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Depression and stroke: an up-to-date review

Published online by Cambridge University Press:  18 May 2011

Pierluigi Politi ,
Paola Sciarini ,
Giovanni Segagni Lusignani  and
Giuseppe Micieli
Pierluigi Politi*
Affiliation:
DSSAeP, Sezione di Psichiatria, Università di Pavia, Pavia Servizio Psichiatrico di Diagnosi e Cura, IRCCS Policlinico San Matteo, Pavia
Paola Sciarini
Affiliation:
DSSAeP, Sezione di Psichiatria, Università di Pavia, Pavia
Giovanni Segagni Lusignani
Affiliation:
DSSAeP, Sezione di Psichiatria, Università di Pavia, Pavia
Giuseppe Micieli
Affiliation:
UC Malattie Cerebrovascolari /Stroke Unit, Fondazione C. Mondino, Pavia
*
Address for correspondence: Professor P. Politi, Sezione di Psichiatria, DSSAeP, Università di Pavia, via Bassi 21, 27100 Pavia. E-mail: [email protected]
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Summary

Aims – To define the epidemiological and clinical characteristics of Post Stroke Depression (PSD) and to evaluate treatment options. Methods – Systematic search using Medline electronic database limited to studies published from year 2000 to 2004, was carried out. Manual search was also performed. Results – Depression after stroke is a common event. The same, stroke incidence in depressed patients is more frequent than by chance. Risk of underdiagnosing a patient with former stroke is high. Disability after stroke is frequent, with compromission of quality of life of patients and relatives. Antidepressants are efficacious in PSD treatment, even if complete remission is difficult to obtain. Conclusions – There is enough evidence concerning epidemiology, pathogenesis, clinical and therapy to justify psychiatrists' interest on relationship between stroke and depression.

Declaration of Interest: in the past two years PP, GSL, PS have received no fees or other financial support from pharmaceutical companies, GM has received speaker fees from Sanofi-Aventis, Lundbeck, Bayer Health Care, Boehringer Ingelheim, Novo Mordisk.

Keywords

cerebrovascular diseasestrokedepressionquality of life
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 15 , Issue 4 , December 2006 , pp. 284 - 294
Copyright
Copyright © Cambridge University Press 2006

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References

Bibliografia

Aben, I., Denollet, J., Lousberg, R., Verhey, F., Wojciechowski, F. & Honig, A. (2002a). Personality and vulnerability to depression in stroke patients: a 1-year prospective follow-up study. Stroke 33, 2391–2395.CrossRefGoogle ScholarPubMed
Aben, I., Verhey, F., Lousberg, R., Lodder, J. & Honig, A. (2002b). Validity of the Beck Depression Inventory, Hospital Anxiety and Depression Scale, SCL-90, and Hamilton Depression Rating Scale as screening instruments for depression in stroke patients. Psychosomatics 43 386–393.CrossRefGoogle Scholar
Alexopulos, J.S., Meyers, B.S., Young, R.C., Campbell, S.Silbersweig, D. & Charleson, M. (1997). “Vascular depression” hypothesis. Archives of General Psychiatry 54, 915–922.CrossRefGoogle Scholar
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th. Ed., Text Revised). American Psychiatric Publishing: Washington DC.Google Scholar
Andersen, G. (1997). Post-stroke depression: diagnosis and incidence. European Psychiatry 12, Suppl. 3, 255–260.CrossRefGoogle ScholarPubMed
Anderson, C.S., Linto, J. & Stewart-Wynne, E.G. (1995). A population-based assessment of the impact and burden of caregiving for long-term stroke survivors. Stroke 26, 843–849.CrossRefGoogle ScholarPubMed
