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An Indicator of Depression in Stroke but Not a Predictor of Rehabilitation Outcome

Michael Reding, MD; Louise Orto, MS; Philip Willensky, MD; Ilia Fortuna, ACSW; Nancy Day, CSW; Shelley Feit Steiner, ACSW; Lesley Gehr, ACSW; Fletcher McDowell, MD

Arch Neurol. 1985;42(3):209-212.

Abstract
• The dexamethasone suppression test (DST) result was found to be abnormal in 49% of patients who were an average of seven weeks post stroke. The DST response correlated with depressive symptoms as measured by both the Zung and modified Hamilton Depression scales. The specificity of the DST for clinically diagnosed depression reached 87% for the 8 am cortisol determination, with a corresponding sensitivity of 47%. It was not related to the patient's final level of self-care function as measured by the Barthel score, need for nursing home placement following discharge, or duration of rehabilitation needed to achieve maximum benefit. Abnormal responses were more prevalent in cerebral hemisphere than in brain-stem or cerebellar strokes. The more extensive the stroke the more likely the possibility of an abnormal DST response. The DST response is stable, with test-retest replicability being 84% at two weeks and 74% at seven weeks.

Author Affiliations
From Cornell University Medical College at Burke Rehabilitation Center, White Plains, NY.

Footnotes
Accepted for publication May 10, 1984.

Reprint requests to Burke Rehabilitation Center, 785 Mamaroneck Ave, White Plains, NY 10605 (Dr Reding).

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