Association between lesion location and depressive symptoms in acute ischemic stroke patients using voxel-based lesion-symptom mapping

Abstract

Objective: The study aimed to investigate the association between lesion location and post-stroke depression (PSD) in acute ischemic stroke patients. Methods: In this case-control study, acute ischemic stroke patients were recruited from the Department of Neurology, First Affiliated Hospital of the University of Science and Technology of China (USTC), between September 2020 and June 2021. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria, the patients were divided into the PSD and non-PSD groups. The 24-item Hamilton Rating Scale (HAMD) was used to evaluate the severity of depression. The Student's t-test, Mann-Whitney test, and Chi-square test were used to compare the clinical baseline characteristics of PSD and non-PSD groups. Voxel-based lesion-symptom mapping (VLSM) was applied to investigate the association between lesion location and depression occurrence and severity. Results: A total of 70 and 173 patients were admitted to the PSD and non-PSD groups, respectively. The mean age of patients was 59 years (23-86). There were 153 males and 90 females. Univariate analysis showed a significant difference only in Hamilton Anxiety (P=0.025) and Depression (P<0.001) scores between the PSD and non-PSD groups. VLSM analysis identified clusters within the anterior cingulate gyrus (Z=-3.05, P<0.001), left hippocampus (Z=-3.15, P<0.001), and left lingual lobe (Z=-3.08, P<0.001) where lesions were significantly associated with PSD. Additionally, the severity of PSD was associated with damage in the anterior cingulate gyrus (Z=-3.64, P<0.001), left hippocampus (Z=-3.51, P<0.001), left lingual lobe (Z=-4.18, P<0.001), and pericalcarine cortex (Z=-3.65, P<0.001). Conclusion: VLSM demonstrated that lesion location could be used to predict the occurrence of PSD in patients with acute ischemic stroke.