纹状体卒中后的神经精神变化——来自观察性精神病后研究的结果。

Q2 Medicine
Anna Kufner, Ana Sofía Ríos, Benjamin Winter, Uchralt Temuulen, Ahmed Khalil, Ulrike Grittner, Johanna Schöner, Asli Akdeniz, Ulrike Lachmann, Golo Kronenberg, Arno Villringer, Karen Gertz, Matthias Endres
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引用次数: 0

摘要

背景:缺血性中风可导致神经精神后遗症,如抑郁症和创伤后应激障碍(PTSD),导致较差的功能预后。脑卒中后精神疾病的心理困扰NCT01187342)研究旨在探讨纹状体缺血性病变是否会增加脑卒中后抑郁和PTSD的风险。方法:本单中心、观察性、病例对照研究纳入84例纹状体缺血性脑损伤患者(n = 54)和非纹状体缺血性脑损伤患者(n = 30)。主要研究终点包括抑郁症状(通过老年抑郁量表评估;GDS-30)和PTSD(通过创伤后症状量表评估;ptsd——中风后90天。一个规范的功能连接体被用来测量纹状体与大脑其他部分的连接(“纹状体网络”)。网络损伤评分用于评估纹状体网络的损伤程度。结果:纹状体病变患者卒中后90天GDS-30评分较高(中位数5.6比3.0;Cohen’s d = 0.39;P = 0.057),表明影响小到中等。然而,在抑郁或创伤后应激障碍的发生率方面,没有观察到有意义的组间差异。在多变量回归分析中,纹状体梗死的校正β系数(β)为1.9 (95%CI 0.19-3.7;p = 0.076), GDS-10和1.8 (95%CI -1.9-5.5;90天后ptsd -10评分p = 0.25)。只有女性与PTSD严重程度独立相关(调整后β = 5.1, 95% CI 1.3-8.8;p = 0.008)。分析病变与纹状体网络的连通性并没有改变这些发现。结论:综上所述,PostPsyDis研究表明卒中患者的精神疾病发病率很高。此外,研究表明纹状体病变患者的神经精神症状增加。显然需要更大规模的研究来调查纹状体在中风后神经精神疾病中的作用。试验注册:ClinicalTrials.gov (NCT01187342) 2009年8月23日注册,https://clinicaltrials.gov/study/NCT01187342。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neuropsychiatric changes following striatal stroke- results from the observational PostPsyDis study.

Background: Ischemic stroke can lead to neuropsychiatric sequelae such as depression and post-traumatic stress disorder (PTSD), resulting in poorer functional outcomes. The POST-stroke PSYchological DIStress PostPsyDis; NCT01187342) study aimed to investigate whether ischemic lesions in the striatum increase the risk of depression and PTSD after stroke.

Methods: This monocenter, observational, case-control study included 84 ischemic stroke patients with striatal (n = 54) and non-striatal ischemic brain lesions (n = 30). Primary study endpoints included symptoms of depression (assessed via the Geriatric Depression Scale; GDS-30) and PTSD (assessed via the Posttraumatic Symptom Scale; PTSS-10) 90 days post-stroke. A normative functional connectome was used to obtain a measure of striatal connectivity to the rest of the brain ("striatal network"). Network damage scores were used to estimate damage of each lesion to the striatal network.

Results: Patients with striatal lesions had higher GDS-30 scores at 90 days post-stroke (median 5.6 vs. 3.0; Cohen's d = 0.39; p = 0.057), indicating a small to moderate effect. However, no meaningful group differences were observed in the incidence of depression or PTSD. In multivariable regression analyses, striatal infarction had an adjusted beta coefficient (β) of 1.9 (95%CI 0.19-3.7; p = 0.076) for GDS-10 and 1.8 (95%CI -1.9-5.5; p = 0.25) for PTSS-10 scores after 90 days. Only female sex was independently associated with PTSD severity (adjusted β = 5.1, 95% CI 1.3-8.8; p = 0.008). Analyzing lesion connectivity to the striatal network did not change these findings.

Conclusions: Taken together, the PostPsyDis study suggests a high rate of psychiatric morbidity in stroke patients. Moreover, the study suggests increased neuropsychiatric symptoms in patients with striatal lesions. There is a clear need for larger studies to investigate the role of the striatum in post-stroke neuropsychiatric disorders.

Trial registration: ClinicalTrials.gov (NCT01187342) Registered 23 August 2009, https://clinicaltrials.gov/study/NCT01187342 .

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