Clinical Characteristics and Influencing Factors of Depressive Symptoms in Patients With Vascular Cognitive Impairment

Abstract

Background: This study aimed to characterize depressive symptoms in patients with vascular cognitive impairment (VCI) after ischemic stroke and to identify independent predictors of treatment response to antidepressant therapy, with a focus on lesion-location heterogeneity.

Methods: This retrospective observational cohort study enrolled 224 patients with VCI and concomitant depressive symptoms from June 2022 to June 2024. Depression severity was assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17). All patients completed 8 weeks of standardized treatment including antidepressant medication and cognitive rehabilitation. Treatment response was defined as ≥50% reduction in HAMD-17 from baseline to week 8. Lesion locations were categorized into eight mutually exclusive anatomical groups (frontal, temporal, parietal, occipital, basal ganglia/internal capsule, thalamus, pons and cerebellum). Univariate and multivariable logistic regression identified predictors of treatment response, and Receiver Operating Characteristic (ROC) analysis evaluated model performance.

Results: Mean baseline HAMD-17 was 27.4 ± 3.1, and 65.2% (146/224) achieved treatment response. Baseline depressive symptom severity differed significantly across lesion locations (one-way analysis of variance (ANOVA): F (7,216) = 3.48, p = 0.001), whereas baseline anxiety severity did not (F (7,216) = 0.72, p = 0.652). In multivariable analysis, lower baseline Hamilton Anxiety Rating Scale (HAMA) score (odds ratio (OR) = 0.93, 95% confidence interval (CI): 0.88–0.98, p = 0.006), shorter time since stroke (OR = 0.86 per month, 95% CI: 0.75 to 0.99, p = 0.034), and higher education-adjusted Montreal Cognitive Assessment (MoCA) score (OR = 1.12 per point, 95% CI: 1.01–1.24, p = 0.031) were independently associated with treatment response. The prediction model demonstrated moderate discriminative ability (area under the curve (AUC) = 0.795, 95% CI: 0.738–0.851), with sensitivity of 0.890 and specificity of 0.608 at the optimal cutoff. 

Conclusions: Depressive symptom burden in poststroke VCI exhibits significant anatomical heterogeneity across lesion locations. Baseline anxiety severity, disease duration, and baseline cognitive performance moderately predict treatment response, supporting early risk stratification and individualized management.