O impacto do primeiro acidente vascular encefálico isquêmico em funções cognitivas e sintomas depressivos
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Data
2019-08-13
Autores
Siqueira, Glória Stefania Alves
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Universidade Estadual Paulista (Unesp)
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Introdução: O acidente vascular encefálico isquêmico (AVEi) te m elevada incidência (85% dos casos) e associa-se a déficits cognitivos e afetivos. Contudo, é difícil determinar se tais disfunções decorrem da idade ou do insulto, uma vez que o AVEi é frequente em pessoas idosas, com baixa escolaridade e, eventualmente, com insultos recidivos. Objetivo: Avaliar os sintomas depressivos e déficits mnemônicos em pacientes pós-acidente vascular encefálico isquêmico, controlando variáveis confundidoras, acompanhando a evolução destes pacientes em dois tempos: tempo 1 (T1) até três meses pósinsulto neurológico e tempo 2 (T2), passados seis meses. Material e Métodos: Estudo neuropsicológico caso-controle prospectivo. Foram recrutados 30 pacientes pós-AVEi e 30 controles saudáveis. O Grupo Caso (Gca) se caracterizou por: i) primeiro episódio de AVEi, ii) idade entre 18-59 anos, iii) escolaridade ≥ 4 anos, e iv) ocorrência do insulto ≤ 100 dias v) ausência de outros transtornos neuropsiquiátricos. O Grupo Controle (GCo) constituiu-se de indivíduos saudáveis pareados quanto ao sexo, idade e escolaridade. A avaliação neuropsicológica incluiu dados socioeconômicos, memória episódica verbal e visual, memória operacional auditivo-verbal e visuoespacial, rastreio do funcionamento cognitivo geral, sintomas depressivos e qualidade de vida. Resultados e Discussão: A média etária do GCa foi M= 45,7 (dp 11,2) anos e do GCo M= 45,6 (11,1) anos, de escolaridade foi M= 7,4 (2,7) anos e M= 7,1 (2,6) anos respectivamente. Quanto ao funcionamento cognitivo geral, houve prejuízos no GCa, em comparação ao GCo (p=0,01) em ambos os tempos. Também houve diferenças entre os grupos na memória episódica verbal (p=0,01) e visual (p=0,01) tanto para evocação imediata quanto tardia. Porém, não foram encontradas diferenças para memória operacional fonológica e visuoespacial. GCa obteve menores níveis de qualidade de vida (p=0,01), assim como mais casos de depressão (p=0,01). Apesar disto, foi observado melhora do GCa na memória episódica verbal (p=0,01), e em evocação imediata para memória episódica visual (p=0,01) em T2. Apesar de verificar aumento nos escores das avaliações referentes ao funcionamento cognitivo geral (p=0,03) e qualidade de vida (p = 0,05), não houve melhora em algum subdomínio específico. Sintomas depressivos foram associados à lesão e idade em T2. Conclusão: Ao controlar variáveis como idade, escolaridade e lesão encefálica, os resultados demonstraram que pacientes com o primeiro AVEi têm redução significativa em seu funcionamento cognitivo geral, principalmente relacionado à memória episódica verbal e visual, assim como pior qualidade de vida do que a população em geral. O estado cognitivo após o AVEi, em adultos, parece estar relacionado com a redução da qualidade de vida e sintomas depressivos.
