Functional and neuroanatomic correlations in poststroke depression - The Sunnybrook stroke study

Background and Purpose-The purpose of our study was to determine the functi onal and neuroanatomic correlates of poststroke depressive symptoms. Methods-Patients with consecutive admissions to a regional stroke center fo r new-onset unilateral hemispheric stroke who:met World Health Organization and National Institute of Neurological and Communicative Disorders and Str oke criteria were eligible for inclusion in a longitudinal study. Acutely, patients underwent CT scanning, and at 3 months and 1 year after stroke, de pressive symptoms were assessed by using both the Montgomery-Asberg Depress ion Rating Scale and the Zung Self-Rating Depression Scale. The Functional Independence Measure (FIM) served as an indication of functional outcome an d was obtained at 1 month, 3 months,and I year after stroke, along with oth er demographic information. The Talairach and Tournoux stereotactic atlas w as used for the primary determination of CT lesion localization. Lesion pro ximity to the anterior frontal pole was also measured. Results-Eighty-one patients participated in the longitudinal study. Stepwis e:linear regression analyses generated a highly significant model (F-3.76=9 .8, R-2=28%, P<0.0005), with lower 1-month total FIM scores, living at home , and damage to the-inferior frontal region predicting higher depression sc ores at 3 months. Similarly, lower 3-month total FIM scores correlated with higher 3-month depression scores, and lower 1-year total FIM scores correl ated with higher I-year depression scores. Conclusions-Functional measures correlated with poststroke depression acros s time and, together with neuroanatomic measures, predicted depressive symp toms longitudinally. Although inferior frontal lesion location, irrespectiv e of side, appeared to play a role as a risk factor in this study, the degr ee of: functional dependence after stroke imparted the greatest risk.