Depression, diabetes tied to worse outcomes after stroke

Survivors of stroke with premorbid depression and diabetes mellitus may fare badly, being at increased risk of loss of independence and dementia, according to a study.

The analysis included 23,579 consecutive patients (mean age, 70.6 years; 46.5 percent female) hospitalized for a first-ever acute ischaemic stroke. Of these patients, 28.9 percent had diabetes mellitus only, 4.8 percent had depression only, 2.4 percent had both diabetes and depression, and the majority (63.9 percent) had neither condition.

A total of 2,364 (10.0 percent) deaths occurred. Of the survivors, 20,201 were discharged back into the community, while 1,014 (4.3 percent) were directly discharged to long-term care (LTC). Among those discharged back into the community, 25.0 percent were admitted to LTC, 21.0 percent had recurrent stroke or transient ischaemic attack (TIA), 19.3 percent developed dementia, and 45.3 percent eventually died over a median follow-up of 5.6 years.

Diabetes mellitus and depression correlated with synergistic hazards of admission to LTC (p=0.02) during the follow-up. This interaction was seen in women, with depression multimorbidity carrying a markedly elevated risk of admission to LTC (adjusted hazard ratio [aHR], 1.57, 95 percent confidence interval [CI], 1.24–1.98) and incident dementia (aHR, 1.85, 95 percent CI, 1.40–2.44) among those with diabetes.

In the entire cohort, diabetes and depression were individually related to LTC admission (aHR, 1.20, 95 percent CI, 1.12–1.29 and aHR, 1.19, 95 percent CI, 1.04–1.37, respectively), incident dementia (aHR, 1.14, 95 percent CI, 1.06–1.23 and aHR, 1.27, 95 percent CI, 1.08–1.49), stroke/TIA readmission (aHR, 1.18, 95 percent CI, 1.10–1.26 and aHR, 1.24, 95 percent CI, 1.07–1.42), and all-cause mortality (aHR, 1.29, 95 percent CI, 1.23–1.36 and aHR, 1.16, 95 percent CI, 1.05–1.29).

The findings underscore a need for long-term stroke recovery strategies targeting high-risk patients with mood and metabolic multimorbidity.