Psychopathological network for early-onset post-stroke depression symptoms

Abstract

Background Post-stroke depression (PSD) can be conceptualized as a complex network where PSD symptoms (PSDS) interact with each other. The neural mechanism of PSD and interactions among PSDS remain to be elucidated. This study aimed to investigate the neuroanatomical substrates of, as well as the interactions between, individual PSDS to better understand the pathogenesis of early-onset PSD. Methods A total of 861 first-ever stroke patients admitted within 7 days poststroke were consecutively recruited from three independent hospitals in China. Sociodemographic, clinical and neuroimaging data were collected upon admission. PSDS assessment with Hamilton Depression Rating Scale was performed at 2 weeks after stroke. Thirteen PSDS were included to develop a psychopathological network in which central symptoms (i.e. symptoms most strongly correlated with other PSDS) were identified. Voxel-based lesion-symptom mapping (VLSM) was performed to uncover the lesion locations associated with overall PSDS severity and severities of individual PSDS, in order to test the hypothesis that strategic lesion locations for central symptoms could significantly contribute to higher overall PSDS severity. Results Depressed mood, Psychiatric anxiety and Loss of interest in work and activities were identified as central PSDS at the early stage of stroke in our relatively stable PSDS network. Lesions in bilateral (especially the right) basal ganglia and capsular regions were found significantly associated with higher overall PSDS severity. Most of the above regions were also correlated with higher severities of 3 central PSDS. The other 10 PSDS could not be mapped to any certain brain region. Conclusions There are stable interactions among early-onset PSDS with Depressed mood, Psychiatric anxiety and Loss of interest as central symptoms. The strategic lesion locations for central symptoms may indirectly induce other PSDS via the symptom network, resulting in higher overall PSDS severity. Trial registration URL: http://www.chictr.org.cn/enIndex.aspx; Unique identifier: ChiCTR-ROC-17013993.

Incidence, temporal profile and neuroanatomic correlates of poststroke epilepsy

“…16,17 A strength of the present study is that we assessed detailed associations between the occurrence of PSE and ischemic lesions by determining voxel-wise lesions, then assessing the voxel-specific lesion overlap in our entire sample of stroke patients, and finally performing analyses between voxel-wise lesion overlap and occurrence of PSE. 18,19 VLSM analyses are statistic imaging analyses for calculating associations between lesion location in the brain and a functional neurologic deficit. They do not predefine lesion sites assumed to be associated with a neurologic deficit, but have the advantage of determining associations between the voxel-wise lesion overlap in any brain area and PSE.…”

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