The Depression Status, Quality Of Life And Change Of Thyroid Function In Patients With Post-stroke Depression

Objective To analyse the relationship between the depressive status and neurological function impairments,survey the life quality and investigate the clinical significances of thyroid function changes in patients with post-stroke depression.Methods Sixty two cases with acute cerebral infarction(CI) were evaluated with self-produced questionary.They were stratified into two groups with Zung self-rating depression scale,single cerebral infarct patients group(CI without PSD) and PSD group(CI with PSD).All the patients were investigated with Hamilton Depression Rating Scale(HAMD),Stroke Speciality-Quality of Life(SS-QOL),and Scandinavia stroke scale (SSS) on 2 days,7days 14days and 21 days after admission.Serum levels of FT3,FT4 and TSH of them were detected at the above time points.The results of the two patient groups were compared with that of the healthy control.Results Twenty seven cases of PSD were diagnosed in this study,the prevalence of PSD was 43.5%.The HAMD Scores were higher significantly in PSD group than single cerebral infarct group.The SSS scores in single cerebral infarct group and mild PSD group were decreased on the 2 days after admission,while increased on the 7 days,14 days and 21 days,while the SSS scores in moderate and severe PSD subgroups were decreased on the 7 days,14 days and 21 days.The HAMD Scores were negatively correrated with SSS scores in the moderate and severe PSD subgroups.In contrast to the single cerebral infarct group,the SS-QOL scores in the PSD group was decreased obviously,especially in the energy,family relationship,emotion,personality,and self-care, social relations and thinking.According to the self-produced questionary,the PSD group was higher significantly in the female,negative life events,education degree,frequency of stroke events,infarct volume hypertension,diabetes mellitus,hypercholesterolemia compared with the single cerebral infarct group.With regard to infarction sites,more frontal lobe infarction and less internal capsule infarction were found in PSD group. Logistic regression analysis showed that the negative life events,frontal lobe infarction and frequency of stroke events maybe the predictive factors in PSD.On the 2 days after admission,the levels of FT₃ in the single cerebral infarct group and PSD group were decreased significantly compared with the health control group,levels of FT₃ in the PSD groups decreased compared with the single cerebral infarct group.On the 7 days,the levels of FT₃ in the single infarct group and PSD group were higher than those on 2 days,and lower than the health control group,with a lower level in the PSD group than in the single cerebral infarct group(p＜0.01).On the 14 days and 21days after admission,the levels of FT₃ in single cerebral infarct group had no obviously elevated than those on 7 days after admission,while the FT₃ levels in PSD group elevated significantly compared with those on 7 days after admission,but decreased than that of the single cerebral infarct group.The levels of FT₄ in the single cerebral infarct and PSD groups were decreased significantly in the 2 days after admission compared with the control group,and in contrast to the single cerebral infarct group,the levels of FT₄ in the PSD group enhanced significantly.The levels of FT₄ in single cerebral infarct group and PSD group on 7 days after admission inceased compared to those on 2 days,while the levels of FT₄ in PSD group were higher than the single cerebral infarct.On the 14 days after admission,the levels of FT₄ in the single cerebral infarct group and PSD group decreased compared with the levels of those on 7 days after admission.The levels of TSH in the single cerebral infarct group on 2 days and 7 days after admission elevated obviously compared with the health control group,and the levels of TSH in the single cerebral infarct group were higher significantly than in PSD group.On 14 and 21 days,the levels of TSH in the single cerebral infarct group decreased compared with that on the 2 days,and had no obviously changes compared with the health control group.On the 2 days,7 days,14 days and 21 days after admission,the levels in the PSD group had no significantly changes compared with the health control group.Conclusion:The prevalence of PSD was 43.5%in this study.The HAMD Scores were negatively correrated with SSS scores in the moderate and severe PSD subgroups.The SS-QOL scale in PSD group was abnormally changed in the items of SS-QOL including energy,family relation,personality,self-care,social relation and thinking.And the discrepancy in the female,negative life events,education degree,stroke risk factors(such as hypertension,diabetes mellitus,hypercholesterolemia),frequency of stroke events were significantly different between the single cerebral infarct group and the PSD group, and negative life events,frontal lobe infarct and frequency of stroke events maybe the predictors of PSD.The decreased serum levels of FT₃ and increased serum levels of FT₄ in the PSD group indicated that the hypothalamic-pituitary-thyroid(HPT) axis maybe exert important role in the pathogenesis of PSD.