Anderson, C.S., Hackett, M.L. & House, A.O. (2004). Interventions for preventing depression after stroke. Cochrane Database of Systematic Reviews, Issue 1.CrossRefGoogle ScholarPubMed
Anderson, R.J., Freedland, K.E., Clouse, R.E., Lustman, PJ (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care 24, 1069–1078.CrossRefGoogle ScholarPubMed
Angelelli, P., Paolucci, S., Bivona, U., Piccardi, L., Ciurli, P., Cantagallo, A., Antonucci, G., Fasotti, L., Di Santantonio, A., Grasso, M.G. & Pizzamiglio, L. (2004). Development of neuropsychiatric symptoms in poststroke patients: a cross-sectional study. Acta Psychiatrica Scandinavica 110, 55–63.CrossRefGoogle ScholarPubMed
Appelros, P. & Viitanen, M. (2004). Prevalence and predictors of depression at one year in a Swedish population-based cohort with first-ever stroke. Journal of Stroke and Cerebrovascular Diseases 13, 52–57.CrossRefGoogle Scholar
Åström, M. (1996). Generalized anxiety disorder in stroke patients: a 3-year longitudinal study. Stroke 27, 270–275.CrossRefGoogle ScholarPubMed
Beekman, A.T.F., Penninx, B.W.J.H., Deeg, D.J.H., Ormel, J., Smit, J.H., Braam, A.W. & van Tilburg, W. (1998). Depression in survivors of stroke: a community-based study of prevalence, risk factors and consequences. Social Psychiatry and Psychiatric Epidemiology 33, 463–470.CrossRefGoogle ScholarPubMed
Benaim, C., Cailly, B., Perennou, D & Pelissie, J. (2004). Validation of the Aphasic Depression Rating Scale. Stroke 35, 1692–1696.CrossRefGoogle ScholarPubMed
Berg, A., Palomaki, H., Lehtihalmes, M., Lonnqvist, J. & Kaste, M. (2001). Poststroke depression in acute phase after stroke. Cerebrovascular Diseases 12, 14–20.CrossRefGoogle ScholarPubMed
Berg, A., Palomaki, H., Lehtihalmes, M., Lonnqvist, J. & Kaste, M. (2003). Poststroke depression: an 18-month follow-up. Stroke 34, 138–143.CrossRefGoogle ScholarPubMed
Bruce, M. (2001). Depression and disability in late life: directions for future research. American Journal of Geriatric Psychiatry 9, 102–112.CrossRefGoogle ScholarPubMed
Burvill, P.W., Johnson, G.A., Chakera, T.M.H., Stewart-Wynne, E.G., Anderson, C.S. & Jamrozik, K.D. (1996). The place of site of lesion in the aetiology of post-stroke depression. Cerebrovascular Diseases 6, 208–215.CrossRefGoogle Scholar
Burvill, P., Johnson, G., Jamrozik, K., Anderson, C. & Stewart-Wynne, E. (1997). Risk factors for post-stroke depression. International Journal of Geriatric Psychiatry 12, 219–226.3.0.CO;2-E>CrossRefGoogle ScholarPubMed
Camus, V., Kraehenbuhl, H., Preisigc, M., Bula, C.J. & Waeber, G. (2004). Geriatric depression and vascular diseases: what are the links? Journal of Affective Disorders 81, 1–16.CrossRefGoogle ScholarPubMed
Carson, A.J., MacHale, S., Allen, K., Lawrie, S.M., Dennis, M, House, A. & Scarpe, M. (2000). Depression after stroke and lesion location: a systematic review. Lancet 356, 122–126.CrossRefGoogle ScholarPubMed
Cassidy, E., O'Connor, R. & O'Keane, V. (2004). Prevalence of post-stroke depression in an Irish sample and its relationship with disability and outcome following inpatient rehabilitation. Disability and Rehabilitation 26, 71–77.CrossRefGoogle Scholar
Castillo, S., Starkstein, S., Fedoroff, P., Price, T. & Robinson, R. (1993). Generalized anxiety after stroke. Journal of Nervous and Mental Disease 181, 100–106.CrossRefGoogle ScholarPubMed
D'Ath, P., Katona, P., Mullan, E., Evans, S., Katona, C. (1994). Screening, detection and management of depression in elderly primary care attenders. I: The acceptability and performance of the 15 item Geriatric Depression Scale (GDS15) and the development of short versions. Family Practice 2, 260–266.CrossRefGoogle Scholar
