背景:已知情绪处理缺陷伴随抑郁症状,并且常见于中风患者。关于中风后抑郁(PSD)症状和特定脑损伤对情绪处理能力改变的影响以及这些现象如何随着时间的推移而发展,人们知之甚少。这种潜在的关系可能会影响卒中后神经和心理社会功能的康复。为了解决这个科学差距,我们在一项纵向研究设计中调查了从卒中后第一天到慢性期早期的PSD症状与情绪处理能力之间的关系.
方法:26名缺血性卒中患者对带有情绪面孔的视频进行了情绪处理任务(\'快乐,\'\'悲伤,\'\'愤怒,\'\'恐惧,\'和\'中性\')在不同的强度水平(20%,40%,60%,80%,100%)。测量了识别精度和响应时间,以及抑郁症状评分(蒙哥马利-奥斯贝格抑郁量表)。28名年龄和性别相匹配的健康参与者作为对照组。进行了全脑支持向量回归病变-症状映射(SVR-LSM)分析,以调查特定病变位置是否与特定情绪类别的识别准确性相关。
结果:与对照组相比,卒中患者的总体识别准确性较差,特别是对快乐的认可,悲伤,可怕的面孔。值得注意的是,更多的抑郁中风患者表现出对特定负面情绪的处理增加,因为他们对愤怒的面孔反应明显更快,并且更准确地识别低强度的悲伤面孔。中风后第一天获得的这些效果部分持续到几个月后的随访评估。SVR-LSM分析显示,下额叶和中额叶区域(IFG/MFG)以及脑岛和壳核与中风中的情绪识别缺陷有关。具体来说,识别快乐的面部表情受到影响前岛的病变的影响,壳核,IFG,MFG,眶额叶皮质,和罗兰式管壳。后脑岛的病变,rolandicopulculum,MFG还与恐惧面部表情的识别准确性降低有关,而悲伤面孔的识别缺陷与额叶极点有关,IFG,和MFG损坏。
结论:PSD症状有助于处理负面情绪刺激,特别是愤怒和悲伤的面部表情。不同情绪类别的识别准确性与情绪相关处理电路中的脑部病变有关,包括脑岛,基底神经节,IFG,和MFG。总之,我们的研究为中风后情绪处理背后的心理社会和神经因素提供了支持,有助于PSD的病理生理学。
BACKGROUND: Emotion processing deficits are known to accompany depressive symptoms and are often seen in stroke patients. Little is known about the influence of post-stroke depressive (PSD) symptoms and specific brain lesions on altered emotion processing abilities and how these phenomena develop over time. This potential relationship may impact post-stroke rehabilitation of neurological and psychosocial function. To address this scientific gap, we investigated the relationship between PSD symptoms and emotion processing abilities in a longitudinal study design from the first days post-stroke into the early chronic phase.
METHODS: Twenty-six ischemic stroke patients performed an emotion processing task on videos with emotional faces (\'happy,\' \'sad,\' \'anger,\' \'fear,\' and \'neutral\') at different intensity levels (20%, 40%, 60%, 80%, 100%). Recognition accuracies and response times were measured, as well as scores of depressive symptoms (Montgomery-Åsberg Depression Rating Scale). Twenty-eight healthy participants matched in age and sex were included as a control group. Whole-brain support-vector regression lesion-symptom mapping (SVR-LSM) analyses were performed to investigate whether specific lesion locations were associated with the recognition accuracy of specific emotion categories.
RESULTS: Stroke patients performed worse in overall recognition accuracy compared to controls, specifically in the recognition of happy, sad, and fearful faces. Notably, more depressed stroke patients showed an increased processing towards specific negative emotions, as they responded significantly faster to angry faces and recognized sad faces of low intensities significantly more accurately. These effects obtained for the first days after stroke partly persisted to follow-up assessment several months later. SVR-LSM analyses revealed that inferior and middle frontal regions (IFG/MFG) and insula and putamen were associated with emotion-recognition deficits in stroke. Specifically, recognizing happy facial expressions was influenced by lesions affecting the anterior insula, putamen, IFG, MFG, orbitofrontal cortex, and rolandic operculum. Lesions in the posterior insula, rolandic operculum, and MFG were also related to reduced recognition accuracy of fearful facial expressions, whereas recognition deficits of sad faces were associated with frontal pole, IFG, and MFG damage.
CONCLUSIONS: PSD symptoms facilitate processing negative emotional stimuli, specifically angry and sad facial expressions. The recognition accuracy of different emotional categories was linked to brain lesions in emotion-related processing circuits, including insula, basal ganglia, IFG, and MFG. In summary, our study provides support for psychosocial and neural factors underlying emotional processing after stroke, contributing to the pathophysiology of PSD.