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Hypercortisolism revealed by the dexamethasone suppression test in patients with acute ischemic stroke
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
1989 (English)In: Stroke, Vol. 20, no 12, 1685-1690 p.Article in journal (Refereed) Published
Abstract [en]

Using the dexamethasone suppression test, we studied the activity of the hypothalamicpituitary-adrenal axis within the first week after onset in 62 patients with acute ischemic stroke. Compared with two control groups (one comprising 25 elderly patients with various acute medical disorders and the other comprising 33 80-year-old volunteers), stroke patients had higher postdexamethasone cortisol levels (p=0.08 and /?=0.001, respectively). By multiple regression analysis, high postdexamethasone cortisol levels in the stroke patients were significantly associated with proximity of the lesion to the frontal pole of the brain (p=0.008) and with disorientation (p=0.03), whereas no association with major depression was seen. Many stroke patients are exposed to hypercortisolism, which may have negative consequences upon organ functions. The extent to which dexamethasone administration suppresses cortisol levels seems to be determined mainly by the site of brain lesion and cannot be used as an indicator of major depression early after stroke.

Place, publisher, year, edition, pages
American Heart Association , 1989. Vol. 20, no 12, 1685-1690 p.
National Category
Psychiatry Medical and Health Sciences
URN: urn:nbn:se:umu:diva-99078DOI: 10.1161/01.STR.20.12.1685OAI: diva2:785688
Available from: 2015-02-03 Created: 2015-02-03 Last updated: 2015-04-10Bibliographically approved
In thesis
1. Depression after stroke
Open this publication in new window or tab >>Depression after stroke
1993 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Both stroke and depression are major health problems in the elderly. In this study, the prevalence of major depression after stroke was investigated in a well-defined sample of acute stroke patients (n=80), followed up at 3 months, 1 year, 2 and 3 years after the stroke event. Links to biological and psychosocial factors were examined. Hypercortisolism was studied by the dexamethasone suppression test and compared with healthy elderly. Living conditions (including demographic caracteristics, economic resources, health, functional ability, activity/leisure, social network) and life satisfaction were described before and after stroke in relation to a general elderly population.

Demographic caracteristics, economic resources, social network and psychiatric morbidity prestroke did not differ from the general elderly population. Already prior to the stroke, patients reported more health problems and lower functional ability in many aspects of daily life, more passive leisure time and a lower global life satisfaction. After stroke, contacts with children were maintained, whilst contacts outside the family declined and remained lower than in the general elderly population. Stroke involved a marked reduction in global life satisfaction. Poor life satisfaction at 1 year remained poor for the entire three years; these stroke victims had a higher frequency of major depression early after stroke.

The prevalence of major depression was 25% at the acute stage, 31% at 3 months, decreased to 16% at 1 year, was 19% at 2 years and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in self-care ability and loss of social contacts outside the family were the most important predictors at 3 months. From 1 year onwards, loss of social contacts contributed most to depression and at 3 years also cerebral atrophy. Sixty percent of patients with early depression (0-3 months) had recovered at 1 year; those not recovered at 1 year had a high risk of chronicitation.

Hypercortisolism as measured by the dexamethasone suppression test was associated with major depression late (3 years) but not early (0-3 months) after stroke. At 3 years, the dexamethasone suppression test had a sensitivity of 70%, a specificity of 97%, a positive predictive value of 88%, a negative predicitive value of 91%, and a diagnostic accuracy of 90%. Nonsuppression of dexamethasone at 3 months was a significant predictor of major depression at 3 years.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 1993. 63 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 364
Cerebrovascular disorders, stroke, depression, living conditions, life satisfaction, social network, dysphasia, self-care ability, cerebral atrophy, dexamethasone
National Category
Medical and Health Sciences Psychiatry
urn:nbn:se:umu:diva-96912 (URN)91-7174-768-0 (ISBN)
Public defence
1993-04-23, Aulan, Administrationsbyggnaden, BV, Norrlands Universitetssjukhus, Umeå universitet, Umeå, 10:00

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Available from: 2015-02-03 Created: 2014-12-05 Last updated: 2015-04-10Bibliographically approved

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Olsson, TommyÅström, MonicaEriksson, StureForssell, Åke
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