Douven Elles, Staals Julie, Freeze Whitney M, Schievink Syenna Hj, Hellebrekers Danique Mj, Wolz Robin, Jansen Jacobus Fa, van Oostenbrugge Robert J, Verhey Frans Rj, Aalten Pauline, Köhler Sebastian
Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neuroscience, Alzheimer Center Limburg, Maastricht, The Netherlands.
Department of Neurology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
Eur Stroke J. 2020 Mar;5(1):78-84. doi: 10.1177/2396987319883445. Epub 2019 Oct 16.
It has been suggested that the development of post-stroke apathy (PSA) and depression (PSD) may be more strongly associated with generalised brain pathology, rather than the stroke lesion itself. The present study aimed to investigate associations between imaging markers of lesion-related and generalised brain pathology and the development of PSA and PSD during a one-year follow-up.
In a prospective cohort study, 188 stroke patients received 3-Tesla MRI at baseline (three months post-stroke) for evaluation of lesion-related, vascular, and degenerative brain pathology. Presence of lacunes, microbleeds, white matter hyperintensities, and enlarged perivascular spaces was summed to provide a measure of total cerebral small vessel disease (cSVD) burden (range 0-4). The Mini International Neuropsychiatric Interview and Apathy Evaluation Scale were administered at baseline and repeated at 6- and 12-month follow-up to define presence of PSD and PSA, respectively.
Population-averaged logistic regression models showed that global brain atrophy and severe cSVD burden (score 3-4) were significantly associated with the odds of having PSA (OR 5.33, 95% CI 1.99-14.25 and 3.04, 95% CI 1.20-7.69, respectively), independent of stroke lesion volume and co-morbid PSD. Medium cSVD burden (score 2) was significantly associated with the odds of having PSD (OR 2.92, 95% CI 1.09-7.78), independent of stroke lesion volume, co-morbid PSA, and pre-stroke depression. No associations were found with lesion-related markers.
The results suggest that generalised degenerative and vascular brain pathology, rather than lesion-related pathology, is an important predictor for the development of PSA, and less strongly for PSD.
有人提出，中风后冷漠（PSA）和抑郁（PSD）的发展可能与广泛性脑病理改变的关联更为密切，而非中风病灶本身。本研究旨在调查与病灶相关及广泛性脑病理改变的影像学标志物与PSA和PSD在一年随访期间发展的相关性。
在一项前瞻性队列研究中，188名中风患者在基线（中风后三个月）接受了3特斯拉磁共振成像（MRI）检查，以评估与病灶相关、血管性和退行性脑病理改变。将腔隙、微出血、白质高信号和血管周围间隙增宽的存在情况相加，以提供全脑小血管病（cSVD）负担的衡量指标（范围为0至4）。在基线时进行了迷你国际神经精神访谈和冷漠评估量表，并在6个月和12个月随访时重复进行，以分别确定PSD和PSA的存在情况。
总体平均逻辑回归模型显示，全脑萎缩和严重的cSVD负担（评分3至4）与发生PSA的几率显著相关（分别为OR 5.33，95%可信区间1.99至14.25和OR 3.04，95%可信区间1.20至7.69），独立于中风病灶体积和共病的PSD。中度cSVD负担（评分2）与发生PSD的几率显著相关（OR 2.92，95%可信区间1.09至7.78），独立于中风病灶体积、共病的PSA和中风前抑郁。未发现与病灶相关标志物有相关性。
结果表明，广泛性退行性和血管性脑病理改变，而非病灶相关病理改变，是PSA发展的重要预测因素，对PSD的预测作用较弱。
