ALESSANDRA FERNANDES BACCARO

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LIM/51 - Laboratório de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina

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  • article 14 Citação(ões) na Scopus
    Does stroke laterality predict major depression and cognitive impairment after stroke? Two-year prospective evaluation in the EMMA study
    (2019) BACCARO, Alessandra; WANG, Yuan-Pang; BRUNONI, Andre Russowsky; CANDIDO, Miriam; CONFORTO, Adriana Bastos; LEITE, Claudia da Costa; LOTUFO, Paulo A.; BENSENOR, Isabela M.; GOULART, Alessandra C.
    Depression and cognitive impairment are common conditions following stroke. We aimed to evaluate stroke laterality as predictor of post-stroke depression (PSD) and cognitive impairment (PCI) in a stroke cohort. Major depression (Patient Health Questionnaire-9, score >= 10) and cognitive impairment (Modified Telephone Interview for Cognitive Status, score < 14) were evaluated at 6 months and yearly up to 2 years. Survival analyses were performed by Kaplan-Meier curves and Cox logistic regression models, adjusted for potential confounders (cumulative hazard ratio, HR; 95% confidence interval, CI), for the likelihood of subsequent PSD or PCI progression at 6 months and 2 years, according to stroke laterality (right hemisphere-reference). Among 100 stroke patients, we found 19% had PSD and 38% had PCI 2 years after stroke. Most participants (53%) presented right-sided stroke. However, right-sided stroke was not associated with PSD or PCI. Overall, left-sided stroke was an independent and long-term predictor of PCI, but not of major depression. Left-sided stroke was associated with a high probability of PCI (42.6% and 53.2%, respectively at 6 months and 2 years, p-log-rank: 0.002). The HR of PCI due to left-sided stroke was 3.25 (95% CI, 1.30-8.12) at 6 months and remained almost the same at 2 years (HR, 3.22;95% CI, 1.43-7.28). The risk of having worse cognition status increased by > 3 times, 2 years after stroke. The results support the hypothesis that involvement of networks in the left, but not in the right hemisphere, contribute to long-term cognitive impairment. Lesion laterality did not influence the risk of PSD.
  • article 28 Citação(ões) na Scopus
    Post-stroke depression and cognitive impairment: Study design and preliminary findings in a Brazilian prospective stroke cohort (EMMA study)
    (2019) BACCARO, Alessandra; WANG, Yuan-Pang; CANDIDO, Miriam; CONFORTO, Adriana Bastos; BRUNONI, Andre Russowsky; LEITE, Claudia da Costa; FILHO, Geraldo Busatto; LOTUFO, Paulo A.; BENSENOR, Isabela M.; GOULART, Alessandra Carvalho
    Background: Post-stroke depression (PSD) and cognitive impairment (PCI) are common conditions. This study aims to describe the protocol and preliminary findings of an investigation into factors associated with PSD and PCI 1-3 months after stroke (subacute phase) in survivors from the Study of Stroke Mortality and Morbidity (EMMA study). Methods: Stroke patients underwent to clinical and neurological evaluations on admission to hospital. Cerebral magnetic resonance and biomarkers (serotonin, BDNF, IL-6 and IL-18) were carried out in the subacute phase. DSM-IV major depression for the diagnosis of PSD, cognitive functioning for the diagnosis of PCI and functional disability were also recorded at same time. Results: Of the 103 eligible patients, 85.4% had ischemic stroke and 73.7% had first-ever stroke. In the subacute phase, 27.2% had PCI and 13.6% had current PSD (5.8% with 'first episode' and 7.8% with 'recurrent' depression). PCI was associated with low education (0-7 years of formal education: 75%) and ageing (median age: 70; interquartile range: 59-75 y-old). Left-sided stroke was more frequently associated with increased PCI than right-sided stroke (71.4% vs. 28.4%, p = 0.005). PSD was neither associated with stroke laterality nor tentorial area. Overall, biomarkers levels were not alterated in patients with PSD and PCI. Limitations: Findings are based on small sample and less disabled stroke participants, e.g. those without aphasia and deafness. Conclusions: Findings reinforce the need of early recognition and rehabilitation of PCI and PSD, mainly among those less educated and with left-sided stroke. PSD might occur through a pathophysiological pathway other than classical depression.