Introduction: Ischemic Stroke has a high incidence (85% of cases) and is associated with cognitive and affective deficits. However, it is difficult to determine whether such dysfunctions stem from age or insult because stroke is frequent in the elderly, with low schooling, and sometimes with recidive insults. Objective: To evaluate depressive symptoms and mnemonic deficits in patients after ischemic stroke, controlling confounding variables, following the evolution of these patients in two periods: time 1 (T1) to three months post neurological insult and time 2 (T2), after six months. Material and Methods: Prospective case-control neuropsychological study. We recruited 30 post-stroke patients and 30 healthy controls. The Case Group (Gca) was characterized by: i) first episode of stroke, ii) age between 18-59 years, iii) schooling ≥ 4 years, and iv) occurrence of insult ≤ 100 days v) absence of other neuropsychiatric disorders. The Control Group (CG) was composed of healthy individuals matched for sex, age and schooling. Neuropsychological assessment included socioeconomic data, verbal and visual episodic memory, auditory-verbal and visuospatial working memory, screening of general cognitive functioning, depressive symptoms and quality of life. Results and Discussion: The mean age of the GCa was M = 45.7 (dp 11.2) years and the GCo, M = 45.6 (11.1) years, schooling was M = 7.4 (2.7 ) years and M = 7.1 (2.6) years, respectively. Regarding general cognitive functioning, there were losses in the GCa, in comparison to the GCo (p = 0.001) in both times. There were also differences between groups in verbal (p = 0.001) and visual (p = 0.001) episodic memory for both immediate and late recall. However, no differences were found for phonological and visuospatial operational memory. GCa had lower levels of quality of life (p = 0.001), as well as more cases of depression (p = 0.001). Despite this, it was observed an improvement in the GCa in verbal episodic memory (p = 0.001), and in immediate recall for visual episodic memory (p = 0.001) in T2. Although there was an increase in the scores of evaluations regarding general cognitive functioning (p = 0.003) and quality of life (p = 0.05), there was no improvement in any specific subdomain. Depressive symptoms were associated with lesion and age at T2. Conclusion: When controlling for variables such as age, schooling and brain injury, the results showed that patients with the first stroke had a significant reduction in their general cognitive functioning, mainly related to verbal and visual episodic memory, as well as worse quality of life than population. The cognitive status after ischemic stroke in adults seems to be related to reduce quality of life and depressive symptoms.
Introduction: Ischemic Stroke has a high incidence (85% of cases) and is associated with cognitive and affective deficits. However, it is difficult to determine whether such dysfunctions stem from age or insult because stroke is frequent in the elderly, with low schooling, and sometimes with recidive insults. Objective: To evaluate depressive symptoms and mnemonic deficits in patients after ischemic stroke, controlling confounding variables, following the evolution of these patients in two periods: time 1 (T1) to three months post neurological insult and time 2 (T2), after six months. Material and Methods: Prospective case-control neuropsychological study. We recruited 30 post-stroke patients and 30 healthy controls. The Case Group (Gca) was characterized by: i) first episode of stroke, ii) age between 18-59 years, iii) schooling ≥ 4 years, and iv) occurrence of insult ≤ 100 days v) absence of other neuropsychiatric disorders. The Control Group (CG) was composed of healthy individuals matched for sex, age and schooling. Neuropsychological assessment included socioeconomic data, verbal and visual episodic memory, auditory-verbal and visuospatial working memory, screening of general cognitive functioning, depressive symptoms and quality of life. Results and Discussion: The mean age of the GCa was M = 45.7 (dp 11.2) years and the GCo, M = 45.6 (11.1) years, schooling was M = 7.4 (2.7 ) years and M = 7.1 (2.6) years, respectively. Regarding general cognitive functioning, there were losses in the GCa, in comparison to the GCo (p = 0.001) in both times. There were also differences between groups in verbal (p = 0.001) and visual (p = 0.001) episodic memory for both immediate and late recall. However, no differences were found for phonological and visuospatial operational memory. GCa had lower levels of quality of life (p = 0.001), as well as more cases of depression (p = 0.001). Despite this, it was observed an improvement in the GCa in verbal episodic memory (p = 0.001), and in immediate recall for visual episodic memory (p = 0.001) in T2. Although there was an increase in the scores of evaluations regarding general cognitive functioning (p = 0.003) and quality of life (p = 0.05), there was no improvement in any specific subdomain. Depressive symptoms were associated with lesion and age at T2. Conclusion: When controlling for variables such as age, schooling and brain injury, the results showed that patients with the first stroke had a significant reduction in their general cognitive functioning, mainly related to verbal and visual episodic memory, as well as worse quality of life than population. The cognitive status after ischemic stroke in adults seems to be related to reduce quality of life and depressive symptoms.
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Avaliação neuropsicológica, Acidente Vascular Cerebral, Depressão, Comprometimento cognitivo, Neuropsychological evaluation, Stroke, Depression, Cognitive impairment