Vidal Julie P C, Danet Lola, Arribarat Germain, Pariente Jérémie, Péran Patrice, Albucher Jean-François, Barbeau Emmanuel J
Brain and Cognition Research Center, (CerCo-UMR 5549), CNRS, University of Toulouse, Toulouse, France.
Toulouse Neuroimaging Center (Tonic-UMR 1214), Inserm, University of Toulouse, Toulouse, France.
J Neurol. 2025 Jan 7;272(1):98. doi: 10.1007/s00415-024-12777-4.
Thalamic strokes produce neurological, cognitive, and behavioral symptoms depending on the thalamic nuclei involved. While traditionally associated with severe cognitive deficits, recent studies suggest more modest impairments. This study aims to identify the factors that influence the severity of cognitive impairment following thalamic stroke.
We recruited 40 patients (mean age 51.1) with chronic isolated thalamic stroke and 45 healthy subjects (mean age 48.5) who underwent neuroimaging and neuropsychological assessment. Cluster and principal component analyses were used to discriminate patients from healthy subjects based on cognitive tasks. Disconnectome maps and cortical thickness were analyzed to understand the distant impact of thalamic strokes.
Two cognitive profiles emerged from the cluster analysis. Cluster 1 included mostly healthy subjects (n = 43) and patients with no or minor deficits (n = 20). Cluster 2 included patients (n = 19) and two healthy subjects with severe deficits in verbal memory, executive functions, and attention. Cluster 1 encompassed all patients with right thalamic stroke, while Cluster 2 included all patients with bilateral stroke or mammillothalamic tract interruption. Patients with left-sided stroke were equally divided between clusters. Significant differences between clusters included age, education, interthalamic adhesion disruption, lesion volume, and location. Patients with left-sided stroke in Cluster 2 had more lateral thalamic lesions and greater disruption of the anterior thalamic projection.
Contrary to common expectations, our findings suggest that many patients with thalamic stroke have relatively good cognitive outcomes. In contrast, we identified the factors behind poor outcomes that will help clinicians.
丘脑中风会根据受累的丘脑核团产生神经、认知和行为症状。虽然传统上与严重的认知缺陷相关，但最近的研究表明损伤程度较为轻微。本研究旨在确定影响丘脑中风后认知障碍严重程度的因素。
我们招募了40例（平均年龄51.1岁）慢性孤立性丘脑中风患者和45名健康受试者（平均年龄48.5岁），他们均接受了神经影像学和神经心理学评估。采用聚类分析和主成分分析，根据认知任务将患者与健康受试者区分开来。分析了脑网络连接图谱和皮质厚度，以了解丘脑中风的远距离影响。
聚类分析产生了两种认知概况。聚类1主要包括健康受试者（n = 43）和无缺陷或轻度缺陷的患者（n = 20）。聚类2包括患者（n = 19）和两名在言语记忆、执行功能和注意力方面有严重缺陷的健康受试者。聚类1涵盖了所有右侧丘脑中风的患者，而聚类2包括所有双侧中风或乳头丘脑束中断的患者。左侧中风的患者在两个聚类中平均分布。聚类之间的显著差异包括年龄、教育程度、丘脑间粘连破坏、病变体积和位置。聚类2中左侧中风的患者丘脑外侧病变更多，丘脑前投射的破坏更大。
与普遍预期相反，我们的研究结果表明，许多丘脑中风患者的认知预后相对较好。相比之下，我们确定了导致预后不良的因素，这将对临床医生有所帮助。
