Network analysis of depressive symptoms and cognitive functions in stroke

Research Objectives: To examine network-based associations between depression and cognition in people after stroke. We identified central depressive symptoms, central cognitive performances, and bridge components that connect these two constructs.

Design: Secondary analysis of baseline data derived from a prospective observational study.

Setting: Home and Community

Participants: 202 participants with mild-to-moderate chronic stroke (median age: 60; 90% ischemic stroke; 45% female; 44% black).

Interventions: Not applicable

Main Outcome Measures: Patient Health Questionnaire (PHQ-8) for depressive symptoms and the NIH Toolbox Cognitive Battery for cognitive functions. The network-based analyses were used to characterize depression and cognition networks, identify central symptoms/functions, and identify the bridge pathway connecting depression and cognition.

Results: Depressive symptoms were positively intercorrelated with each other. The top three central symptoms of depression included: Mood (expected influence = 1.58), concentration (expected influence = 0.67), and guilt (expected influence = 0.63). Cognitive functions also showed similar network patterns, with the top three central functions as executive function (expected influence = 0.89), expressive language (expected influence = 0.68), and processing speed (expected influence = 0.48). Psychomotor functioning (bridge expected influence = 2.49) and attention (bridge expected influence = 1.10) were the most salient symptoms/functions connecting depression and cognition.

Conclusions: The central and bridge symptoms/functions may serve as potential intervention targets. This approach may be more effective than conventional interventions addressing depression or cognitive impairment as a homogenous clinical syndrome. Future trials are warranted to test the effectiveness of such centering/bridging targeted interventions.

Author(s) Disclosures: Dr. Lenze has served as a consultant for Boehringer Ingelheim, Prodeo, Pritikin, Merck, and IngenioRx. Dr. Mohr has served as a consultant for Otsuka Pharmaceuticals, Optum Behavioral Health, Centerstone Research Institute, and OneMind Foundation. Dr.Mohr receives royalties from Oxford Press and has an ownership interest in Adaptive Health. Dr. Lee has served as a consultant for Biogen and Regenera. Dr. Hu has a stockholder interest in Tencent Holdings Limited. Dr. Metts has an ownership interest in Infinite Arms. Dr. Fong has served as an independent contractor for Isaac Ray Forensic Group and Michigan Avenue Neuropsychologists.