Abstract
ObjectiveTo explore the structural basis of post-stroke apathy by using voxel-based analysis (VBA) of fractional anisotropy (FA) maps.MethodsWe enrolled 54 consecutive patients with ischemic stroke during convalescence, and divided them into apathy (n = 31) and non-apathy (n = 23) groups. We obtained magnetic resonance images of their brains, including T1, T2 and DTI sequences. Age, sex, education level, Hamilton Depression Scale (HAMD) scores, Mini-Mental State Examination (MMSE) scores, National Institutes of Health Stroke Scale (NIHSS) scores, and infarct locations for the two groups were compared. Finally, to investigate the structural basis of post-stroke apathy, VBA of FA maps was performed in which we included the variables that a univariate analysis determined had P-values less than 0.20 as covariates.ResultsHAMD (P = 0.01) and MMSE (P<0.01) scores differed significantly between the apathy and non-apathy groups. After controlling for age, education level, HAMD scores, and MMSE scores, significant FA reduction was detected in four clusters with peak voxels at the genu of the corpus callosum (X = −16, Y = 30, Z = 8), left anterior corona radiata (−22, 30, 10), splenium of the corpus callosum (−24, −56, 18), and right inferior frontal gyrus white matter (52, 24, 18), after family-wise error correction for multiple comparisons.ConclusionsPost-stroke apathy is related to depression and cognitive decline. Damage to the genu of the corpus callosum, left anterior corona radiata, splenium of the corpus callosum, and white matter in the right inferior frontal gyrus may lead to apathy after ischemic stroke.
Highlights
Apathy is a common symptom after ischemic stroke, and is defined as ‘‘a symptom without initiative action, but which cannot be completely explained by using consciousness, depression, and cognitive dysfunction’’ [1]
We found that Hamilton Depression Scale (HAMD) scores (P50.01) and Mini-Mental State Examination (MMSE) scores (P,0.01) significantly differed between patients with and without apathy, whereas age (P50.12) and education level (P50.06) tended to differ across groups
Stroke lesions were detected in the left frontal lobe in 16 patients, right frontal lobe in 18, left parietal lobe in 4, right parietal lobe in 6, left temporal lobe in 3, right temporal lobe in 3, left occipital lobe in 3, right occipital lobe in 2, left basal ganglia in 21, right basal ganglia in 18, left thalamus in 11, right thalamus in 12, left brain stem in 13, right brain stem in 8, left cerebellum in 3 and right cerebellum in 2
Summary
Apathy is a common symptom after ischemic stroke, and is defined as ‘‘a symptom without initiative action, but which cannot be completely explained by using consciousness, depression, and cognitive dysfunction’’ [1]. The structural basis of poststroke apathy is complicated, and studies have suggested that it is associated with damage to the frontal lobe [4], basal ganglia [5], temporal lobe [6], and other brain regions. Diffusion tensor imaging (DTI) is a noninvasive technique used for evaluating the structural integrity of white matter in the brain. This is accomplished in part through measuring the fractional anisotropy (FA) which when low indicates damage or degeneration in white matter. In addition to primary lesions, this technique may provide information regarding distal fiber degeneration secondary to stroke (i.e. Wallerian degeneration) and other types of changes [8] or lesions [9] in white matter that have been linked to apathetic behavior. The development of voxel-based analysis (VBA) [10] has made it possible to put the individual FA images into the same standard space and statistically compare whole-brain FA values voxel by voxel
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