Article Text

Download PDFPDF
Research paper
Co-occurrence of depressive symptoms and executive dysfunction after stroke: associations with brain pathology and prognosis
  1. Elles Douven1,
  2. Pauline Aalten1,
  3. Julie Staals2,
  4. Syenna H J Schievink1,
  5. Robert J van Oostenbrugge2,3,
  6. Frans R J Verhey1,
  7. Sebastian Köhler1
  1. 1Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Alzheimer Center Limburg, Maastricht University, Maastricht, The Netherlands
  2. 2Department of Neurology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
  3. 3Department of Neurology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, The Netherlands
  1. Correspondence to Dr Sebastian Köhler, School for Mental Health and Neuroscience, Maastricht University, PO BOX 616 (DRT12) 6200 MD Maastricht, The Netherlands; s.koehler{at}


Objective To examine, first, whether the co-occurrence of executive dysfunction (ED) and poststroke depression (PSD) shows different associations with neuroimaging markers and the course of depression and executive function, and second, whether it is associated with a different course on other cognitive domains and quality of life.

Methods The present study included 245 stroke patients (35.9% female, mean age 67.5 years (SD=11.9). All patients completed neuropsychological and neuropsychiatric assessment 3 months poststroke, which were repeated at 6-month and 12-month follow-up. A subset (n=186) received 3-Tesla brain MRI at baseline to evaluate lesion-related imaging markers, white matter hyperintensity volume, global brain atrophy and total cerebral small vessel disease burden.

Results Patients with ‘depression–executive dysfunction syndrome’ (DES) showed higher white matter hyperintensity volumes compared with all other groups and more frequently showed left-sided lesions compared with ED only and PSD only. They also had more frequently old infarcts and higher total cerebral small vessel disease burden compared with PSD only and patients with neither ED nor PSD, and more global brain atrophy compared with PSD only. Longitudinal analyses showed that patients with DES had a more chronic course of depressive symptoms relative to PSD only, and a stable pattern of worse cognitive performance similar to patients with ED only.

Conclusions The co-occurrence of ED and PSD is associated with a worse prognosis of depression, persistent cognitive impairment and a higher amount of vascular and degenerative brain pathology. Future studies are needed to examine whether these patients represent a more severe subtype within the PSD spectrum.

Clinical trial registration NCT02585349;Results.

  • depression
  • cognition
  • stroke
  • neuroimaging
  • prognosis

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors All authors have made substantial contributions to conception and design, acquisition of data or analysis and interpretation of data; drafting of the article or revising it critically for important intellectual content and provided final approval of the version to be published. Roles were as follows: ED: acquisition of data, analysis and interpretation of data, segmentation of stroke lesion and WMH and writing the manuscript. PA: study design, study coordination and critical revision of manuscript. JS: study design, visual rating of MRI data, interpretation of data and critical revision of manuscript. SHJS: data collection and critical revision of manuscript. RJvO: study design, visual rating of MRI data and critical revision of manuscript. FRJV: study design, critical revision of manuscript. SK: study design, study coordination, assisted with statistical analyses and critical revision of manuscript.

  • Funding This project was funded by Maastricht University, Health Foundation Limburg, and the Adriana van Rinsum-Ponsen Stichting.

  • Competing interests None declared.

  • Ethics approval Medical Ethics Committee of Maastricht University Medical Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.