Analysis of Correlation Between White Matter Changes and Functional Responses in Post-stroke Depression

Relationship between weight-to-waist index and post-stroke depression

BACKGROUND

The weight-to-waist index (WWI) serves as an innovative metric specifically designed to assess central obesity. However, the relationship between WWI and the prevalence of post-stroke depression (PSD) remains inadequately explored in the literature.

AIM

To elucidate the relationship between WWI and PSD.

METHODS

Data from the National Health and Nutrition Examination Survey 2005 to 2018 were analyzed. Multivariable logistic regression models and propensity score matching were utilized to investigate the association between WWI and PSD, with adjustments for potential confounders. The restricted cubic spline statistical method was applied to explore non-linear associations.

RESULTS

Participants with elevated WWI values had a significantly greater risk of developing PSD. Specifically, individuals in the higher WWI range exhibited more than twice the likelihood of developing PSD compared to those with lower WWI values (odds ratio = 2.21, 95% confidence interval: 1.84-2.66, P < 0.0001). After propensity score matching, the risk of PSD remained significantly elevated (odds ratio = 1.43, 95%confidence interval: 1.09-1.88, P = 0.01). Tertile analysis revealed that participants in the highest WWI tertile faced a significantly higher risk of PSD compared to those in the lowest tertile. Restricted cubic spline analysis further revealed a non-linear association, with the risk of PSD plateauing at higher WWI values.

CONCLUSION

There is a significant association between elevated WWI and increased risk of PSD. Thus, regular depression screening should be implemented in stroke patients with elevated WWI to enhance patient outcomes.

Detection of structural-functional coupling abnormalities using multimodal brain networks in Alzheimer's disease: A comparison of three computational models

Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by the disconnection of white matter fibers and disrupted functional connectivity of gray matter; however, the pathological mechanisms linking structural and functional changes remain unclear. This study aimed to explore the interaction between the structural and functional brain network in AD using advanced structural-functional coupling (S-F coupling) models to assess whether these changes correlate with cognitive function, Aβ deposition levels, and gene expression. In this study, we utilized multimodal magnetic resonance imaging data from 41 individuals with AD, 112 individuals with mild cognitive impairment, and 102 healthy controls to explore these mechanisms. We applied different computational models to examine the changes in the S-F coupling associated with AD. Our results showed that the communication and graph harmonic models demonstrated greater heterogeneity and were more sensitive than the statistical models in detecting AD-related pathological changes. In addition, S-F coupling increases with AD progression at the global, subnetwork, and regional node levels, especially in the medial prefrontal and anterior cingulate cortices. The S-F coupling of these regions also partially mediated cognitive decline and Aβ deposition. Furthermore, gene enrichment analysis revealed that changes in S-F coupling were strongly associated with the regulation of cellular catabolic processes. This study advances our understanding of the interaction between structural and functional connectivity and highlights the importance of S-F coupling in elucidating the neural mechanisms underlying cognitive decline in AD.

Temporoparietal structural-functional coupling abnormalities in drug-naïve first-episode major depressive disorder

INTRODUCTION

Major depressive disorder (MDD) is a debilitating and heterogeneous disease. Many MDD patients experience concurrent anxiety symptoms, often referred to as anxious depression (MDD-ANX). The relationships between network alterations in structural connectivity (SC) and functional connectivity (FC) in MDD and its anxiety-related subtype remain areas that require further investigation.

METHODS

We investigated SC-FC coupling at the system and regional levels in 80 never-treated first-episode MDD patients and 80 healthy control (HC) subjects. For brain systems and regions showing significant between-group coupling differences, we further conducted subgroup comparisons between MDD-ANX, non-anxious depression (MDD-NANX) and HC. We also investigated topological features at the corresponding levels, and assessed the correlation patterns between significant coupling alterations and the topological and clinical characteristics.

RESULTS

Relative to HC, MDD patients showed increased SC-FC coupling in the temporal system (right hippocampus and left superior temporal gyrus [STG]) but decreased coupling in the parietal system (right postcentral gyrus and left angular gyrus). These systems and regions were further characterized by disturbed inter-module connections and impaired structural network efficiency in MDD. Notably, SC-FC coupling of the right hippocampus was significantly increased in MDD-ANX compared to MDD-NANX, which further showed distinct correlation patterns with structural network efficiency.

CONCLUSIONS

Alterations in both SC-FC coupling and topological properties in the temporal and parietal regions provide insights into the interplay between the structural and functional network abnormalities in MDD. SC-FC coupling alterations in the right hippocampus, associated with structural nodal efficiency, may be implicated in the neuropathology of anxious depression.

