nnpNeurology, Neuropsychiatry, PsychosomaticsНеврология, нейропсихиатрия, психосоматика2074-27112310-1342"IMA-Press", LLC10.14412/2074-2711-2013-2354nnp-205Research ArticleArticlesСтатьиUse of escitalopram to prevent depression and cognitive impairments in the acute phase of strokeПрименение эсциталопрама для профилактики синдрома депрессии и когнитивных нарушений в остром периоде инсультаKhasanovaDina RustemovnaKhasanovaDina Rustemovnadhasanova@mail.ruZhitkovaYu VZhitkovaYu Vdhasanova@mail.ruГУ «Межрегиональный клинико-диагностический центр», КазаньРоссияInterregional Clinical and Diagnostic Center, KazanRussian Federation20130811201352SSpecial issue "Stroke"1622Copyright © Khasanova D.R., Zhitkova Y.V., 20132013Khasanova D.R., Zhitkova Y.V.Khasanova D.R., Zhitkova Y.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://nnp.ima-press.net/nnp/article/view/205

The purpose of the study was to comparatively analyze the rate of post-stroke depression and cognitive impairments in escitalopram (cipralex)-treated and untreated (control) patients. Emotional and affective cognitive symptoms, neurological deficit, and day-to-day activity were evaluated over time 1, 3, and 6 months after treatment. The results of the study indicated that escitalopram used to prevent depression in the acute phase of stroke provided a good effect. This drug caused a prompter recovery of cognitive impairments and reduced the pace of development of neurodegenerative disorders underlying the post-stroke 2D (depression and dementia) syndrome. The study group was recorded to have more favorable functional outcomes of stroke and patient mobility indicators associated with lower disability rates.

Цель исследования – сравнительный анализ частоты депрессии и когнитивных нарушений в постинсультном периоде у пациентов, леченных эсциталопрамом (ципралекс), и у пациентов контрольной группы, не получавших этот препарат. Оценку эмоционально-аффективных когнитивных симптомов, а также неврологического дефицита и повседневной активности в динамике проводили через 1, 3 и 6 мес лечения. Результаты исследования показали, что применение эсциталопрама для профилактики депрессии в остром периоде инсульта дало хороший эффект. Этот препарат также способствовал более быстрому восстановлению когнитивных расстройств и снижал темпы развития нейродегенеративных нарушений, лежащих в основе постинсультного синдрома «2Д» (депрессия и деменция). В сравнении с контрольной группой зарегистрированы более благоприятные функциональ-ные исходы инсульта и показатели мобильности пациентов, ассоциирующиеся с уменьшением инвалидизации.

депрессиядеменцияцереброваскулярная реактивностьdepressiondementiacerebrovascular responsivenessReferences<div><p>Burvill PW, Johnson GA, Jamrozik KD et al. Prevalence of depression after stroke: the Perth Community Stroke Study. Br J Psychiatry. 1995;166(3):320–7. DOI: 10.1192%2Fbjp.166.3.320.</p><p>Eastwood MR, Rifat SL, Nobbs H, Ruderman J. Mood disorder following cerebrovascular assident. Br J Psychiatry. 1989;154:195–200.</p><p>Fedoroff JP, Starkstein SE, Parikh RM et al. Are depressive symptoms non-specific in patients with acute stroke? Am J Psychiatry. 1991;148(9):1172–6.</p><p>Leys D, Henon H, Mackowlak-Cordoliani MA, Pasquier F. Poststroke dementia. Lancet Neurol. 2005;4(11):752–9. DOI: 10.1016%2FS1474-4422%2805%2970221-0.</p><p>Lobo A, Launer L, Fratiglioni L et al. Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000; 54(11 Suppl 5):S4–9.</p><p>O'Brien JT, Erkinjuntti T, Reisberg B et al. Vascular cognitive impairment. Lancet Neurol. 