Associations of Depression and Cognition in Acute, Chronic, and Recurrent Cerebrovascular Accidents: A Cross-sectional Study

Abstract

Background: About 10% of first-time strokes and 30% of recurrent strokes develop into post-stroke cognitive impairment and are severe when associated with post-stroke depression. Objectives: To examine the association of depression and cognitive impairment in patients after a stroke in acute, subacute, or chronic phases. Methods: Cross-sectional data of CT/MRI brain-confirmed stroke patients was obtained after protocol approval by the ethics committee. Socio-demographic data, the Patient Health Questionnaire (PHQ9), the Addenbrooke Cognitive Examination (ACE3), and the Barthel Index for Activities of Daily Living were administered. Normality assumptions and frequencies with percentages were assessed for continuous data. One-way ANOVA for group comparisons and Spearman’s nonparametric correlation with matrix plot display were done. Results: Stroke patients (13 with acute, 8 each with chronic and recurrent) aged 46–80 years were recruited. Higher Barthel Index scores across all groups were seen. Mean PHQ9 scores were in the moderate depression range with no differences among groups. The mean (SD) ACE3 attention score in acute cerebrovascular accident (CVA), 13.62 (2.76), was significantly higher than in chronic CVA, 9.63 (5.50). ACE3 language score was 20.15 (3.72) in acute CVA and 14.75 (6.84) in chronic CVA. Significant negative correlations were seen in ACE3 Memory in acute –.56 and in chronic cases- Attention –.76, Memory –.79, Fluency –.76. All CVA groups had moderate depression. Chronic CVA impacts cognition associated with depression more than other groups. Conclusion: The study shows a need for the assessment of cognitive impairments and depression for CVAs even where activities of daily living were better.