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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.
Cerebrovascular Diseases (Basel, Switzerland)
|October 24, 2022
Summary
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.
