What is the clinical evidence from this study?

Study design: Cohort. Population: Poststroke depression (n=697). Intervention: Structural disconnection (SDC) score vs. Lower SDC score. Primary outcome: Poststroke depression (PSD) at 3 months (OR 1.25, 95% CI 1.07-1.48, p=0.006).

November 3, 2022Open Access

Structural disconnection-based prediction of poststroke depression

Key Result

The structural disconnection (SDC) score independently predicted poststroke depression at 3 months (OR 1.25) and significantly improved the performance of clinical prediction models.

Study Design

Type

Cohort (n=697)

Multicenter

Yes

Structured PICO

Does structural disconnection score predict poststroke depression in acute ischemic stroke patients?

Population

697 adult patients with first-ever acute ischemic stroke, free of prior psychiatric disorders, followed for 3 months to assess poststroke depression.

Exposure

Structural disconnection (SDC) score derived from neuroimaging

Outcome

Poststroke depression (PSD) at three months poststroke

Structural disconnection scores derived from neuroimaging independently predict poststroke depression at 3 months and improve clinical prediction models.

Main Result

Odds Ratio: 1.25 (95% CI 1.07–1.48)

p-value: p=0.006

Limitations

Selection bias due to the exclusion of aphasic patients
Mass-univariate approach is vulnerable to consistent errors resulting from collateral vasculature
Disconnection map was indirectly estimated from a normative atlas rather than representing actual structural disconnection
Baseline depression status was not included as a covariate
Requires validation in populations of various regions or ethnicities

Abstract

Poststroke depression (PSD) is a common complication of stroke. Brain network disruptions caused by stroke are potential biological determinants of PSD but their conclusive roles are unavailable. Our study aimed to identify the strategic structural disconnection (SDC) pattern for PSD at three months poststroke and assess the predictive value of SDC information. Our prospective cohort of 697 first-ever acute ischemic stroke patients were recruited from three hospitals in central China. Sociodemographic, clinical, psychological and neuroimaging data were collected at baseline and depression status was assessed at three months poststroke. Voxel-based disconnection-symptom mapping found that SDCs involving bilateral temporal white matter and posterior corpus callosum, as well as white matter next to bilateral prefrontal cortex and posterior parietal cortex, were associated with PSD. This PSD-specific SDC pattern was used to derive SDC scores for all participants. SDC score was an independent predictor of PSD after adjusting for all imaging and clinical-sociodemographic-psychological covariates (odds ratio, 1.25; 95% confidence interval, 1.07, 1.48; P = 0.006). Split-half replication showed the stability and generalizability of above results. When added to the clinical-sociodemographic-psychological prediction model, SDC score significantly improved the model performance and ranked the highest in terms of predictor importance. In conclusion, a strategic SDC pattern involving multiple lobes bilaterally is identified for PSD at 3 months poststroke. The SDC score is an independent predictor of PSD and may improve the predictive performance of the clinical-sociodemographic-psychological prediction model, providing new evidence for the brain-behavior mechanism and biopsychosocial theory of PSD.

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