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Am J Psychiatry 1991; 148:351-356
Copyright © 1991 by American Psychiatric Association
Depressive symptoms following stroke
RA Stern and DL Bachman
Department of Neurology, Department of Veterans Affairs Medical Center, Boston, Mass.
OBJECTIVE: The primary purpose of this study was to assess the relation of
lesion location to mood and vegetative disturbance following stroke.
METHOD: Fifty-two inpatients and outpatients who had had single, unilateral
strokes were included. Patients with past CNS or psychiatric disorders were
excluded. A modified Visual Analogue Dysphoria Scale was used to allow the
inclusion of all but the most impaired aphasic patients. Sleep and eating
disturbances were measured by using both self-report and nursing
assessments. Location of lesions was determined by CT scan and classified
according to three dimensions: right-left, dorsal-ventral, and
frontal-nonfrontal. RESULTS: On measures of dysphoric mood and sleep
disturbance, results indicated significant three-way interactions among the
three lesion dimensions. No differences were found with regard to eating
disturbance. Greater dysphoria and sleep disturbance were found in subjects
with left parietal/occipital, left inferior frontal, right superior
frontal, and right temporal lesions than in subjects with lesions in other
locations. Depressive symptoms were not associated with functional
impairment as measured by activities of daily living, motor strength, or
severity of aphasia. CONCLUSIONS: These results support the hypothesis that
lesion location is a valid and significant factor in the mixture of
influences which may result in a dysphoric mood state following stroke. The
relation between the site of the lesion and subsequent depressive symptoms,
however, may be more complex than has been reported previously.
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