Affective and Behavioural Dysfunctions in Patients with Subcortical Stroke

Luis Gutierrez Cabello, Isabel Gómez-Ruiz, Angel Aguilar Alonso, Salvador Pedraza Gutiérrez

(IDI) Service of Radiology, Dr Josep Trueta University Hospi-tal, Girona, Spain.
Department of Basic Psychology, University of Barcelona, Barcelona, Spain.
Department of Neurology, Hospital General de L’Hospitalet, Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain.
Department of Personality, Psychological As-sessment and Treatment, University of Barcelona, Barcelona, Spain.

DOI: 10.4236/nm.2012.32019                

Abstract

Objective: To investigate the association of ischaemic and haemorrhagic strokes with the site of subcortical focal cerebrovascular injuries with affective, behavioural and cognitive dysfunctions in the acute phase and after three months. Sample: 58 patients with focal cerebrovascular injuries; mean age 61.5 ± 13.5, 72.4% male. Control group: 20 healthy subjects, mean age 67.1 ± 7.6, 50% male. Results: Significant differences were observed (p = 0.006) between the acute phase and three months later on the apathy items of the Neuropsychiatric Inventory (NPI) in patients with subcortical stroke. Significant differences were also observed on the affective scale of the BRMS (p = 0.004), the behaviour scale of the Maudsley Obsessive-Compulsive Inventory (MOCI) (p = 0.000), and on the Mini Mental State Examination (MMSE) (p = 0.006). No significant differences were observed on the Hamilton Rating Scale-Depression (HRSM) (p = 0.101). Significant differences were found according to the infarct type: patients with haemorrhagic lesions had higher raw scores on the HRS-D than those with ischaemic lesions (p = 0.024). Conclusions: The performance of patients with subcortical stroke on affective, behavioural and cognitive scales improves after three months. Patients with haemorrhagic lesions are more likely to be depressive than those with ischaemic lesions.

