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Neuropsychiatric sequelae of stroke

Key Points

  • Neuropsychiatric sequelae of stroke are often disabling, have a negative effect on stroke recovery, and decrease quality of life

  • Neuropsychiatric disorders after stroke are relatively common: one-third of stroke survivors experience depression, anxiety or apathy; recovery from these disorders is only moderate, and the risk of recurrence is high

  • Some of these disorders are treatable; for example, antidepressants reduce the number and severity of depressive symptoms and episodes and decrease anxiety scores in patients with stroke

  • Research into the pathophysiology of stroke-associated neuropsychiatric disturbances would greatly benefit from improved study design, including incorporation of control groups in functional imaging studies and specification of working hypotheses

  • Pilot studies on the effects of behavioural interventions and large-scale randomized trials of drugs that are safe to use in patients with stroke would improve the management of neuropsychiatric sequelae of stroke

Abstract

Stroke survivors are often affected by psychological distress and neuropsychiatric disturbances. About one-third of stroke survivors experience depression, anxiety or apathy, which are the most common neuropsychiatric sequelae of stroke. Neuropsychiatric sequelae are disabling, and can have a negative influence on recovery, reduce quality of life and lead to exhaustion of the caregiver. Despite the availability of screening instruments and effective treatments, neuropsychiatric disturbances attributed to stroke are currently underdiagnosed and undertreated. Stroke severity, stroke-related disabilities, cerebral small vessel disease, previous psychiatric disease, poor coping strategies and unfavourable psychosocial environment influence the presence and severity of the psychiatric sequelae of stroke. Although consistent associations between psychiatric disturbances and specific stroke locations have yet to be confirmed, functional MRI studies are beginning to unveil the anatomical networks that are disrupted in stroke-associated psychiatric disorders. Evidence regarding biochemical and genetic biomarkers for stroke-associated psychiatric disorders is still limited, and better understanding of the biological determinants and pathophysiology of these disorders is needed. Investigation into the management of these conditions must be continued, and should include pilot studies to assess the benefits of innovative behavioural interventions and large-scale cooperative randomized controlled pharmacological trials of drugs that are safe to use in patients with stroke.

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Figure 1: Major psychosocial and cerebrovascular predictors of stroke-associated depression.
Figure 2: Shift towards the negative pole of personality trait domains after stroke.

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Acknowledgements

This review was partially supported by a post-doctoral grant (“Rehabilitation of apathetic stroke patients”, SFRH/BPD/100399/2014) from the Fundação para Ciência e Tecnologia to Lara Caeiro.

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All authors contributed substantially to the discussion of the content and researched the data for the article. J.M.F. and L.C. wrote and reviewed and/or edited the manuscript before submission.

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Correspondence to José M. Ferro.

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Ferro, J., Caeiro, L. & Figueira, M. Neuropsychiatric sequelae of stroke. Nat Rev Neurol 12, 269–280 (2016). https://doi.org/10.1038/nrneurol.2016.46

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