April 25, 2023; 100 (17) Research Article
Depressive Symptoms and Risk of Acute Stroke
INTERSTROKE Case-Control Study
View ORCID ProfileRobert P. Murphy, View ORCID ProfileCatriona Reddin, View ORCID ProfileAnnika Rosengren, View ORCID ProfileConor Judge, View ORCID ProfileGraeme J. Hankey, View ORCID ProfileJohn Ferguson, Alberto Alvarez-Iglesias, Shahram Oveisgharan, Mohammad Wasay, Clodagh McDermott, Helle Klingenberg Iversen, Fernando Lanas, Fawaz Al-Hussain, Anna Czlonkowska, Aytekin Oguz, Adesola Ogunniyi, View ORCID ProfileAlbertino Damasceno, Denis Xavier, Alvaro Avezum, Xingyu Wang, Peter Langhorne, Salim Yusuf, Martin O'Donnell, for the INTERSTROKE investigators
First published March 8, 2023, DOI: https://doi.org/10.1212/WNL.0000000000207093
Robert P. Murphy
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MBCatriona Reddin
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MBAnnika Rosengren
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDConor Judge
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
PhDGraeme J. Hankey
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MBBS, MD, FRACPJohn Ferguson
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
PhDAlberto Alvarez-Iglesias
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
PhDShahram Oveisgharan
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDMohammad Wasay
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDClodagh McDermott
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MB BCh, BAO, MScHelle Klingenberg Iversen
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDFernando Lanas
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDFawaz Al-Hussain
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDAnna Czlonkowska
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MD, PhDAytekin Oguz
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDAdesola Ogunniyi
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDAlbertino Damasceno
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDDenis Xavier
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDAlvaro Avezum
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
MDXingyu Wang
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
PhDPeter Langhorne
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
PhDSalim Yusuf
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
DPhilMartin O'Donnell
From the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
PhDFrom the HRB Clinical Research Facility Galway (R.P.M., C.R., C.J., J.F., A.A.-I., C.M., M.O.D.), School of Medicine, NUI Galway; Wellcome Trust-HRB (C.R., C.J.), Irish Clinical Academic Training, Galway, Ireland; Sahlgrenska University Hospital and Sahlgrenska Academy (A.R.), University of Gothenburg, Sweden; Population Health Research Institute (C.J., S.Y., M.O.D.), Hamilton Health Sciences and McMaster University, Ontario, Canada; School of Medicine and Pharmacology (G.J.H.), The University of Western Australia, Perth, Washington; Rush Alzheimer Disease Research Center (S.O.), Rush University Medical Center, Chicago, IL; Aga Khan University (M.W.), Karachi, Pakistan; Department of Neurology (H.K.I.), Rigshospitalet, University of Copenhagen; Health and Medical Sciences (H.K.I.), University of Copenhagen, Blegdamsvej 9, Denmark; Faculty of Medicine (F.L.), Universidad de La Frontera, Temuco, Chile; King Saud University (F.A.-H.), Riyadh, Saudi Arabia; Institute of Psychiatry and Neurology (A.C.), Warsaw, Poland; Department of Internal Medicine (Aytekin Oguz), Faculty of Medicine, Istanbul Medeniyet University, Turkey; Division of Cardiovascular Medicine (Adesola Ogunniyi), Department of Medicine, University College Hospital, Ibadan, Nigeria; Eduardo Mondlane University (A.D.), Maputo, Mozambique; St John's Medical College and Research Institute (D.X.), Bangalore, India; Instituto Dante Pazzanese de Cardiologia (A.A.), Sao Paulo, Brazil; Laboratory of Human Genetics (X.W.), Beijing Hypertension League Institute, China; and Academic Section of Geriatric Medicine (P.L.), Glasgow Royal Infirmary, University of Glasgow, United Kingdom.
Depressive Symptoms and Risk of Acute Stroke
INTERSTROKE Case-Control Study
Robert P. Murphy, Catriona Reddin, Annika Rosengren, Conor Judge, Graeme J. Hankey, John Ferguson, Alberto Alvarez-Iglesias, Shahram Oveisgharan, Mohammad Wasay, Clodagh McDermott, Helle Klingenberg Iversen, Fernando Lanas, Fawaz Al-Hussain, Anna Czlonkowska, Aytekin Oguz, Adesola Ogunniyi, Albertino Damasceno, Denis Xavier, Alvaro Avezum, Xingyu Wang, Peter Langhorne, Salim Yusuf, Martin O'Donnell, for the INTERSTROKE investigators
Neurology Apr 2023, 100 (17) e1787-e1798; DOI: 10.1212/WNL.0000000000207093
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Abstract
Background and Objectives Depression has been reported to be a risk factor of acute stroke, based largely on studies in high-income countries. In the INTERSTROKE study, we explored the contribution of depressive symptoms to acute stroke risk and 1-month outcome across regions of the world, within subpopulations and by stroke type.
Methods The INTERSTROKE is an international case-control study of risk factors of first acute stroke, conducted in 32 countries. Cases were patients with CT- or MRI-confirmed incident acute hospitalized stroke, and controls were matched for age, sex, and within sites. Standardized questions asked about self-reported depressive symptoms during the previous 12 months and the use of prescribed antidepressant medications were recorded. Multivariable conditional logistic regression was used to determine the association of prestroke depressive symptoms with acute stroke risk. Adjusted ordinal logistic regression was used to explore the association of prestroke depressive symptoms with poststroke functional outcome, measured with the modified Rankin scale at 1 month after stroke.
Results Of 26,877 participants, 40.4% were women, and the mean age was 61.7 ± 13.4 years. The prevalence of depressive symptoms within the last 12 months was higher in cases compared with that in controls (18.3% vs 14.1%, p < 0.001) and differed by region (p interaction <0.001), with lowest prevalence in China (6.9% in controls) and highest in South America (32.2% of controls). In multivariable analyses, prestroke depressive symptoms were associated with greater odds of acute stroke (odds ratio [OR] 1.46, 95% CI 1.34–1.58), which was significant for both intracerebral hemorrhage (OR 1.56, 95% CI 1.28–1.91) and ischemic stroke (OR 1.44, 95% CI 1.31–1.58). A larger magnitude of association with stroke was seen in patients with a greater burden of depressive symptoms. While preadmission depressive symptoms were not associated with a greater odds of worse baseline stroke severity (OR 1.02, 95% CI 0.94–1.10), they were associated with a greater odds of poor functional outcome at 1 month after acute stroke (OR 1.09, 95% CI 1.01–1.19).
Discussion In this global study, we recorded that depressive symptoms are an important risk factor of acute stroke, including both ischemic and hemorrhagic stroke. Preadmission depressive symptoms were associated with poorer functional outcome, but not baseline stroke severity, suggesting an adverse role of depressive symptoms in poststroke recovery.
Glossary
- ICH=
- intracerebral hemorrhage;
- mRS=
- modified Rankin scale;
- OR=
- odds ratio
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
INTERSTROKE coinvestigators are listed in Appendix 2 at the end of the article.
Submitted and externally peer reviewed. The handling editor was Editor-in-Chief José Merino, MD, MPhil, FAAN.
Infographic links.lww.com/WNL/C728
- Received May 9, 2022.
- Accepted in final form January 10, 2023.
- © 2023 American Academy of Neurology
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