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Am Fam Physician. 2000;61(1):215

Approximately one third of stroke survivors experience poststroke depression, with early and late onset. One dilemma in determining the incidence of poststroke depression is that some of the symptoms used to classify depression in the Diagnostic and Statistical Manual of Mental Disorders, 3d ed (DSM-III) can be the direct result of brain damage incurred from the stroke. Depression can also have a significant impact on poststroke rehabilitation. Paolucci and colleagues studied the prevalence of poststroke depression, the prognostic factors associated with it and the impact this depression has on rehabilitation.

The study was a prospective evaluation of patients admitted for rehabilitation of neurologic sequelae of a first stroke. The diagnosis of stroke was based on history, clinical examination and neuroimaging. Patients with a previous history of depression or stroke, presence of a language disorder or severe cognitive dysfunction were excluded from the study. Patients were evaluated on admission with a clinical interview, the Hamilton Rating Scale for Depression, observation of behavior by health care providers and conversations with family members and friends of the patient. Repeat observations were performed after one week to eliminate depression caused by the adjustment to hospitalization. Baseline neurologic and functional assessments were also performed. The rehabilitation program was consistent with a standardized protocol.

Of the 470 patients enrolled in the study, 129 (27.4 percent) experienced poststroke depression. Factors associated with a higher risk for depression included female sex and high school (or higher) education. There were no significant differences between the depressed group and the nondepressed group with regard to rehabilitation parameters, but the depressed group did have significantly lower activities of daily living scores.

The authors conclude that poststroke depression is common among patients, with women and persons who have more education being at higher risk. Identification and treatment of poststroke depression can have a significant impact on patients' ability to rehabilitate after this neurologic event.

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