2003;2(2):89–98. DOI: 10.1016%2FS1474-4422%2803%2900305-3.</p><p>Robinson RG. Poststroke depression: Prevalence, diagnosis, treatment and disease progression. Biol Psychiatry. 2003;54(3):376–87. DOI: 10.1016%2FS0006-3223%2803%2900423-2.</p><p>Robinson RG. The clinical neuropsychiatry of stroke. Cambridge: University Press; 2006. 470 p.</p><p>Усольцева НИ, Левин ОС. Соотношение когнитивных и двигательных нарушений у пациентов, перенесших ишемический инсульт. Современные подходы к нейрореабилитации. Москва: 2007. [Usol'tseva NI, Levin OS. Sootnoshenie kognitivnykh i dvigatel'nykh narusheniy u patsientov, perenesshikh ishemicheskiy insul't. Sovremennye podkhody k neyroreabilitatsii. Moscow: 2007.]</p><p>Del Ser T, Hachinski V, Merskey H, Munoz DG. Alzheimer’s disease with and without cerebral infarcts. J Neurol Sci. 2005;231(1–3):3–11. DOI: 10.1016%2Fj.jns.2004.08.016. Epub 2004 Dec 29.</p><p>Jorge RE, Robinson RG, Arndt S, Starkstein S. Mortality and poststroke depression: a placebo controlled trial of antidepressants. Am J Psychiatry. 2003;160(10):1823–9. DOI: 10.1176%2Fappi.ajp.160.10.1823.</p><p>Panisset M, Gauther S, Moessler H et al. Cerebrolysin in Alzheimer’s disease: a randomizer double-blind placebo controlled trial with a neurotrophic agent. J Neurol Trans. 2002;109(7–8):1089–104. DOI: 10.1007%2Fs007020200092.</p><p>Parikh RM, Robinson RG, Lipsey JR et al. The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. Arch Neurol. 1990;47(7):785–9. DOI: 10.1001%2Farchneur.1990.00530070083014.</p><p>Wade DT, Legh-Smith J, Hewer RA. Depressed mood after stroke. A community study of its frequency. Br J Psychiatry. 1987;151:200–5. DOI: 10.1192%2Fbjp.151.2.200.</p><p>Robinson RG, Srarr LB, Kubos KL, Price TR. A two-year longitudinal study of post-stroke mood disorders: findings during the initial evaluation. Stroke. 1983;14(5):736–41. DOI: 10.1161%2F01.STR.14.5.736.</p><p>Robinson RG, Szetela B. Mood changes following left hemisphere brain injury. Ann Neurol. 1981;9(5):447–53. DOI: 10.1002%2Fana.410090506.</p><p>Robinson RG, Kubos KL, Srarr LB, Price TR. Mood changes in stroke patients: relation to lesion location. Brain. 1984;107:81–93.</p><p>Erkinjuntti T, Roman G, Gauthier S et al. Emerging therapies for vascular dementia and vascular cognitive impairment. Stroke. 2004;35(4):1010–7. DOI: 10.1161%2F01.STR.0000120731.88236.33. Epub 2004 Mar 4.</p><p>Sachdev PS, Brodaty H, Valenzuela MJ et al. The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology. 2004;62(6):912–9. DOI: 10.1212%2F01.WNL.0000115108.65264.4B.</p><p>Jorge RE, Acion L, Moser D et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry. 2010;67(2):187–96. DOI: 10.1001/archgenpsychiatry.2009.185.</p><p>Martinowich K, Lu B. Interaction between BDNF and serotonin: role in mood disorders. Neuropsychopharmacology. 2007;33(1):73–83. DOI: 10.1038%2Fsj.npp.1301571. Epub 2007 Sep 19.</p><p>Терапия антидепрессантами и другие методы лечения депрессивных расстройств. Доклад рабочей группы CINP на основе обзора доказательных данных. Москва; 2008. С 150. [Terapiya antidepressantami i drugie metody lecheniya depressivnykh rasstroystv. Doklad rabochey gruppy CINP na osnove obzora dokazatel'nykh dannykh. Moscow; 2008. P. 150.]</p><p>Narushima K, Kosier JT, Robinson RG. Preventing of poststroke depression. A 12-week double-blind randomized treatment trial with 21-month follow-up. J Nerv Ment Dis. 2002;190(5):296–303. DOI: 10.1097%2F00005053-200205000-00005.