Possible Biomarker for an Important Yet Neglected Symptom After Stroke ― Metalloproteinase-9 and Post-Stroke Depression ―

Yoshinobu Wakisaka
2019 Circulation Journal  
and therapeutic scales. In this issue of the Journal, Che et al 7 report that the serum level of matrix metalloproteinase (MMP)-9 in the acute stage of stroke is a possible biomarker for predicting T he incidence and prevalence of stroke increase with age, and the number of stroke patients is highly expected to rise with the ageing of populations. Despite recent advancements in stroke treatment such as thrombolytic therapy and mechanical thrombectomy, stroke continues to be a leading cause of
more » ... ronic and severe adult disability, resulting in a serious human problem, both for patients and caregivers, and a dramatic public financial burden. After stroke, many survivors are faced with a veritable array of physical and neuropsychiatric deficits. The sudden functional deficits and concomitant effect on motivation, the fear of emotional instability and death, and the demands of rehabilitation may result in hopelessness and helplessness leading to stress and depression. Post-stroke depression (PSD) is the most common emotional disorder after stroke. Approximately one-third of stroke survivors are affected it. 1 Depressive symptoms are most common in the first 3-6 months after stroke, and the prevalence of PSD remains at a high level in the following several years. 2 PSD is known to have an important effect on the course, recovery, and prognosis of stroke. The depression negatively affects a patent's ability to engage in rehabilitation therapies, and is strongly associated with further worsening of physical and cognitive recovery, functional outcome, and quality of life, and imposes a heavy burden on society and the family. 3 Moreover, PSD is associated with earlier recurrence of stroke. 3 Therefore, early accurate diagnosis of PSD is very important and should be taken seriously by clinicians. However, although a high proportion of stroke patients develop PSD, and PSD is more predictive of quality of life than actual neurological disability, PSD have received little attention in the field of stroke until now, presumably because the pathogenesis of PSD is very complex, involving both biological and sociopsychological mechanisms, and appropriate and reliable diagnostic criteria for PSD have not been developed yet. 4 As a result, PSD is often underdiagnosed and under-treated. 5 In addition, populations at risk for PSD are yet to be identified. 6 Thus, it is necessary to explore the pathogenesis and related influencing factors for PSD, and to establish appropriate screening, assessment, and diagnostic criteria, and determine the best preventive
doi:10.1253/circj.cj-19-0815 pmid:31582640 fatcat:3d2pwtlrcraxflhsmojgcpvoem