Zhou Shanshan, Liu Xiaodie, Chen Mengyuan, Chen Wenyi, Pan Yawen, Zhi Yinghao
Department of Rehabilitation Medicine, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou, Zhejiang, China.
Front Neurol. 2025 Jul 18;16:1599733. doi: 10.3389/fneur.2025.1599733. eCollection 2025.
Post-stroke depression (PSD) is a prevalent psychiatric complication following a stroke, significantly delaying neurological recovery. The assessment of scales in clinical diagnosis often lacks objectivity, while functional near-infrared spectroscopy (fNIRS) has been recognized as an adjunctive diagnosis of depression. This research was designed to evaluate whether fNIRS signals can differentiate different degrees of PSD and explore the pathogenesis behind PSD.
We recruited 56 stroke patients treated at the Wenzhou TCM Hospital of Zhejiang Chinese Medical University and stratified them into three groups according to PSD severity: non-PSD ( = 18), mild-PSD ( = 19), and moderate-PSD ( = 19). fNIRS was employed to monitor frontotemporal cortical activity while administering a verbal fluency task across all participant groups. Differences in hemodynamic activity and functional connectivity across six frontotemporal cortex subregions were examined in three patient groups, and their correlations with 17-item Hamilton Depression Rating Scale (HAMD-17) scores were evaluated.
In terms of brain activation, the moderate-PSD group demonstrated significantly diminished activation in four particular brain regions in comparison to the non-PSD group ( < 0.05): the bilateral medial prefrontal cortex (mPFC), the ipsilateral dorsolateral prefrontal cortex (DLPFC), and the contralateral temporal lobe (TL), and the activation intensity within these regions was negatively associated with HAMD-17 scores (L-mPFC: r = -0.315, = 0.018; R-mPFC: = -0.377, = 0.004; L-DLPFC: = -0.323, = 0.015; R-TL: = -0.401, = 0.002). Mild-PSD exhibited lower activation only in CH42 but higher in CH6 than moderate-PSD ( < 0.05). Regarding brain functional connectivity, the strength of connectivity between the DLPFC~mPFC on the ipsilesional side was positively correlated with the HAMD-17 scores (r = 0.405, = 0.002), with significant disparities in the moderate-PSD versus the non-PSD groups. In contrast, the mild-PSD group displayed no notable connectivity differences between the two groups.
This study presents distinct patterns of frontotemporal cortex activation and functional connectivity alterations associated with varying severity levels of PSD. In contrast with patients with stroke alone, PSD patients showed decreased activation levels and abnormally increased functional connectivity, and this change was more pronounced in moderate-PSD patients. These findings indicate that functional features of the frontotemporal cortex may serve as a neural indicator for identifying high-risk cases of PSD.
https://www.chictr.org.cn/showproj.html?proj=249555, ChiCTR2400093089.
中风后抑郁（PSD）是中风后常见的精神并发症，显著延迟神经功能恢复。临床诊断中量表评估往往缺乏客观性，而功能近红外光谱技术（fNIRS）已被认可为抑郁症的辅助诊断方法。本研究旨在评估fNIRS信号能否区分不同程度的PSD，并探索PSD背后的发病机制。
我们招募了在浙江中医药大学附属温州中医院接受治疗的56例中风患者，并根据PSD严重程度将他们分为三组：非PSD组（n = 18）、轻度PSD组（n = 19）和中度PSD组（n = 19）。在所有参与者组进行言语流畅性任务时，使用fNIRS监测额颞叶皮质活动。检查了三个患者组在六个额颞叶皮质亚区域的血流动力学活动和功能连接差异，并评估了它们与17项汉密尔顿抑郁量表（HAMD - 17）评分的相关性。
在脑激活方面，与非PSD组相比，中度PSD组在四个特定脑区的激活明显减弱（P < 0.05）：双侧内侧前额叶皮质（mPFC）、同侧背外侧前额叶皮质（DLPFC）和对侧颞叶（TL），这些区域内的激活强度与HAMD - 17评分呈负相关（左mPFC：r = -0.315，P = 0.018；右mPFC：r = -0.377，P = 0.004；左DLPFC：r = -0.323，P = 0.015；右TL：r = -0.401，P = 0.002）。轻度PSD仅在CH42处激活较低，但在CH6处比中度PSD更高（P < 0.05）。关于脑功能连接，患侧DLPFC~mPFC之间的连接强度与HAMD - 17评分呈正相关（r = 0.405，P = 0.002），中度PSD组与非PSD组之间存在显著差异。相比之下，轻度PSD组在两组之间未显示出明显的连接差异。
本研究呈现了与不同严重程度PSD相关的额颞叶皮质激活和功能连接改变的不同模式。与单纯中风患者相比，PSD患者显示激活水平降低和功能连接异常增加，且这种变化在中度PSD患者中更为明显。这些发现表明额颞叶皮质的功能特征可能作为识别PSD高危病例的神经指标。
https://www.chictr.org.cn/showproj.html?proj=249555，ChiCTR2400093089 。
