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Related Experiment Video

Updated: Jun 11, 2025

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Tracing volitional recovery in post-stroke akinetic mutism using longitudinal microstructure imaging: Insights from a

Jie Zhang1, Yingqiao Wang2, Zhenyu Shu3

  • 1Center for Rehabilitation Medicine, Rehabilitation and Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, China; Wellcome Center for Human Neuroimaging, Department of Imaging Neuroscience, Institute of Neurology, University College London, London, UK.

Cortex; a Journal Devoted to the Study of the Nervous System and Behavior
|October 6, 2024
PubMed
Summary

Akinetic mutism (AM) recovery involves widespread brain network changes. Increased white matter fiber density in the frontal-subcortical circuitry may serve as a biomarker for improved volition.

Keywords:
Akinetic mutismDiffusion magnetic resonance imagingMicrostructureStrokeVolition

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Area of Science:

  • Neuroimaging
  • Neurology
  • Neuroscience

Background:

  • Akinetic mutism (AM) results from frontal-subcortical circuitry damage, causing reduced volition.
  • The microstructural brain changes during AM recovery are not well understood.

Observation:

  • A patient with post-stroke AM underwent clinical, neuropsychological, and multimodal MRI assessments.
  • Diffusion MRI and biophysical models (neurite orientation dispersion and density imaging, fixel-based analysis) were used for microstructure analysis.
  • Longitudinal data from the patient were compared with healthy controls.

Findings:

  • Reduced gray matter neurite density and white matter fiber density were observed in extensive brain areas, including temporal regions and subcortical nuclei.
  • Persistent microstructural degeneration was noted in the anterior cingulate cortex and cingulum.
  • Most frontal-subcortical tracts showed increased fiber density during recovery, correlating with improved volition after dopamine agonist and physical therapy.

Implications:

  • Brain network microstructure plays a crucial role in the disruption and recovery of volition.
  • Increased fiber density in the frontal-subcortical circuitry shows potential as a biomarker for volitional recovery in akinetic mutism.