Low Testosterone Level as a Predictor of Poststroke Emotional Disturbances: Anger Proneness and Emotional Incontinence

Abstract

BACKGROUND: The role of sex hormones in poststroke mood and emotional disturbances is unclear. We aimed to evaluate the impact of sex hormones on poststroke emotional disturbance, especially anger proneness (AP) and emotional incontinence (EI). We also investigated whether statins, which are widely used for stroke prevention, affect sex hormone levels or the presence of poststroke AP/EI based on the hypothesis that intensive treatment with statins would inhibit the synthesis of cholesterol, the preferred substrate of testosterone. METHODS: We prospectively enrolled 40 patients who experienced ischemic stroke at least 3 months prior to study enrollment. We performed clinical and laboratory evaluations, including hormone-level measurements and neuropsychological tests. Poststroke AP and EI were assessed using interviews, then patients were divided into 2 groups: AP/EI-present or absent. RESULTS: Of the 40 patients (30 men, mean age 58.8 years), 16 (40.0%) were classified as AP/EI-present group. AP/EI were not related to stroke severity or location: however, the testosterone level was significantly lower in patients with AP/EI than in those without AP/EI (2.1 +/- 1.7 vs. 3.9 +/- 2.5 ng/mL, P = .023). After adjusting for potential confounding variables, low testosterone levels were a significant independent predictor of AP/EI (odds ratio .68, 95% confidence interval .49-.96, P = .027). In contrast, sex hormone levels and AP/EI prevalence did not differ between statin users and nonusers. CONCLUSIONS: AP/EI were associated with low testosterone levels in patients with previous ischemic stroke, but statin use did not affect AP/EI prevalence.