Aubignat Mickael, Roussel Martine, Aarabi Ardalan, Lamy Chantal, Andriuta Daniela, Tasseel-Ponche Sophie, Makki Malek, Godefroy Olivier
Department of Neurology, Amiens University Hospital, Amiens, France.
Department of Neurology, Amiens University Hospital, Amiens, France; Laboratory of Functional Neurosciences (UR UPJV 4559), Jules Verne University of Picardie, Amiens, France.
Cortex. 2023 Mar;160:55-66. doi: 10.1016/j.cortex.2022.12.012. Epub 2023 Jan 18.
Apathy occurs in approximately one third of people after stroke. Despite its frequency and functional consequences, the determinants of apathy have only been partially defined. The major difficulty lies in disentangling the reduction in activity due to apathy itself from those secondary to comorbidities, such as depression, sensorimotor deficits, and cognitive impairment. Here, we aimed to examine the prevalence of apathy, identify confounding sources of hypoactivity, and define its neuroimaging determinants using multivariate voxel lesion symptom-mapping (mVLSM) analyses. We assessed apathy in a subgroup (n = 325, mean age: 63.8 ± 10.5 years, 91.1% ischemic stroke) of the GRECogVASC cohort using the validated Behavioral Dysexecutive Syndrome Inventory, interpreted using GREFEX criteria, as well as confounding factors (depression, anxiety, severity of the neurological deficit, and gait disorders). mVLSM analysis was used to define neuroimaging determinants and was repeated after controlling for confounding factors. Apathy was present for 120 patients (36.9%, 95% CI: 31.7-42.2). Stepwise linear regression identified three factors associated with apathy: depressive symptoms (R = .3, p = .0001), cognitive impairment (R = .015, p = .02), and neurological deficit (R = .110, p = .0001). Accordingly, only 9 (7.5%) patients had apathy without a confounding factor, i.e., isolated apathy. In conventional VLSM analysis, apathy was associated with a large number of subcortical lesions that were no longer considered after controlling for confounding factors. Strategic site analysis identified five regions associated with isolated apathy: the F3 orbitalis pars, left amygdala, left thalamus, left pallidum, and mesencephalon. mVLSM analysis identified four strategic sites associated with apathy: the right corticospinal tract (R = .11; p = .0001), left frontostriatal tract (R = .11; p = .0001), left thalamus (R = .04; p = .0001), and left amygdala (R = .01; p = .013). These regions remained significant after controlling for confounding factors but explained a lower amount of variance. These findings indicate that poststroke apathy is more strongly associated with depression, neurological deficit, and cognitive impairment than with stroke lesions locations, at least using VLSM analysis.
中风后约三分之一的人会出现冷漠症状。尽管冷漠症状很常见且会产生功能后果，但其决定因素仅得到部分定义。主要困难在于区分冷漠本身导致的活动减少与继发于合并症（如抑郁症、感觉运动缺陷和认知障碍）的活动减少。在此，我们旨在研究冷漠症状的患病率，确定活动减退的混杂来源，并使用多变量体素损伤症状映射（mVLSM）分析来定义其神经影像学决定因素。我们使用经过验证的行为执行功能障碍综合征量表，按照GREFEX标准进行解读，并评估了GRECogVASC队列中的一个亚组（n = 325，平均年龄：63.8±10.5岁，91.1%为缺血性中风）的冷漠症状以及混杂因素（抑郁症、焦虑症、神经功能缺损严重程度和步态障碍）。mVLSM分析用于定义神经影像学决定因素，并在控制混杂因素后重复进行。120名患者存在冷漠症状（36.9%，95%置信区间：31.7 - 42.2）。逐步线性回归确定了与冷漠症状相关的三个因素：抑郁症状（R = 0.3，p = 0.0001）、认知障碍（R = 0.015，p = 0.02）和神经功能缺损（R = 0.110，p = 0.0001）。因此，只有9名（7.5%）患者存在无混杂因素的冷漠症状，即孤立性冷漠。在传统的体素损伤症状映射（VLSM）分析中，冷漠症状与大量皮质下病变相关，但在控制混杂因素后这些病变不再被考虑。策略性部位分析确定了与孤立性冷漠相关的五个区域：眶额部F3区、左侧杏仁核、左侧丘脑、左侧苍白球和中脑。mVLSM分析确定了与冷漠症状相关的四个策略性部位：右侧皮质脊髓束（R = 0.11；p = 0.0001）、左侧额纹状体束（R = 0.11；p = 0.0001）、左侧丘脑（R = 0.04；p = 0.0001）和左侧杏仁核（R = 0.01；p = 0.013）。这些区域在控制混杂因素后仍然显著，但解释的方差量较低。这些发现表明，至少使用VLSM分析时，中风后冷漠与抑郁症、神经功能缺损和认知障碍的关联比与中风病变位置的关联更强。
