Predictors for Depressive Mood in Geriatric Patients After Traumatic Brain Injury: A Retrospective Cross-Sectional Study
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Objective To identify predictors for depressive mood in geriatric patients after traumatic brain injury (TBI).Methods A retrospective review of patients’ medical charts was performed in TBI patients who were older than 60 years and referred to the Department of Rehabilitation Medicine at Severance Hospital in 2002–2016. The patients were classified into two groups based on the Geriatric Depression Scale (GDS): non-depressive group (0≤GDS≤16) and depressive group (17≤GDS≤30). Data was collected on demographic, socioeconomic, comorbidities, and trauma-related factors, as well as the pathophysiology of TBI, localization of lesion, post-traumatic complications, functional level, and cognitive and linguistic function. Significant variables from univariate analysis were analyzed using logistic regression.Results Forty-two patients were included, of whom 64.3% displayed a depressive mood. Patients in the depressive group had higher comorbidity scores (p=0.03), lower Functional Independence Measure (FIM) totals (p=0.03) and FIM motor (p=0.03) scores, higher modified Rankin Scale scores (p=0.04), and frequently had a bilateral or left side brain lesion (p=0.002). Higher comorbidity scores (odds ratio [OR], 1.764; 95% confidence interval [CI], 1.047–2.971), bilateral lesions (OR, 13.078; 95% CI, 1.786–95.780), and left side lesions (OR, 46.074; 95% CI, 3.175–668.502) were independently associated with a depressive mood in the multiple logistic regression analysis.Conclusion The risk of depressive mood in geriatric patients after TBI is associated with comorbidity, functional limitation, and the horizontal distribution of brain lesions. The most significant determining factors were comorbidity and the horizontal distribution of brain lesions. Early detection of risk factors is important to prevent and manage depressive mood in geriatric patients after TBI.
Abstract
Objective To identify predictors for depressive mood in geriatric patients after traumatic brain injury (TBI).Methods A retrospective review of patients’ medical charts was performed in TBI patients who were older than 60 years and referred to the Department of Rehabilitation Medicine at Severance Hospital in 2002–2016. The patients were classified into two groups based on the Geriatric Depression Scale (GDS): non-depressive group (0≤GDS≤16) and depressive group (17≤GDS≤30). Data was collected on demographic, socioeconomic, comorbidities, and trauma-related factors, as well as the pathophysiology of TBI, localization of lesion, post-traumatic complications, functional level, and cognitive and linguistic function. Significant variables from univariate analysis were analyzed using logistic regression.Results Forty-two patients were included, of whom 64.3% displayed a depressive mood. Patients in the depressive group had higher comorbidity scores (p=0.03), lower Functional Independence Measure (FIM) totals (p=0.03) and FIM motor (p=0.03) scores, higher modified Rankin Scale scores (p=0.04), and frequently had a bilateral or left side brain lesion (p=0.002). Higher comorbidity scores (odds ratio [OR], 1.764; 95% confidence interval [CI], 1.047–2.971), bilateral lesions (OR, 13.078; 95% CI, 1.786–95.780), and left side lesions (OR, 46.074; 95% CI, 3.175–668.502) were independently associated with a depressive mood in the multiple logistic regression analysis.Conclusion The risk of depressive mood in geriatric patients after TBI is associated with comorbidity, functional limitation, and the horizontal distribution of brain lesions. The most significant determining factors were comorbidity and the horizontal distribution of brain lesions. Early detection of risk factors is important to prevent and manage depressive mood in geriatric patients after TBI.