Desmond, D.W., Remien, R.H., Moroney, J.T., Stern, Y., Sano, M. & Williams, J.B. (2003). Ischemic stroke and depression. Journal of the International Neuropsychological Society 9, 429–439.CrossRefGoogle ScholarPubMed
Eriksson, M, Asplund, K., Glader, E.L., Norrving, B., Stegmayr, B., Terent, A., Asberg, K.H., Wester, P.O. & Riks-Stroke Collaboration (2004). Self-reported depression and use of antidepressants after stroke: a national survey. Stroke 35, 936–941.CrossRefGoogle Scholar
Fedoroff, J.P., Starkstein, S.E., Parikh, R.M., Price, T.R. & Robinson, R.G. (1991). Are depressive symptoms non-specific in patients with acute stroke? American Journal of Psychiatry 148, 1172–1176.Google Scholar
Fruehwald, S., Loffler, H., Eher, R., Saletu, B. & Baumhackl, U. (2001). Relationship between depression, anxiety and quality of life: a study of stroke patients compared to chronic low back pain and myocardial ischemia patients. Psychopalhology 34, 50–56.CrossRefGoogle Scholar
Gillen, R., Tenne, H., McKee, T.E. & Gernert-Dott, P. (2001). Depressive symptoms and history of depression predict rehabilitation efficiency in stroke patients. Archives of Physical Medicine and Rehabilitation 82, 1645–1649.CrossRefGoogle ScholarPubMed
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders: a BioSocial Model. Routledge: London.Google Scholar
Hackett, M.L., Anderson, C.S. & House, A.O. (2004). Interventions for treating depression after stroke. Cochrane Database of Systematic Reviews, Issue 2.CrossRefGoogle Scholar
Hatano, S. (1976). Experience from a multicentre stroke register: a preliminary report. Bulletin of the WHO 54, 541–553.Google Scholar
Herrmann, M. & Wallesch, C. (1993). Depressive changes in stroke patients. Disability and Rehabilitation 15, 55–66.CrossRefGoogle ScholarPubMed
House, A., Knapp, P., Bamford, J. & Vail, A. (2001). Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke 32, 696–701.CrossRefGoogle ScholarPubMed
Jaracz, K. & Kozubski, W. (2003). Quality of life in stroke patients. Acta Neurologica Scandinavica 107, 324–329.CrossRefGoogle ScholarPubMed
Jaracz, K., Jaracz, J., Kozubski, W. & Rybakowski, J.K. (2002). Post-stroke quality of life and depression. Acta Neuropsychiatrica 14, 219–225.CrossRefGoogle ScholarPubMed
Jonas, B.S. & Mussolino, M.E. (2000). Symptoms of depression as a prospective risk factor for stroke. Psychosomatic Medicine 62, 463–471.CrossRefGoogle ScholarPubMed
Jorge, R.E., Robinson, R.G., Tateno, A., Narushima, K., Acion, L., Moser, D., Arndt, S. & Chemerinski, E. (2004). Repetitive transcranial magnetic stimulation as a treatment of poststroke depression: a preliminary study. Biological Psychiatry 55, 398–405.CrossRefGoogle ScholarPubMed
Jorgensen, L., Engstad, T. & Jacobsen, B.K. (2002). Higher incidence of falls in long-term stroke survivors than in population controls: depressive symptoms predict falls after stroke. Stroke 33, 542–547.CrossRefGoogle ScholarPubMed
Kauhanen, M.L., Korpelainen, J.T., Hiltunen, P., Maatta, R., Mononen, H., Brusin, E., Sotaniemi, K.A. & Myllyla, V.V. (2000). Aphasia, depression, and non-verbal cognitive impairment in ischaemic stroke. Cerebrovascular Diseases 10, 455–461.CrossRefGoogle ScholarPubMed
Kim, J.M., Stewart, R., Shin, I.S. & Yoon, J.S. (2002). Previous stroke but not vascular risk factors are associated with depression in a cognitively impaired older Korean population. International Journal of Geriatric Psychiatry 17, 453–458.CrossRefGoogle ScholarPubMed
