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Stroke and Depression: A Meta-Analysis Clarifies the Relationship

In left-hemisphere stroke, severity of depressive symptoms was inversely correlated to the distance between the anterior border of the lesion and the frontal pole.

In 1981, Robert Robinson reported one of the most important observations in neuropsychiatry: the association of major depression with acute strokes located in the anterior border of the left hemisphere. Since then, research groups attempting to confirm this association have had mixed results. In this study, Robinson and colleagues performed a meta-analysis to determine whether the proximity of the lesion to the frontal pole in each hemisphere was associated with the severity of depressive symptoms during the first 6 months following stroke.

Studies were included if they used standard measures of depression and CT or magnetic resonance imaging, had appropriately sized study populations, and excluded patients with comprehension deficits. Of 356 potentially eligible studies, 13 studies of 163 patients with left-hemisphere stroke and 10 studies of 106 patients with right-hemisphere stroke met the inclusion criteria.

The investigators combined several studies with overlapping populations and excluded data from patients with known prestroke histories of depression. In 6 of 8 studies of patients with left- hemisphere stroke, the severity of depressive symptoms was significantly and inversely correlated to the distance between the anterior border of the lesion and the frontal pole. Only one of 5 studies of patients with right-hemisphere stroke reported a similar correlation.

Comment: This meta-analysis explains the discrepancy in findings of other investigators and, more generally, highlights the importance of precise description of patient populations in neuropsychiatric studies. Standardization of diagnostic criteria, measurement instruments, demographic information, and imaging techniques is critical for producing reliable data that further our understanding of the connection between brain structure and function.

— Jonathan Silver, MD

Published in Journal Watch Psychiatry December 23, 2003

Citation(s):

Narushima K et al. A reappraisal of poststroke depression, intra- and inter-hemispheric lesion location using meta-analysis. J Neuropsychiatry Clin Neurosci 2003 Fall; 15:422-30.

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