Center for Cognition and Brain Disorders, The Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang, China; Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, Hangzhou, Zhejiang, China.
Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
J Affect Disord. 2023 Sep 1;336:52-63. doi: 10.1016/j.jad.2023.05.016. Epub 2023 May 17.
Lesion locations of post-stroke depression (PSD) mapped to a depression circuit which centered by the left dorsolateral prefrontal cortex (DLPFC). However, it remains unknown whether the compensatory adaptations that may occur in this depression circuit due to the lesions in PSD.
Rs-fMRI data were collected from 82 non-depressed stroke patients (Stroke), 39 PSD patients and 74 healthy controls (HC). We tested the existence of depression circuit, examined PSD-related alterations of DLPFC-seeded connectivity and their associations with depression severity, and analyzed the connectivity between each repetitive transcranial magnetic stimulation (rTMS) target and DLPFC to find the best treatment target for PSD.
We found that: 1) the left DLPFC showed significantly stronger connectivity to lesions of PSD than Stroke group; 2) in comparison to both Stroke and HC groups, PSD exhibited increased connectivity with DLPFC in bilateral lingual gyrus, contralesional superior frontal gyrus, precuneus, and middle frontal gyrus (MFG); 3) the connectivity between DLPFC and the contralesional lingual gyrus positively correlated with depression severity; 4) the rTMS target in center of MFG showed largest between-group difference in connectivity with DLPFC, and also reported the highest predicted clinical efficacy.
Longitudinal studies are required to explore the alterations of depression circuit in PSD as the disease progress.
PSD underwent specific alterations in depression circuit, which may help to establish objective imaging markers for early diagnosis and interventions of the disease.
卒中后抑郁（PSD）的病灶部位映射到以左侧背外侧前额叶皮层（DLPFC）为中心的抑郁回路。然而，目前尚不清楚 PSD 病灶是否会导致该抑郁回路发生代偿性改变。
从 82 名非抑郁卒中患者（Stroke）、39 名 PSD 患者和 74 名健康对照者（HC）中收集 rs-fMRI 数据。我们测试了抑郁回路的存在，检查了 PSD 相关的 DLPFC 种子连通性改变及其与抑郁严重程度的关系，并分析了每个重复经颅磁刺激（rTMS）靶区与 DLPFC 之间的连通性，以找到 PSD 的最佳治疗靶区。
我们发现：1）左侧 DLPFC 与 PSD 病灶的连接明显强于 Stroke 组；2）与 Stroke 和 HC 组相比，PSD 与双侧舌回、对侧额上回、楔前叶和中额回（MFG）的 DLPFC 连接增强；3）DLPFC 与对侧舌回的连接与抑郁严重程度呈正相关；4）MFG 中心的 rTMS 靶区与 DLPFC 的连通性在组间差异最大，且报告的预测临床疗效最高。
需要进行纵向研究，以探索 PSD 疾病进展过程中抑郁回路的改变。
PSD 经历了抑郁回路的特定改变，这可能有助于为疾病的早期诊断和干预建立客观的影像学标志物。
