Korean Journal of Biological Psychiatry (생물정신의학)

The Korean Society of Biological Psychiatry (대한생물정신의학회)
권호 표지

Depression and Executive Dysfunction in Stroke

뇌졸중에서 우울증과 실행기능부전에 대한 고찰

  • Na, Kyoung-Sae (Department of Psychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital) ;
  • Kim, Shin-Gyeom (Department of Psychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital) ;
  • Lee, Soyoung Irene (Department of Psychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital) ;
  • Jung, Han-Yong (Department of Psychiatry, College of Medicine, Soonchunhyang University, Bucheon Hospital)
  • 나경세 (순천향대학교 의과대학 부천병원 정신건강의학교실) ;
  • 김신겸 (순천향대학교 의과대학 부천병원 정신건강의학교실) ;
  • 이소영 (순천향대학교 의과대학 부천병원 정신건강의학교실) ;
  • 정한용 (순천향대학교 의과대학 부천병원 정신건강의학교실)
  • Received : 2012.06.21
  • Accepted : 2012.07.30
  • Published : 2012.11.30
Download PDF
⟨ Previous Next ⟩

Abstract

Depression and executive dysfunction are common neuropsychiatric sequelae of stroke. Patients with stroke are more predisposed to depression and executive dysfunction compared to patients with similar degree of physical disability. Both depression and executive dysfunction are also associated with poor prognosis such as high mortality and delayed recovery after stroke. Complex neurobiological and anatomical mechanisms are associated with the development of depression and executive dysfunction after stroke. Activation of pro-inflammatory cytokines is thought to be associated with onset of depression, whereas injuries in frontal-subcortical circuit are thought to be a link between depression and executive dysfunction. Early detection of depressive symptoms and both pharmacological and non-pharmacological treatment would be helpful. In this review paper, the authors investigated 1) biological and neuroanatomical substrate for poststroke depression and executive dysfunction, 2) the relationship and common etiopathology for poststroke depression and executive dysfunction, and 3) pharmacological and non-pharmacological treatment for poststroke depression. The contents of the paper are as follows : the prevalence, clinical manifestation, and biological etiology for poststroke depression, neuroanatomical abnormalities as a common etiological factor for depression and executive dysfunction, pharmacotherapy and non-pharmacological approach.

