Sun Jingjing, Tang Yanlin, Wang Wenni, Zhang Yong, Ji Hengshan, Wang Peng
Department of Nuclear Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
School of Medical Imaging, Bengbu Medical University, Bengbu, China.
Front Aging Neurosci. 2025 May 13;17:1583655. doi: 10.3389/fnagi.2025.1583655. eCollection 2025.
Post-stroke fatigue (PSF) is a prevalent but often overlooked complication, particularly in middle-aged and older stroke survivors. Neuroimaging studies exploring the neural mechanisms of PSF in this age group are limited. This study aimed to identify imaging markers for PSF in middle-aged and older adults using a multimodal imaging approach.
This retrospective case-control study analyzed data from patients with first ischemic stroke aged 50 years and above who were treated from January 2021 to June 2022 at the First Hospital of the University of Science and Technology of China. PSF was assessed using the Fatigue Severity Scale (FSS) and diagnostic criteria. All patients underwent resting-state functional MRI (rs-fMRI) and diffusion tensor imaging along perivascular space (DTI-ALPS) to assess brain functional connectivity and glymphatic system function.
The PSF group (mean age 62.7 ± 10.50 years) showed reduced global functional connectivity compared to non-fatigued controls (mean age 58.40 ± 9.20 years) ( < 0.05, FDR corrected), with enhanced connectivity between the insula and right inferior frontal gyrus. DTI-ALPS analysis revealed a negative correlation between DTI-ALPS index and fatigue severity (R = 0.40, < 0.001) in the PSF group, suggesting an association between impaired glymphatic clearance and fatigue symptoms in middle-aged and older stroke survivors.
This multimodal neuroimaging study highlights altered brain functional connectivity and glymphatic dysfunction as potential neural correlates of PSF in middle-aged and older adults. The findings provide novel insights into the complex pathophysiology of PSF in the aging brain, implicating both functional brain networks and the glymphatic system. Further research is warranted to validate these age-specific findings and explore targeted interventions for PSF in older stroke survivors.
中风后疲劳（PSF）是一种常见但常被忽视的并发症，在中老年中风幸存者中尤为如此。探索该年龄组PSF神经机制的神经影像学研究有限。本研究旨在使用多模态成像方法识别中老年PSF的影像学标志物。
这项回顾性病例对照研究分析了2021年1月至2022年6月在中国科学技术大学第一附属医院接受治疗的50岁及以上首次缺血性中风患者的数据。使用疲劳严重程度量表（FSS）和诊断标准评估PSF。所有患者均接受静息态功能磁共振成像（rs-fMRI）和沿血管周围间隙的扩散张量成像（DTI-ALPS），以评估脑功能连接和类淋巴系统功能。
与无疲劳对照组（平均年龄58.40±9.20岁）相比，PSF组（平均年龄62.7±10.50岁）的整体功能连接性降低（<0.05，FDR校正），岛叶与右下额回之间的连接性增强。DTI-ALPS分析显示，PSF组的DTI-ALPS指数与疲劳严重程度呈负相关（R=0.40，<0.001），提示中老年中风幸存者类淋巴清除受损与疲劳症状之间存在关联。
这项多模态神经影像学研究强调了脑功能连接改变和类淋巴功能障碍是中老年PSF的潜在神经关联。这些发现为衰老大脑中PSF的复杂病理生理学提供了新的见解，涉及功能性脑网络和类淋巴系统。有必要进一步研究以验证这些特定年龄的发现，并探索针对老年中风幸存者PSF的靶向干预措施。
