Clinical predictors of anxiety-depressive disorders in the acute period of ischemic stroke

Anxiety-depressive disorders (ADD) are among the most frequent and clinically significant complications of stroke, significantly affecting the rehabilitation process and the patients’ quality of life. The relevance of this study is driven by the high prevalence of these conditions and their role in the development of cognitive impairment (CI), as well as their influence on the course and prognosis of stroke. The aim of this work is to identify clinical predictors for the development of post-stroke anxiety and depression in patients during the acute period of ischemic stroke to improve early diagnosis and treatment strategies. Materials and Methods. The study was conducted at the Regional Vascular Center (Yakutsk). The sample included 91 patients (53 men, 38 women; mean age approx. 59 years) with ischemic stroke. Exclusion criteria: hemorrhagic stroke, severe speech and cognitive impairment, and a history of neurodegenerative diseases. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Scale (mRS). Neuropsychological testing included the Hospital Anxiety and Depression Scale (HADS), the Montreal Cognitive Assessment (MoCA), and the Mini-Mental State Examination (MMSE). Brain MRI was used to verify the localization and volume of the lesion, and stroke etiology was refined using instrumental and laboratory diagnostic methods. Results. In the acute period of ischemic stroke, anxiety was detected in 36 patients (39.6 %), and depression in 24 patients (26.4 %). A comorbid course of anxiety-depressive disorders was observed in 18.68 % of those examined. It was established that the presence of an anxiety syndrome significantly increases the risk of developing post-stroke depression (p=0.003; OR=4.8). These findings underscore the necessity of early screening for affective disorders in the post-stroke period to predict cognitive deficit and optimize rehabilitation measures.

1. Kotov S. V., Isakova E. V., Egorova Yu. V. Post-stroke depression and the potential of antidepressants to increase the effectiveness of neurorehabilitation. Nevrologiya, neiropsikhiatriya, psikhosomatika. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(6):110–116 (in Russian). DOI:10.14412/2074-2711-2020-6-110-11.

2. Zhou L., Wang T., Yu Y., et al. The etiology of poststroke-depression: a hypothesis involving HPA axis. Biomedicine & Pharmacotherapy. 2022;151(1131460. DOI:10.1016/j.biopha.2022.113146.

3. Mondal A.C., Fatima M. Direct and indirect evidences of BDNF and NGF as key modulators in depression: role of antidepressants treatment. International Journal of Neuroscience. 2019;129(3):283–296. DOI:10.1080/00207454.2018.1527328.

4. Medeiros G.C., Roy D., Kontos N., Beach S.R. Post-stroke depression: A 2020 updated review. General Hospital Psychiatry. 2020;66:70–80. DOI:10.1016/j.genhosppsych.2020.06.011.

5. Skvortsova V. I., Gubsky L.V., Stakhovskaya L.V. Ischemic stroke. In: Gusev E.I., Konovalov A.N., Skvortsova V.I. (Eds.) Neurology: national guidelines. Moscow: GEOTAR-Media; 2009:593–615 (in Russian).

6. Filatova E.G. Post-stroke depression. Medical Council. 2017;1S:47–51 (in Russian).

7. Emerski E., Robinson R. The Neuropsychiatry of Stroke. Psychosomatics. 2000;41(1):5–14.

8. Hackett M., Anderson C.S. Predictors of depression after stroke: a systematic review of observational studies. Stroke. 2005;36(10):2296–2031.

9. Castillo C.S., Starkstein S.E., Fedoroff J.P., et al. Generalized anxiety disorder after stroke. The Journal of Nervous and Mental Disease. 1993;181(2):100–106.

10. Kuptniratsaikul V., Kovindha A., Dajpratham P., Piravej K. Main outcomes of stroke rehabilitation: a multi-centre study in Thailand. Journal of Rehabilitation Medicine. 2009:41(1):54–58.

11. Petrova E.A., Savina M.A., Georgievskaya N.A., et al. Post-stroke affective disorders. S.S. Korsakov Journal of Neurology and Psychiatry. 2011;111(3):16–23 (in Russian).

12. Astrom M., Olsson T., Asplund K. Different linkage of depression to hypercortisolism early vs. late after stroke: a 3-year longitudinal study. Stroke. 1993;24(1):52–57.

13. Eastwood M.R., Rifat S.L., Nobbs H., Ruderman J. Mood disorder following cerebrovascular accident. British Journal of Psychiatry. 1989;154(2):195–200.

14. Beblo T., Wallesch C.W., Herrmann M. The crucial role of frontostriatal circuits for depressive disorders in the postacute stage after stroke. Neuropsychiatry, Neuropsychology, and Behavioral Neurology. 1999;12(4):236– 246.

15. Vataja R., Pohjasvaara T., Leppavuori A., et al. Magnetic resonance imaging correlates of depression after ischemic stroke. Archives of General Psychiatry. 2001;58(10):925–1031.

16. Terrill A.L., Moreno-Gomez V., Kumar M., MacKenzie J.J. Poststroke depression and anxiety: a comprehensive topical review. Stroke. 2026; 57. DOI:10.1161/STROKEAHA.125.051664.