Keywords

References

  1. Lenzi GL, Altieri M, Maestrini I. Post-stroke depression. Rev Neurol (Paris) 2008;164:837-840. https://doi.org/10.1016/j.neurol.2008.07.010
  2. Maes M, Yirmyia R, Noraberg J, Brene S, Hibbeln J, Perini G, et al. The inflammatory & neurodegenerative (I & ND) hypothesis of depression: leads for future research and new drug developments in depression. Metab Brain Dis 2009;24:27-53. https://doi.org/10.1007/s11011-008-9118-1
  3. Di Carlo A, Launer LJ, Breteler MM, Fratiglioni L, Lobo A, Martinez-Lage J, et al. Frequency of stroke in Europe: A collaborative study of population-based cohorts. ILSA Working Group and the Neurologic Diseases in the Elderly Research Group. Italian Longitudinal Study on Aging. Neurology 2000;54(11 Suppl 5):S28-S33.
  4. Maes M. Inflammatory and oxidative and nitrosative stress pathways underpinning chronic fatigue, somatization and psychosomatic symptoms. Curr Opin Psychiatry 2009;22:75-83. https://doi.org/10.1097/YCO.0b013e32831a4728
  5. Aben I, Verhey F, Strik J, Lousberg R, Lodder J, Honig A. A comparative study into the one year cumulative incidence of depression after stroke and myocardial infarction. J Neurol Neurosurg Psychiatry 2003;74:581-585. https://doi.org/10.1136/jnnp.74.5.581
  6. Robinson RG. Poststroke depression: prevalence, diagnosis, treatment, and disease progression. Biol Psychiatry 2003;54:376-387. https://doi.org/10.1016/S0006-3223(03)00423-2
  7. Folstein MF, Maiberger R, McHugh PR. Mood disorder as a specific complication of stroke. J Neurol Neurosurg Psychiatry 1977;40:1018-1020. https://doi.org/10.1136/jnnp.40.10.1018
  8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington DC: American Psychiatric Association;1994.
  9. Morris PL, Robinson RG, Andrzejewski P, Samuels J, Price TR. Association of depression with 10-year poststroke mortality. Am J Psychiatry 1993;150:124-129. https://doi.org/10.1176/ajp.150.1.124
  10. Wade DT, Legh-Smith J, Hewer RA. Depressed mood after stroke. A community study of its frequency. Br J Psychiatry 1987;151:200-205. https://doi.org/10.1192/bjp.151.2.200
  11. Muller N, Schwarz MJ. COX-2 inhibition in schizophrenia and major depression. Curr Pharm Des 2008;14:1452-1465. https://doi.org/10.2174/138161208784480243
  12. Elenkov IJ, Iezzoni DG, Daly A, Harris AG, Chrousos GP. Cytokine dysregulation, inflammation and well-being. Neuroimmunomodulation 2005;12:255-269. https://doi.org/10.1159/000087104
  13. Loftis JM, Huckans M, Morasco BJ. Neuroimmune mechanisms of cytokine-induced depression: current theories and novel treatment strategies. Neurobiol Dis 2010;37:519-533. https://doi.org/10.1016/j.nbd.2009.11.015
  14. Connor TJ, Leonard BE. Depression, stress and immunological activation: the role of cytokines in depressive disorders. Life Sci 1998;62:583-606. https://doi.org/10.1016/S0024-3205(97)00990-9
  15. Nichols KK, Foulks GN, Bron AJ, Glasgow BJ, Dogru M, Tsubota K, et al. The international workshop on meibomian gland dysfunction: executive summary. Invest Ophthalmol Vis Sci 2011;52:1922-1929. https://doi.org/10.1167/iovs.10-6997a
  16. Gabbay V, Klein RG, Katz Y, Mendoza S, Guttman LE, Alonso CM, et al. The possible role of the kynurenine pathway in adolescent depression with melancholic features. J Child Psychol Psychiatry 2010;51:935-943. https://doi.org/10.1111/j.1469-7610.2010.02245.x
  17. Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry 2009;65:732-741. https://doi.org/10.1016/j.biopsych.2008.11.029
  18. Na KS, Kim YK. Monocytic, Th1 and th2 cytokine alterations in the pathophysiology of schizophrenia. Neuropsychobiology 2007;56:55-63. https://doi.org/10.1159/000111535
