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Depression–Executive Dysfunction Syndrome in Stroke Patients

Received June 20, 2004; revised September 12, October 31, 2004; accepted November 4, 2004. From the Department of Neurology (MK), Memory Research Unit (RV,ML,TP,RY,MH,TE), and Department of Psychiatry, Psychiatric Consultation Unit (AL), and Helsinki Medical Imaging Center (RM,OS,HJA), Helsinki University Central Hospital, and Department of Psychology (HK), University of Helsinki, Helsinki, Finland, and Kellokoski Hospital (RV), Kellokoski, Finland. Send correspondence and reprint requests to Timo Erkinjuntti, M.D., Ph.D., Memory Research Unit, Department of Neurology, Helsinki University Central Hospital, P.O. BOX 300, FIN-00029 HUS, Finland. e-mail: timo.erkinjuntti{at}hus.fi
© 2005 American Association for Geriatric Psychiatry

Objective: It has been suggested that executive dysfunction could be the core defect in patients with geriatric or vascular depression, and that this depression–dysexecutive syndrome (DES) might be related to frontal-subcortical circuit dysfunction. The authors tested this hypothesis in 158 poststroke patients, of whom 21 had both depression and executive dysfunction. Methods: In this cross-sectional cohort study, a neurological, psychiatric, and neuropsychological examination was carried out 3 months after ischemic stroke, and brain infarcts, white-matter changes, and brain atrophy were recorded by MRI. Results: The 21 patients with DES had significantly more brain infarcts affecting their frontal-subcortical circuit structures than the 137 patients without DES, or the 41 patients with depression but without executive dysfunction. Patients with DES also had more severe depressive symptoms and worse psychosocial functioning, and they coped less well in complex activities of daily living. Conclusions: DES is a valid concept and may define a subgroup of poststroke patients with frontal-subcortical pathology and with distinct prognosis and treatment options.

Key Words: Depression • Stroke • Executive Functioning • Physical Comorbidity • Neuropathology • Cognition

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