</p><p>Niedermaier N, Bohrer E, Schulte K et al. Prevention and treatment of poststroke depression with mirtazapine in patients with acute stroke. J Clin Psychiatry. 2004:65(12):1619–23. DOI: 10.4088%2FJCP.v65n1206.</p><p>Rasmussen A, Lunde M, Poulsen DL et al. A double-blind placebo controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics. 2003;44(3):216–22. DOI: 10.1176%2Fappi.psy.44.3.216.</p><p>Ween JE. Prophylactic mirtazapine may help to prevent post-stroke depression in people with good cognitive function. Evid Based Ment Health. 2005;8(3):74. DOI: 10.1136%2Febmh.8.3.74.</p><p>Robinson RG, Schultz SK, Castillo C et al. Nortriptyline versus fluoxetine in the treatment of depression and in short term recovery after stroke: a placebo controlled, double-blind study. Am J Psychiatry. 2000;157(3):351–9. DOI: 10.1176%2Fappi.ajp.157.3.351.</p><p>Starkstein SE, Robinson RG, Berther ML, Price TR. Depressive disorders following posterior circulation ascompared with middle cerebral artery infarcts. Brain. 1988;11( Pt 2):375–87.</p><p>Hama S, Yamashita H, Yamawaki S, Kurisu K. Post-stroke depression and apathy: Interactions between functional recovery, lesion location, and emotional response. Phsychogeriatrics. 2011;11(1):68–76. DOI: 10.1111/j.1479-8301.2011.00358.x.</p></div><br /><div><p>Burvill PW, Johnson GA, Jamrozik KD et al. Prevalence of depression after stroke: the Perth Community Stroke Study. Br J Psychiatry. 1995;166(3):320–7. DOI: 10.1192%2Fbjp.166.3.320.</p><p>Eastwood MR, Rifat SL, Nobbs H, Ruderman J. Mood disorder following cerebrovascular assident. Br J Psychiatry. 1989;154:195–200.</p><p>Fedoroff JP, Starkstein SE, Parikh RM et al. Are depressive symptoms non-specific in patients with acute stroke? Am J Psychiatry. 1991;148(9):1172–6.</p><p>Leys D, Henon H, Mackowlak-Cordoliani MA, Pasquier F. Poststroke dementia. Lancet Neurol. 2005;4(11):752–9. DOI: 10.1016%2FS1474-4422%2805%2970221-0.</p><p>Lobo A, Launer L, Fratiglioni L et al. Prevalence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology. 2000; 54(11 Suppl 5):S4–9.</p><p>O'Brien JT, Erkinjuntti T, Reisberg B et al. Vascular cognitive impairment. Lancet Neurol. 2003;2(2):89–98. DOI: 10.1016%2FS1474-4422%2803%2900305-3.</p><p>Robinson RG. Poststroke depression: Prevalence, diagnosis, treatment and disease progression. Biol Psychiatry. 2003;54(3):376–87. DOI: 10.1016%2FS0006-3223%2803%2900423-2.</p><p>Robinson RG. The clinical neuropsychiatry of stroke. Cambridge: University Press; 2006. 470 p.</p><p>Усольцева НИ, Левин ОС. Соотношение когнитивных и двигательных нарушений у пациентов, перенесших ишемический инсульт. Современные подходы к нейрореабилитации. Москва: 2007. [Usol'tseva NI, Levin OS. Sootnoshenie kognitivnykh i dvigatel'nykh narusheniy u patsientov, perenesshikh ishemicheskiy insul't. Sovremennye podkhody k neyroreabilitatsii. Moscow: 2007.]</p><p>Del Ser T, Hachinski V, Merskey H, Munoz DG. Alzheimer’s disease with and without cerebral infarcts. J Neurol Sci. 2005;231(1–3):3–11. DOI: 10.1016%2Fj.jns.2004.08.016. Epub 2004 Dec 29.</p><p>Jorge RE, Robinson RG, Arndt S, Starkstein S. Mortality and poststroke depression: a placebo controlled trial of antidepressants. Am J Psychiatry. 2003;160(10):1823–9. DOI: 10.1176%2Fappi.ajp.160.10.1823.</p><p>Panisset M, Gauther S, Moessler H et al. Cerebrolysin in Alzheimer’s disease: a randomizer double-blind placebo controlled trial with a neurotrophic agent. J Neurol Trans. 2002;109(7–8):1089–104. DOI: 10.1007%2Fs007020200092.