Volume 28, Issue 6 pp. 1949-1957
ORIGINAL ARTICLE

Early apathetic, but not depressive, symptoms are associated with poor outcome after stroke

Anna Maria Lopatkiewicz

Anna Maria Lopatkiewicz

Department of Neurology, Jagiellonian University Medical College, Krakow, Poland

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Joanna Pera

Joanna Pera

Department of Neurology, Jagiellonian University Medical College, Krakow, Poland

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Agnieszka Slowik

Agnieszka Slowik

Department of Neurology, Jagiellonian University Medical College, Krakow, Poland

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Tomasz Dziedzic

Corresponding Author

Tomasz Dziedzic

Department of Neurology, Jagiellonian University Medical College, Krakow, Poland

Correspondence

Tomasz Dziedzic, Department of Neurology, Jagiellonian University Medical College, 31-503 Kraków, ul. Botaniczna 3, Poland.

Emails: [email protected]; [email protected]

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First published: 22 February 2021
Citations: 15

Funding information

This study was supported by a grant from the National Science Center (2015/19/B/NZ4/00287).

Abstract

Background and purpose

Depression and apathy are frequent neuropsychiatric disturbances after stroke and may appear together. Despite the overlap in symptoms between poststroke depression and apathy, these two syndromes might be associated with different prognoses and benefit from different treatments. We aimed to disentangle the relationship between early depressive and apathetic symptoms and outcome after stroke.

Methods

Of 698 enrolled patients with ischemic stroke, we included 443 participants (median age = 69 years, 51% female) who underwent depressive and apathetic symptom assessment on Day 8 after stroke. We divided patients into four groups: without greater depressive and apathetic symptoms (Group 1), with only apathetic symptoms (Group 2), with only depressive symptoms (Group 3), and with both depressive and apathetic symptoms (Group 4).

Results

After adjusting for age and stroke severity, Group 2 and Group 4 had an increased risk of poor 3-month outcome (odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.16–3.38, p = 0.01 and OR = 1.58, 95% CI = 1.24–2.01, p < 0.01, respectively). Group 2 and Group 4 also had an increased risk of poor 12-month outcome (OR = 3.85, 95% CI = 2.19–6.78, p < 0.01 and OR = 1.54, 95% CI = 1.22–1.96, p < 0.01, respectively) and mortality (hazard ratio [HR] = 2.76, 95% CI = 1.19–6.41, p = 0.02 and HR = 1.77, 95% CI = 1.32–2.38, p < 0.01, respectively). Compared with Group 1, Group 3 did not have an increased risk of unfavorable outcomes.

Conclusions

Early apathetic, but not depressive, symptoms are related to worse outcomes after stroke. Our study underscores the importance of recognizing apathetic symptoms independently from depressive symptoms.

CONFLICT OF INTEREST

None.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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