Kim, J.S. & Choi-Kwon, S. (2000). Poststroke depression and emotional incontinence: correlation with lesion location. Neurology 54, 1805–1810.CrossRefGoogle ScholarPubMed
Lieberman, D., Friger, M., Fried, V., Grinshpun, Y., Myths, N., Tylis, R., Galinsky, D. & Lieberman, D. (1999). Characterization of elderly patients in rehabiliation: stroke versus hip fracture. Disability and Rehabilitation 21, 542–547.CrossRefGoogle Scholar
Lincoln, N.B. & Flannaghan, T. (2003). Cognitive behavioural psychotherapy for depression following stroke: a randomized controlled trial. Stroke 34, 111–115.CrossRefGoogle ScholarPubMed
Lincoln, N.B., Nicholl, C.R., Flannaghan, T., Leonard, M. & Van der Gucht, E. (2003). The validity of questionnaire measures for assessing depression after stroke. Clinical Rehabilitation 17, 840–846.CrossRefGoogle ScholarPubMed
Narushima, K. & Robinson, R.G. (2003). The effect of early versus late antidepressant treatment on physical impairment associated with poststroke depression: is there a time-related therapeutic window? Journal of Nervous and Mental Disease 191, 645–652.CrossRefGoogle Scholar
Narushima, K., Kosier, J. T. & Robinson, R.J (2002). Preventing poststroke depression: a 12-week double-blind randomized treatment trial and 21-month follow-up. Journal of Nervous & Mental Disease 190, 296–303.CrossRefGoogle ScholarPubMed
Ng, K., Chan, K. & Straughan, P. (1995). A study of post-stroke depression in a rehabilitative center. Acta Psychiatrica Scandinavica 92, 75–79.CrossRefGoogle Scholar
Ohira, T., Iso, H., Satoh, S., Sankai, T., Tanigawa, T., Ogawa, Y., Imano, H., Sato, S., Kitamura, A. & Shimamoto, T. (2001). Prospective study of depressive symptoms and risk of stroke among Japanese. Stroke 32, 903–907.CrossRefGoogle ScholarPubMed
Ostir, G.V., Markides, K.S., Peek, M.K. & Goodwin, J.S. (2001). The association between emotional well-being and the incidence of stroke in older adults. Psychosomatic Medicine 63, 210–215.CrossRefGoogle ScholarPubMed
Ouimet, M.A., Primeau, F. & Cole, M.G. (2001). Psychosocial risk factors in poststroke depression: a systematic review. Canadian Journal of Psychiatry 46, 819–828.CrossRefGoogle ScholarPubMed
Paolucci, S., Antonucci, G., Grasso, M.G., Morelli, D., Troisi, E., Coiro, P., De Angelis, D., Rizzi, F. & Bragoni, M. (2001). Post stroke depression, antidepressant treatment and rehabilitation results: a case control study. Cerebrovascular Diseases 12, 264–271.CrossRefGoogle ScholarPubMed
Parikh, R., Robinson, R., Lipsey, J., Starkstein, S., Fedoroff, J. & Price, T. (1990). The impact of poststroke depression on recovery in activities of daily living over a 2-year follow-up. Archives of Neurology 47, 785–789.CrossRefGoogle ScholarPubMed
Pohjasvaara, T., Vataja, R., Leppavuori, A., Kaste, M. & Erkinjuntti, T. (2001a). Depression is an independent predictor of poor long-term functional outcome post-stroke. European Journal of Neurology 8, 315–319.CrossRefGoogle ScholarPubMed
Pohjasvaara, T., Vataja, R., Leppavuori, A., Kaste, M. & Erkinjuntti, T. (2001b). Suicidal ideas in stroke patients 3 and 15 months after stroke. Cerebrovascular Diseases 12, 21–26.CrossRefGoogle ScholarPubMed
Pohjasvaara, T., Leskela, M., Vataja, R., Kalska, H., Ylikoski, R., Hietanen, M., Leppavuori, A., Kaste, M. & Erkinjuntti, T. (2002). Post-stroke depression, executive dysfunction and functional outcome. European Journal of Neurology 9, 269–275.CrossRefGoogle ScholarPubMed
Radloff, L.S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.CrossRefGoogle Scholar
