Inflammation, sleep-circadian disruption, and neuropsychiatric recovery after stroke: Mechanisms and integrated interventions for post-stroke depression and anxiety

Table 1 Assessment domains for post-stroke mood-sleep-circadian-inflammatory dysregulation

Domain	Suggested assessments	Clinical value	Important cautions
Mood symptoms	PHQ-9, HDRS, HADS, GAD-7, clinical interview	Identify depression, anxiety, comorbidity, and symptom severity	Somatic items may overlap with fatigue, aphasia, cognitive impairment, and neurological deficits
Sleep disturbance	PSQI, ISI, ESS, sleep diary, snoring/apnea screening	Identify insomnia, daytime sleepiness, sleep-disordered breathing, and fragmented sleep	Subjective sleep complaints may be influenced by mood and cognition
Circadian rhythm	Sleep timing, nap pattern, light exposure, activity rhythm, actigraphy	Identify irregular sleep-wake rhythm, low daytime activity, and weak day-night contrast	Actigraphy is useful but not always available in routine care
Inflammatory status	CRP, IL-6, TNF-α, IL-1β, NLR	Characterize inflammatory risk and biological vulnerability	Markers are nonspecific and affected by infection, stroke severity, metabolic disease, and medications
Rehabilitation context	Activity level, therapy participation, ward environment, pain, nocturia	Identify modifiable barriers to recovery	Requires multidisciplinary observation and repeated assessment

PHQ-9: Patient Health Questionnaire-9; HDRS: Hamilton Depression Rating Scale; HADS: Hospital Anxiety and Depression Scale; Generalized Anxiety Disorder-7; PSQI: Pittsburgh Sleep Quality Index; ISI: Insomnia Severity Index; ESS: Epworth Sleepiness Scale; CRP: C-reactive protein; IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-α; IL-1β: Interleukin-1β; NLR: Neutrophil-to-lymphocyte ratio.