Brainstem raphe hypoechogenicity is an independent predictor of post-stroke depression

Abstract

Purpose Post-stroke depression (PSD) is a common complication after stroke and has a substantial effect on the quality of life of patients. Nevertheless, reliable individual prediction of PSD is not possible. As depressive symptoms have been associated with brainstem raphe (BR) hypoechogenicity on transcranial sonography (TCS), we aimed to explore the association of BR hypoechogenicity and the occurrence of PSD.

Materials and Methods The Prognostic Markers of Post-Stroke Depression (PROMoSD) study is a prospective, observational, single-center, investigator-initiated study that included patients with acute ischemic stroke (AIS) to investigate the presence of BR hypoechogenicity by TCS early after symptom onset. The primary outcome was the presence of PSD assessed at the three-month follow-up investigation by a blinded psychiatrist and defined according to the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V criteria).

Results From 105 included AIS patients, 99 patients completed the study. AIS patients with a hypoechogenic BR developed a PSD at three months more frequently compared to patients with normal echogenicity (48.0% versus 4.1%, P <0.001). After adjustment for confounders (sex, mRS at follow-up, previous depressive episode), a hypoechogenic BR remained independently associated with a substantial increase in the appearance of PSD (adjusted OR: 6.371, 95%-CI: 1.181–34.362).

Conclusion A hypoechogenic BR is a strong and independent predictor of PSD at three months after AIS. TCS could be a routine tool to assess PSD risk in clinical practice, thereby streamlining diagnostic and therapeutic algorithms.

Zusammenfassung

Ziel Eine zuverlässige Vorhersage einer Post-Stroke Depression (PSD) ist bis heute nicht möglich. Der Nachweis einer hypoechogenen Hirnstammraphe (BR) in der transkraniellen Sonografie (TCS) wurde in verschiedenen Arbeiten mit dem Vorhandensein depressiver Symptome in Verbindung gebracht. Ziel dieser Studie war es, den Zusammenhang zwischen einer hypoechogenen BR und dem Auftreten einer PSD zu untersuchen.

Material und Methode Die PROMoSD-Studie (Prognostic Markers of Post-Stroke Depression) war eine prospektive, monozentrische Beobachtungsstudie. Es wurden Patienten mit einem akuten ischämischen Schlaganfall (AIS) eingeschlossen und frühzeitig nach dem Ereignis auf das Vorhandensein einer hypoechogenen BR untersucht. Der primäre Endpunkt war die Entwicklung einer PSD drei Monate nach dem Indexereignis, welche im Follow-up durch einen verblindeten Untersucher gemäß der DSM-V-Kriterien diagnostiziert wurde.

Ergebnisse Von den 105 eingeschlossenen AIS-Patienten schlossen 99 Patienten die Studie ab. AIS-Patienten mit einer hypoechogenen BR entwickelten häufiger eine PSD als normoechogene Patienten (48,0% vs. 4,1%, P <0,001). In der adjustierten Regressionsanalyse bestätigte sich die hypoechogene BR als unabhängiger Prädiktor für das Auftreten einer PSD (adjustierte OR: 6,371, 95%-KI: 1,181–34,362).

Schlussfolgerungen Ein hypoechogene BR ist ein relevanter und unabhängiger Prädiktor für das Auftreten einer PSD drei Monate nach einem AIS. Die TCS sollte daher in der klinischen Praxis als Routineinstrument zur Beurteilung des PSD-Risikos benutzt werden, um die Versorgung der Patienten durch intensivierte diagnostische oder therapeutische Maßnahmen zu verbessern.

Keywords

Post-stroke depression - Brainstem raphe - TCS - Sonography

Publication History

Received: 12 July 2023

Accepted after revision: 25 March 2024

Article published online:
25 June 2024

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