Dimensions of post-stroke depression and neuropsychological deficits in older adults

ABSTRACT Objective Post-stroke depression (PSD) has a heterogeneous presentation and is often accompanied by cognitive impairment. This study aimed to identify distinct dimensions of depressive symptoms in older adults with PSD and to evaluate their relationship to cognitive functioning. Design Cross-sectional factor and correlational analyses of patients with post-stroke depression. Setting Patients were recruited from the community and from acute inpatient stroke rehabilitation hospitals. Participants Participants had suffered a stroke and met DSM-IV criteria for major depression (≥18 Montgomery Asberg Depression Scale; MADRS). Intervention None Measurements MADRS was used to quantify depression severity at study entry. Neuropsychological assessment at the time of study entry consisted of measures Global Cognition, Attention, Executive Function, Processing Speed, Immediate Memory, Delayed Memory, and Language. Results The participants were 135 older adults (age ≥50) with PSD and varying degrees of cognitive impairment (MMSE Total ≥ 20). Factor analysis of the MADRS identified three factors, i.e. Sadness, Distress, and Apathy. Items comprising each factor were totaled and correlated with neuropsychological domain z-score averages. Symptoms of the apathy factor (lassitude, inability to feel) were significantly associated with greater impairment in executive dysfunction, memory, and global cognition. Symptoms of the sadness and distress factors had no relationship to cognitive impairment. Conclusions PSD consists of three correlated dimensions of depressive symptoms. Apathy symptoms are associated with cognitive impairment across several neuropsychological domains. PSD patients with prominent apathy may benefit from careful attention to cognitive functions and by interventions that address both psychopathology and behavioral deficits resulting from cognitive impairment.