Avaliação de biomarcadores periféricos na depressão pós-acidente vascular encefálico isquêmico agudo

Abstract

Introduction: stroke is a major public health problem worldwide and leads to high rates of morbidity and mortality. Neuropsychiatric sequelae are very commom after a cerebrovascular event, with emphasis on depression. Mental disorders associated with stroke negatively impact the recovery, quality of life and survival of affected patients. Unfortunately, there are still few tools that could aid in clinical diagnosis, such as biomarkers. Objective: to investigate the prevalence of psychiatric comorbidities associated with acute ischemic stroke and to look for peripheral biomarkers associated with de development of post-stroke depression (PSD). Methods: we evaluated sixty patients with acute ischemic, who were admitted to the stroke unit at the Hospital Municipal Odilon Behrens, in Belo Horizonte, Minas Gerais. Patients were assessed by the use of a structured clinical interview (Mini International Neuroppsychiatric Interview) and the application of the Mini-Mental State Examination (MMSE), the Hospital Anxiety and Depression Scale (HADS), the Pathological Laugh and Crying Scale, the Functional Independence Measure (MIF), the National Institutes of Health Stroke Scale, and the Rankin Modified Scale (mRS). Plasma levels of IL-2, IL-6, IL-10, IL-17A, IFNγ, TNF, sTNFR1, sTNFR2, TWEAK, STREM-1, E-Selectin, VCAM, BDNF, GDNF, NGF, Leptin and Adiponectin were evaluated by ELISA and CBA. Patients were compared with 15 healthy control subjects and 15 individuals with major depression, without cerebrovascular comorbidities. Results: We found a prevalence of some mental disorder in 55% of the patients affected by acute ischemic stroke, with predominance of depression (26.7%) and anxiety disorders (23.3%), as well as alcohol abuse or dependence (11.7% ). Patients with PSD had greater disability at admission, as measured by the mRS, worse functionality assessed by MIF, and worse cognitive performance on the MMSE. The presence of diabetes increased by 3-fold the risk of developing PSD. HADS performed well in tracking cases of depression. We found the cutoff value of 6 for the depression subscale, which reached sensitivity of 100% and specificity of 99.17%. Regarding biomarkers, we observed that individuals with PSD presented reduced levels of STREM-1 and GDNF and that these proteins correlated inversely with the intensity of depressive symptoms, as measured by the HADS. Conclusions: this study strengthens the view that the stroke is related to the development of mental disorders and suggests that the interrelationships between diabetes, chronic inflammation and acute cerebrovascular insult can trigger the manifestation of depressive symptoms.