Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2015

Open Access 01-12-2015 | Research article

Apathy and suicide-related ideation 3 months after stroke: a cross-sectional study

Authors: Wai Kwong Tang, Lara Caeiro, Chieh Grace Lau, Huajun Liang, Vincent Mok, Gabor S Ungvari, Ka Sing Wong

Published in: BMC Neurology | Issue 1/2015

Login to get access

Abstract

Background

Both apathy and suicide are common in poststroke patients. However, the association between poststroke apathy and suicide-related ideation (SI) in Chinese stroke patients is not clear and poorly understood. The aim of this study was to examine the association between apathy and SI in stroke.

Methods

A cross-sectional study was conducted to investigate the association in 518 stroke survivors from Acute Stroke Unit of the Prince of Wales Hospital in Hong Kong. Geriatric Mental State Examination-Version A (GMS) and Neuropsychiatric Inventory-apathy subscale (NPI-apathy) were employed to assess poststroke SI and apathy, respectively. Patients’ clinical characteristics were obtained with the following scales: the National Institutes of Health Stroke Scale (NIHSS), the Mini-Mental State Examination (MMSE), and the Geriatric Depression Scale (GDS).

Results

Thirty-two (6.2%) stroke survivors reported SI. The SI group had a significantly higher frequency of NPI-apathy than the non-SI group (31.2% vs 5.3%, p < 0.001). The SI group also had higher GDS scores (10.47 ± 3.17 vs 4.24 ± 3.71, p < 0.001). Regression analysis revealed that NPI-apathy (OR 2.955, 95% CI 1.142-7.647, p = 0.025) was a significant predictor of SI. The GDS score also predicted SI (OR 1.436, 95% CI 1.284-1.606, p < 0.001).

