24 Poststroke Depression in Patients with Infratentorial Stroke Undergoing Acute Inpatient Stroke Rehabilitation

Abstract

Objective:

Poststroke depression is common in those with stroke and is associated with worse functional outcomes, recurrence of stroke, and increased mortality. Poststroke depression has been most commonly associated with lesions of the frontal lobe and anterior regions of the brain, in addition to lesions in subcortical structures. Yet, there is also evidence that indicates the presence of depressive symptoms in those with infratentorial (including brainstem, pontine, and cerebellar) stroke, which may be mediated by alternative pathophysiologic mechanisms. Patients undergoing acute inpatient stroke rehabilitation may present with depressive symptoms that go unassessed or untreated throughout their recovery, including those with infratentorial stroke. The current objective was to evaluate the degree of depressive symptoms in patients with infratentorial stroke compared to those with supratentorial stroke.

Participants and Methods:

Participants were admitted to an acute inpatient rehabilitation unit for stroke rehabilitation. Participants were enrolled in an ongoing clinical trial. Participants with recent infratentorial stroke (N = 7; 4 female; Median age = 69 years; Median education = 16 years) were administered the Patient Health Questionnaire-9 (PHQ-9) to assess symptoms of depression. Severity of depressive symptoms (PHQ-9 total score) in participants with infratentorial stroke was compared to those with supratentorial stroke (N = 19; 10 female; Median age = 69 years; Median education = 15 years) through Mann-Whitney U tests.

Results:

Participants with infratentorial stroke endorsed similar levels of depression to those with supratentorial stroke. Participants with infratentorial stroke endorsed overall mild depressive symptoms (Mean PHQ-9 score = 7.29; Median = 7), similar to those with supratentorial stroke (Mean PHQ-9 score = 7.11; Median = 6). Significant differences in depressive symptoms were not observed between participants with infratentorial and supratentorial stroke (p = .785).

Conclusions:

Patients with infratentorial and supratentorial stroke may experience a similar degree of poststroke depression. Despite differences in suspected pathophysiologic mechanisms, infratentorial and supratentorial stroke appear to influence depressive symptoms to a similar extent. While future analyses with larger sample sizes are indicated, the current study indicates that patients with infratentorial and supratentorial stroke should be evaluated for depressive symptoms during the acute phases of recovery to inform treatment and potentially improve outcomes.