Post-stroke depression: systematic review on pre- and post-stroke clinical and neuroimaging correlates

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Many studies have described the frequency and risk factors of post-stroke depression/depressive symptoms, although they often lack assessment of confounders (such as depression in the medical history, white matter lesions and atrophy) that may be related to depression, independent from the stroke. Therefore, we have systematically reviewed the available data on post-stroke depression by taking the previously mentioned confounding factors into account. We performed a systematic PubMed and EMBASE search with the following medical subject heading terms and keywords: ‘cerebrovascular disorder’, ‘brain infarction’ and ‘depression’. The search yielded 1796 papers; 107 fulfilled inclusion criteria. Patients with post-stroke physical/cognitive impairment or depression in their medical history had the highest prevalence of post-stroke depression/depressive symptoms. There were almost no studies that adjusted for confounders in multivariate analysis. This study reviews the largest number of papers in this area thus far. We found that psychiatric or depressive disorders in medical history or post-stroke physical limitations are related with post-stroke depression/depressive symptoms rather than stroke specific (e.g., location or size) factors. Virtually no study reported adjustment for confounding factors.

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