The dexamethasone suppression test. An indicator of depression in stroke but not a predictor of rehabilitation outcome
M. Reding, L. Orto, P. Willensky, I. Fortuna, N. Day, S. F. Steiner, L. Gehr and F. McDowell
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.
