XVII. European Stroke Conference
Nice, France

Poster Session: Behavior and mood 
 

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

  
IMPAIRMENT OF FRONTAL LOBE FUNCTION IN PATIENTS WITH POSTSTROKE EMOTIONAL INCONTINENCE
Y.K.Chen    A. Wong    V.C.T.Mok     W.W.M.Lam     K.S.Wong    W.K.Tang                             
 
Chinese University of Hong Kong

HONG-KONG

Background: Emotional incontinence(EI)is a common and distressing complication of stroke.There are two previous reports on frontal lobe dysfunction in non-stroke patients with emotional incontinence (EI). To the best of our knowledge, there has been no published data on the frontal lobe function in poststroke emotional incontinence (PSEI). The aim of this case-control study was to assess whether patients of PSEI have impairment of frontal lobe functions.Methods:509 consecutive Chinese patients of acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong were recruited. According to Kim’s criteria, 39 (7.7%) had PSEI 3 months after the index stroke. 39 stroke patients without PSEI served as the control group. The frontal lobe functions were assessed by the Stroop Test, Modified Card Sorting Test (MSCT), Modified Verbal Fluency Test (VFT), Go-No-Go Test, and the Frontal Assessment Battery (FAB), 3 months after the index stroke. The severity of depressive symptoms was measured by the Geriatric Depression Scale (GDS).Results: The colours reaction time in Stroop test (35.42+/-14.22s vs 28.25+/-10.73s), number of omission errors (6.14+/-3.81 vs 4.31+/-3.00), number of commission errors (9.03+/-6.32 vs 5.31+/-3.34) in Go-No-Go Test and FAB total scores (13.44+/-1.77 vs 14.38+/-1.55) were significant different between PSEI group and control group (p<0.05). After adjusted by GDS scores, the differences in the colours reaction time in Stroop test and number of commission errors in Go-No-Go Test remained significant. Discussion: Impairment of frontal lobe function exists in PSEI, which is independent of any concurrent poststroke depression.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

  
Post-traumatic stress disorder and post-traumatic stress disorder-like syndrome after minor stroke or transient ischemic attack
P. Favrole    L.  Jehel    M.J. Manifacier     S. Descombes     S. Alamowitch                                    
 
Neurology

FRANCE

Background: Depressive disorders are frequent after stroke but few data exist about the frequency of post-traumatic stress disorder (PTSD) or PTSD-like syndrome after stroke or transient ischemic attack (TIA). Objective: To assess frequency and predictors of PTSD or PTSD-like syndrome after minor ischemic stroke or TIA. Methods: After informed consent, a consecutive cohort of minor ischemic stroke or TIA patients was studied, 1 to 3 months after the cerebral ischemic event. Exclusion criteria were cognitive impairment and aphasia. All the patients completed questionnaires measuring PTSD symptoms (PTSD-Interview Scale, Impact of Event Scale-Revised), moods alterations (Hospital Anxiety Depression Scale), trauma experience (intensity of the peri-traumatic reaction) and psychological risk factors (traumatic events and psychiatric history). Results: Forty patients (14 women and 26 men; mean age: 52 years) were studied (mean delay: 116 days) after a minor stroke (30 patients; mean initial NIHSS 4.9) or TIA. PTSD was present in 4 patients (10%), and PTSD-like syndrome in 5 patients (12.5%). PTSD and PTSD-like syndrome were more frequent in women, significantly related to psychiatric history and anterior traumatic event, and associated with intensity of the depressive and anxious reactions. Others demographic factors (age, education level), delay of evaluation, neurological severity (initial NIHSS, modified Rankin scale at evaluation) were unrelated to post-traumatic symptoms. Conclusions: Nearly 25% of patients have PTSD or PTSD-like syndrome after a minor ischemic stroke or TIA. PTSD and PTSD-like syndrome were associated with traumatic and psychiatric history, and accompanied by depressive and anxious states. These data need to be confirmed in a larger cohort of patients.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

