Associations of lesion location, structural disconnection, and functional diaschisis with depressive symptoms post stroke

Julian Klingbeil; Max-Lennart Brandt; Anika Stockert; Petra Baum; Karl-Titus Hoffmann; Dorothee Saur; Max Wawrzyniak

doi:10.3389/fneur.2023.1144228

Associations of lesion location, structural disconnection, and functional diaschisis with depressive symptoms post stroke

Front Neurol. 2023 May 17:14:1144228. doi: 10.3389/fneur.2023.1144228. eCollection 2023.

Authors

Julian Klingbeil¹, Max-Lennart Brandt¹, Anika Stockert¹, Petra Baum², Karl-Titus Hoffmann³, Dorothee Saur¹, Max Wawrzyniak¹

Affiliations

¹ Neuroimaging Laboratory, Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany.
² Department of Neurology, University of Leipzig Medical Center, Leipzig, Germany.
³ Department of Neuroradiology, University of Leipzig Medical Center, Leipzig, Germany.

Abstract

Introduction: Post-stroke depressive symptoms (PSDS) are common and relevant for patient outcome, but their complex pathophysiology is ill understood. It likely involves social, psychological and biological factors. Lesion location is a readily available information in stroke patients, but it is unclear if the neurobiological substrates of PSDS are spatially localized. Building on previous analyses, we sought to determine if PSDS are associated with specific lesion locations, structural disconnection and/or localized functional diaschisis.

Methods: In a prospective observational study, we examined 270 patients with first-ever stroke with the Hospital Anxiety and Depression Scale (HADS) around 6 months post-stroke. Based on individual lesion locations and the depression subscale of the HADS we performed support vector regression lesion-symptom mapping, structural-disconnection-symptom mapping and functional lesion network-symptom-mapping, in a reanalysis of this previously published cohort to infer structure-function relationships.

Results: We found that depressive symptoms were associated with (i) lesions in the right insula, right putamen, inferior frontal gyrus and right amygdala and (ii) structural disconnection in the right temporal lobe. In contrast, we found no association with localized functional diaschisis. In addition, we were unable to confirm a previously described association between depressive symptom load and a network damage score derived from functional disconnection maps.

Discussion: Based on our results, and other recent lesion studies, we see growing evidence for a prominent role of right frontostriatal brain circuits in PSDS.

Keywords: depression; diaschisis; disconnection; lesion network mapping; stroke.