目的:中风后抑郁(DAS)是中风的严重并发症,严重限制了康复。脑成像技术是研究DAS情感网络的重要方法。然而,很少有研究关注网络内的动态交互。本研究的目的是使用多变量格兰杰因果关系分析(GCA)方法调查额叶DAS的情绪网络,该技术可以评估大脑区域之间的关联,以分析从DAS和卒中后无抑郁(NDAS)收集的功能磁共振成像(fMRI)数据。
方法:36例首次缺血性右额叶卒中患者接受了静息状态功能磁共振成像(rs-fMRI)扫描。用于筛选受试者的临床评估量表如下:24项汉密尔顿抑郁量表(HAMD-24),美国国立卫生研究院卒中量表(NIHSS),迷你精神状态检查(MMSE),和Barthel指数(BI)。多变量GCA方法用于分析从DAS和NDAS收集的fMRI数据。
结果:结果显示从腹内侧前额叶皮质(VMPFC)开始的正向调节,前扣带皮质(ACC),杏仁核(AMYG)到丘脑,当交互顺序相反时,调节作用是负面的。丘脑可以通过ACC预测岛叶(IC)的负活性。背外侧前额叶皮层(DLPFC)可以通过颞极(TP)预测ACC的活动。
结论:这项研究发现了VMPFC-ACC-AMYG-丘脑情绪回路,以解释与DAS相关的不同大脑区域之间的网络。DLPFC和TP在DAS的情绪调节中起重要作用,IC的功能受丘脑的负调控。这些发现推进了DAS的神经理论,这是基于不同大脑区域之间的功能关系。
OBJECTIVE: Depression after stroke (
DAS) is a serious complication of stroke that significantly restricts rehabilitation. Brain imaging technology is an important method for studying the emotional network of
DAS. However, few studies have focused on dynamic interactions within the network. The aim of this study was to investigate the emotional network of frontal lobe
DAS using the multivariate Granger causality analysis (GCA) method, a technique that can estimate the association among the brain areas to analyze functional magnetic resonance imaging (fMRI) data collected from DAS and no depression after stroke (NDAS).
METHODS: Thirty-six first-time ischemic right frontal lobe stroke patients underwent resting-state fMRI (rs-fMRI) scans. The clinical assessment scale used for screening subjects was as follows: the 24-item Hamilton Rating Scale for Depression (HAMD-24), the National Institutes of Health Stroke Scale (NIHSS), the Mini-Mental State Examination (MMSE), and the Barthel Index (BI). The multivariate GCA method was used to analyze fMRI data collected from
DAS and NDAS.
RESULTS: The results showed positive regulations in the order from the ventromedial prefrontal cortex (VMPFC), the anterior cingulate cortex (ACC), and the amygdala (AMYG) to the thalamus, and when the interaction order is opposite, the moderating effect is negative. The thalamus could predict the negative activity of the insular (IC) via the ACC. The dorsolateral prefrontal cortex (DLPFC) could predict the activity of the ACC via the temporal pole (TP).
CONCLUSIONS: This study found a VMPFC-ACC-AMYG-thalamus emotional circuit to explain the network between different brain regions associated with DAS. The DLPFC and TP play an important role in the emotional regulation of
DAS, and the function of the IC is regulated negatively by the thalamus. These findings advance the neural theory of DAS, which is based on the functional relationship between different brain areas.