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(Stroke. 2000;31:637.)
© 2000 American Heart Association, Inc.

Original Contributions

Functional and Neuroanatomic Correlations in Poststroke Depression

The Sunnybrook Stroke Study

Anu Singh, MD, FRCPC; Sandra E. Black, MD, FRCPC; Nathan Herrmann, MD, FRCPC; Farrell S. Leibovitch, MSc; Patricia L. Ebert, MSc; Joanne Lawrence, RN, BSc John P. Szalai, PhD, CPsy

From the Department of Psychiatry (A.S., N.H.); Medicine (Neurology), Research Program in Aging (S.E.B., F.S.L., P.L.E., J.L.); and Research Design and Biostatistics (J.P.S.), Sunnybrook & Women’s College Health Sciences Centre and University of Toronto, Toronto, Canada.

Correspondence to Dr Sandra E. Black, Head, Division of Neurology, Sunnybrook & Women’s College Health Sciences Centre, 2075 Bayview Ave, Room A421, Toronto, Ontario M4N 3M5, Canada. E-mail black{at}sten.sunnybrook.utoronto.ca

Background and Purpose—The purpose of our study was to determine the functional and neuroanatomic correlates of poststroke depressive symptoms.

Methods—Patients with consecutive admissions to a regional stroke center for new-onset unilateral hemispheric stroke who met World Health Organization and National Institute of Neurological and Communicative Disorders and Stroke criteria were eligible for inclusion in a longitudinal study. Acutely, patients underwent CT scanning, and at 3 months and 1 year after stroke, depressive symptoms were assessed by using both the Montgomery-Asberg Depression Rating Scale and the Zung Self-Rating Depression Scale. The Functional Independence Measure (FIM) served as an indication of functional outcome and was obtained at 1 month, 3 months, and 1 year after stroke, along with other demographic information. The Talairach and Tournoux stereotactic atlas was used for the primary determination of CT lesion localization. Lesion proximity to the anterior frontal pole was also measured.

Results—Eighty-one patients participated in the longitudinal study. Stepwise linear regression analyses generated a highly significant model (F_3,76=9.8, R²=28%, P<0.0005), with lower 1-month total FIM scores, living at home, and damage to the inferior frontal region predicting higher depression scores at 3 months. Similarly, lower 3-month total FIM scores correlated with higher 3-month depression scores, and lower 1-year total FIM scores correlated with higher 1-year depression scores.

Conclusions—Functional measures correlated with poststroke depression across time and, together with neuroanatomic measures, predicted depressive symptoms longitudinally. Although inferior frontal lesion location, irrespective of side, appeared to play a role as a risk factor in this study, the degree of functional dependence after stroke imparted the greatest risk.

Key Words: depression • stroke assessment • stroke outcome • tomography, x-ray computed

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