</p><p>Parikh RM, Robinson RG, Lipsey JR et al. The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. Arch Neurol. 1990;47(7):785–9. DOI: 10.1001%2Farchneur.1990.00530070083014.</p><p>Wade DT, Legh-Smith J, Hewer RA. Depressed mood after stroke. A community study of its frequency. Br J Psychiatry. 1987;151:200–5. DOI: 10.1192%2Fbjp.151.2.200.</p><p>Robinson RG, Srarr LB, Kubos KL, Price TR. A two-year longitudinal study of post-stroke mood disorders: findings during the initial evaluation. Stroke. 1983;14(5):736–41. DOI: 10.1161%2F01.STR.14.5.736.</p><p>Robinson RG, Szetela B. Mood changes following left hemisphere brain injury. Ann Neurol. 1981;9(5):447–53. DOI: 10.1002%2Fana.410090506.</p><p>Robinson RG, Kubos KL, Srarr LB, Price TR. Mood changes in stroke patients: relation to lesion location. Brain. 1984;107:81–93.</p><p>Erkinjuntti T, Roman G, Gauthier S et al. Emerging therapies for vascular dementia and vascular cognitive impairment. Stroke. 2004;35(4):1010–7. DOI: 10.1161%2F01.STR.0000120731.88236.33. Epub 2004 Mar 4.</p><p>Sachdev PS, Brodaty H, Valenzuela MJ et al. The neuropsychological profile of vascular cognitive impairment in stroke and TIA patients. Neurology. 2004;62(6):912–9. DOI: 10.1212%2F01.WNL.0000115108.65264.4B.</p><p>Jorge RE, Acion L, Moser D et al. Escitalopram and enhancement of cognitive recovery following stroke. Arch Gen Psychiatry. 2010;67(2):187–96. DOI: 10.1001/archgenpsychiatry.2009.185.</p><p>Martinowich K, Lu B. Interaction between BDNF and serotonin: role in mood disorders. Neuropsychopharmacology. 2007;33(1):73–83. DOI: 10.1038%2Fsj.npp.1301571. Epub 2007 Sep 19.</p><p>Терапия антидепрессантами и другие методы лечения депрессивных расстройств. Доклад рабочей группы CINP на основе обзора доказательных данных. Москва; 2008. С 150. [Terapiya antidepressantami i drugie metody lecheniya depressivnykh rasstroystv. Doklad rabochey gruppy CINP na osnove obzora dokazatel'nykh dannykh. Moscow; 2008. P. 150.]</p><p>Narushima K, Kosier JT, Robinson RG. Preventing of poststroke depression. A 12-week double-blind randomized treatment trial with 21-month follow-up. J Nerv Ment Dis. 2002;190(5):296–303. DOI: 10.1097%2F00005053-200205000-00005.</p><p>Niedermaier N, Bohrer E, Schulte K et al. Prevention and treatment of poststroke depression with mirtazapine in patients with acute stroke. J Clin Psychiatry. 2004:65(12):1619–23. DOI: 10.4088%2FJCP.v65n1206.</p><p>Rasmussen A, Lunde M, Poulsen DL et al. A double-blind placebo controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics. 2003;44(3):216–22. DOI: 10.1176%2Fappi.psy.44.3.216.</p><p>Ween JE. Prophylactic mirtazapine may help to prevent post-stroke depression in people with good cognitive function. Evid Based Ment Health. 2005;8(3):74. DOI: 10.1136%2Febmh.8.3.74.</p><p>Robinson RG, Schultz SK, Castillo C et al. Nortriptyline versus fluoxetine in the treatment of depression and in short term recovery after stroke: a placebo controlled, double-blind study. Am J Psychiatry. 2000;157(3):351–9. DOI: 10.1176%2Fappi.ajp.157.3.351.</p><p>Starkstein SE, Robinson RG, Berther ML, Price TR. Depressive disorders following posterior circulation ascompared with middle cerebral artery infarcts. Brain. 1988;11( Pt 2):375–87.</p><p>Hama S, Yamashita H, Yamawaki S, Kurisu K. Post-stroke depression and apathy: Interactions between functional recovery, lesion location, and emotional response. Phsychogeriatrics. 2011;11(1):68–76. DOI: 10.1111/j.1479-8301.2011.00358.x.</p></div><br />

The authors declare that there are no conflicts of interest present.