Trajectories of poststroke depression among older adults.

Abstract

Background: Depression, a common outcome following stroke, has been repeatedly associated with poststroke cognitive deficits and is inversely associated with prestroke cognitive functioning or cognitive reserve. In particular, affected executive functioning has been linked to poststroke depression severity whereas preserved executive functioning is associated with poststroke recovery. Moreover, a growing body of research has demonstrated distinct prototypical trajectories of depression following major medical events. This work has consistently indicated that resilience, or a stable trajectory of healthy adjustment following adverse or potentially traumatic events, is the most common outcome.

Objective: To examine trajectories of poststroke depression and their associations with prestroke cognitive functioning.

Design: Secondary longitudinal data analysis of a large cohort study.

Setting: Institutional; RAND Health and Retirement Study sponsored by the University of Michigan and the National Institute on Aging.

Participants: Participants (N = 2298) were drawn from a national, longitudinal dataset of older adults who experienced a stroke and survived for at least 2 years afterward.

Interventions: Not applicable.

Main outcome measures: Depression was assessed via a modified version of the Center for Epidemiologic Studies Depression Scale Short Form.

Results: Results showed that resilience was the most common outcome (65.5% of the sample) following stroke and was associated with greater prestroke working memory (p < .001), age (p < .001), and gender (p < .001).

Conclusions: Stroke survivors demonstrate the same depression trajectory patterns as observed following other major medical events. These results help illuminate the longitudinal relationship between working memory and poststroke depression and potentially inform interventions. Additional research is required to understand how these findings may be applied in clinical settings.