Poststroke depression and its multifactorial nature: results from a prospective longitudinal study.

OBJECTIVE: Poststroke depression (PSD) is commonly observed in stroke patients and has a negative impact on functional outcome and quality of life. Therefore, a prospective, longitudinal epidemiological study was conducted aiming to determine prevalence and risk factors for PSD at 1, 3, 6, 12 and 18 months poststroke. METHODS: A total of 222 patients were included in the study and 201 patients entered data analysis. Demographic data, vascular risk factors, stroke characteristics, functional and neurocognitive outcome measures and psychosocial factors were considered as potential risk factors for PSD. Clinically significant signs and symptoms of PSD were quantified by means of the Cornell Scale for Depression (CSD) and the Montgomery and Åsberg Depression Rating Scale (MADRS). RESULTS: PSD was present at 1, 3, 6, 12 and 18 months poststroke in 24.5%, 27.1%, 28.3%, 19.8% and 26.3% of the patients respectively. Univariate regression analyses revealed that PSD was significantly associated with stroke severity, physical disability, cognitive impairment and stroke outcome during the 18 months time frame of the study. Reduced social activities and the presence of apraxia were consistently associated with PSD whereas aphasia was only significantly associated in the first 6 months after stroke. Patients with relational problems had a 3 times greater risk of becoming depressed at 18 months poststroke than patients without relational problems (OR=3.09; 95% CI=1.31-7.26). CONCLUSIONS: Risk factors for PSD seem variable indicating the need for clinicians to consider the dynamic and multifactorial nature of PSD emphasizing the importance of a rigorous and long-term monitoring and support of stroke patients and their caregivers.

Psychosocial problems associated with depression at 18 months poststroke.

OBJECTIVE: With a prevalence that varies between 20% and 65%, poststroke depression (PSD) is a frequent sequel of stroke. The aim of this study was to determine incidence and risk factors for PSD 18 months after stroke. METHODS: As part of the Middelheim Interdisciplinary Stroke Study, patients were followed up for 18 months in this prospective and longitudinal epidemiological study. Clinically significant signs and symptoms of PSD were quantified by means of the Cornell Scale for Depression (CSD) and the Montgomery and Åsberg Depression Rating Scale. Activities, including social activities, were measured with the Stroke Impact Scale (SIS). Relational problems since stroke onset were defined by a questionnaire. RESULTS: Data analysis was performed on 125 patients who completed follow-up assessments. Depression (CSD score ≥8) was diagnosed in 28% of the patients. Patients with PSD were more dependent for activities of daily living and displayed more physical and cognitive impairment than patients without PSD. The risk to become depressed decreased with 5% when the patient's activities increased with one unit on the SIS (odds ratio (OR) = 0.95; 95% confidence interval (CI) = 0.93-0.97). Patients with persistent relational problems since stroke onset had approximately four and a half times greater risk of becoming depressed than patients without (OR = 4.48; 95%CI = 1.17-16.87). CONCLUSIONS: Multiple regression models indicated that the most determining features for developing PSD at 18 months poststroke include reduced activity and relationship problems due to stroke. Further studies on risk factors for PSD are essential, including psychosocial aspects, given its negative impact on rehabilitation and quality of life.

A prospective study on the prevalence and risk factors of poststroke depression.