Conclusions

The current findings show that poststroke apathy is an independent predictor of SI 3 months after stroke. Early screening for and intervention targeting apathy through medication and psychological treatments may be necessary to improve stroke patients’ apathy and reduce SI.
Literature
1.
Silverman MM, Berman AL, Sanddal ND, O'Carroll PW, Joiner TE. Rebuilding the Tower of Babel: a revised nomenclature for the study of suicide and suicidal behaviors. Part 2: suicide-related ideations, communications, and behaviors. Suicide Life Threat Behav. 2007;37:264–77.CrossRefPubMed
2.
Santos CO, Caeiro L, Ferro JM, Figueira ML. A study of suicidal thoughts in acute stroke patients. J Stroke Cerebrovasc Dis. 2012;21:749–54.CrossRefPubMed
3.
Kishi Y, Kosier JT, Robinson RG. Suicidal plans in patients with acute stroke. J Nerv Ment Dis. 1996;184:274–80.CrossRefPubMed
4.
Pohjasvaara T, Vataja R, Leppavuori A, Kaste M, Erkinjuntti T. Suicidal ideas in stroke patients 3 and 15 months after stroke. Cerebrovasc Dis. 2001;12:21–6.CrossRefPubMed
5.
6.
Tang WK, Lu JY, Liang H, Chan TT, Mok V, Ungvari GS, et al. Is insomnia associated with suicidality in stroke? Arch Phys Med Rehabil. 2011;92:2025–7.CrossRefPubMed
7.
Forsstrom E, Hakko H, Nordstrom T, Rasanen P, Mainio A. Suicide in patients with stroke: a population-based study of suicide victims during the years 1988–2007 in northern Finland. J Neuropsychiatry Clin Neurosci. 2010;22(2):182–7.CrossRefPubMed
8.
9.
Hama S. Post-stroke depression and apathy. High Brain Funct Res. 2010;30:285–98.CrossRef
10.
Hama S, Yamashita H, Yamawaki S, Kurisu K. Post-stroke depression and apathy: interactions between functional recovery, lesion location, and emotional response. Psychogeriatrics. 2011;11:68–76.CrossRefPubMed
11.
12.
Angelelli P, Paolucci S, Bivona U, Piccardi L, Ciurli P, Cantagallo A, et al. Development of neuropsychiatric symptoms in poststroke patients: a cross-sectional study. Acta Psychiatr Scand. 2004;110:55–63.CrossRefPubMed
13.
Brodaty H, Sachdev PS, Withall A, Altendorf A, Valenzuela MJ, Lorentz L. Frequency and clinical, neuropsychological and neuroimaging correlates of apathy following stroke - the Sydney Stroke Study. Psychol Med. 2005;35:1707–16.CrossRefPubMed
14.
Jorge RE, Starkstein SE, Robinson RG. Apathy following stroke. Can J Psychiatry. 2010;55:350–4.PubMed
15.
Mayo NE, Fellows LK, Scott SC, Cameron J, Wood-Dauphinee S. A longitudinal view of apathy and its impact after stroke. Stroke. 2009;40:3299–307.CrossRefPubMed
16.
Santa N, Sugimori H, Kusuda K, Yamashita Y, Ibayashi S, Iida M. Apathy and functional recovery following first-ever stroke. Int J Rehabil Res. 2008;31:321–6.CrossRefPubMed
17.
Starkstein SE, Fedoroff JP, Price TR, Leiguarda R, Robinson RG. Apathy following cerebrovascular lesions. Stroke. 1993;24:1625–30.CrossRefPubMed
18.
Charlifue SW, Gerhart KA. Behavioral and demographic predictors of suicide after traumatic spinal cord injury. Arch Phys Med Rehabil. 1991;72:488–92.PubMed
19.
Hubers AA, Reedeker N, Giltay EJ, Roos RA, van Duijn E, van der Mast RC. Suicidality in Huntington’s disease. J Affect Disord. 2012;136:550–7.CrossRefPubMed
20.
Chiu HFK, Lee HC, Chung WS, Kwong PK. Reliability and validity of the Cantonese version of the mini-mental state examination: a preliminary study. Hong Kong J Psychiatr. 1994;4:25–8.
21.
Brott T, Adams Jr HP, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989;20:864–70.CrossRefPubMed
22.
Copeland JR, Dewey ME, Henderson AS, Kay DW, Neal CD, Harrison MA, et al. The Geriatric Mental State (GMS) used in the community: replication studies of the computerized diagnosis AGECAT. Psychol Med. 1988;18:219–23.CrossRefPubMed
23.
Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology. 1994;44:2308–14.CrossRefPubMed
24.
Hsieh CJ, Chu H, Cheng JJ, Shen WW, Lin CC. Validation of apathy evaluation scale and assessment of severity of apathy in Alzheimer’s disease. Psychiatry Clin Neurosci. 2012;66:227–34.CrossRefPubMed
25.
Zhao H, Zhao Z, Huang L, Preter M. Diagnosis and assessment of apathy in Chinese patients with Alzheimer’s disease. J Psychosom Res. 2012;72:405–7.CrossRefPubMed
26.
Leung VP, Lam LC, Chiu HF, Cummings JL, Chen QL. Validation study of the Chinese version of the neuropsychiatric inventory (CNPI). Int J Geriatr Psychiatry. 2001;16:789–93.CrossRefPubMed
27.
Tang WK, Chan SS, Chiu HF, Wong KS, Kwok TC, Mok V, et al. Can the Geriatric Depression Scale detect poststroke depression in Chinese elderly? J Affect Disord. 2004;81:153–6.CrossRefPubMed
28.
29.
Bass DS, Attix DK, Phillips-Bute B, Monk TG. An efficient screening tool for preoperative depression: the Geriatric Depression Scale-Short Form. Anesth Analg. 2008;106:805–9.CrossRefPubMed
30.
Chan AC. Clinical validation of the Geriatric Depression Scale (GDS): Chinese version. J Aging Health. 1996;8:238–53.CrossRefPubMed