Keywords

Subcortical Lesions; Stroke; Cognitive; Affective and Behaviour

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. L. Cummings, “Neuropsychiatric Manifestations of Right Hemisphere Lesions,” Brain and Language, Vol. 57, No. 1, 1997, pp. 22-37. doi:10.1006/brln.1997.1832
[2]	J. L. Cummings and M. F. Mendez, “Secondary Mania with Focal Cerebrovascular Lesions,” American Journal of Psychiatry, Vol. 141, No. 9, 1984, pp. 1084-1087.
[3]	M. F. Folstein, R. Maigberger and P. R. McHugh, “Mood Disorder as Specific Complication of Stroke,” Journal of Neurology, Neurosurgery & Psychiatry, Vol. 40, No. 10, 1977, pp. 1018-1020. doi:10.1136/jnnp.40.10.1018
[4]	M. R. Eastwood, S. L. Rifat, H. Nobbs, et al., “Mood Disorder Following Cerebrovascular Accident,” British Journal of Psychiatry, Vol. 154, 1989, pp. 195-200. doi:10.1192/bjp.154.2.195
[5]	M. Sharpe, K. Hawton, A. House, et al., “Mood Disorder in Long-Term Survivors of Stroke: Association with Brain Location and Volume,” Psychological Medicine, Vol. 20, No. 4, 1990, pp. 815-828. doi:10.1017/S0033291700036503
[6]	J. Kulisevsky, M. L. Berthier and J. Pujol, “Hemiballismus and Secondary Mania Following a Right Thalamic Infarction,” Neurology, Vol. 43, No. 7, 1993, pp. 1422- 1424. doi:10.1212/WNL.43.7.1422
[7]	S. E. Starkstein, H. S. Mayberg, M. L. Berthier, et al., “Mania after Brain Injury: Neuroradiological and Metabolic Findings,” Annals of Neurology, Vol. 27, No. 6, 1990, pp. 652-259. doi:10.1002/ana.410270612
[8]	S. E. Starkstein and R. G. Robinson, “Mechanism of Disinhibition after Brain Lesions,” Journal of Nervous & Mental Disease, Vol. 185, No. 2, 1997, pp. 108-114. doi:10.1097/00005053-199702000-00007
[9]	G. D. Pearlson, “Structural and Functional Brain Changes in Bipolar Disorder: A Selective Review,” Schizophrenia Research, Vol. 39, No. 2, 1999, pp. 133-140. doi:10.1016/S0920-9964(99)00112-7
[10]	S. C Modell, J. M. Mountz, G. Curtis, et al., “Neurophysiologic Dysfunction in Basal Ganglia/Limbic Striatal and Thalamocortical Circuits as a Pathogenetic Mechanism of Obsessive-Compulsive Disorder,” Journal of Neuropsychiatry & Clinical Neurosciences, Vol. 1, No. 1, 1989, pp. 27-36.
[11]	K. J. Swoboda and M. A. Jenike, “Frontal Abnormalities in a Patient with Obsessive-Compulsive Disorder: The Role of Structural Lesions in Obsessive-Compulsive Behavior,” Neurology, Vol. 45, No. 12, 1995, pp. 2130-2134. doi:10.1212/WNL.45.12.2130
[12]	R. C. Chacko, M. A. Corbin and R. G. Harper, “Acquired Obsessive-Compulsive Disorder Associated with Basal Ganglia,” Journal of Neuropsychiatry and Clinical Neurosciences, Vol. 12, No. 2, 2000, pp. 269-272. doi:10.1176/appi.neuropsych.12.2.269
[13]	T. Abel, G. Stein, S. Pereyra, et al., “Neuropsychological Study of 12 Patients with Pure Degenerative Cerebellar Disease,” Revue Neurologique, Vol. 40, No. 8, 2005, pp. 465-472.
[14]	American Psychiatric Association, “DSM-IV-TR Diagnostic and Statistical Manual of Mental Disorder,” 4th Edition, American Psychiatric Publishing, Washington DC, 2000.
[15]	J. L. Cummings, M. D. Mega, K. Gray, et al., “The Neuropsychiatric Inventory: Comprehensive Assessment of Psychopathology in Dementia,” Neurology, Vol. 44, No. 12, 1990, pp. 2308-2314. doi:10.1212/WNL.44.12.2308
[16]	M. A. Hamilton, “A Rating Scale for Depression,” Journal of Neurology, Neurosurgery & Psychiatry, Vol. 23, No. , 1960, pp. 56-62. doi:10.1136/jnnp.23.1.56
[17]	P. Bech, T. G. Bolwing, P. Kram and O. J. Rafaelsen, “The Bech-Rafaelsen Mania Scale and Hamilton Depression Scale,” Acta Psychiatrica Scandinavica, Vol. 59, No. 4, 1979, pp. 420-430. doi:10.1111/j.1600-0447.1979.tb04484.x
[18]	R. J. Hodgson and S. Rachman, “Obsessional-Compulsive Complaints,” Behaviour Research and Therapy, Vol. 15, No. 5, 1977, pp. 389-395. doi:10.1016/0005-7967(77)90042-0
[19]	M. F. Folstein, S. E. Folstein and P. R. McHugh, “‘Mini-Mental State’: A Practical Method for Grading the Cognitive State of Patients for the Clinician,” Journal of Psychiatric Research, Vol. 12, No. 3, 1975, pp. 189-198. doi:10.1016/0022-3956(75)90026-6
[20]	P. Gerhardt and W. Frommhold, “Atlas of Anatomic Correlations in CT and MRI,” Thieme-Stratton Corp., New York, 1987.
[21]	D. Sinyor, P. Jacques, D. G. Kaloupek, et al., “Poststroke Depression and Lesion Location. An Attempted Replication,” Brain, Vol. 109, No. 3, 1986, pp. 537-546. doi:10.1093/brain/109.3.537
[22]	S. E. Starkstein, R. G. Robinson and T. R. Price, “Comparison of Patients with and without Poststroke Major Depression Matched for Size and Location of Lesion,” Archives of General Psychiatry, Vol. 45, No. 3, 1988, pp. 247-252.
[23]	J. R. Lipsey, R. G. Robinson, G. D. Pearlson, et al., “Mood Change Following Bilateral Hemisphere Brain Injury,” British Journal of Psychiatry, Vol. 143, 1983, pp. 266-73. doi:10.1192/bjp.143.3.266
[24]	J. R. Lipsey, W. C. Spencer, P. V. Rabins, et al., “Phenomenal Comparison of Post-Stroke Depression and Functional Depression,” American Journal of Psychiatry, Vol. 143, No. 4, 1986, pp. 527-529.
[25]	R. G. Robinson, K. L. Kubos, L. B. Starr, et al., “Mood Disorder in Stroke Patients: Importance of Location of Lesion,” Brain, Vol. 107, No. 1, 1984, pp. 81-93. doi:10.1093/brain/107.1.81
[26]	A. House, M. Dennis, L. Mogridge, et al., “Mood Disorder in the Year after First Stroke,” British Journal of Psychiatry, Vol. 158, 1991, pp. 83-92. doi:10.1192/bjp.158.1.83
[27]	S. Signer, J. L. Cummings and D. F. Benson, “Delusions and Mood Disorder in Patients with Chronic Aphasia,” Journal of Neuropsychiatry, Vol. 1, No. 1, 1989, pp. 40-45.
[28]	R. A. Stern and D. L. Bachman, “Depressive Symptoms Following Stroke,” American Journal of Psychiatry, Vol. 148, No. 3, 1991, pp. 351-356.
[29]	R. G. Robinson, J. D. Boston, S. E. Starkstein, et al., “Comparison of Mania and Depression after Brain Injury: Causal factors,” American Journal of Psychiatry, Vol. 145, No. 2, 1988, pp. 172-178.
[30]	S. Simpson and B. Baldwin, “Neuropsychiatry and SPECT of an Acute Obsessive-Compulsive Syndrome Patient,” British Journal of Psychiatry, Vol. 166, No. 3, 1995, pp. 390-392. doi:10.1192/bjp.166.3.390
[31]	J. L. Cumming, J. I. Victoroff, “Noncognitive Neuropsychiatric Syndromes in Alzheimer’s Disease,” Neuropsychiatry, Neuropsychology & Behavioral Neurology, Vol. 3, No. 2, 1990, pp. 140-158.
[32]	J. L. Cummings, B. Miller, M. A. Hill, et al., “Neuropsychiatric Aspects of Multi-Infarct Dementia and Dementia of the Alzheimer Type,” Archives of Neurology, Vol. 44, No. 4, 1987, pp. 389-393.
[33]	P. Birkett, “The Psychiatry of Stroke,” American Psychiatric Press, Washington DC, 1966.
[34]	A. E. Hillis, R. J. Wityk, P. B. Barker, et al., “Subcortical Aphasia and Neglect in Acute Stroke: The Role of Cortical Hypoperfusion,” Brain, Vol. 125, No. 5, 2002, pp. 1094-1104. doi:10.1093/brain/awf113