  
Validation of a short form of the Apathy Evaluation Scale-Clinical Version
L. Caeiro    J.M.Ferro                                                           
 
Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa

PORTUGAL

BACKGROUND and PURPOSE: Apathy is frequent in stroke. In order to obtain a short version of the Apathy Evaluation Scale-Clinical Version (AES-C), we aimed to describe the reliability and validity of a 10-item version of AES-C (AES-C-10) to be used in acute hospital settings. METHODS: Caregivers of stroke patients attending Stroke Outpatient Clinic were invited to participate in this study. Exclusion criteria were: 1) any psychiatric disorder based on the DSM-IV-TR criteria and 2) cognitive impairment (MMSE). Factor analysis of principal components (varimax rotation and extraction of 3 factors) estimated construct validity. In order to calculate reliability analysis, we used: 1) Cronbach Alpha and 2) Split-half. Bivariate analysis was performed using ANOVA (F) and T-test. Acute stroke inpatients partook aiming comparing the results of the participants with a clinical sample. As a cut-point for the AES-C-10 we used the mean plus two standard deviations. RESULTS: We included 156 participants (mean age= 52 years old; 72% women) with the AES-C-10 (mean score=12.5, SD=2.6). Factor analysis explained 59% of the variance. Internal consistency reliability (0.70) and split-half (0.79) represented good reliability analysis. There were differences in AES-C-10 means (F=4.55, p<.01) among three groups of education (</=4 and 5-9 years: 19 points; >/=10 years: 16 points), but no differences in mean scores between genders and among age groups (p>.05). We assessed 129 acute stroke patients (mean age= 54.6 years old; 41% women) with the AES-C-10 (mean score=16.9, SD=5.4). There were differences in AES-C-10 means (p<.01) among three groups of education, but no differences in mean scores between genders and among three age groups (p>.05). Comparing means between participants and stroke patients these presented higher mean scale scores (p<.01). DISCUSSION: AES-C-10 presented good construct validity and reliability analysis. Scores in acute stroke inpatients were higher than scores in a non-clinical sample. We suggest the use of cut-points based on the educational level.

Session: Poster Session II
Date: Thursday 15 May 2008  
Time: 12:30 - 14:00
Room: Agora 3

  
MAGNETIC RESONANCE IMAGING CORRELATES OF DEPRESSION AFTER ACUTE ISCHEMIC STROKE IN CHINESE POPULATION
Y.K.Chen    V.C.T.Mok    W.M.Lam     K.S.Wong     W.K.Tang                                    
 
Department of Psychiatry, Chinese University of Hong Kong

HONG-KONG

Background: Vascular depression is an important concept postulating that pathological (ischemic) changes in certain brain areas may raise the risk of depression in late life. Stroke-related depression is regarded as a type of vascular depression. Despite numerous existing studies on poststroke depression (PSD), the role of cerebral atrophy and white matter lesion in the pathogenesis of PSD is uncertain. The aim of this study is to evaluate the MRI correlates of PSD in Chinese patients with first or recurrent stroke. Methods: 327 consecutive Chinese patients of acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong were recruited. The MRI examinations were performed within the first 7 days after admission. Three months after the index stroke, a psychiatrist interviewed all participants and identified PSD, according to the DSMIV criteria. Results: 34 (10.4%) had poststroke depression (PSD) 3 months after the index stroke. In the univariate analysis, the presence of severe frontal lobe atrophy (15.2% vs 5.1%) and severe deep white matter lesions (14.7% vs 3.1%) were significantly associated with PSD (p < 0.05). The above MRI findings remained significant in a subsequent logistic regression, after adjusting for age, gender and education level. Discussion: Severe frontal lobe atrophy and severe deep white matter lesions are independent MRI predictors of PSD, which may indicate the importance of frontal lobe function and chronic ischemic changes in the pathogenesis of PSD.