Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China
Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.
BMJ Open. 2024 Aug 13;14(8):e081800. doi: 10.1136/bmjopen-2023-081800.
Structural and functional abnormalities in the cortical-striatal network (CSN) are hypothesised to play a key role in the pathogenesis of neurological disease-associated fatigue. Some small-scale functional MRI (fMRI) studies have suggested that poststroke fatigue (PSF) is related to focal functional connectivity (FC) changes. To date, there has been no published large-scale fMRI study on PSF. This planned study will examine the role of the CSN FC on PSF.
The planned study will be a prospective cohort study conducted at the Neurology Unit of the Prince of Wales Hospital. We will recruit 738 participants. The project duration will be 36 months. A psychiatrist will administer the Fatigue Severity Scale (FSS) at 3 months (P1) following the index stroke. PSF is defined as an FSS Score≥4.0. PSF severity will be defined by the FSS total score at P1. Participants with PSF at P1 will undergo two follow-up assessments at 9 (P2) and 15 (P3) months post stroke. PSF remission at P2 or P3 will be defined as a 50% reduction in FSS. Participants will undergo MRI examinations within 2 weeks of the 3-month poststroke assessment. Structural MRI, resting-state fMRI and diffusion tensor imaging will be performed. FC, structural connectivity, infarcts, cerebral microbleeds and white matter hyperintensities will be analysed. For the primary analysis, the effect of PSF on the FC, structural connectivity and diffusion metrics of CSN of stroke survivors, voxel-wise two-sample t-tests will be performed with FDR correction for multiple comparison and significance level set at p<0.05.
Ethical approval was obtained from the Joint Chinese University of Hong Kong-New Territories East Cluster clinical research ethics committee. The study findings will be shared through peer-reviewed journal publications, national and international conferences and social media platforms.
皮质纹状体网络（CSN）的结构和功能异常被认为在神经疾病相关疲劳的发病机制中起着关键作用。一些小规模的功能磁共振成像（fMRI）研究表明，卒中后疲劳（PSF）与局部功能连接（FC）变化有关。迄今为止，尚无关于 PSF 的大型 fMRI 研究发表。本计划研究将检查 CSN FC 在 PSF 中的作用。
该计划研究将是在威尔斯亲王医院神经内科进行的前瞻性队列研究。我们将招募 738 名参与者。项目持续时间为 36 个月。精神病医生将在指数卒中后 3 个月（P1）使用疲劳严重程度量表（FSS）进行评估。PSF 的定义为 FSS 评分≥4.0。PSF 的严重程度将根据 P1 时的 FSS 总分来定义。P1 时有 PSF 的参与者将在卒中后 9 个月（P2）和 15 个月（P3）进行两次随访评估。P2 或 P3 时的 PSF 缓解将定义为 FSS 降低 50%。参与者将在卒中后 3 个月评估后 2 周内进行 MRI 检查。将进行结构 MRI、静息态 fMRI 和弥散张量成像。将分析 FC、结构连接、梗死、脑微出血和脑白质高信号。对于主要分析，采用 FDR 校正多重比较和显著性水平为 p<0.05 的两样本 t 检验，对 PSF 对卒中幸存者 CSN 的 FC、结构连接和弥散指标的影响进行分析。
已获得香港中文大学-新界东联网临床研究伦理委员会的批准。研究结果将通过同行评审的期刊发表、国家和国际会议以及社交媒体平台进行分享。
