Prevalence of anxiety and depression following small subcortical ischemic stroke and their association with MRI-defined brain damage: The DHU-LAC cohort study

• We found a high prevalence of anxiety and depression in a clinically homogeneous cohort of patients with minor stroke. • Lower levels of anxiety and depression—even among patients who had achieved near-complete recovery—were still associated with better cognitive outcomes and higher perceived quality of life. • Despite the homogeneity of this cohort, no imaging markers were identified as significant predictors of elevated anxiety or depression six months after stroke. : Data on imaging predictors of anxiety and depression remain limited in patients with minor stroke. We aimed to evaluate their prevalence six months after minor stroke and to determine whether MRI markers can help identify patients at increased risk. : DHU-LAC is an ongoing multicentre prospective French study including patients with minor ischaemic stroke likely due to cerebral small vessel disease. Anxiety and depression were assessed at baseline and 6 months using the Hospital Anxiety and Depression Scale (HADS-A and HADS-D; scores≥8 indicating mild, ≥11 moderate symptoms). Disability was measured with the modified Rankin Scale (mRS), global cognition with the Montreal Cognitive Assessment (MOCA), and quality of life with the EQ-5D. Brain damage on MRI was assessed via the CSVD score. Predictors of HADS-A and HADS-D were explored using linear mixed-effects models. : Among 163 patients (mean age 63±11 years; 28% women), residual disability was minimal at 6 months (median mRS [interquartile range]: 1 [0.5–1.5]). At that time, 40% of patients showed mild to moderate anxiety scores, and 19% mild to moderate depression scores. In multivariable models, lower anxiety and depression scores were associated with better EQ-5D (β=–0.045, p<0.001; β =–0.13, p=0.021 respectively) and MOCA (β=–0.058, p<0.001; β=–0.11, p=0.028) scores. No consistent clinical or imaging predictors of elevated anxiety or depression scores were identified. : Anxiety and depression are common after minor stroke despite minimal physical disability. The absence of clear imaging or clinical predictors highlights the importance of systematic psychological screening, even in patients with minor stroke.