| 소속 |
Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute1, Chungnam National University, Department of Rehabilitation Medicine, School of Medicine2, Konkuk University School of Medicine, Department of Rehabilitation Medicine3, Yonsei University College of Medicine, Department and Research Institute of Rehabilitation Medicine4, Chonnam National University Medical School, Department of Physical and Rehabilitation Medicine5, Pusan National University School of Medicine, Pusan National University Yangsan Hospital, Department of Rehabilitation Medicine6, Wonkwang University, School of Medicine, Department of Preventive Medicine7, Kyungpook National University School of Medicine, Kyungpook National University Hospital, Department of Rehabilitation Medicine8, Wonkwang University School of Medicine, Department of Rehabilitation Medicine9, Jeju National University Hospital, Jeju National University School of Medicine, Department of Rehabilitation Medicine10, Hallym University, Department of Statistics11, Ewha Womans University, Department of Health Convergence12, Korea Centers for Disease Control and Prevention, Division of Chronic Disease Prevention, Center for Disease13, Korea Centers for Disease Control and Prevention, Division of Chronic Disease Control, Center for Disease Prevention14, Sungkyunkwan University, Department of Health Science and Technology, Department of Medical Device Management and Research, SAIHST15 |
| 저자 |
Minyoung Shin1*, Min Kyun Sohn2, Jongmin Lee3, Deog Young Kim4, Sam-Gyu Lee5, Yong-Il Shin6, Gyung-Jae Oh7, Yang-Soo Lee8, Min Cheol Joo9, Eun Young Han10, Junhee Han11, Jeonghoon Ahn12, Min A Shin1, Won Hyuk Chang1, Yun-Hee Kim1,13† |
Purpose: The primary purpose of this study was to investigate whether there were differences in prevalence and severity of depression or cognitive impairment between male and female patients with stroke. In addition to that, early features of depression or cognitive impairment associated with long term depression or cognitive impairment were studied for male and female stroke patients respectively.
Methods: This study was an interim analysis of the Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) designed as 10 years long-term follow-up study of stroke patients. All patients who admitted to the representative hospitals in 9 distinct areas of Korea with their acute first-ever stroke (from August 2012 to May 2015) were recruited. In this study, a total of 7,166 patients with depression scale or cognitive test score at least at one time point until 30 months after onset were included. Score of Korean Version of Geriatric Depression Scale Short Form (K-GDS-SF) and Performance on Korean Version of Mini-Mental State Examination (K-MMSE) was analyzed with ANCOVA and logistic regression.
Results: The prevalence of depression (K-GDS-SF≥8) and cognitive impairment (K-MMSE<16%ile) was higher in female stroke patients (61.4% to 25.5% for depression and 53.7% to 31.5% for cognitive impairment) than male stroke patients (53% to 19.6% for depression and 39.6% to 17.2% for cognitive impairment) at every time points. As a result of ANCOVA, depression and cognitive impairment were more severe in female stroke patients than in male stroke patients at every time points (p<0.05). In logistic regression analysis, female stroke patients were at increased risk for depression at discharge, 6 months and 18 months after stroke and for cognitive impairment at every time points except at transfer to rehabilitation (p<0.05). In sub scores analysis, high score of the ‘lowered affect’ factor in the K-GDS-SF at acute phase increased the risk of depression at 30 months and low score of the ‘orientation’ domain in K-MMSE at acute phase increased the risk of cognitive impairment at 30 months only in female stroke patients. In male stroke patients, high score of the ‘cognitive inefficiency and a lack of motivation’ factor in K-GDS-SF increased the risk of depression at 30 months and low score of ‘memory’ domain in K-MMSE increased the risk of cognitive impairment at 30 months. High score of the ‘Negative judgment' factor in the K-GDS-SF, and low score of the ‘attention’ or ‘construction’ domain of the K-MMSE were common risk factors in both male and female stroke patients.
Conclusion: There was sex difference in the prevalence and severity of depression or cognitive impairment after stroke, and in the effect of sub scores on the prediction of long term depression or cognitive impairment. These results are consistent with the traditional view that female patients have more severe emotional or cognitive outcomes after stroke than male patients. |
