1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA 2 Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti G. d'Annunzio, via dei Vestini 33, 66013, Chieti, Italy 3 Institute for Advanced Biomedical Technologies, G. d'Annunzio University Foundation, University of Chieti G. d'Annunzio, via dei Vestini 33, 66013, Chieti, Italy.
1 Department of Neurology, Washington University in St. Louis School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110, USA.
Brain. 2014 Dec;137(Pt 12):3267-83. doi: 10.1093/brain/awu297. Epub 2014 Nov 2.
The relationship between spontaneous brain activity and behaviour following focal injury is not well understood. Here, we report a large-scale study of resting state functional connectivity MRI and spatial neglect following stroke in a large (n=84) heterogeneous sample of first-ever stroke patients (within 1-2 weeks). Spatial neglect, which is typically more severe after right than left hemisphere injury, includes deficits of spatial attention and motor actions contralateral to the lesion, and low general attention due to impaired vigilance/arousal. Patients underwent structural and resting state functional MRI scans, and spatial neglect was measured using the Posner spatial cueing task, and Mesulam and Behavioural Inattention Test cancellation tests. A principal component analysis of the behavioural tests revealed a main factor accounting for 34% of variance that captured three correlated behavioural deficits: visual neglect of the contralesional visual field, visuomotor neglect of the contralesional field, and low overall performance. In an independent sample (21 healthy subjects), we defined 10 resting state networks consisting of 169 brain regions: visual-fovea and visual-periphery, sensory-motor, auditory, dorsal attention, ventral attention, language, fronto-parietal control, cingulo-opercular control, and default mode. We correlated the neglect factor score with the strength of resting state functional connectivity within and across the 10 resting state networks. All damaged brain voxels were removed from the functional connectivity:behaviour correlational analysis. We found that the correlated behavioural deficits summarized by the factor score were associated with correlated multi-network patterns of abnormal functional connectivity involving large swaths of cortex. Specifically, dorsal attention and sensory-motor networks showed: (i) reduced interhemispheric functional connectivity; (ii) reduced anti-correlation with fronto-parietal and default mode networks in the right hemisphere; and (iii) increased intrahemispheric connectivity with the basal ganglia. These patterns of functional connectivity:behaviour correlations were stronger in patients with right- as compared to left-hemisphere damage and were independent of lesion volume. Our findings identify large-scale changes in resting state network interactions that are a physiological signature of spatial neglect and may relate to its right hemisphere lateralization.
自发性脑活动与局灶性损伤后行为之间的关系尚不清楚。在这里，我们报告了一项针对首次中风患者（中风后 1-2 周内）的大规模静息状态功能连接 MRI 与空间忽略的研究，该研究样本量较大且具有异质性（n=84）。空间忽略通常在右半球损伤后比左半球损伤更为严重，包括对侧空间注意力和运动动作的缺陷，以及由于警觉/唤醒受损而导致的整体注意力低下。患者接受了结构和静息状态功能 MRI 扫描，并使用 Posner 空间提示任务和 Mesulam 及行为性疏忽测试取消测试来测量空间忽略。对行为测试的主成分分析揭示了一个占总方差 34%的主要因素，该因素捕捉到了三个相关的行为缺陷：对侧视野的视觉忽略、对侧视野的视动忽略以及整体表现低下。在一个独立的样本（21 名健康受试者）中，我们定义了 10 个由 169 个脑区组成的静息状态网络：视觉-中央凹和视觉-周边、感觉-运动、听觉、背侧注意、腹侧注意、语言、额顶控制、扣带回控制和默认模式。我们将忽略因子得分与 10 个静息状态网络内和跨网络的静息状态功能连接强度进行了相关性分析。从功能连接：行为相关分析中去除了所有受损的脑体素。我们发现，由因子得分总结的相关行为缺陷与涉及大片皮质的异常功能连接的相关多网络模式有关。具体而言，背侧注意和感觉运动网络表现为：（i）左右半球间功能连接减少；（ii）右侧额顶和默认模式网络的反相关减少；（iii）与基底节的半球内连接增加。这些功能连接：行为相关性的模式在右半球损伤患者中比左半球损伤患者更为强烈，并且与病变体积无关。我们的发现确定了静息状态网络相互作用的大规模变化，这是空间忽略的生理特征，可能与其右半球偏侧化有关。
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