Total magnetic resonance imaging burden of cerebral small‐vessel disease is associated with post‐stroke depression in patients with acute lacunar stroke

Zhang, X.; Tang, Yong; Xie, Yi; Ding, Caixia; Xiao, Jing; Jiang, Xuemei; Shan, Hua; Lin, Yinyao; Li, C.; Hu, Dan; Li, T.; Sheng, Lei

doi:10.1111/ene.13213

Cited by 50 publications

(37 citation statements)

References 31 publications

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“…They evaluated deep WMH (DWMH) and periventricular WMH (PWMH) and observed no significant relationship between WMH and the presence of depressive symptoms. By contrast, another recent study reported a significant correlation between markers of small vessel disease, i.e., WMH and asymptomatic lacunar infarcts, and PSD ( 41 ). Brain network damage affecting fronto-limbic circuits might represent the common mechanism between small vessel disease and white matter damage linked to VD, on the one hand, and PSD after singular stroke lesions, but as of today this has not been further studied.…”

Section: Psd and The Vascular Depression Hypothesismentioning

confidence: 92%

Post-Stroke Depression: Impact of Lesion Location and Methodological Limitations—A Topical Review

Nickel

Thomalla

2017

Front. Neurol.

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Post-stroke depression (PSD) affects approximately one-third of all stroke patients. It hinders rehabilitation and is associated with worse functional outcome and increased mortality. Since the identification of PSD is a significant clinical problem, clinicians and researchers have tried to identify predictors that indicate patients at risk of developing PSD. This also includes the research question whether there is an association between PSD and stroke lesion characteristics, e.g., lesion size and lesion location. Early studies addressing this question are largely limited by technical constraints and, thus, focused on simple lesion characteristics such as lesion side or proximity of the lesion to the frontal pole of the brain. More recent studies have addressed the impact of involvement of specific neuronal circuits in the stroke lesion. State-of-the-art methods of lesion symptom mapping to study PSD have only been applied to small patient samples. Overall, results are controversial and no clear pattern of stroke lesions associated with PSD has emerged, though there are findings suggesting that more frontal stroke lesions are associated with higher incidence of PSD. Available studies are hampered by methodological limitations, including drawbacks of lesion analysis methods, small sample size, and the issue of patient selection. These limitations together with differences in approaches to assess PSD and in methods of image analysis limit the comparability of results from different studies. To summarize, as of today no definite association between lesion location and PSD can be ascertained and the understanding of PSD rests incomplete. Further insights are expected from the use of modern lesion inference analysis methods in larger patient samples taking into account standardized assessment of possible confounding parameters, such as stroke treatment and reperfusion status.

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Section: Psd and The Vascular Depression Hypothesismentioning

confidence: 92%

Post-Stroke Depression: Impact of Lesion Location and Methodological Limitations—A Topical Review

Nickel

Thomalla

2017

Front. Neurol.

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“…However, none of the above studies combined all 4 SVD markers based on MRI to evaluate the total brain damage caused by SVD. More recently, similar to our rating method on SVD burden, a prospective study of lacunar stroke demonstrated the role of SVD burden in depression at 3 months after stroke (Zhang et al, 2016 ). Another two large-scale studies of patients with acute ischemic stroke found that SVD burden could be an imaging marker predicting mortality after stroke (Song et al, 2017 ) and stroke recurrence (Lau et al, 2017 ).…”

Section: Discussionmentioning

confidence: 74%

“…The markers of SVD on magnetic resonance imaging (MRI) are white matter hyperintensities (WMH), lacunes, cerebral microbleeds (CMB) and enlarged perivascular spaces (EPVS; Wardlaw et al, 2013a ). As these markers are closely associated with increased mortality (Song et al, 2017 ), poor physical function (Arauz et al, 2003 ; Charidimou et al, 2016 ; Sato et al, 2016 ; Senda et al, 2016 ; Yang et al, 2016 ; Helenius et al, 2017 ), stroke recurrence (Arauz et al, 2003 ; Lau et al, 2017 ), cognitive decline (Huijts et al, 2013 ; Uiterwijk et al, 2016 ) and depression (Zhang et al, 2016 ) after stroke, SVD is thought to be a poor prognostic marker of stroke (Kim and Lee, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

“…A “total SVD score” is constructed by summing up all individual SVD markers into a single measure that is thought to better represent the total brain damage from SVD (Staals et al, 2014 ). Several recent studies have suggested a role for SVD burden in predicting mortality (Song et al, 2017 ), unfavorable functional outcome (Yang et al, 2016 ; Arba et al, 2017 ), cognitive decline (Huijts et al, 2013 ; Uiterwijk et al, 2016 ) and depression (Zhang et al, 2016 ) after stroke. However, to the best of our knowledge, the association between SVD burden and poststroke HRQoL has never been investigated, which gave the impetus to examine this relationship at 3 months after the index acute ischemic stroke in a large cohort of systematically screened and assessed patients.…”

Section: Introductionmentioning

confidence: 99%

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Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke

Liang

Chen

Deng

et al. 2017

Front. Aging Neurosci.

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Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke.Methods: Patients admitted with acute ischemic stroke of any etiology were prospectively screened between January 2010 to December 2014 and enrolled in the study if they met study entry criteria. HRQoL was evaluated with the 12-item Stroke Specific Quality of Life (SSQoL) at 3 months after the onset of acute ischemic stroke. SVD was ascertained by the presence of any of the SVD markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds (CMB) and enlarged perivascular spaces (EPVS) in the basal ganglia or their combinations on brain magnetic resonance imaging (MRI). The presence of each individual marker scored 1 point and was summed up to generate an ordinal “SVD score” (0–4) capturing total SVD burden. Linear regression was used to determine the associations between SVD burden and HRQoL.Results: Of the743 acute ischemic stroke patients that formed he study sample (mean age: 66.3 ± 10.6 years; 41.7% women), 49.3%, 22.5%, 16.0%, 9.2% and 3.1% had SVD scores of 0, 1, 2, 3 and 4, respectively. After adjusting for demographic, clinical and imaging variables, the SVD score was independently associated with lower overall score of SSQoL (B = −1.39, SE = 0.56, p = 0.01), and its domains of mobility (B = −0.41, SE = 0.10, p < 0.001) and vision (B = −0.12, SE = 0.06, p = 0.03). Acute infract volume (B = −1.44, SE = 0.54, p = 0.01), functional independence (B = 5.69, SE = 0.34, p < 0.001) and anxious (B = −1.13, SE = 0.23, p < 0.001) and depressive symptoms (B = −3.41, SE = 0.22, p < 0.001) were also the significant predictors of the overall score of SSQoL.Conclusion: The brain’s SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies.

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“…Stroke remains the most common problem for neurologists to diagnose and treat . Preventative measures, such as control of hypertension, reduction in smoking and treatment of hyperlipidaemia, have made a significant contribution to preventing and delaying stroke onset.…”

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confidence: 99%

Progress in neurology 2017–2018

Schapira

2018

Euro J of Neurology

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Total magnetic resonance imaging burden of cerebral small‐vessel disease is associated with post‐stroke depression in patients with acute lacunar stroke

Abstract: This study demonstrated that greater total MRI burden of cSVD may predict the presence of PSD in patients with acute lacunar stroke.

Cited by 50 publications

References 31 publications

Post-Stroke Depression: Impact of Lesion Location and Methodological Limitations—A Topical Review

Post-Stroke Depression: Impact of Lesion Location and Methodological Limitations—A Topical Review

Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke

Progress in neurology 2017–2018

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