Neurobiological Mechanisms Underlying Psychological Dysfunction After Brain Injuries

Despite the presentation of similar psychological symptoms, psychological dysfunction secondary to brain injury exhibits markedly lower treatment efficacy compared to injury-independent psychological dysfunction. This gap remains evident, despite extensive research efforts. This review integrates clinical and preclinical evidence to provide a comprehensive overview of the neurobiological mechanisms underlying neuropsychological disorders, focusing on the role of key brain regions in emotional regulation across various forms of brain injuries. It examines therapeutic interventions and mechanistic targets, with the primary goal of identifying pathways for targeted treatments. The review highlights promising therapeutic avenues for addressing injury-associated psychological dysfunction, emphasizing Nrf2, neuropeptides, and nonpharmacological therapies as multi-mechanistic interventions capable of modulating upstream mediators to address the complex interplay of factors underlying psychological dysfunction in brain injury. Additionally, it identifies sexually dimorphic factors as potential areas for further exploration and advocates for detailed investigations into sex-specific patterns to uncover additional contributors to these disorders. Furthermore, it underscores significant gaps, particularly the inadequate consideration of interactions among causal factors, environmental influences, and individual susceptibilities. By addressing these gaps, this review provides new insights and calls for a paradigm shift toward a more context-specific and integrative approach to developing targeted therapies for psychological dysfunction following brain injuries.

Individualized identification value of stress-related network structural-functional properties and HPA axis reactivity for subthreshold depression

Accumulating studies have highlighted the links between stress-related networks and the HPA axis for emotion regulation and proved the mapping associations between altered structural and functional networks (called SC-FC coupling) in depression. However, the signatures of SC-FC coupling in subthreshold depression (StD) individuals and their relationships with HPA axis reactivity, as well as the predictive power of these combinations for discriminating StD, remain unclear. This cross-sectional study enrolled 160 adults, including 117 StD and 43 healthy controls (HC). The propensity score matching method was applied for match-pair analysis between StD and HC. Herein, we measured depression level, cortisol level, and brain imaging outcomes. The functional MRI and diffusion tensor imaging methods were employed to acquire the network SC-FC couplings and topological attributes. Support vector machine models were employed to discriminate StD from HC. Herein, 43 pairs were matched, but four participants were excluded due to over-threshold head motion, leaving 41 participants in each group. General linear model results revealed a significant SC-FC coupling increase in the default mode network (DMN) and decrements of global efficiency in DMN and frontoparietal control network (P < 0.05), while the cortisol secretion significantly increased (P < 0.001) in StD individuals. Partial correlation analysis revealed positive associations between DMN coupling and cortisol values (r = 0.298, P = 0.033), and their combination provided greater power for discriminating StD than another single model, with the classification accuracy and AUC value up to 85.71% and 0.894, respectively. In summary, this study clarified the relationship between stress-related network SC-FC coupling and cortisol secretion in influencing depressive symptoms, whose combination would contribute to discriminating subthreshold depressive states in the future.

Brain structural-functional coupling mechanism in mild subcortical stroke and its relationship with cognition

OBJECTIVES

Stroke can lead to significant restructuring of brain structure and function. However, the precise changes in the coordination between brain structure and function in subcortical stroke patients remain unclear. We investigated alterations in brain structural-functional coupling (SC-FC coupling) and their impact on cognitive function in subcortical basal ganglia infarction patients.

METHODS

The study comprised 40 patients with mild stroke with basal ganglia region infarcts and 29 healthy controls (HC) who underwent multidimensional neuroimaging examination and neuropsychological testing. The subcortical stroke patients were divided into post-stroke cognitive impairment (PSCI) and stroke with no cognitive impairment (NPSCI) groups based on cognitive performance, with 22 individuals undergoing follow-up examination after three months. We investigated differences in brain structural-functional coupling across three groups, and their associations with cognitive functions.

RESULTS

Compared to both HC participants and NPSCI, PSCI exhibited significantly reduced structural-functional coupling strength in specific brain regions. After a three-month period, there was observed an increase in structural-functional coupling strength within the frontal lobe (precentral gyrus and paracentral lobule). The strength of SC-FC coupling within the precentral gyrus, precuneus, and paracentral lobule regions demonstrated a decline correlating with the deterioration of cognitive function (MoCA, memory and visual motor speed functions).

CONCLUSIONS

After subcortical basal ganglia stroke, PSCI patients demonstrated decreased SC-FC coupling in the frontal lobe region, correlating with multidimensional cognitive impairment. Three months later, there was an increase in SC-FC coupling in the frontal lobe, suggesting a compensatory mechanism during the recovery phase of cognitive impairment following stroke.

