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White Matter Hyperintensities and Poststroke Apathy: A Fully Automated MRI Segmentation Study
Rui Kleber Martins-Filho1, Guilherme Rodrigues1, Raul Ferreira da Costa1
1Department of Neurosciences and Behavioural Sciences, Hospital das Clínicas - Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Introduction:
Poststroke apathy (PSA) is a common neuropsychiatric disorder that may affect up to 30% of stroke patients. Despite the difficulties of investigating this condition (overlapping with depression, heterogeneity of diagnostic criteria, a small number of studies), some recent diffusion tensor imaging studies have suggested that widespread microstructural white matter (WM) disruption plays a key role in the development of PSA. Therefore, we intended to investigate this hypothesis by evaluating the relationship between WM hyperintensities (WMH) and apathy in patients with cerebrovascular disease.
Methods:
We studied patients with apathy (n = 7), depression (n = 13), comorbid apathy and depression (n = 13), and controls (n = 20), and we investigated the variables associated with the volume of WMH measured by an automated brain MRI segmentation software.
Results:
The overall prevalence of PSA was 37.7% (pure and comorbid). Patients with apathy presented a higher volume of WMH in comparison to controls. Mini-Mental State Examination (MMSE), NPI-A, and the number of cerebral microbleeds were the only variables associated with WMH. Conversely, NPI-D did not correlate to WMH.
Discussion/Conclusion:
This is an exploratory study that supports the view of PSA as a distinct syndrome from PSD mediated mainly by diffuse white matter hyperintensities, which suggests that WM disruption is an important pathway to the development of apathy in stroke patients.
Insights
Poststroke apathy (PSA) is linked to increased white matter hyperintensities (WMH). This study suggests WM disruption is a key factor in developing apathy after stroke, distinguishing it from depression.
Area of Science:
- Neurology
- Neuroimaging
- Psychiatry
Background:
- Poststroke apathy (PSA) affects up to 30% of stroke survivors.
- Investigating PSA is challenging due to overlap with depression and diagnostic heterogeneity.
- Previous studies suggest white matter (WM) microstructural disruption is implicated in PSA.
Purpose of the Study:
- To evaluate the relationship between white matter hyperintensities (WMH) and apathy in patients with cerebrovascular disease.
- To explore WMH as a potential biomarker for PSA.
- To investigate if WM disruption is a distinct pathway for apathy post-stroke.
Main Methods:
- Studied patients with apathy, depression, comorbid apathy and depression, and controls.
- Utilized automated brain MRI segmentation software to measure WMH volume.
- Assessed associations between WMH volume and clinical variables.
Main Results:
- Overall PSA prevalence was 37.7% (pure and comorbid).
- Patients with apathy showed a significantly higher WMH volume compared to controls.
- WMH volume correlated with Mini-Mental State Examination (MMSE) scores, NPI-A, and cerebral microbleeds, but not NPI-D.
Conclusions:
- Findings support PSA as a distinct syndrome from poststroke depression (PSD).
- Diffuse white matter hyperintensities appear to be a primary mediator in PSA development.
- WM disruption is a significant pathway contributing to apathy in stroke patients.
