Post-stroke depression (I). Epidemiology diagnostic criteria and risk factors

Aim. Post-stroke depression (PSD) is the most frequent neuropsychiatric condition after a stroke. We review the diagnostic criteria, differential diagnosis, type of scales applied, the epidemiological studies and associated risk factors in PSD. Development. PSD may be considered early when appear in the first three months after a stroke or late. We reviewed PSD case series, Stroke Unit or rehabilitation Unit studies, and community studies. Frequency of PSD has been estimated between 18 and 60%. Several methodological problems regarding inclusion criteria (acute vs chronic patients, exclusion of demented and aphasic patients), type of scales used (self applied scales, DSM-IV criteria interview, Hamilton, etc.) limit direct comparison between studies. Symptoms of PSD appear in three areas: cognition, affective and somatic. Relation between stroke location in left frontal region and left basal ganglia has not been demonstrated in further epidemiological studies. Conclusion. Post-stroke depression is a highly prevalent, potentially treatable and infra-diagnosed condition. Disparity in inclusion criteria, study timing and types of scales are the main bias of the PSD epidemiological studies.