Alarjan, Sami
(2016)
Examining the relationship between post-stroke cognitive dysfunctions and mood disorders in hospitalised Saudi patients.
PhD thesis, University of Nottingham.
Abstract
Background: The Ministry of Health in Saudi Arabia estimates that there are at least 20,000 strokes per year across the country (126/100,000) and approximately half of those with stroke may develop cognitive dysfunction or mood disorders. However, a review of the literature revealed that research in the area of post-stroke cognitive dysfunction and mood disorders in the Kingdom of Saudi Arabia (KSA) is severely lacking. Accordingly, these studies aimed to bridge the knowledge gap with an emphasis on three central aspects. The first aim was to assess the prevalence of post-stroke cognitive dysfunctions in the KSA population using neuropsychological tests. The second aim was to assess the prevalence of post-stroke mood disorders in the KSA using self-report scales. The third aim was to evaluate the relationship between cognitive dysfunctions and mood disorders.
Method: Observational methods were used to collect descriptive information about the prevalence of cognitive dysfunctions and mood disorders in the Saudi population. Participants were recruited from three medical centres in the KSA: King Abdulaziz Medical City, King Fahad Medical City, and Sultan Bin Abdulaziz Humanitarian City. The target sample was age 18 years and above who were diagnosed by neurologists with ischemic or haemorrhagic stroke according to CT-scan results, and who were at least one month post first-ever stroke, and either attending out-patient clinics or admitted to medical centre. Participants were excluded from the study sample if they satisfied any the following conditions: severe dementia; sever aphasia; chronic psychiatric or other concurrent neurological disorders; a known history of alcohol or drug abuse; blindness or deafness; participant non Saudi citizen; an inability to speak or understand Arabic; or medically unstable.
Results: For the empirical investigation, 76 men and 24 women were recruited (mean age 60.53 ± 11.26 years). Of these, 52% had deficits of orientation/attention, 55% of memory, 36% of fluency, 46% of language, 26% of visuospatial ability, 35.7% of visual neglect, 58.4% of visual-motor skills, 69% of executive function, and 52% had overall cognitive impairment, 36% had anxiety and 44% had depression after stroke. The results confirmed a strong relationship between cognitive dysfunctions and mood disorders. However, from the regression model, it was found that ‘literacy’ (literate vs. illiterate), ‘time since stroke’ (≤ 6 vs. ≥ 7 months), ‘fluency impairment’ and ‘memory impairment’ were significant predictors of the severity of anxiety disorder after stroke. Similarly, ‘literacy’ (literate vs. illiterate), ‘time since stroke’ (≤ 6 vs. ≥ 7 months), ‘fluency impairment’, ‘memory impairment’, ‘visuospatial ability impairment’ and ‘visual neglect’ were significant predictors of the severity of depression after stroke.
Conclusion: Based on the sample of Saudi patients (n= 100), it can be concluded that cognitive dysfunctions have an effect on the stroke patient’s mood. The severity of cognitive dysfunction is significantly related with mood disorders, in particular depression disorder.
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