Association of Frontal Subcortical Circuits Infarcts in Poststroke Depression: A Magnetic Resonance Imaging Study of 591 Chinese Patients With Ischemic Stroke

Abstract

Despite extensive research into poststroke depression (PSD), the role played by lesion location in the pathogenesis of PSD remains uncertain. The aim of this study was to estimate the magnetic resonance imaging (MRI) correlates of PSD in Chinese patients with first or recurrent stroke. A total of 591 patients with acute ischemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong were recruited. A psychiatrist assessed all the patients 3 months after the stroke. The psychiatrist used the Structured Clinical Interview for Diagnostic and Statistical Manual, fourth edition (DSM-IV) to confirm whether the patients met the criteria of a depressive disorder. In addition, a host of demographic, clinical, and radiological variables were examined. A tota; of 475 and 116 patients had first and recurrent strokes, respectively. In all, 75 (12.7%) patients received a diagnosis of PSD. In univariate analysis of the MRI findings, the presence of infarcts in the frontal subcortical circuits ([FSC], 66.7% vs 53.3%) was significantly associated with PSD (P = .03) compared to the patients without PSD. The FSC infarct-PSD association remained significant (odds ratio = 2.6) in subsequent logistic regression analysis after adjusting for gender, history of depression, neurological impairment, level of social support, and major life events. In conclusion, FSC infarcts are independent predictors of PSD. Further work is needed to clarify whether these infarcts have an impact on the clinical presentation, treatment responses, and prognosis of PSD.

The Relationship between Frontal Lobe Lesions, Course of Post-Stroke Depression, and 1-year Prognosis in Patients with First-Ever Ischemic Stroke

“…The lack of consensus about the relationship between lesion locations and PSD might be due to different study methodology, including the source of study populations, timing of first interview after stroke, and measurement of depression [11]. A number of recent studies have demonstrated that patients with lesions in the frontal lobe had a higher risk of PSD and have provided some pathophysiological underpinnings for PSD [12], [13]. Whether frontal lobe lesions are associated with the course of PSD is still unknown.…”

An association between the location of white matter changes and the behavioral and psychological symptoms of dementia in Alzheimer's disease patients

“…MRI studies reveal that major depressive disorder may involve pathological changes of the temporal and frontal lobes, including the superior temporal gyrus, the hippocampus, the amygdala, the anterior cingulate gyrus, and the orbitofrontal area [22] . Involvement of the frontal lobe and infarcts on frontal subcortical circuits are also an independent predictor of the development of post-stroke depression [23][24][25] . Medial pre-frontal networks that are connected to the medial pre-frontal cortex and the medial as well as the caudo-lateral orbital cortex are involved in the neural networks related to depressive episodes [26] .…”

Post-stroke depression

“…Az egyik leggyakrabban vizsgált és sokat vitatott kér-dés a PSD és az agyi károsodás lokalizációja közötti összefüggés. Ugyanazon munkacsoport a bal frontális pólushoz való közelség, illetve a jobb occipitalis laesio és a depresszió összefüggését hangsúlyozta [24,33], megint mások egyéb anatómiai képletek károsodásával állítják párhuzamba a depresszió előfordulását [30,34]. A legtöbb vizsgálat azonban nem talált szignifi káns kapcsolatot a károsodott agyi terület oldallokalizációja és anteroposterior elhelyezkedése között [35,36].…”