참고문헌 (40)
- Pagulayan KF, "Functional limitations and depression after traumatic brain injury: examination of the temporal relationship", Arch Phys Med Rehabil, 89, pp.1887~1892 (2008)
- Menzel JC, "Depression in the elderly after traumatic brain injury: a systematic review", Brain Inj, 22, pp.375~380 (2008)
- Hart T, "A longitudinal study of major and minor depression following traumatic brain injury", Arch Phys Med Rehabil, 93, pp.1343~1349 (2012)
- Rapoport MJ, "The clinical significance of major depression following mild traumatic brain injury", Psychosomatics, 44, pp.31~37 (2003)
- Pudelek B, "Geriatric trauma: special needs for a special population", AACN Clin Issues, 13, pp.61~72 (2002)
- Mushkudiani NA, "Prognostic value of demographic characteristics in traumatic brain injury: results from the IMPACT study", J Neurotrauma, 24, pp.259~269 (2007)
- Tokutomi T, "Age-associated increases in poor outcomes after traumatic brain injury: a report from the Japan Neurotrauma Data Bank", J Neurotrauma, 25, pp.1407~1414 (2008)
- Hukkelhoven CW, "Patient age and outcome following severe traumatic brain injury: an analysis of 5600 patients", J Neurosurg, 99, pp.666~673 (2003)
- Levin HS, "Depression as a secondary condition following mild and moderate traumatic brain injury", Semin Clin Neuropsychiatry, 2, pp.207~215 (1997)
- Oldfield RC, "The assessment and analysis of handedness:the Edinburgh inventory", Neuropsychologia, 9, pp.97~113 (1971)
- Charlson M, "Validation of a combined comorbidity index", J Clin Epidemiol, 47, pp.1245~1251 (1994)
- Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation", J Chronic Dis, 40, pp.373~383 (1987)
- Goldstein LB, "Charlson Index comorbidity adjustment for ischemic stroke outcome studies", Stroke, 35, pp.1941~1945 (2004)
- Thompson HJ, "Utilization and costs of health care after geriatric traumatic brain injury", J Neurotrauma, 29, pp.1864~1871 (2012)
- Kim H, "Normative data on the Korean version of the Western Aphasia Battery", J Clin Exp Neuropsychol, 26, pp.1011~1020 (2004)
- Linacre JM, "The structure and stability of the Functional Independence Measure", Arch Phys Med Rehabil, 75, pp.127~132 (1994)
- Holden MK, "Clinical gait assessment in the neurologically impaired: reliability and meaningfulness", Phys Ther, 64, pp.35~40 (1984)
- van Swieten JC, "Interobserver agreement for the assessment of handicap in stroke patients", Stroke, 19, pp.604~607 (1988)
- Ji Yang Kim, "Standardization of the Korean Version of the Geriatric Depression Scale: Reliability, Validity, and Factor Structure", PSYCHIATRY INVESTIGATION, 5(4), pp.232~238 (2008), 대한신경정신의학회
- Seel RT, "Depression after traumatic brain injury: a National Institute on Disability and Rehabilitation Research Model Systems multicenter investigation", Arch Phys Med Rehabil, 84, pp.177~184 (2003)
- Bowen A, "Mood disorders following traumatic brain injury: identifying the extent of the problem and the people at risk", Brain Inj, 12, pp.177~190 (1998)
- Rao V, "Predictors of new-onset depression after mild traumatic brain injury", J Neuropsychiatry Clin Neurosci, 22, pp.100~104 (2010)
- Rapoport MJ, "Depression following traumatic brain injury: epidemiology, risk factors and management", CNS Drugs, 26, pp.111~121 (2012)
- Alexopoulos GS, "Editorial: geriatric depression in primary care", Int J Geriatr Psychiatry, 11, pp.397~400 (1996)
- Dikmen SS, "Natural history of depression in traumatic brain injury", Arch Phys Med Rehabil, 85, pp.1457~1464 (2004)
- Fann JR, "Psychiatric illness following traumatic brain injury in an adult health maintenance organization population", Arch Gen Psychiatry, 61, pp.53~61 (2004)
- Park M, "Geriatric depression in primary care", Psychiatr Clin North Am, 34, pp.469~487 (2011)
- Lipsey JR, "Mood change following bilateral hemisphere brain injury", Br J Psychiatry, 143, pp.266~273 (1983)
- Starkstein SE, "Comparison of cortical and subcortical lesions in the production of poststroke mood disorders", Brain, 110(Pt 4), pp.1045~1059 (1987)
- Fedoroff JP, "Depression in patients with acute traumatic brain injury", Am J Psychiatry, 149, pp.918~923 (1992)
- Jorge RE, "Major depression following traumatic brain injury", Arch Gen Psychiatry, 61, pp.42~50 (2004)
- Starkstein SE, "Differential mood changes following basal ganglia vs thalamic lesions", Arch Neurol, 45, pp.725~730 (1988)
- Flor-Henry P, "On certain aspects of the localization of the cerebral systems regulating and determining emotion", Biol Psychiatry, 14, pp.677~698 (1979)
- Silberman EK, "Hemispheric lateralization of functions related to emotion", Brain Cogn, 5, pp.322~353 (1986)
- Tucker DM, "Lateral brain function, emotion, and conceptualization", Psychol Bull, 89, pp.19~46 (1981)
- Davidson RJ, "Affective style and affective disorders:perspectives from affective neuroscience", Cogn Emot, 12, pp.307~330 (1998)
- Mayberg HS, "Limbic-cortical dysregulation: a proposed model of depression", J Neuropsychiatry Clin Neurosci, 9, pp.471~481 (1997)
- Hudak A, "Brain morphometry changes and depressive symptoms after traumatic brain injury", Psychiatry Res, 191, pp.160~165 (2011)
- Hoffman JM, "Understanding pain after traumatic brain injury: impact on community participation", Am J Phys Med Rehabil, 86, pp.962~969 (2007)
- Sullivan-Singh SJ, "Comorbidity of pain and depression among persons with traumatic brain injury", Arch Phys Med Rehabil, 95, pp.1100~1105 (2014)