Irritability in stroke: a protocol for a prospective study

Background

Poststroke irritability (PSI) is common among stroke survivors and can lead to a poor quality of life, difficulties in social interactions, criticism from caregivers, and caregiver stress. The planned study will evaluate the clinical, neuropsychological, and magnetic resonance imaging (MRI) correlates of PSI in a cohort of stroke survivors. In addition, the study will examine the 15-month progression of PSI.

Methods

This will be a prospective cohort study that will recruit 285 participants. Participants and their caregivers will undergo detailed assessments at a research clinic at 3, 9, and 15 months after stroke onset (T1/T2/T3). The irritability/lability subscale of the Chinese version of the Neuropsychiatric Inventory (CNPI) will be completed by caregivers. Potential covariates will also be measured. Patients will undergo MRI, including diffusion-weighted imaging, within 1 week of stroke onset. A stepwise logistic regression will be performed to evaluate the importance of lesions in the regions of interest (ROIs) along with other significant variables identified in univariate analyses. These analyses will be repeated for patients with and without PSI at T2 and T3. Repeated measures analysis of covariance (ANCOVA) will be used to assess changes in CNPI scores for the entire sample. In ANCOVA analyses, the frequency of infarcts in the ROIs will be treated as the predictor.

Discussion

This will be the first MRI study on PSI in stroke survivors. The findings will provide insights into the association of the orbitofrontal cortex, anterior cingulate cortex, anterior temporal lobe, insula, amygdala, thalamus, and basal ganglia lesions with the risk of PSI.

Association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and the risk of post-stroke depression: A cross-sectional study

BACKGROUND

Limited observational research has explored the relationship between the non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR) and the risk of post-stroke depression (PSD). This study aims to investigate the potential associations between NHHR and PSD.

METHODS

A cross-sectional study was conducted using data from stroke participants aged 20 and older, sourced from the National Health and Nutrition Examination Survey (NHANES) spanning 2005 to 2018. Depression was assessed using the PHQ-9 questionnaire. The association between NHHR and PSD risk was evaluated through weighted multivariate logistic regression and restricted cubic spline (RCS) models. Subgroup and sensitivity analyses were performed to validate the findings.

RESULTS

In the continuous model, the NHHR value for the PSD group (3.23±1.84) was significantly higher than that of the non-PSD group (2.79±1.40, p=0.015). Logistic regression analysis in the fully adjusted model revealed a positive association between NHHR and PSD (OR 1.16, 95 % CI 1.03-1.30, p=0.016). Interaction tests showed no significant differences across strata (p > 0.05 for interaction). Restricted cubic spline results indicated a linear dose-response relationship between NHHR and PSD risk (P for non-linearity = 0.6). This association persisted in various subgroup analyses.

CONCLUSION

NHHR was significantly correlated with an increased risk of PSD among U.S. adults. Further re-search on NHHR could contribute to the prevention and treatment of PSD.

Non-Invasive Brain Stimulation Progression in Post-Stroke Depression Treatment: A Systematic Review

Objective

Post-stroke depression (PSD) is the most common psychological disorder in patients with stroke. It not only seriously affects the patient's functional recovery, quality of life, and ability to return to society but also increases stroke recurrence rate and mortality. However, the effectiveness of drug treatment is unpredictable and associated with certain side effects and low compliance. Pharmacological therapy is limited. The field of noninvasive brain stimulation (NIBS) has recently made great progress in developing specific stimulation protocols to alleviate the symptoms of patients with PSD and might offer valid, alternative strategies.

Methods

We systematically searched PubMed, Embase, and the Cochrane Library for investigating the use of NIBS in the treatment of PSD. The methodological quality of selected studies was assessed according to the Risk of Bias 2 (ROB2).

Results

We identified 814 references in 3 databases. After excluding irrelevant and duplicate studies, 14 studies were included. According to the PRISMA checklist, 4 studies were overall comprehensive, 6 had some problems, and 4 had considerable problems with the presented information. The evidence was evaluated using ROB2, with 5 "low-risk" studies, 5 "some concerns" studies, and 4 "high-risk" studies included.

Conclusion

This review provides a comprehensive overview of the clinical trials reported in PSD. Noninvasive brain stimulation is a potentially promising treatment strategy. However, an optimal stimulation protocol needs to be formulated, and much work is required before NIBS can be widely applied in the clinic.

