Baseline characteristic of patients presenting with lacunar stroke and cerebral small vessel disease may predict future development of depression

Objective: Cerebral small vessel disease (SVD) is associated with late-onset depression and increases the risk for depression after stroke. We aimed to investigate baseline predictors of depression after long-term follow-up in patients with SVD, initially presenting with first-ever lacunar stroke, free of depression and cognitive impairment. Methods: A total of 294 patients with SVD were evaluated 3-5 years after the qualifying event. We analyzed baseline demographic data, vascular risk factors, functional status expressed as a score on modified Rankin Scale (mRS), cognitive status, presence of depression, total number of lacunar infarcts and severity of white matter hyperintensities (WMH) on MRI with Age-Related White Matter Changes scale total score (tARWMC) and Fazekas scale periventricular and deep subcortical scores. Results: On follow-up, depression was registered in 117 (39.8%) SVD patients. At the baseline, patients with depression compared with non-depressed were older (64.4 vs 60.9years; p= 0.007), had higher mRS score (2.8 +/- 0.7 vs 1.5 +/- 0.7; p< 0.0001) and had more severe lesions on MRI scales (p< 0.0001 for all parameters). On follow-up, depressed patients more frequently exhibited cognitive decline (75.2% depressed vs 56.5% non-depressed; p= 0.003). No difference was detected in risk factor frequency between groups. Multivariate Cox regression analysis adjusted by age and gender revealed independent predictors of depression: baseline mRS > 2 (HR 2.17, 95% CI 1.74-2.72; p< 0.0001) and tARWMC (HR 1.05, 95% CI 1.02-1.09; p= 0.005), and cognitive decline on follow-up (HR 1.80, 95% CI 1.12-2.89; p= 0.015). Conclusions: Baseline functional status and severity of WMH and development of cognitive decline predict the occurence of late-onset depression in patients with SVD. Copyright (C) 2015 John Wiley & Sons, Ltd.