile, the patients who had PSF at admission had a poor prognosis based on their m RS score 3 months later(P<0.01). Basal ganglia(BG), corona radiate(CR) or internal capsule(IC) infarction(P<0.05), high NIHSS score at admission(P<0.01),severe disability(m RS; P<0.01), low social utilization(SSRS; P<0.01), high confrontation(MCMQ; P<0.05), and high resignation score(MCMQ; P<0.01)were all significant risk factors associated with PSF at 3 months. We also found that patients with 1- 20 hours weekly working time and cerebellum infarction were not susceptible to PSF(P <0.05). ④Patients with a high NIHSS score and with both motor and sensory dysfunction(P<0.01) were more susceptible to PSEI at admission compared to individuals with a low NIHSS score and pure motor or sensory dysfunction(P<0.01). Moreover, high avoidance(P<0.05) and resignation(P<0.01) scores on the MCMQ, and low objective support(P<0.05) were also predisposing factors for PSEI. In addition, the patients who had PSEI at admission suffered a poor prognosis as evaluated by their m RS scores 3 months later(P<0.01).Anterior cortex(P<0.05), pons and midbrain(P<0.05) infarction, bilateral lesion location(P<0.01), a high NIHSS score at admission(P<0.01), severe degree of disability(P<0.01), severe white matter change(P<0.05), high avoidance score(P<0.05), and high resignation score(P<0.01) were all significant risk factors associated with PSEI 3 months later. We also found that the patients who had pure sensory dysfunction at admission were not susceptible to PSEI(P <0.01). ⑤Multivariate logistic regression analysis indicated that initial presentation with PSD was related to resignation score on the MCMQ at admission(P<0.01), whereas at 3months, PSD was associated with NIHSS score at admission(P<0.01), severe social utilization score of SSRS(P<0.01), and resignation(P<0.01) on the MCMQ. PSF at admission was also associated with the resignation styles(MCMQ; P<0.01) and the low degree of social utilization(SSRS; P<0.05). PSF at 3 months was related to BG, CR or IC infarction(P<0.05); the confrontation(MCMQ; P<0.05) and avoidance(MCMQ; P<0.01) styles, and the low degree of social utilization(SSRS;P<0.01). PSEI at admission was also associated with high NIHSS scores(P<0.05),avoidance(P<0.01) and resignation score on the MCMQ(P<0.01), whereas it was related to anterior cortex infarction(P<0.05), avoidance(P<0.05) and resignation score(P<0.01) on the MCMQ 3 months later. ⑥The patients whose lesion location was on the left had high avoidance scores. Bilateral lesion location has lower avoidance score.(P<0.05) ⑦In single-marker-based analysis, the rs17110747-G homozygote polymorphism was found to be more frequent in the PSEI patients 3months after stroke. The rs4570625-G homozygote polymorphism was found to be more frequent in the PSD patients 3 months after strokeConclusion: ①Multivariate logistic regression analysis indicated that initial presentation with PSD was related to resignation at admission, whereas at 3 months,PSD was associated with NIHSS score at admission, social utilization score of SSRS and resignation. PSF at admission was also associated with the resignation and the degree of social utilization. PSF at 3 months was related to BG, CR or IC infarction,confrontation, resignation and the degree of social utilization. PSEI at admission was also associated with high NIHSS score, avoidance and resignation, whereas it was related to anterior cortex infarction and resignation 3 months later. ②The patients whose lesion location was on the left had high avoidance scores. Bilateral lesion location has lower avoidance score. ③In single-marker-based analysis, the rs17110747-G homozygote polymorphism was found to be more frequent in the PSEI patients 3 months after stroke. The rs4570625-G homozygote polymorphism was found to be more frequent in the PSD patients 3 months after stroke...