Elucidating genetic and molecular basis of altered higher-order brain structure-function coupling in major depressive disorder

Previous studies have shown that major depressive disorder (MDD) patients exhibit structural and functional impairments, but few studies have investigated changes in higher-order coupling between structure and function. Here, we systematically investigated the effect of MDD on higher-order coupling between structural connectivity (SC) and functional connectivity (FC). Each brain region was mapped into embedding vector by the node2vec algorithm. We used support vector machine (SVM) with the brain region embedding vector to distinguish MDD patients from health controls (HCs) and identify the most discriminative brain regions. Our study revealed that MDD patients had decreased higher-order coupling in connections between the most discriminative brain regions and local connections in rich-club organization and increased higher-order coupling in connections between the ventral attentional network and limbic network compared with HCs. Interestingly, transcriptome-neuroimaging association analysis demonstrated the correlations between regional rSC-FC coupling variations between MDD patients and HCs and α/β-hydrolase domain-containing 6 (ABHD6), β 1,3-N-acetylglucosaminyltransferase-9(β3GNT9), transmembrane protein 45B (TMEM45B), the correlation between regional dSC-FC coupling variations and retinoic acid early transcript 1E antisense RNA 1(RAET1E-AS1), and the correlations between regional iSC-FC coupling variations and ABHD6, β3GNT9, katanin-like 2 protein (KATNAL2). In addition, correlation analysis with neurotransmitter receptor/transporter maps found that the rSC-FC and iSC-FC coupling variations were both correlated with neuroendocrine transporter (NET) expression, and the dSC-FC coupling variations were correlated with metabotropic glutamate receptor 5 (mGluR5). Further mediation analysis explored the relationship between genes, neurotransmitter receptor/transporter and MDD related higher-order coupling variations. These findings indicate that specific genetic and molecular factors underpin the observed disparities in higher-order SC-FC coupling between MDD patients and HCs. Our study confirmed that higher-order coupling between SC and FC plays an important role in diagnosing MDD. The identification of new biological evidence for MDD etiology holds promise for the development of innovative antidepressant therapies.

Analysis of radiological features in patients with post-stroke depression and cognitive impairment

Post-stroke depression (PSD) and post-stroke cognitive impairment (PSCI) are common complications following a stroke, significantly impacting the quality of life and survival time of survivors. Currently, the comorbidity of PSCI and PSD is receiving increasing attention, as they share some common clinical characteristics, mechanisms, risk factors, radiological features, and treatment strategies. They influence each other, with the clinical prevalence of PSD comorbid with PSCI reaching as high as 26.15 %. The prevention, screening, diagnosis, and treatment of PSD and PSCI require collaboration across clinical, radiological, and neuropsychological evaluations. This paper aims to summarize the common radiological features of both conditions from a radiological perspective, which may aid in identifying early screening and predictive imaging biomarkers.

Research progress on post-stroke depression

Stroke is a highly prevalent and widely detrimental cardiovascular disease, frequently resulting in impairments of both motor function and neural psychological capabilities, such as post-stroke depression (PSD). PSD is the most prevalent neuropsychological disorder among stroke patients, characterized by persistent emotional lowness and diminished interest as its primary features. This article summarizes the mechanism research, animal models and related treatments of PSD. Further improvements are needed in the screening of research subjects and the construction of animal models in the study of PSD. At the same time, in the study of the mechanism of PSD, we need to consider the interaction between multiple systems. The treatment of PSD requires more careful consideration. This can help us to find something new in the study of the mechanism of complex PSD, which provides a new direction for us to develop new treatment delivery.

Neural Substrates of Poststroke Depression: Current Opinions and Methodology Trends

Poststroke depression (PSD), affecting about one-third of stroke survivors, exerts significant impact on patients’ functional outcome and mortality. Great efforts have been made since the 1970s to unravel the neuroanatomical substrate and the brain-behavior mechanism of PSD. Thanks to advances in neuroimaging and computational neuroscience in the past two decades, new techniques for uncovering the neural basis of symptoms or behavioral deficits caused by focal brain damage have been emerging. From the time of lesion analysis to the era of brain networks, our knowledge and understanding of the neural substrates for PSD are increasing. Pooled evidence from traditional lesion analysis, univariate or multivariate lesion-symptom mapping, regional structural and functional analyses, direct or indirect connectome analysis, and neuromodulation clinical trials for PSD, to some extent, echoes the frontal-limbic theory of depression. The neural substrates of PSD may be used for risk stratification and personalized therapeutic target identification in the future. In this review, we provide an update on the recent advances about the neural basis of PSD with the clinical implications and trends of methodology as the main features of interest.