Background: Up to two-thirds of stroke survivors experience persistent sensorimotor impairments. Recovery relies on the integrity of spared brain areas to compensate for damaged tissue. Subcortical regions play critical roles in the control and regulation of sensorimotor circuits. Identifying relationships between sensorimotor behavior and non-lesioned subcortical volumes will reveal new neural targets for improving outcomes. Methods: We pooled high-resolution T1-weighted MRI brain scans and behavioral data in 828 individuals with unilateral stroke from 28 cohorts worldwide (age: median 63, interquartile range 19 years; 516 males, 312 females). Cross-sectional analyses using linear mixed-effects models related post-stroke sensorimotor behavior to non-lesioned subcortical volumes. We analyzed subacute (≤90 days) and chronic (≥180 days) stroke; sub-analyses in chronic stroke were performed on class of sensorimotor deficit (impairment, activity limitations) and side of lesioned hemisphere, with exploratory analyses in early stroke (≤21 days) and across time (Bonferroni-corrected, p<0.004). Results: Worse sensorimotor behavior was associated with a smaller ipsilesional thalamic volume in both subacute (n=274, d=0.46) and early stroke (n=179; d=0.68). In chronic stroke (n=404), worse sensorimotor behavior was associated with smaller ipsilesional putamen (d=0.52) and nucleus accumbens (d=0.39) volumes, and a larger ipsilesional lateral ventricle volume (d=-0.42), representing atrophy. In chronic stroke, worse sensorimotor impairment specifically (measured by the Fugl-Meyer Assessment; n=256) was associated with a smaller ipsilesional putamen (d=0.72), and larger lateral ventricle (d=-0.41), while several measures of activity limitations (n=116) showed no significant relationships. Side of lesion (left=214, right=190) had no impact. The full cohort (n=828) revealed associations of sensorimotor behavior with the ipsilesional nucleus accumbens (d=0.23), putamen (d=0.33), thalamus (d=0.33), and lateral ventricle (d=-0.23). Discussion: This analysis identified significant relationships between sensorimotor behavior and key subcortical regions at different times post-stroke. While further longitudinal studies are needed, these findings may represent brain imaging markers of resilience and reserve and provide putative neuroanatomical targets for improving sensorimotor outcomes post-stroke.
Due to the continuing high suicide rates among young men, there is a need to understand help-seeking behaviour and engagement with tailored suicide prevention interventions. The aim of this study was to explore help-seeking behaviour and engagement for young men aged 18 to 30 years who attended a therapeutic centre for men in a suicidal crisis. In this prospective cohort study, data were collected from 546 men who were referred into a community-based therapeutic service in North West England. Of the 546 men, 337 (52%) received therapy; 161 (48%) were aged between 18 and 30 years (mean age 24 years, SD=3.4). One third (n=54; 34%) of the men were seen within 48 hours of their referral. Analyses included baseline differences, symptom trajectories for the CORE-34 Clinical Outcome Measure (CORE-OM) and engagement with the therapy. For the CORE 34 there was a clinically significant reduction in mean scores between assessment and discharge (p<0.001), with all outcomes demonstrating a large effect size. Future research needs to assess the long-term effects of help-seeking using a brief psychological intervention for young men in order to understand whether the effects of the therapy are sustainable over a period of time following discharge from the service.
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