Ramasubbu, R., Robinson, R.G.Hint, A.J., Rosier, T. & Price, T.R. (1998). Functional impairment associated with acute poststroke depression: The Stroke Data Bank study. Journal of Neuropsychiatry and Clinical Neurosciences 10, 26–33.CrossRefGoogle ScholarPubMed
Rampello, L., Chiechio, S., Nicoletti, G., Alvano, A., Vecchio, I., Raffaele, R. & Malaguarnera, M. (2004). Prediction of the response to citalopram and reboxetine in post-stroke depressed patients. Psychopharmacology (Berl.) 173, 73–78.CrossRefGoogle ScholarPubMed
Rasmussen, A.. Lunde, M., Poulsen, D.L., Sorensen, K.. Qvitzau, S. & Bech, P. (2003). A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics 44, 216–21. Erratum in: Psychosomatics. 45, 91.CrossRefGoogle ScholarPubMed
Robinson, R.G. (2003). Poststroke depression: prevalence, diagnosis, treatment, and disease progression. Biological Psychiatry 54, 376–387.CrossRefGoogle ScholarPubMed
Robinson, R., Kubos, K., Starr, L., Rao, K. & Price, T.R. (1984a). Mood disorders in stroke patients: importance of location of lesion. Brain 107. 81–93.CrossRefGoogle ScholarPubMed
Robinson, R., Starr, L., Lipsey, J., Rao, K. & Price, T.R. (1984b). A twoyear longitudinal study of post-stroke mood disorders: Dynamic changes in associated variables over the first six months of followup. Stroke 15, 510–517.CrossRefGoogle ScholarPubMed
Robinson, R., Lipsey, J., Rao, K. & Price, T. (1986). Two-year longitudinal study of post-stroke mood disorders: comparison of acute-onset with delayed-onset depression. American Journal of Psychiatry 143, 1238–1244.Google ScholarPubMed
Robinson-Smith, G., Johnston, M.V. & Allen, J. (2000). Self-care selfefficacy, quality of life, and depression after stroke. Archives of Physical Medicine and Rehabilitation 81, 460–464.CrossRefGoogle ScholarPubMed
Sandberg, O., Franklin, K.A., Bucht, G. & Gustafson, Y. (2001). Sleep apnea, delirium, depressed mood, cognition, and ADL ability after stroke. Journal of the American Geriatrics Society 49, 391–397.CrossRefGoogle ScholarPubMed
Sato, R., Bryan, R. & Fried, L. (1999). Neuroanatomic and functional correlates of depressed mood. The Cardiovascular Health Study. American Journal of Epidemiology 150, 919–929.CrossRefGoogle ScholarPubMed
Sayal, K.S., Duncan-McConnell, D.A., McConnell, H.W. & Taylor, D.M. (2000). Psychotropic interactions with warfarin. Ada Psychiatrica Scandinavica 102, 250–255.CrossRefGoogle ScholarPubMed
Schramke, C., Stowe, R., Ratcliff, G., Goldstein, G. & Condray, R. (1998). Poststroke depression and anxiety: different assessment methods result in variations in incidence and severity estimates. Journal of Clinical and Experimental Neuropsychology 20, 723–737.Google ScholarPubMed
Sembi, S., Tarrier, N., O'Neill, P., Burns, A. & Faragner, B. (1998). Does post-traumatic stress disorder occur after stroke: a preliminary study. International Journal of Geriatric Psychiatry 13, 315–322.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
Sharpe, M., Hawton, K., House, A., Molyneux, A., Sandercock, P., Bamford, J. & Warlow, C. (1990). Mood disorders in long-term survivors of stroke: associations with brain lesion location and volume. Psychological Medicine 20, 815–828.CrossRefGoogle ScholarPubMed
Singh, A., Black, S.E., Herrmann, N., Leibovitch, F.S., Ebert, P.L., Lawrence, J. & Szalai, J.P. (2000). Functional and neuroanatomic correlations in poststroke depression: the Sunnybrook stroke study. Stroke 31, 637–644.CrossRefGoogle ScholarPubMed
