Does Cerebral White Matter Disease Predict Post-stroke Fatigue or Depression in an Afro-Caribbean Cohort?
Jonathan Solis Ramirez1, Yohannes Mulatu1, Nadege Gilles1, Steven Levine1
1SUNY Downstate Medical Center
Objective:
To determine the relationship between white matter disease (WMD) severity and the development of post-stroke fatigue or depression in patients from minority groups.
Background:
Fatigue and depression frequently occur after ischemic stroke and are associated with worse Health-Related Quality of Life. While there has been research on the correlation between the burden of WMD and the onset of depressive symptoms, this relationship has yet to be validated in patients with stroke from minority groups.
Design/Methods:
An IRB-approved retrospective, cross-sectional study. The study sampled a cohort of patients aged ≥18 years old who had stroke within the last 3 years and were assessed with standardized questionnaires for fatigue (Fatigue Assessment Scale [FAS], range 10-50) and depression (Beck’s Depression Inventory, range 0-63). Patients with available MRI were evaluated using a validated visual scale to grade WMD (Fazekas scale, range 0-3). Grading was conducted blinded to patient's fatigue and depression scores. The collected ordinal data presented a non-parametric distribution thus was analyzed using the Spearman correlation coefficient.
Results:
Of 72 patients with available MRI, 96% were African or Caribbean; mean age = 66, median FAS score = 19 (IQR 14-26), and median BDI score = 6 (IQR 2-11). The prevalence of stroke-related disability (modified ranking scale ≥ 2) was 38%. Within the Fazekas grading, the score was 0 in 12.4%, 1 in 41.4%, 2 in 31.7%, and 3 in 13.8%. Spearman coefficients showed non significant associations between WMD severity and either depression (Rs=0.058, p=0.62, 95%CI -0.17,0.29) or fatigue (Rs=0.059, p=0.62, 95% CI -0.18,0.30).
Conclusions:
Our results suggest no association between WMD severity and the development of post-stroke fatigue or depression in an Afro-Caribbean population. However, the lack of statistical significance might be due to limited sample size and patient heterogeneity, since few patients exhibited high fatigue and depression scores. Further research is needed to confirm these findings.