Jaywant Abhishek, DelPonte Larissa, Kanellopoulos Dora, O'Dell Michael W, Gunning Faith M
Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.
J Geriatr Psychiatry Neurol. 2022 Jan;35(1):3-11. doi: 10.1177/0891988720968270. Epub 2020 Oct 19.
Post-stroke depression and executive dysfunction co-occur and are highly debilitating. Few treatments alleviate both depression and executive dysfunction after stroke. Understanding the brain network changes underlying post-stroke depression with executive dysfunction can inform the development of targeted and efficacious treatment. In this review, we synthesize neuroimaging findings in post-stroke depression and post-stroke executive dysfunction and highlight the network commonalities that may underlie this comorbidity. Structural and functional alterations in the cognitive control network, salience network, and default mode network are associated with depression and executive dysfunction after stroke. Specifically, post-stroke depression and executive dysfunction are both linked to changes in intrinsic functional connectivity within resting state networks, functional over-connectivity between the default mode and salience/cognitive control networks, and reduced cross-hemispheric frontoparietal functional connectivity. Cognitive training and noninvasive brain stimulation targeted at these brain network abnormalities and specific clinical phenotypes may help advance treatment for post-stroke depression with executive dysfunction.
中风后抑郁和执行功能障碍同时出现，且极具致残性。很少有治疗方法能缓解中风后的抑郁和执行功能障碍。了解中风后伴有执行功能障碍的抑郁背后的脑网络变化，可为有针对性且有效的治疗方法的开发提供依据。在本综述中，我们综合了中风后抑郁和中风后执行功能障碍的神经影像学研究结果，并强调了可能是这种共病基础的网络共性。认知控制网络、突显网络和默认模式网络中的结构和功能改变与中风后的抑郁和执行功能障碍相关。具体而言，中风后抑郁和执行功能障碍均与静息态网络内的内在功能连接变化、默认模式网络与突显/认知控制网络之间的功能过度连接以及跨半球额顶叶功能连接减少有关。针对这些脑网络异常和特定临床表型的认知训练和非侵入性脑刺激可能有助于推进对伴有执行功能障碍的中风后抑郁的治疗。
