Predictores de la depresión, apatía y deterioro cognitivo tras sufrir un ictus minor y/o ataque isquémico transitorio (AIT)

Introducció: La depressió post-ictus (DPI), l’apatia i el deteriorament cognitiu són complicacions neuropsiquiàtriques i neuropsicològiques associades a l’ictus. L’objectiu va ser estudiar la prevalença, evolució i factors de risc d’aquestes complicacions després de patir un ictus minor i/o atac isquèmic transitori (AIT). Metodologia: Es va realitzar un estudio observacional, prospectiu i longitudinal (12 mesos) incloent de forma consecutiva subjectes amb ictus minor (NIHSS ≤ 4) i/o AIT. Es va realitzar una avaluació incloent dades sociodemogràfiques, de neuroimatge (RM), d’afectivitat, funcionalitat i qualitat de vida, i de rendiment cognitiu. Resultats: Els resultats van indicar que la prevalença de DPI i apatia era similar a la trobada en subjectes amb ictus establert. Durant el primer any els nivells de DPI van disminuir i els d’apatia es van mantenir estables. El dèficit cognitiu també va disminuir però en menor grau. Conclusions: Malgrat patir símptomes neurològics mínims o transitoris, els subjectes amb ictus minor i AIT pateixen DPI, apatia i deteriorament cognitiu. Els factors de risc trobats coincideixen amb els descrits prèviament a la literatura.Introducción: La depresión post-ictus (DPI), la apatía y el deterioro cognitivo son complicaciones neuropsiquiátricas y neuropsicológicas asociadas al ictus. El objetivo fue estudiar la prevalencia, evolución y factores de riesgo de estas complicaciones tras sufrir un ictus minor y/o ataque isquémico transitorio (AIT). Metodología: Se realizó un estudio observacional, prospectivo y longitudinal (12 meses) incluyendo de forma consecutiva sujetos con ictus minor (NIHSS ≤ 4) y/o AIT. Se realizó una evaluación incluyendo datos sociodemográficos, de neuroimagen (RM), de afectividad, funcionalidad y calidad de vida, y de rendimiento cognitivo. Resultados: Los resultados indicaron que la prevalencia de DPI y apatía era similar a la encontrada en sujetos con ictus establecido. Durante el primer año los niveles de DPI disminuyeron y los de apatía se mantuvieron estables. El déficit cognitivo también disminuyó pero en menor medida. Conclusiones: A pesar de sufrir síntomas neurológicos mínimos o transitorios, los sujetos con ictus minor y AIT sufren DPI, apatía y deterioro cognitivo. Los factores de riesgo hallados coinciden con los reportados previamente en la literatura.Introduction: Post-stroke depression (DPI), apathy and cognitive impairment are neuropsychiatric and neuropsychological complications associated with stroke. The objective was to study the prevalence, evolution and risk factors of these complications after minor stroke and / or transient ischemic attack (TIA). Methodology: An observational, prospective and longitudinal study (12 months) including consecutive subjects with minor stroke (NIHSS ≤4) and / or TIA was performed. An evaluation was made including sociodemographic data, neuroimaging (MRI), affectivity, functionality and quality of life, and cognitive performance. Results: The results indicated that the prevalence of PDS and apathy was similar to that found in subjects with established stroke. During the first year the levels of PSD decreased and those of apathy remained stable. Cognitive deficit also declined but to a lesser extent. Conclusions: Despite minor or transient neurological symptoms, subjects with minor stroke and TIA suffer from PSD, apathy and cognitive impairment. The risk factors found coincide with those previously reported in the literature

Depression and apathy after transient ischemic attack or minor stroke : prevalence, evolution and predictors

Few previous studies have focused on affective impairment after transient ischemic attack (TIA) and/or minor stroke. The aim was to establish the prevalence, evolution and predictors of post-stroke depression (PSD) and post-stroke apathy (PSA) over a 12-month follow-up period. We prospectively included TIA and minor stroke patients (NIHSS ≤4) who had undergone magnetic resonance imaging <7 days. PSD was diagnosed according to DSM-5 criteria and PSA was defined based on an Apathy Evaluation Scale (AES-C) score of ≥37. Clinical and neuroimaging variables (presence and patterns of lesion, cerebral bleeds and white matter disease) were analysed in order to find potential predictors for PSD and PSA. Follow-up was performed at 10 days and after 2, 6, 9 and 12 months. 82 patients were included (mean 66.4 [standard deviation11.0] years) of whom 70 completed the follow-up. At 10 days, 36 (43.9%) and 28 (34.1%) patients respectively were diagnosed with PSD and PSA. At 12 months, 25 of 70 (35.7%) patients still had PSA, but only 6 of 70 (8.6%) had PSD. Beck Depression Inventory-II score, mini mental state examination (MMSE) and a previous history of depression or anxiety were predictors for PSD. While MMSE score, The Montgomery Asberg Depression Rating Scale and having previously suffered a stroke were also risk factors for PSA. Acute basal ganglia lesion and periventricular leukoaraiosis were associated with PSA while deep leukorariosis with PSD. Despite the presence of few or only transient symptoms, PSD and PSA frequent appear early after TIA and minor stroke. Unlike PSD, apathy tends to persist during follow-up

Sleep quality in individuals with post-COVID-19 condition: Relation with emotional, cognitive and functional variables

The study aimed to assess sleep quality in PCC patients and its predictors by analysing its relationship with emotional, cognitive and functional variables, as well as possible differences based on COVID-19 severity. We included 368 individuals with PCC and 123 healthy controls (HCs) from the NAUTILUS Project (NCT05307549 and NCT05307575). We assessed sleep quality (Pittsburgh Sleep Quality Index, PSQI), anxiety (Generalized Anxiety Disorder, GAD-7), depression (Patient Health Questionnaire, PHQ-9), global cognition (Montreal Cognitive Assessment, MoCA), everyday memory failures (Memory Failures of Everyday Questionnaire, MFE-30), fatigue (Chadler Fatigue Questionnaire, CFQ), quality of life (European Quality of Life-5 Dimensions, EQ-5D), and physical activity levels (International Physical Activity Questionnaire, IPAQ). 203 were nonhospitalized, 83 were hospitalized and 82 were admitted to the intensive care unit (ICU). We found statistically significant differences in the PSQI total score between the PCC and HC groups (p < 0.0001), but there were no differences among the PCC groups. In the multiple linear regressions, the PHQ-9 score was a predictor of poor sleep quality for mild PCC patients (p = 0.003); GAD-7 (p = 0.032) and EQ-5D (p = 0.011) scores were predictors of poor sleep quality in the hospitalized PCC group; and GAD-7 (p = 0.045) and IPAQ (p = 0.005) scores were predictors of poor sleep quality in the group of ICU-PCC. These results indicate that worse sleep quality is related to higher levels of depression and anxiety, worse quality of life and less physical activity. Therapeutic strategies should focus on these factors to have a positive impact on the quality of sleep