Alterations of cerebrospinal fluid dynamics in post-stroke depression: A longitudinal multimodal imaging study

Altered cerebrospinal fluid (CSF) dynamics is probably related to post-stroke depression (PSD) through different mechanism. However, temporal changes in perivascular CSF dynamics after stroke remain poor understood. This study investigated the temporal relationship between CSF dynamics and PSD recovery using multimodal neuroimaging strategy.

We enrolled 308 stroke patients underwent baseline neuropsychological assessment and magnetic resonance imaging scan, and 110 completed 6-month follow-up evaluations. CSF dynamics were assessed through three imaging indicators, including choroid plexus volume (CPV), diffusion tensor imaging along perivascular (DTI-ALPS) index, and global coupling of blood-oxygen-level-dependent with cerebrospinal fluid signals (gBOLD-CSF coupling). Longitudinal trajectories of imaging indicators and depression psychological score were analyzed using growth mixture modeling.

Stroke patients with crucial depression severity exhibited impaired neuroimaging indicators. In acute stage, critical depression severity is correlated with large CPV, low DTI-ALPS index and weak gBOLD-CSF coupling (CPV: b = 13.19, P < 0.05; DTI-ALPS: b = -8.73, P < 0.05; gBOLD-CSF: b = 4.48, P < 0.05), while relates to low DTI-ALPS index and weak gBOLD-CSF coupling in chronic stage (DTI-ALPS: b = -6.21, P < 0.05; gBOLD-CSF: b = 6.57, P < 0.05). The growth trajectory of DTI-ALPS index and gBOLD-CSF coupling are temporally associated with growth trajectory of HAMD score (DTI-ALPS: b = -0.77, P < 0.05; gBOLD-CSF: b = 22.43, P < 0.05).

Our findings reveal CSF dynamics-related imaging measures are associated with PSD severity and recovery. These imaging measures may provide quantitative information and intervention targets of PSD.