Larger deep white matter hyperintensity volume correlates with more severe social behavioral changes in patients with subacute ischemic stroke

Jian-Feng Qu; Hui-Hong Hu; Jian-Fei Liu; Yue-Qiong Zhou; Wei-Yang Cheng; Lin Shi; Yi-Shan Luo; Lei Zhao; Yang-Kun Chen

doi:10.3389/fnagi.2023.1259690

Larger deep white matter hyperintensity volume correlates with more severe social behavioral changes in patients with subacute ischemic stroke

Front Aging Neurosci. 2023 Nov 22:15:1259690. doi: 10.3389/fnagi.2023.1259690. eCollection 2023.

Authors

Jian-Feng Qu^#^{1

2}, Hui-Hong Hu^#³, Jian-Fei Liu^{1

4}, Yue-Qiong Zhou^{1

5}, Wei-Yang Cheng¹, Lin Shi⁶, Yi-Shan Luo⁷, Lei Zhao⁷, Yang-Kun Chen^{1

2}

Affiliations

¹ Department of Neurology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People's Hospital), Dongguan, Guangdong, China.
² Intelligent Brain Imaging and Brain Function Laboratory (Dongguan Key Laboratory), Dongguan People's Hospital, Dongguan, Guangdong, China.
³ Community Health Service Center of Dongguan Dongcheng, Dongguan, Guangdong, China.
⁴ Faculty of Neurology, Graduate School of Southern Medical University, Guangzhou, Guangdong, China.
⁵ Faculty of Neurology, Graduate School of Guangdong Medical University, Zhanjiang, Guangdong, China.
⁶ Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
⁷ BrainNow Research Institute, Shenzhen, Guangdong, China.

^# Contributed equally.

Abstract

Background: Changes in social behavior can occur after ischemic stroke. We aimed to investigate the potential correlations between neuroimaging variables and changes in social behavior in patients who experienced subacute ischemic stroke.

Methods: We prospectively screened patients with first-ever ischemic stroke. Three months after the index stroke, changes in patients' social behavior were investigated by the Frontal Behavioral Inventory (FBI), which consists of both deficit and positive groups of behaviors. The protocol of brain magnetic resonance imaging (MRI) including the baseline MRI at the acute stage and additional MRI with three-dimensional T1-weighted imaging on follow-up. Using these MRI scans, we assessed the acute infarction and the volumes of various brain structures by an automatic volumetry tool.

Results: Eighty patients were enrolled. In univariate analyses, patients with deficit behavioral changes had more left cortical infarction (r = 0.271, p = 0.015), Cholinergic Pathways Hyperintensities Scale scores (r = 0.227, p = 0.042), DWMH volumes (r = 0.349, p = 0.001), and modified Rankin Scale (mRS) scores (r = 0.392, p < 0.001). Patients with positive behavioral changes had more frequency of men (r = 0.229, p = 0.041) and a history of hypertension (r = 0.245, p = 0.028). In multiple stepwise linear regression models, after adjusting for age, deep WMH volumes (β = 0.849, 95% confidence interval = 0.352-1.346, p = 0.001) and mRS scores on follow-up (β = 1.821, 95% confidence interval = 0.881-2.76, p < 0.001) were significantly correlated with deficit behavioral changes (R² = 0.245).

Conclusion: Larger deep WMH volumes and poorer mRS scores on follow-up were significantly correlated with deficit behavioral changes in patients with subacute ischemic stroke.

Keywords: brain structure volumetry; ischemic stroke; mRS score; social behavior; white matter hyperintensities.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the Dongguan Science and Technology of Social Development Program (20211800905182) and Guangdong Basic and Applied Basic Research Foundation (2020B1515120055).