  19. Dobos N, de Vries EF, Kema IP, Patas K, Prins M, Nijholt IM, et al. The role of indoleamine 2,3-dioxygenase in a mouse model of neuroinflammation-induced depression. J Alzheimers Dis 2012;28:905-915.
  20. Lyons KE, Zelazo PD. Monitoring, metacognition, and executive function: elucidating the role of self-reflection in the development of self-regulation. Adv Child Dev Behav 2011;40:379-412.
  21. Broomfield NM, Laidlaw K, Hickabottom E, Murray MF, Pendrey R, Whittick JE, et al. Post-stroke depression: the case for augmented, individually tailored cognitive behavioural therapy. Clin Psychol Psychother 2011;18:202-217. https://doi.org/10.1002/cpp.711
  22. Royall DR, Lauterbach EC, Cummings JL, Reeve A, Rummans TA, Kaufer DI, et al. Executive control function: a review of its promise and challenges for clinical research. A report from the Committee on Research of the American Neuropsychiatric Association. J Neuropsychiatry Clin Neurosci 2002;14:377-405. https://doi.org/10.1176/appi.neuropsych.14.4.377
  23. Duke LM, Kaszniak AW. Executive control functions in degenerative dementias: a comparative review. Neuropsychol Rev 2000;10:75-99. https://doi.org/10.1023/A:1009096603879
  24. Cummings JL. Frontal-subcortical circuits and human behavior. Arch Neurol 1993;50:873-880. https://doi.org/10.1001/archneur.1993.00540080076020
  25. Devinsky O, Morrell MJ, Vogt BA. Contributions of anterior cingulate cortex to behaviour. Brain 1995;118(Pt 1):279-306. https://doi.org/10.1093/brain/118.1.279
  26. Walter M, Henning A, Grimm S, Schulte RF, Beck J, Dydak U, et al. The relationship between aberrant neuronal activation in the pregenual anterior cingulate, altered glutamatergic metabolism, and anhedonia in major depression. Arch Gen Psychiatry 2009;66:478-486. https://doi.org/10.1001/archgenpsychiatry.2009.39
  27. Campbell JJ 3rd, Coffey CE. Neuropsychiatric significance of subcortical hyperintensity. J Neuropsychiatry Clin Neurosci 2001;13:261-288. https://doi.org/10.1176/appi.neuropsych.13.2.261
  28. van Swieten JC, van den Hout JH, van Ketel BA, Hijdra A, Wokke JH, van Gijn J. Periventricular lesions in the white matter on magnetic resonance imaging in the elderly. A morphometric correlation with arteriolosclerosis and dilated perivascular spaces. Brain 1991;114(Pt 2):761-774. https://doi.org/10.1093/brain/114.2.761
  29. Pantoni L, Garcia JH. Pathogenesis of leukoaraiosis: a review. Stroke 1997;28:652-659. https://doi.org/10.1161/01.STR.28.3.652
  30. Jokinen H, Kalska H, Ylikoski R, Madureira S, Verdelho A, van der Flier WM, et al. Longitudinal cognitive decline in subcortical ischemic vascular disease--the LADIS Study. Cerebrovasc Dis 2009;27:384-391. https://doi.org/10.1159/000207442
  31. Radanovic M, Mansur LL, Azambuja MJ, Porto CS, Scaff M. Contribution to the evaluation of language disturbances in subcortical lesions: a pilot study. Arq Neuropsiquiatr 2004;62:51-57. https://doi.org/10.1590/S0004-282X2004000100009
  32. Frisoni GB, Galluzzi S, Bresciani L, Zanetti O, Geroldi C. Mild cognitive impairment with subcortical vascular features: clinical characteristics and outcome. J Neurol 2002;249:1423-1432. https://doi.org/10.1007/s00415-002-0861-7
  33. Kramer JH, Reed BR, Mungas D, Weiner MW, Chui HC. Executive dysfunction in subcortical ischaemic vascular disease. J Neurol Neurosurg Psychiatry 2002;72:217-220. https://doi.org/10.1136/jnnp.72.2.217
  34. O'Sullivan M, Lythgoe DJ, Pereira AC, Summers PE, Jarosz JM, Williams SC, et al. Patterns of cerebral blood flow reduction in patients with ischemic leukoaraiosis. Neurology 2002;59:321-326. https://doi.org/10.1212/WNL.59.3.321
