Correlated Resting-State Functional MRI Activity of Frontostriatal, Thalamic, Temporal, and Cerebellar Brain Regions Differentiates Stroke Survivors with High Compared to Low Depressive Symptom Scores

Peter Goodin, Gemma Lamp, Rishma Vidyasagar, Alan Connelly, Stephen Rose, Bruce C V Campbell, Tamara Tse, Henry Ma, David Howells, Graeme J Hankey, Stephen Davis, Geoffrey Donnan, Leeanne M Carey, Peter Goodin, Gemma Lamp, Rishma Vidyasagar, Alan Connelly, Stephen Rose, Bruce C V Campbell, Tamara Tse, Henry Ma, David Howells, Graeme J Hankey, Stephen Davis, Geoffrey Donnan, Leeanne M Carey

Abstract

Background: One in three survivors of stroke experience poststroke depression (PSD). PSD has been linked with poorer recovery of function and cognition, yet our understanding of potential mechanisms is currently limited. Alterations in resting-state functional MRI have been investigated to a limited extent. Fluctuations in low frequency signal are reported, but it is unknown if interactions are present between the level of depressive symptom score and intrinsic brain activity in varying brain regions.

Objective: To investigate potential interaction effects between whole-brain resting-state activity and depressive symptoms in stroke survivors with low and high levels of depressive symptoms.

Methods: A cross-sectional analysis of 63 stroke survivors who were assessed at 3 months poststroke for depression, using the Montgomery-Åsberg Depression Rating Scale (MÅDRS-SIGMA), and for brain activity using fMRI. A MÅDRS-SIGMA score of >8 was classified as high depressive symptoms. Fractional amplitude of frequency fluctuations (fALFF) data across three frequency bands (broadband, i.e., ~0.01-0.08; subbands, i.e., slow-5: ~0.01-0.027 Hz, slow-4: 0.027-0.07) was examined.

Results: Of the 63 stroke survivors, 38 were classified as "low-depressive symptoms" and 25 as "high depressive symptoms." Six had a past history of depression. We found interaction effects across frequency bands in several brain regions that differentiated the two groups. The broadband analysis revealed interaction effects in the left insula and the left superior temporal lobe. The subband analysis showed contrasting fALFF response between the two groups in the left thalamus, right caudate, and left cerebellum. Across the three frequency bands, we found contrasting fALFF response in areas within the fronto-limbic-thalamic network and cerebellum.

Conclusions: We provide evidence that fALFF is sensitive to changes in poststroke depressive symptom severity and implicates frontostriatal and cerebellar regions, consistent with previous studies. The use of multiband analysis could be an effective method to examine neural correlates of depression after stroke. The START-PrePARE trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12610000987066.

Trial registration: ClinicalTrials.gov NCT00887328.

Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Overlap of lesion locations for all participants, low depressive symptom score group, high depressive symptom score group, and overlap of lesion location for the low and high groups. For columns All, Low, and High, cooler colours indicate lower numbers of participants with overlapping lesions, and warmer colours indicate higher numbers of participants with overlapping lesions. For the Overlap column, green = low depressive symptom score group, dark blue = high depressive symptom score group, and light blue = overlap between the two groups. All brain images are shown in neurological convention.
Figure 2
Figure 2
Cluster locations showing a significant interaction effect between the low and high depressive symptom score groups with the mean cluster fALFF response plotted against the MÅDRS-SIGMA score for broadband, slow-4 band, and slow-5 band (green represents low depressive symptom score group, blue represents high depressive symptom score group, and bands along regression line represent the 95% confidence interval). (a) Broadband: left insula. (b) Broadband: left superior temporal. (c) Slow-4: left thalamus. (d) Slow-4: right caudate. (e) Slow-5: left cerebellum. In the high depressive symptom group, high response from these regions was associated with an increased depressive symptom score. The low depressive symptom group showed no significant association between these regions and depressive symptom score. All brain images are shown in neurological convention.

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