Network analysis of neuropsychiatric, cognitive, and functional complications of stroke: implications for novel treatment targets

Lena K L Oestreich; Jessica W Lo; Maria A Di Biase; Perminder S Sachdev; Alice H Mok; Paul Wright; John D Crawford; Ben Lam; Latchezar Traykov; Sebastian Köhler; Julie E A Staals; Robert van Oostenbrugge; Christopher Chen; David W Desmond; Kyung-Ho Yu; Minwoo Lee; Aleksandra Klimkowicz-Mrowiec; Régis Bordet; Michael J O'Sullivan; Andrew Zalesky

doi:10.1111/pcn.13633

Network analysis of neuropsychiatric, cognitive, and functional complications of stroke: implications for novel treatment targets

Psychiatry Clin Neurosci. 2024 Apr;78(4):229-236. doi: 10.1111/pcn.13633. Epub 2024 Jan 29.

Authors

Lena K L Oestreich^{1

2}, Jessica W Lo³, Maria A Di Biase^{4

5}, Perminder S Sachdev^{3

6}, Alice H Mok¹, Paul Wright⁷, John D Crawford³, Ben Lam³, Latchezar Traykov⁸, Sebastian Köhler⁹, Julie E A Staals¹⁰, Robert van Oostenbrugge¹⁰, Christopher Chen¹¹, David W Desmond¹², Kyung-Ho Yu¹³, Minwoo Lee¹³, Aleksandra Klimkowicz-Mrowiec¹⁴, Régis Bordet¹⁵, Michael J O'Sullivan^{16

17}, Andrew Zalesky^{4

18}

Affiliations

¹ School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.
² Centre for Advanced Imaging and Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Queensland, Australia.
³ (CHeBA), Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
⁴ Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne and Melbourne Health, Carlton, Victoria, Australia.
⁵ Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁶ Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, New South Wales, Australia.
⁷ Biomedical Engineering Department, King's College London, London, UK.
⁸ Department of Neurology, UH Alexandrovska, Medical University-Sofia, Sofia, Bulgaria.
⁹ School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
¹⁰ Department of Neurology, School for Cardiovascular diseases (CARIM), Maastricht University Medical Center (MUMC+), The Netherlands.
¹¹ Memory Ageing and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
¹² Independent Researcher, Florida, USA.
¹³ Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, South Korea.
¹⁴ Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland.
¹⁵ Department of Pharmacology, Lille Neuroscience & Cognition, University of Lille, Lille, France.
¹⁶ Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
¹⁷ Institute of Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia.
¹⁸ Melbourne School of Engineering, The University of Melbourne, Parkville, Victoria, Australia.

PMID: 38113307
DOI: 10.1111/pcn.13633

Abstract

Aim: Recovery from stroke is adversely affected by neuropsychiatric complications, cognitive impairment, and functional disability. Better knowledge of their mutual relationships is required to inform effective interventions. Network theory enables the conceptualization of symptoms and impairments as dynamic and mutually interacting systems. We aimed to identify interactions of poststroke complications using network analysis in diverse stroke samples.

Methods: Data from 2185 patients were sourced from member studies of STROKOG (Stroke and Cognition Consortium), an international collaboration of stroke studies. Networks were generated for each cohort, whereby nodes represented neuropsychiatric symptoms, cognitive deficits, and disabilities on activities of daily living. Edges characterized associations between them. Centrality measures were used to identify hub items.

Results: Across cohorts, a single network of interrelated poststroke complications emerged. Networks exhibited dissociable depression, apathy, fatigue, cognitive impairment, and functional disability modules. Worry was the most central symptom across cohorts, irrespective of the depression scale used. Items relating to activities of daily living were also highly central nodes. Follow-up analysis in two studies revealed that individuals who worried had more densely connected networks than those free of worry (CASPER [Cognition and Affect after Stroke: Prospective Evaluation of Risks] study: S = 9.72, P = 0.038; SSS [Sydney Stroke Study]: S = 13.56, P = 0.069).

Conclusion: Neuropsychiatric symptoms are highly interconnected with cognitive deficits and functional disabilities resulting from stroke. Given their central position and high level of connectedness, worry and activities of daily living have the potential to drive multimorbidity and mutual reinforcement between domains of poststroke complications. Targeting these factors early after stroke may have benefits that extend to other complications, leading to better stroke outcomes.

Keywords: affective disorders; depression; multimorbidity; stroke; worry.

MeSH terms

Activities of Daily Living / psychology
Cognition
Cognition Disorders* / complications
Cognitive Dysfunction* / complications
Depression / psychology
Humans
Stroke* / complications
Stroke* / therapy

Abstract

MeSH terms

Grants and funding