Sinyor, D., Amato, P. & Kaloupek, P. (1986). Post-stroke depression: relationship to functional impairment, coping strategies, and rehabilitation outcome. Stroke 17, 112–117.CrossRefGoogle ScholarPubMed
Spalletta, G., Guida, G.. De Angelis, D. & Caltagirone, C. (2002). Predictors of cognitive level and depression severity are different in patients with left and right hemispheric stroke within the first year of illness. Journal of Neurology 249, 1541–1551.CrossRefGoogle ScholarPubMed
Spencer, K., Tompkins, C. & Schulz, R. (1997). Assessment of depression in patients with brain pathology: the case of stroke. Psychological Bulletin 122, 132–152.CrossRefGoogle ScholarPubMed
SPREAD (2003). Ictus Cerebrate: Linee Guida Italiane di Prevenzione e Trattamento. Catel: Milano.Google Scholar
Starkstein, S., Cohen, B., Fedoroff, P., Parikh, R., Price, T. & Robinson, R. (1990). Relationship between anxiety disorders and depressive disorders in patients with cerebrovascular injury. Archives of General Psychiatry A1, 246–251.CrossRefGoogle Scholar
Stewart, R., Prince, M., Richards, M., Brayne, C. & Mann, A. (2001). Stroke, vascular risk factors and depression. Cross-sectional study in a UK Caribbean-born population. British Journal of Psychiatry 178, 23–28.CrossRefGoogle Scholar
Sturm, J.W., Donnan, G.A., Dewey, H.M., Macdonell, R.A., Gilligan, A.K., Srikanth, V. & Thrift, A.G. (2004). Quality of life after stroke, the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 35, 2340–2345.CrossRefGoogle Scholar
Sutcliffe, L.M. & Lincoln, N.B. (1998). The assessment of depression in aphasic stroke patients: the development of the Stroke Aphasic Depression Questionnaire. Clinical Rehabilitation 12, 506–513.CrossRefGoogle Scholar
Sinyor, D., Amato, P. & Kaloupek, P. (1986). Post-stroke depression: relationship to functional impairment, coping strategies, and rehabilitation outcome. Stroke 17, 112–117.CrossRefGoogle ScholarPubMed
Thomas, A. J., Kalaria, R.N. & O'Brien, J.T. (2004). Depression and vascular disease: what is the relationship? Journal of Affective Disorders 19, 81–95.CrossRefGoogle Scholar
Turner-Stokes, L. & Hassan, N. (2002a). Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway. Part 1: diagnosis, frequency and impact. Clinical Rehabilitation 16, 231–247.CrossRefGoogle ScholarPubMed
Turner-Stokes, L. & Hassan, N. (2002b). Depression after stroke: a review of the evidence base to inform the development of an integrated care pathway. Part 2: treatment alternatives. Clinical Rehabilitation 16, 248–260.CrossRefGoogle ScholarPubMed
Vataja, R., Leppavuori, A., Pohjasvaara, T., Mantyla, R.. Aronen, H.J., Salonen, O., Kaste, M. & Erkinjuntti, T. (2004). Poststroke depression and lesion location revisited. Journal of Neuropsychiatry and Clinical Neurosciences 16, 156–162.CrossRefGoogle ScholarPubMed
Verdelho, A., Henon, H., Lebert, F., Pasquier, F. & Leys, D. (2004). Depressive symptoms after stroke and relationship with dementia: a three-year follow-up study. Neurology 62, 905–911.CrossRefGoogle ScholarPubMed
Whyte, E.M. & Mulsant, B.M. (2002). Post stroke depression: epidemiology, pathophysiology, and biological treatment. Biological Psychiatry 52, 253–264.CrossRefGoogle ScholarPubMed
Whyte, E.M., Mulsant, B.H., Vanderbilt, J., Dodge, H.H. & Ganguli, M. (2004). Depression after stroke: a prospective epidemiological study. Journal of the American Geriatrics Society 52, 774–778.CrossRefGoogle ScholarPubMed
Williams, L.S., Ghose, S.S. & Swindle, R.W. (2004). Depression and other mental health diagnoses increase mortality risk after ischemic stroke. American Journal of Psychiatry 161, 1090–1095.CrossRefGoogle ScholarPubMed