Dementia following stroke: the effect of antidepressants

RICARDO JORGE; FACUNDO MANES; STEPHAN ARNDT; SUSAN SCHULTZ; ROBERT ROBINSON

Florida

Encuentro; 11th Annual Meeting of the American Neuropsychiatric Association; 2000

American Neuropsychiatric Association

Background: The objective of this study was to examine the effect of treatment with antidepressants on the frequency of dementia following stroke. Methods: A group of 84 patients participated in a treatment study of mood and cognitive disorders associated with stroke. Stroke severity was assessed with the NIH Stroke Scale (NIHSS). The Johns Hopkins Functioning Inventory and the Social Functioning Examination were used as measures of impairment in activities of daily living and social functioning, respectively. Patients were randomly assigned to a 12-week course of either fluoxetine, nortriptyline, or placebo treatment. At 3-month follow-up, 55 patients completed a detailed neuropsychological evaluation, and dementia was diagnosed according to a previously validated paradigm and DSM-IV criteria. Results: At the 3-month follow-up visit, 15 of the 55 patients who completed the protocol (27.3%) met diagnostic criteria for dementia. Patients with dementia had significantly higher NIHSS scores (P=0.004) and a significantly higher frequency of multiple lesions (P=0.05) than the nondemented patients. Of the 30 patients who received placebo, 12 patients developed dementia at 3-month follow-up, compared with 3 of 25 patients who received antidepressants (P=0.03). Conclusions: Dementia associated with stroke is related to several factors. Patients with dementia had more severe strokes and significantly more lesions than the nondemented group. In addition, dementia was significantly more frequent among the patients who received placebo rather than active antidepressant treatment with fluoxetine or nortriptyline.