Depression and anxiety symptoms are associated to disruption of default mode network in subacute ischemic stroke

Abstract

Depression and anxiety symptoms are common after stroke and associated to reduction in quality of life and poor physical and social outcomes. The Default Mode Network (DMN) plays an important role in the emotional processing. We investigated whether these symptoms are associated to a disruption of DMN functional connectivity in the first month after stroke. Thirty-four subacute ischemic stroke patients were submitted to: 1) behavioral assessment through Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Structured Clinical Interview for DSM Disorders; 2) neuropsychological assessment using Mini Mental State Examination and Montreal Cognitive Assessment; 3) resting state functional magnetic resonance imaging acquisition using a 3 T scanner (Philips Achieva). Patients with depression and/or anxiety symptoms showed an increased DMN functional connectivity in left inferior parietal gyrus and left basal nuclei, when compared to stroke controls. Specific correlation between BDI/BAI scores and DMN functional connectivity indicated that depression symptoms are correlated with increased functional connectivity in left inferior parietal gyrus, while anxiety symptoms are correlated with increased functional connectivity in cerebellum, brainstem and right middle frontal gyrus. Our study provides new insights into the underlying mechanisms of post stroke depression and anxiety, suggesting an alternate explanation other than regional structural damage following ischemic event, that these psychiatric symptoms are related to brain network dysfunction.

Anxiety in Patients With Acute Ischemic Stroke: Risk Factors and Effects on Functional Status

“…Fornito et al (43) reported that functional neuronal network disruption may be more critical than lesion location to explain PSA. Vicentini et al (12) reported that PSA was not associated with infarct location but correlated with disruption of the default mode network (DMN) in the brain. Accordingly, examining the effects of the integrity of brain networks or neural circuits rather than a single location on PSA might be another direction for further research.…”

“…Risk factors related to PSA include depression (5–7), cognitive impairment (5, 8), fatigue (9), age (10–12), female sex (10, 12), lesion location (13, 14), and sleep disturbance (9, 15), indicating PSA might be multifactorial. Apart from stress due to acute ischemic stroke, the biological mechanisms of PSA should also be considered.…”

Inefficient Involvement of Insula in Sensorineural Hearing Loss

“…Chand et al (2017), also found abnormal interactions among the SN, DMN, and CEN in subjects with mild cognitive impairments. Recent research suggest that that depression and anxiety are associated with alterations in the DMN, expanding the role of DMN in emotion processing (Vicentini et al, 2017), as FC of left dAI-right DLPFC not only showed positive correlation with SDMT performance, but also negative correlation with SAS scores. Combing the hyperperfusion in the insula, we used an “inefficient high-order control” theory to illustrate this phenomenon.…”

Altered Topology of the Structural Brain Network in Patients With Post-stroke Depression

“…The superior frontal gyrus and middle frontal gyrus are both involved in emotional disorders and higher cognitive functions (Tucker et al, 1981; Mayberg, 1994). Using modern neuroscience technologies like proton magnetic resonance spectroscopy (Kumar et al, 2002), DTI (Yang et al, 2015b), resting-state electroencephalogram (EEG) (Zhang et al, 2015), and resting-state functional MRI (rs-fMRI) (Vicentini et al, 2017), researchers have found that the frontal lobe of depressive or PSD patients also has white matter biochemical abnormalities, loss of white matter integrity, decreased EEG complexity, and increased functional connectivity. The anatomical basis behind these findings might include the extensive connections between frontal cortex and structures related to emotional behavior, such as the amygdala, basal ganglia, and thalamus (Soares and Mann, 1997).…”