BACKGROUND AND PURPOSE: Poststroke depression (PSD) is common. Early detection of depressive symptoms and identification of patients at risk for PSD are important as PSD negatively affects stroke outcome and costs of medical care. Therefore, the aim of this study was to determine incidence and risk factors for PSD at 3 months after stroke. METHODS: We conducted a prospective, longitudinal epidemiological study aiming to determine incidence and risk factors for PSD at 1, 3, 6, 12 and 18 months poststroke. The present data analysis covers the convalescent phase of 3 months poststroke. Participants in this study were inpatients, admitted to a stroke unit with first or recurrent stroke. Demographic data and vascular risk factors were collected and patients were evaluated at baseline and 3 months poststroke for functional and cognitive deficits, stroke characteristics, stroke severity and stroke outcome. Signs and symptoms of depression were quantified by means of the Cornell Scale for Depression (CSD) and Montgomery and Åsberg Depression Rating Scale (MADRS). Significantly associated variables from univariate analysis were analyzed by using multiple linear and logistic regression methods. RESULTS: Data analysis was performed in 135 patients who completed follow-up assessments at 3 months poststroke. Depression (CSD score ≥8) was diagnosed in 28.1% of the patients. Patients with PSD were significantly more dependent with regard to activities of daily living (ADL) and displayed more severe physical and cognitive impairment than patients without PSD. A higher prevalence of speech and language dysfunction and apraxia were observed in patients with PSD (36.8 and 34.3%, respectively) compared to non-depressed stroke patients (19.6 and 12.4%; p = 0.036 and p = 0.004, respectively). Applying multiple linear regressions, cognitive impairment and reduced mobility as part of the Stroke Impact Scale were independently associated with PSD, as scored using CSD and MADRS (r(2) = 0.269 and r(2) = 0.474, respectively). CONCLUSIONS: The risk of developing PSD is increased in patients with more functional and cognitive impairment, greater dependency with regard to ADL functions and with occurrence of speech and language dysfunctions and apraxia. Multiple regression models indicated that the most determining features for depression risk in the convalescent phase after stroke include reduced mobility and cognitive impairment. Further studies on risk factors for PSD are essential, given its negative impact on rehabilitation and quality of life. Identification of risk factors for PSD may allow more efficacious preventive measures and early implementation of adequate antidepressive treatment.

Interrupted shear of granular media.

The response of a granular material during a stop-and-go shear experiment is investigated using an annular shear cell and silicagel powders of different particle sizes. The experimental results are examined on the basis of the Dieterich-Rice-Ruina model for solid friction. In addition to making this analogy with solid friction, we describe a new instability that is observed when restarting shear, where the powder bed is found to slip and compact for short hold times but only dilates for long hold times. The minimum hold time to restore a non-slip behaviour has been investigated for different size particles and normal loadings. The observed dependencies show analogies between this behaviour and the sliding rearrangements seen above the stick-slip threshold.

Slip events and dilatancy in a sheared fine noncohesive powder.

We present experimental results of the transition from steady-state sliding to oscillatory motion for a fine noncohesive powder, sheared in an annular cell. The onset of instability is compared to the Dieterich-Ruina model for solid friction. We present data showing that at low velocity and close to the transition, the major sliding jumps are preceded by a short or long period of unstable plastic yielding of the granular matter. This ambivalent behavior suggests that the jumps are initiated when the sliding overcomes a critical velocity. During the stick-slip motion, the dilatancy of the powder bed has been also observed: the slippage is associated with a compaction whose value increases with the jump in the friction coefficient.

Instability of a Meniscus Due to Surface Tension Gradient-Driven Flow.

The instability of a meniscus due to a Marangoni flow is investigated in the case of a mixture of two liquids of different volatility and surface tension. We propose a theoretical description of this behavior which predicts the wavelength of the instability, in agreement with the experiments of Vuilleumier et al. performed with ethanol-water mixtures and for isooctane-decane solutions. Copyright 1999 Academic Press.

Gravity and Inertia Effects in Plate Coating.

Coating processes are of technological interest. We focus here on the extraction of a vertical plate out of a wetting liquid. We first summarize the Landau-Levich-Derjaguin theory, including the gravity corrections which have been proposed in particular by White and Tallmadge. We propose a new numerical solution to the problem. Then, we discuss further developments: for liquids of low viscosity, it is shown that above a threshold in capillary number, the film is thickened because of inertia. A simple scaling argument is proposed for predicting the location of the threshold. Copyright 1998 Academic Press.

On the Spreading of an Insoluble Surfactant over a Thin Viscous Liquid Layer

Reported here are results of a theoretical and experimental study of the spreading of an insoluble surfactant over a thin liquid layer. Initial concentrations of surfactant above and below CMC have been considered. If the concentration is above CMC two distinct stages of spreading are found. (i) The first stage is the faster, and it is connected with micelle dissolution; (ii) the second stage is the slower, when the surfactant concentration falls below CMC. In the second stage, the formation of a dry spot in the center of the film is observed. A similarity solution of the corresponding equations for spreading gives good agreement with experimental observations.