  35. Debette S, Markus HS. The clinical importance of white matter hyperintensities on brain magnetic resonance imaging: systematic review and meta-analysis. BMJ 2010;341:c3666. https://doi.org/10.1136/bmj.c3666
  36. Herrmann LL, Le Masurier M, Ebmeier KP. White matter hyperintensities in late life depression: a systematic review. J Neurol Neurosurg Psychiatry 2008;79:619-624.
  37. Greenwald BS, Kramer-Ginsberg E, Krishnan RR, Ashtari M, Aupperle PM, Patel M. MRI signal hyperintensities in geriatric depression. Am J Psychiatry 1996;153:1212-1215. https://doi.org/10.1176/ajp.153.9.1212
  38. de Groot JC, de Leeuw FE, Oudkerk M, van Gijn J, Hofman A, Jolles J, et al. Cerebral white matter lesions and cognitive function: the Rotterdam Scan Study. Ann Neurol 2000;47:145-151. https://doi.org/10.1002/1531-8249(200002)47:2<145::AID-ANA3>3.0.CO;2-P
  39. Vataja R, Pohjasvaara T, Leppavuori A, Mantyla R, Aronen HJ, Salonen O, et al. Magnetic resonance imaging correlates of depression after ischemic stroke. Archives of general psychiatry 2001;58:925-931. https://doi.org/10.1001/archpsyc.58.10.925
  40. Pariel-Madjlessi S, Pouillon M, Robcis I, Sebban C, Fremont P, Belmin J. [Depression: an underrated consequence of stroke in elderly]. Psychol Neuropsychiatr Vieil 2005;3:7-16.
  41. Alexopoulos GS, Kiosses DN, Klimstra S, Kalayam B, Bruce ML. Clinical presentation of the "depression-executive dysfunction syndrome" of late life. Am J Geriatr Psychiatry 2002;10:98-106.
  42. Alexopoulos GS, Meyers BS, Young RC, Campbell S, Silbersweig D, Charlson M. 'Vascular depression' hypothesis. Arch Gen Psychiatry 1997;54:915-922. https://doi.org/10.1001/archpsyc.1997.01830220033006
  43. Alexopoulos GS. Role of executive function in late-life depression. J Clin Psychiatry 2003;64 Suppl 14:18-23.
  44. Lockwood KA, Alexopoulos GS, van Gorp WG. Executive dysfunction in geriatric depression. Am J Psychiatry 2002;159:1119-1126. https://doi.org/10.1176/appi.ajp.159.7.1119
  45. Bour A, Rasquin S, Limburg M, Verhey F. Depressive symptoms and executive functioning in stroke patients: a follow-up study. Int J Geriatr Psychiatry 2011;26:679-686. https://doi.org/10.1002/gps.2581
  46. Cui X, Lyness JM, Tu X, King DA, Caine ED. Does depression precede or follow executive dysfunction? Outcomes in older primary care patients. Am J Psychiatry 2007;164:1221-1228. https://doi.org/10.1176/appi.ajp.2007.06040690
  47. Melkas S, Vataja R, Oksala NK, Jokinen H, Pohjasvaara T, Oksala A, et al. Depression-executive dysfunction syndrome relates to poor poststroke survival. Am J Geriatr Psychiatry 2010;18:1007-1016. https://doi.org/10.1097/JGP.0b013e3181d695d7
  48. Carson AJ, MacHale S, Allen K, Lawrie SM, Dennis M, House A, et al. Depression after stroke and lesion location: a systematic review. Lancet 2000;356:122-126. https://doi.org/10.1016/S0140-6736(00)02448-X
  49. Vataja R, Pohjasvaara T, Leppavuori A, Mantyla R, Aronen HJ, Salonen O, et al. Magnetic resonance imaging correlates of depression after ischemic stroke. Arch Gen Psychiatry 2001;58:925-931. https://doi.org/10.1001/archpsyc.58.10.925
  50. Bolla-Wilson K, Robinson RG, Starkstein SE, Boston J, Price TR. Lateralization of dementia of depression in stroke patients. Am J Psychiatry 1989;146:627-634. https://doi.org/10.1176/ajp.146.5.627
  51. Spalletta G, Guida G, De Angelis D, Caltagirone C. Predictors of cognitive level and depression severity are different in patients with left and right hemispheric stroke within the first year of illness. J Neurol 2002;249:1541-1551. https://doi.org/10.1007/s00415-002-0885-z
