Published online Sep 19, 2026. doi: 10.5498/wjp.118381
Revised: February 25, 2026
Accepted: July 15, 2026
Published online: September 19, 2026
Processing time: 205 Days and 22 Hours
Cerebral infarction is the leading cause of death and disability among adults, with post-stroke depression (PSD) and anxiety affecting 30%-50% of survivors. PSD and anxiety worsens rehabilitation outcomes and increases mortality risk, yet 30%-40% of patients respond inadequately to first-line therapy. Predictors of treatment response remain poorly characterized.
To investigate the anatomical patterns, clinical characteristics, and predictive factors of PSD, and to examine the influence of infarct location, age, and bio
This retrospective study enrolled 256 stroke patients with depression from June 2022 to June 2024. Depression severity was assessed using the 17-item Hamilton Depression Rating Scale (HAMD). All patients completed 8 weeks of standardized treatment including antidepressant medication and rehabilitation therapy. Serum biomarkers were measured before and after treatment. Treatment response was defined as ≥ 25% reduction in HAMD scores. Patients were stratified across eight anatomical infarct locations and three age groups for detailed analysis. Univariate and multivariate logistic regression identified independent predictors of treat
Baseline HAMD scores averaged 24.2 ± 6.0 points, with 77.3% of patients achieving favorable treatment response. Depression severity demonstrated striking anatomical specificity, with subcortical lesions exhibiting significantly higher HAMD scores than cortical lesions. Basal ganglia/internal capsule infarcts showed the highest depression severity, followed by thalamic infarcts. Among cortical regions, frontal lobe infarcts demonstrated the highest scores, while occipital lesions showed the lowest burden. Posterior fossa structures exhibited intermediate depression severity. Multivariate logistic regression identified lower baseline HAMD score, shorter disease duration, and absence of comorbid hypertension as independent predictors of favorable treatment response. The predictive model demonstrated good discriminative ability. There was a moderate positive correlation between age and depression severity, and older patients had significantly higher HAMD scores than younger patients.
For the anatomical specificity of PSD, we found that the particularly subcortical lesions involving with the basal ganglia and thalamus are a much higher risk. This anatomical vulnerability indicates that subcortical-frontal mood regulatory circuits likely play a critical role. Depression severity and treatment response progressively increase with age, where greater degrees of baseline symptom severity, longer disease duration, and presence of vascular comorbidites predicted response.
Core Tip: Post-stroke depression is a heterogeneous clinical condition. Modified Soufeng Decoction could significantly improve the anxiety, depression and recovery of neurological function in patients with cerebral infarction when combined with conventional therapy. Treatment response is conditioned by baseline symptom severity, disease duration and vascular comorbidities, thus reinforcing the necessity of early and tailored intervention.