*2.1. Population and Design*

The consecutive patients admitted to the Stroke Unit at the University Hospital in Krakow, with stroke (ischemic or hemorrhagic) or transient ischemic attack (TIA) met inclusion criteria (Patients > 18 years of age, admitted within 48 h from the first stroke symptoms, speaking Polish, without serious communication deficits), were included into this sub-study. All patients had neuroimaging (CT/MRI) performed on admission. Stroke was defined as a sudden onset of neurological deficit lasting longer than 24 h. All patients were treated according to standard protocols of international guidelines [7].

Data regarding socio-demographic factors and comorbidities was collected. The Cumulative Illness Rating Scale (CIRS) was used as a general indicator of health status [8]. The severity of clinical deficit after stroke was graded by the National Institutes of Health Stroke Scale (NIHSS) [9] and the disability prior to admission was assessed by the modified Rankin Scale (mRS) [10].

Depression symptoms were assessed between 7 and 10 days after admission with Polish version of Patient Health Questionnaire-9 (PHQ-9) [11]. This questionnaire queries symptoms present using 4-point Likert scale with item scores ranging from 0 (symptoms not present) to 3 (symptoms present nearly every day). The score ranges from 0 (no depressive symptoms) to 27 (all symptoms occurring nearly every day) and can be used to determine depression severity (0–4 indicates no depression, 5–9 mild depression, 10 to 14 moderate depression, 15–19 moderately severe depression and 20–27 severe depression). PHQ-9 shows good reliability, validity and clinical utility when used in stroke patients [12]. Patients enrolled in the study completed the questionnaire on their own or with the help of a psychologist when filling out was impossible or difficult (e.g., the patient could not hold the pen because of a paresis or had a visual impairment). Depression was diagnosed if the patient received 5 or more points on the PHQ-9 scale [13].

To evaluate post-stroke apathy (PSA), the Apathy Evaluation Scale-C (AES-C) [14] was used. AES is an 18-item questionnaire with a clinician rated version that was applied in this study. The questions address patient's activities, interest in doing things, relationship with others and feelings over the past two to three weeks. Each item is rated on a 4-point Likert scale with item scoring ranging from 1 (not at all true) to 4 (very true). The total AES-C score ranges from 18 to 72, with higher scores indicating greater apathy. The AES has good reliability and validity and was frequently used in studies on post-stroke apathy [14]. Apathy was diagnosed with AES score of ≥ 37 points [15].

Anxiety was measured with Polish adaptation of State Trait Anxiety Inventory (STAI) [16,17], the 40-item instrument, measuring, respectively, transient and enduring levels of anxiety. The state scale used in the present study administered as a self-completion questionnaire by the interviewer, assessed how the patients felt at the moment or in the recent past and how they anticipate their feelings to be in a specific, hypothetic situation in the future. The STAI scale is scored on four levels of anxiety intensity from 1 (not at all) to 4 (very much) and with a sum score between 20 and 80. The raw results are interpreted by referring to a relevant sten scores and then categorized into three levels of anxiety: low (1–4 sten), moderate (5–6 sten) and high (7–10 sten) [17].

Patients were screened for delirium with the abbreviated version of Confusion Assessment Method (bCAM) or the Intensive Care Units version (CAM-ICU), specifically in patients with motor aphasia or those who could not communicate for other reasons [18,19]. The final diagnosis of delirium was based on both clinical observation and structural assessment. The diagnostic criteria for delirium were based on the DSM-5 classification [20].

To screen for pre-stroke depression (pre-SD), a member of family/spouse or a close informant of the patient's household filled out the Neuropsychiatric Inventory [21]. In addition, patients were asked about previous treatment for depression, and medical records were checked for antidepressants among the medications currently taken by the patient.

In order to diagnose patients with pre-stroke dementia, a Polish version of Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) was used [22].