  52. Robinson RG, Spalletta G. Poststroke depression: a review. Can J Psychiatry 2010;55:341-349. https://doi.org/10.1177/070674371005500602
  53. Fruehwald S, Gatterbauer E, Rehak P, Baumhackl U. Early fluoxetine treatment of post-stroke depression--a three-month double-blind placebo-controlled study with an open-label long-term follow up. J Neurol 2003;250:347-351. https://doi.org/10.1007/s00415-003-1014-3
  54. Rasmussen A, Lunde M, Poulsen DL, Sorensen K, Qvitzau S, Bech P. A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics 2003;44:216-221. https://doi.org/10.1176/appi.psy.44.3.216
  55. Robinson RG, Jorge RE, Moser DJ, Acion L, Solodkin A, Small SL, et al. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial. JAMA 2008;299:2391-2400. https://doi.org/10.1001/jama.299.20.2391
  56. Jorge RE, Acion L, Moser D, Adams HP Jr, Robinson RG. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry 2010;67:187-196. https://doi.org/10.1001/archgenpsychiatry.2009.185
  57. Almeida OP, Waterreus A, Hankey GJ. Preventing depression after stroke: Results from a randomized placebo-controlled trial. J Clin Psychiatry 2006;67:1104-1109. https://doi.org/10.4088/JCP.v67n0713
  58. Palomaki H, Kaste M, Berg A, Lonnqvist R, Lonnqvist J, Lehtihalmes M, et al. Prevention of poststroke depression: 1 year randomised placebo controlled double blind trial of mianserin with 6 month follow up after therapy. J Neurol Neurosurg Psychiatry 1999;66:490-494. https://doi.org/10.1136/jnnp.66.4.490
  59. Bondareff W, Alpert M, Friedhoff AJ, Richter EM, Clary CM, Batzar E. Comparison of sertraline and nortriptyline in the treatment of major depressive disorder in late life. Am J Psychiatry 2000;157:729-736. https://doi.org/10.1176/appi.ajp.157.5.729
  60. Grigsby J, Kaye K, Baxter J, Shetterly SM, Hamman RF. Executive cognitive abilities and functional status among community-dwelling older persons in the San Luis Valley Health and Aging Study. J Am Geriatr Soc 1998;46:590-596. https://doi.org/10.1111/j.1532-5415.1998.tb01075.x
  61. Lincoln NB, Flannaghan T, Sutcliffe L, Rother L. Evaluation of cognitive behavioural treatment for depression after stroke: a pilot study. Clin Rehabil 1997;11:114-122. https://doi.org/10.1177/026921559701100204
  62. Lincoln NB, Flannaghan T. Cognitive behavioral psychotherapy for depression following stroke: a randomized controlled trial. Stroke 2003;34:111-115. https://doi.org/10.1161/01.STR.0000044167.44670.55
  63. Rasquin SM, Van De Sande P, Praamstra AJ, Van Heugten CM. Cognitive-behavioural intervention for depression after stroke: five single case studies on effects and feasibility. Neuropsychol Rehabil 2009;19:208-222. https://doi.org/10.1080/09602010802091159
  64. Watkins CL, Auton MF, Deans CF, Dickinson HA, Jack CI, Lightbody CE, et al. Motivational interviewing early after acute stroke: a randomized, controlled trial. Stroke 2007;38:1004-1009. https://doi.org/10.1161/01.STR.0000258114.28006.d7
  65. Smith J, Forster A, House A, Knapp P, Wright J, Young J. Information provision for stroke patients and their caregivers. Cochrane Database Syst Rev 2008:CD001919.
  66. Williams LS, Kroenke K, Bakas T, Plue LD, Brizendine E, Tu W, et al. Care management of poststroke depression: a randomized, controlled trial. Stroke 2007;38:998-1003. https://doi.org/10.1161/01.STR.0000257319.14023.61
  67. Mohlman J, Gorman JM. The role of executive functioning in CBT: a pilot study with anxious older adults. Behav Res Ther 2005;43:447-465. https://doi.org/10.1016/j.brat.2004.03.007