Hypercortisolism Early Versus Late After Stroke A 3-Year Longitudinal Study

Background and Purpose: Using the dexamethasone suppression test, we studied the suppressibility of the cortisol axis and its clinical determinants at various time points after stroke. A major aim was to examine the dexamethasone test as a diagnostic tool for the diagnosis of major depression in stroke patients. Methods: The dexamethasone suppression test, major depression, functional ability, and disorientation were assessed in a cohort of 70 patients with acute stroke and after 3 months (n=63) and 3 years (n=43). Results: Early after stroke, 24% of the patients were nonsuppressors, with about the same proportion at 3 months (22%) and 3 years (21%). None of the controls (17 healthy elderly volunteers) were nonsuppressors. High cortisol levels early after stroke were significantly associated with functional impairment (r=0.35; p=0.003) and disorientation (r=0.27; p=0.03). Three years after stroke, high postdexamethasone cortisol levels were significantly associated with major depression (r=0.57; p<0.001). The sensitivity of the dexamethasone test was 70% and the specificity 97%. In a longitudinal analysis of the long-term survivors (n=42), postdexamethasone cortisol values at 3 months predicted major depression at 3 years. Conclusions: Hypercortisolism is associated with major depression late (3 years) but not early (0-3 months) after stroke. Patients with hypercortisolism 3 months after stroke are at risk of major depression later in the course and warrant careful follow-up from a psychiatric viewpoint. (Stroke 1993;24:52-57)