Adjunctive restorative therapies administered during the first few months after stroke, the period with the greatest degree of spontaneous recovery, reduce the number of stroke patients with significant disability.To examine the effect of escitalopram on cognitive outcome. We hypothesized that patients who received escitalopram would show improved performance in neuropsychological tests assessing memory and executive functions than patients who received placebo or underwent Problem Solving Therapy.Randomized trial.Stroke center.One hundred twenty-nine patients were treated within 3 months following stroke. The 12-month trial included 3 arms: a double-blind placebo-controlled comparison of escitalopram (n = 43) with placebo (n = 45), and a nonblinded arm of Problem Solving Therapy (n = 41).Change in scores from baseline to the end of treatment for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Trail-Making, Controlled Oral Word Association, Wechsler Adult Intelligence Scale-III Similarities, and Stroop tests.We found a difference among the 3 treatment groups in change in RBANS total score (P < .01) and RBANS delayed memory score (P < .01). After adjusting for possible confounders, there was a significant effect of escitalopram treatment on the change in RBANS total score (P < .01, adjusted mean change in score: escitalopram group, 10.0; nonescitalopram group, 3.1) and the change in RBANS delayed memory score (P < .01, adjusted mean change in score: escitalopram group, 11.3; nonescitalopram group, 2.5). We did not observe treatment effects in other neuropsychological measures.When compared with patients who received placebo or underwent Problem Solving Therapy, stroke patients who received escitalopram showed improvement in global cognitive functioning, specifically in verbal and visual memory functions. This beneficial effect of escitalopram was independent of its effect on depression. The utility of antidepressants in the process of poststroke recovery should be further investigated. Trial Registration clinicaltrials.gov Identifier: NCT00071643.
Abstract For more than 100 years clinicians have recognized that language functions are frequently disrupted by unilateral lesions of the left hemisphere (Broca 1861). For almost the same length of time clinicians have recognized that specific emotional disorders are associated with unilateral brain injury (Kraepelin 1921, Meyer 1904). Some of these emotional disorders have also been lateralized or associated with lesions of one hemisphere. In 1922, Babinski noted that indifference or euphoric reactions can follow right hemisphere cerebral damage. This disorder was later termed the 'indifference reaction' by Hecaen (1951) and Denny-Brown, Meyer and Horenstein (1952). Depression, which is the most common emotional disorder following brain lesions has frequently, but not always, been associated with dominant hemisphere lesions (Gainotti 1972, Folstein, Maiberger and McHugh 1977).
The aims of this study were (i) to determine the frequency of emotional lability following first ever stroke, and (ii) to identify factors associated with this condition. Sixty-six consecutive inpatients with first ever stroke were surveyed two months post stroke for the presence of emotional lability. Demographic, clinical, psychiatric and stroke lesion characteristics were also assessed. Emotional lability was present in 12 of the 66 patients (prevalence: 18%). Emotional lability occurred independently of post stroke depression. Single lesions located in anterior regions of the cerebral hemispheres had four times the odds of emotional lability than lesions located anywhere else (p<0.05). Emotional lability is a common emotional-behavioural syndrome following stroke and is probably a separate condition from post stroke depression. The aetiology of this condition is possibly related to the consequences of injury to anterior regions of the cerebral hemispheres.
Dexamethasone suppression tests (DSTs) were given to 65 acute and chronic stroke patients. For patients who had had a stroke less than 1 year earlier, nonsuppression on the DST was significantly associated with the presence of poststroke depression. The authors, who used the DSM-III symptom criteria for major depression, found that DST sensitivity was 67% but specificity was only 70%. False positive tests in the stroke patients seemed related to large lesion volume. The DST, although of limited clinical utility in this population because of false positive tests, may help define more homogeneous subtypes of poststroke depression for research.
