Published online Jun 19, 2026. doi: 10.5498/wjp.v16.i6.115917
Revised: December 10, 2025
Accepted: January 26, 2026
Published online: June 19, 2026
Processing time: 195 Days and 1.3 Hours
Post-stroke depression affects up to 40% of stroke survivors, with age being a critical but incompletely understood risk factor for depression onset patterns and treatment response.
To investigate the impact of age on depression symptom onset patterns, temporal evolution, and treatment response following acute cerebral infarction, providing scientific evidence for developing age-specific prevention and treatment strate
A multicenter retrospective study was conducted, including 300 patients with acute cerebral infarction admitted to two hospitals in Quanzhou City from January 2022 to January 2024. Patients were divided into a young group (18-44 years, n = 68), middle-aged group (45-64 years, n = 124), and elderly group (≥ 65 years, n = 108). Depression symptoms were assessed using Hamilton Depression Rating Scale-17 items (HAMD-17) and Patient Health Questionnaire-9 items, cognitive function was evaluated using Mini-Mental State Examination (MMSE), and functional status was assessed using Barthel index and modified Rankin Scale. Follow-up assessments were conducted at discharge, 1 month, 3 months, and 6 months post-discharge. Statistical analyses included repeated measures analysis of variance (ANOVA), generalized estimating equations, and multiple regression analysis.
No significant difference in depression symptom incidence was observed among the three groups at discharge (P > 0.05), but onset patterns differed. The young group showed peak HAMD-17 scores at 1-month post-discharge followed by gradual decline (12.8 ± 5.2 to 10.1 ± 4.3), the middle-aged group maintained high levels from 1-3 months, and the elderly group showed continuous increase in the first 3 months followed by stabilization (10.4 ± 5.6 to 15.8 ± 7.1). Repeated measures ANOVA revealed significant time × group interaction effects (F = 12.847, P < 0.001). Cognitive function recovery showed a graded pattern: Young group > middle-aged group > elderly group (P < 0.001). Multiple linear regression analysis identified age (β = 0.124, P < 0.001), National Institutes of Health Stroke Scale score (β = 0.346, P < 0.001), and high-sensitivity C-reactive protein level (β = 0.187, P = 0.006) as independent risk factors for HAMD-17 scores at 6 months, while MMSE score was a protective factor (β = -0.308, P = 0.002). Generalized estimating equation analysis showed different treatment responses across age groups, with the young group showing the best response and the elderly group the worst (P < 0.001).
The onset patterns of depression symptoms and response to treatment after acute cerebral infarction have a great impact on age. The symptoms of young patients are severe and of an acute phase, but elderly patients deteriorate slowly and with less response to treatment. The major influencing factors are differences in neuroplasticity, level of inflammatory response and status of cognitive functions. The clinical practice is also to create the age-stratified screening and assessment systems and to create the individual approach to treatment.
Core Tip: This study reported on post-stroke depression among 300 patients with cerebral injury focusing on both age change variables and differential depression patterns and treatment response. Changes in depression were more pronounced in the younger patients toward the positive and the elderly toward the negative. The elderly patients exhibited the longest depression duration with minimal treatment response. Age, cognitive function, and depression severity alone were effective prognosticators of post-stroke outcomes and additional variables which were more clinically pronounced, were not additive. The study advocates for the formation of age-related post-stroke depression symptomatic treatment and management response protocols to enhance rehabilitation.