Elizabeth M. Aradine, DO
Kapoor A, Si K, Yu AYX, Lanctot KL, Herrmann N, Murray BJ, et al. Younger Age and Depressive Symptoms Predict High Risk of Generalized Anxiety After Stroke and Transient Ischemic Attack. Stroke. 2019;50:2359-2363.
Poststroke anxiety is not uncommon and can negatively affect quality of life. The relationship between stroke and anxiety has been demonstrated, but few studies have included young patients. Furthermore, the presence of premorbid depression is a predictor of poststroke anxiety; however, it is unknown if the absence of depression is a protector against poststroke anxiety. The authors of this study sought to elucidate the effect of age and depression on poststroke or TIA anxiety.
This study was conducted using registry data from the DOC Feasibility Study, a prospective longitudinal cohort of stroke, TIA, and non-stroke patients. Only those with a diagnosis of stroke or TIA were included for analysis in this study. Aphasic patients were excluded. Anxiety was assessed using the Generalized Anxiety Disorder 7-item (GAD-7) scale with a score ≥10 indicating moderate to severe symptoms. Depression was assessed using the Epidemiological Studies Depression Scale (CES-D) with ≥16 indicating moderate to severe symptoms.
257 patients were included, 125 with stroke and 133 with a TIA. 21.7% of patients had a GAD-7 score of ≥10. 25.2% had CES-D scores ≥16. Young patients (<50 years old) and those with CES-D scores ≥16 were more likely to have anxiety after a TIA or stroke. See Figure.
Assessment for depression and anxiety was conducted after the vascular event. The recall bias intrinsic to the study design limits the ability to assess the influence of prestroke depression on poststroke or TIA anxiety. While this study showed that patients with poststroke depression also had anxiety, this result is not surprising as the two diseases are comorbid. It can be presumed that patients with depression and/or anxiety prior to a vascular event would continue to have anxiety. This confounder was not accounted for. Despite these limitations, this study highlights that anxiety after a TIA or stroke is not uncommon and is more commonly seen in young patients. Young patients presenting with an acute focal neurological deficit can easily be dismissed as having functional symptoms, especially if they appear anxious. While anxiety should not be ignored, it must not be the top differential in young patients presenting with an acute focal neurological deficit. A stroke misdiagnosis can delay treatment and alter functional outcome.