31.
Tang WK, Chen YK, Liang HJ, Chu WC, Mok VC, Ungvari GS, et al. Location of infarcts and apathy in ischemic stroke. Cerebrovasc Dis. 2013;35:566–71.CrossRefPubMed
32.
Nye JA, Purselle D, Plisson C, Voll RJ, Stehouwer JS, Votaw JR, et al. Decreased brainstem and putamen sert binding potential in depressed suicide attempters using [11C]-zient PET imaging. Depress Anxiety. 2013;30:902–7.PubMed
33.
Gos T, Krell D, Bielau H, Brisch R, Trubner K, Steiner J, et al. Tyrosine hydroxylase immunoreactivity in the locus coeruleus is elevated in violent suicidal depressive patients. Eur Arch Psychiatry Clin Neurosci. 2008;258:513–20.CrossRefPubMed
34.
Starkstein SE, Mizrahi R, Capizzano AA, Acion L, Brockman S, Power BD. Neuroimaging correlates of apathy and depression in Alzheimer’s disease. J Neuropsychiatry Clin Neurosci. 2009;21:259–65.CrossRefPubMed
35.
Desmyter S, van Heeringen C, Audenaert K. Structural and functional neuroimaging studies of the suicidal brain. Prog Neuropsychopharmacol Biol Psychiatry. 2011;35:796–808.CrossRefPubMed
36.
Pompili M, Innamorati M, Mann JJ, Oquendo MA, Lester D, Del Casale A, et al. Periventricular white matter hyperintensities as predictors of suicide attempts in bipolar disorders and unipolar depression. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:1501–7.CrossRefPubMed
37.
Serafini G, Pompili M, Innamorati M, Fusar-Poli P, Akiskal HS, Rihmer Z, et al. Affective temperamental profiles are associated with white matter hyperintensity andsuicidal risk in patients with mood disorders. J Affect Disord. 2011;129:47–55.CrossRefPubMed
38.
Caeiro L, Ferro JM, Costa J. Apathy secondary to stroke: a systematic review and meta-analysis. Cerebrovasc Dis. 2013;35:23–39.CrossRefPubMed
39.
Lucas-Carrasco R, Allerup P, Bech P. The validity of the WHO-5 as an early screening for apathy in an elderly population. Curr Gerontol Geriatr Res. 2012;2012:171857.CrossRefPubMedPubMedCentral
40.
Robinson RG, Jorge RE, Clarence-Smith K, Starkstein S. Double-blind treatment of apathy in patients with poststroke depression using nefiracetam. J Neuropsychiatry Clin Neurosci. 2009;2:144–51.CrossRef
41.
Toyoda G, Saika R, Aoyama A, Abe S, Mitaki S, Kouno N, et al. The effect of cilostazol on apathy after cerebral infarction. Jpn J Stroke. 2011;33:182–4.CrossRef
42.
Mikami K, Jorge RE, Moser DJ, Arndt S, Jang M, Solodkin A, et al. Prevention of poststroke apathy using escitalopram or problem-solving therapy. Am J Geriatr Psychiatry. 2013;21:855–62.CrossRefPubMed
43.
Lane-Brown A, Tate R. Evaluation of an intervention for apathy after traumatic brain injury: a multiple-baseline, single-case experimental design. J Head Trauma Rehabil. 2010;25:459–69.CrossRefPubMed
44.
Fischer-Terworth C, Probst P. Effects of a psychological group intervention on neuropsychiatric symptoms and communication in Alzheimer’s dementia. Z Gerontol Geriatr. 2012;45:392–7.CrossRefPubMed
45.
Ferrero-Arias J, Goni-Imizcoz M, Gonzalez-Bernal J, Lara-Ortega F, da Silva-Gonzalez A, Diez-Lopez M. The efficacy of nonpharmacological treatment for dementia-related apathy. Alzheimer Dis Assoc Disord. 2011;25:213–9.CrossRefPubMed
46.
Pompili M, Venturini P, Campi S, Seretti ME, Montebovi F, Lamis DA, et al. Do stroke patients have an increased risk of developing suicidal ideation or dying by suicide? An overview of the current literature. CNS Neurosci Ther. 2012;18:711–21.CrossRefPubMed
47.
Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the Hopelessness scale. J Consult Clin Psychol. 1974;42:861–5.CrossRefPubMed
Metadata
Title
Apathy and suicide-related ideation 3 months after stroke: a cross-sectional study
Authors
Wai Kwong Tang
Lara Caeiro
Chieh Grace Lau
Huajun Liang
Vincent Mok
Gabor S Ungvari
Ka Sing Wong
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2015
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-015-0323-3

Other articles of this Issue 1/2015

BMC Neurology 1/2015 Go to the issue

Research article

Ceruloplasmin activity and iron chelation treatment of patients with Parkinson’s disease

Research article

Total antioxidant capacity is associated with mortality of patients with severe traumatic brain injury

Case report

Diagnosing moyamoya syndrome using ultrasound - a case report

Case report

Anti-N-methyl-D-aspartate receptor encephalitis concomitant with multifocal subcortical white matter lesions on magnetic resonance imaging: a case report and review of the literature

Research article

Sub-analysis of geographical variations in the 2-year observational COPTIMIZE trial of patients with relapsing–remitting multiple sclerosis converting to glatiramer acetate

Research article

Patients’ expectations of coming home with Very Early Supported Discharge and home rehabilitation after stroke - an interview study