What is the clinical evidence from this study?

Study design: Observational. Population: Acute ischemic stroke (n=219). Intervention: Acute infarcts in cerebral hemispheric white matter (CHWM) vs. No acute infarcts in CHWM. Primary outcome: Poststroke anxiety (PSA) in the acute stage (OR 2.902, 95% CI 1.052-8.007, p=0.040).

April 17, 2019Open Access

Anxiety in Patients With Acute Ischemic Stroke: Risk Factors and Effects on Functional Status

Key Result

Acute infarcts in cerebral hemispheric white matter significantly increased the risk of poststroke anxiety in the acute stage (OR 2.902), supporting a lesion-location hypothesis.

Study Design

Type

Observational (n=219)

Multicenter

Structured PICO

Do acute infarcts in cerebral hemispheric white matter and depressive symptoms predict post-stroke anxiety and affect functional status in patients with acute ischemic stroke?

Population

219 Chinese patients aged 40 to 80 years with mild-to-moderate acute ischemic stroke, followed for 3 months to assess risk factors and functional impacts of poststroke anxiety.

Comparator

Patients without post-stroke anxiety (HARS score <14)

Outcome

Post-stroke anxiety (PSA) defined by a Hamilton Anxiety Rating Scale (HARS) score >=14 at the acute stage (5-14 days) and at 3 months after stroke.patient reported

Depressive symptoms and acute infarcts in cerebral hemispheric white matter are significant predictors of post-stroke anxiety, which is subsequently associated with poorer activities of daily living and quality of life.

Main Result

Odds Ratio: 2.902 (95% CI 1.052–8.007)

p-value: p=0.040

Limitations

Only patients with mild-to-moderate ischemic stroke without severe cognitive impairment and aphasia were recruited, limiting generalizability.
Did not collect medication or rehabilitation data after discharge.
Used a screening tool (HDRS) rather than a standard psychiatric interview to define PSA.
The associations between PSA and QOL or ADL do not indicate causality due to the observational study design.

Abstract

Background: Anxiety is prevalent after a stroke. The pathophysiological mechanisms underlying the development of poststroke anxiety (PSA) remain unclear. The aim of this study was to investigate the clinical and neuroimaging risk factors for development of PSA and examine the effects of PSA on activities of daily living (ADL) and quality of life (QOL) in Chinese patients with ischemic stroke. Methods: Two hundred and nineteen patients with acute ischemic stroke were recruited to the study. A series of comprehensive assessments, including Hamilton Anxiety Rating Scale (HARS), Hamilton Depression Rating Scale (HDRS), Lawton ADL scale, and the Stroke-Specific Quality of Life Scale (SSQOL), were conducted in the acute stage and three months after stroke. Magnetic resonance imaging assessment focused on evaluation of infarctions, white matter lesions, and brain atrophy. Results: In the acute stage and 3 months after stroke, 34 (16%) and 33 (15%) patients had PSA, respectively. Multiple logistic regression analysis indicated HDRS (OR=1.269, 95% C.I.=1.182-1.364, P<0.001) and acute infarcts in cerebral hemispheric white matter (CHWM) (OR=2.902, 95% C.I.=1.052-8.007, P=0.040) were significant correlates of PSA in the acute stage of stroke. Three months after stroke, these correlates remained significant predictors, along with male sex.Multiple linear regressions showed that age, NIHSS, HARS and HDRS in the acute stage were significant predictors for both ADL and SSQOL at 3 months after stroke. Conclusion: Depressive symptoms are the major correlates of PSA while more severe PSA is associated with poorer ADL and health-related QOL. Acute lesions involving CHWM may correlate with PSA with mild-to-moderate neurologic deficits, supporting a lesion-location hypothesis in PSA.

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