TY - JOUR
T1 - Strategic infarct locations for post-stroke depressive symptoms
T2 - a lesion- and disconnection-symptom mapping study
AU - Weaver, Nick A
AU - Lim, Jae-Sung
AU - Schilderinck, Janniek
AU - Biessels, Geert Jan
AU - Kang, Yeonwook
AU - Kim, Beom Joon
AU - Kuijf, Hugo J
AU - Lee, Byung-Chul
AU - Lee, Keon-Joo
AU - Yu, Kyung-Ho
AU - Bae, Hee-Joon
AU - Biesbroek, J Matthijs
N1 - Funding Information:
This work was supported by a Vici grant from ZonMw, The Netherlands Organisation for Health Research and Development (Grant No. 918.16.616 [to GJB] ), and a Young Talent Fellowship from the UMC Utrecht Brain Center (to JMB).
Publisher Copyright:
© 2021 Society of Biological Psychiatry
PY - 2023/4
Y1 - 2023/4
N2 - BACKGROUND: Depression is the most common neuropsychiatric complication after stroke. Infarct location is associated with poststroke depressive symptoms (PSDS), but it remains debated which brain structures are critically involved. We performed a large-scale lesion-symptom mapping study to identify infarct locations and white matter disconnections associated with PSDS.METHODS: We included 553 patients (mean [SD] age = 69 [11] years, 42% female) with acute ischemic stroke. PSDS were measured using the 30-item Geriatric Depression Scale. Multivariable support vector regression (SVR)-based analyses were performed both at the level of individual voxels (voxel-based lesion-symptom mapping) and at predefined regions of interest to relate infarct location to PSDS. We externally validated our findings in an independent stroke cohort (N = 459). Finally, disconnectome-based analyses were performed using SVR voxel-based lesion-symptom mapping, in which white matter fibers disconnected by the infarct were analyzed instead of the infarct itself.RESULTS: Infarcts in the right amygdala, right hippocampus, and right pallidum were consistently associated with PSDS (permutation-based p < .05) in SVR voxel-based lesion-symptom mapping and SVR region-of-interest analyses. External validation confirmed the association between infarcts in the right amygdala and pallidum, but not the right hippocampus, and PSDS. Disconnectome-based analyses revealed that disconnections in the right parahippocampal white matter, right thalamus and pallidum, and right anterior thalamic radiation were significantly associated (permutation-based p < .05) with PSDS.CONCLUSIONS: Infarcts in the right amygdala and pallidum and disconnections of right limbic and frontal cortico-basal ganglia-thalamic circuits are associated with PSDS. Our findings provide a comprehensive and integrative picture of strategic infarct locations for PSDS and shed new light on pathophysiological mechanisms of depression after stroke.
AB - BACKGROUND: Depression is the most common neuropsychiatric complication after stroke. Infarct location is associated with poststroke depressive symptoms (PSDS), but it remains debated which brain structures are critically involved. We performed a large-scale lesion-symptom mapping study to identify infarct locations and white matter disconnections associated with PSDS.METHODS: We included 553 patients (mean [SD] age = 69 [11] years, 42% female) with acute ischemic stroke. PSDS were measured using the 30-item Geriatric Depression Scale. Multivariable support vector regression (SVR)-based analyses were performed both at the level of individual voxels (voxel-based lesion-symptom mapping) and at predefined regions of interest to relate infarct location to PSDS. We externally validated our findings in an independent stroke cohort (N = 459). Finally, disconnectome-based analyses were performed using SVR voxel-based lesion-symptom mapping, in which white matter fibers disconnected by the infarct were analyzed instead of the infarct itself.RESULTS: Infarcts in the right amygdala, right hippocampus, and right pallidum were consistently associated with PSDS (permutation-based p < .05) in SVR voxel-based lesion-symptom mapping and SVR region-of-interest analyses. External validation confirmed the association between infarcts in the right amygdala and pallidum, but not the right hippocampus, and PSDS. Disconnectome-based analyses revealed that disconnections in the right parahippocampal white matter, right thalamus and pallidum, and right anterior thalamic radiation were significantly associated (permutation-based p < .05) with PSDS.CONCLUSIONS: Infarcts in the right amygdala and pallidum and disconnections of right limbic and frontal cortico-basal ganglia-thalamic circuits are associated with PSDS. Our findings provide a comprehensive and integrative picture of strategic infarct locations for PSDS and shed new light on pathophysiological mechanisms of depression after stroke.
KW - Geriatric Depression Scale
KW - Ischemic stroke
KW - Lesion location
KW - Lesion-symptom mapping
KW - Magnetic resonance imaging
KW - Poststroke depression
UR - http://www.scopus.com/inward/record.url?scp=85120177410&partnerID=8YFLogxK
U2 - 10.1016/j.bpsc.2021.09.002
DO - 10.1016/j.bpsc.2021.09.002
M3 - Article
C2 - 34547548
SN - 2451-9022
VL - 8
SP - 387
EP - 396
JO - Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
JF - Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
IS - 4
ER -