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Depression, diabetes “add up” to bad news for those recovering from stroke, CPSR study finds

Depression and diabetes “add up” to bad news for those recovering from stroke, CPSR study finds

Swardfager W, MacIntosh BJ. Depression, Type 2 Diabetes, and Poststroke Cognitive Impairment. Neurorehabil Neural Repair. 2016 Jun 29. [Epub ahead of print]

What was the purpose of this research?
Ten percent of stroke survivors develop dementia, and after multiple strokes, this increases to more than a third. Many risk factors for stroke are also risk factors for dementia, but some risk factors like diabetes and depression are overlooked as important contributors to stroke outcomes. We wanted to know if these problems were linked to cognitive impairment in the period after stroke, posing barriers for patients who are working with clinicians on their rehabilitation.

What were the major findings from this work?
Here we showed that depression and diabetes “added up” to bad news for those recovering from stroke. Having one of these problems doubled the risk of severe cognitive impairment, and having both tripled the risk. In women, depression and diabetes were closely related to the overall severity of impairments in addition to cognitive impairment. In men and in older people particularly, having both depression and diabetes upped the odds of cognitive impairment much more than having depression or diabetes alone.

What implications might this work have on stroke recovery?
Stroke comorbidities are not the exception, they are the rule – diabetes or depression affected nearly two-thirds of survivors. The implication is that determining optimal ways to manage these comorbidities in people at high risk for a stroke, or in the critical recovery period after a stroke, might also help to prevent dementia.

What are the major outstanding questions that arise from this work?
The work raises a lot of questions. For instance, future studies will continue to explore how diabetes and depression impact the brain’s recovery from stroke. New ways to boost cognitive recovery from stroke might stem from treatments that boost brain metabolism, protect blood vessels from the effects of diabetes, or protect neurons and enhance synaptic plasticity as they alleviate mood symptoms.

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