Objective: There is no unequivocal information on the epidemiology, pathophysiology, or natural history of post stroke depression [PSD]. Over 20 years ago Robinson et al1 suggested that the risk of PSD is influenced by the location of the brain lesion. This hypothesis was popular and widely publicised. However, over the subsequent years a conflicting body of literature has suggested that in an unselected group of stroke patients, depression is no more common, and of no more specific aetiology, than it is among elderly patients with other physical illness2. More recently, a systematic review offered no support for the hypothesis that the risk of depression after stroke is affected by the location of the brain lesion3. Aims: The principal hypothesis to be addressed by this study is that the incidence of significant depressive symptoms/ major depression in older people post stroke is higher than that following other major medical illness. Methods: A prospective study of acute admissions with a first stroke to the stoke unit and emergency admissions to the general ward of a medical gerontology department. Each subject was screened within two weeks of admission for cognitive impairment, depression, and alcohol related disorders. These assessments were repeated after 1 month, 6 months, and 1 year. Results: The prevalence of depression two weeks post stroke was only 12%. However, almost 50% of stoke subjects who were followed for 1 year had an episode of depression. In the non-stroke emergency admissions group the 1-year incidence of depression was <10%. Conclusions: The study supports the concept of PSD.
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