Cholinergic and hippocampal systems facilitate cross-domain cognitive recovery after stroke.
Cholinergic and hippocampal systems facilitate cross-domain cognitive recovery after stroke.
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DOI：
10.1093/brain/awac070
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发表时间：
2022-06-03
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影响因子：
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运动和认知功能的自发恢复发生在许多个体中风后。这些机制尚未完全理解，但可能涉及支持神经可塑性的神经递质系统，参与学习的网络以及能够灵活适应需求的大脑区域（如“多需求系统”）。42例首次出现症状性缺血性卒中的患者被纳入卒中后认知功能的纵向队列研究。卒中后平均70 ± 18天进行高分辨率容积、弥散MRI和神经心理学评估。中风后1年重复进行认知评估，使用平行测试版本以避免学习效应，并计算长期情景记忆、短期记忆和工作记忆的变化分数。通过两阶段分析确定了预测认知评分变化的结构MRI特征：发现阶段以无假设无偏的方式使用全脑方法;和独立聚焦阶段，其中测量值来自发现阶段确定的区域，使用靶向体积测量或纤维束成像。胆碱能基底前脑的评价，基于一个有效的地图集为基础的方法，被纳入了先前的证据，在神经可塑性的作用。穹窿，胆碱能基底前脑和一组海马子字段的状态被发现预测长期记忆性能的改善。与先前的预期相反，短期记忆和工作记忆也发现了相同的模式，这表明这些区域是支持跨认知领域恢复的共同基础设施的一部分。胆碱能基底前脑容量和认知恢复之间的关联主要发现在亚区与Meynert基底核，这表明它是胆碱能外流到新皮层，使恢复。来自穹窿，胆碱能基底前脑和海马子字段的基线测量的支持向量回归模型能够解释62%的变化，在随后的9个月的长期情节和41%的工作记忆性能的变化。提示胆碱能系统和扩展海马网络在脑卒中后认知功能恢复中起重要作用。在中风后早期评估这些系统可以为个性化治疗策略提供信息，以促进恢复。中风后认知功能自发恢复的基础尚不清楚。O 'Sullivan等人表明，中风后数月内胆碱能和海马系统的结构可预测第一年认知能力的改善。这些系统构成了支持跨域恢复的通用体系结构的一部分。有关这篇文章的科学评论，请参见Geranmayeh（https：//doi.org/10.1093/brain/awac142）。
Spontaneous recovery of motor and cognitive function occurs in many individuals after stroke. The mechanisms are incompletely understood, but may involve neurotransmitter systems that support neural plasticity, networks that are involved in learning and regions of the brain that are able to flexibly adapt to demand (such as the ‘multiple-demand system'). Forty-two patients with first symptomatic ischaemic stroke were enrolled in a longitudinal cohort study of cognitive function after stroke. High-resolution volumetric, diffusion MRI and neuropsychological assessment were performed at a mean of 70 ± 18 days after stroke. Cognitive assessment was repeated 1 year after stroke, using parallel test versions to avoid learning effects, and change scores were computed for long-term episodic, short-term and working memory. Structural MRI features that predicted change in cognitive scores were identified by a two-stage analysis: a discovery phase used whole-brain approaches in a hypothesis-free unbiased way; and an independent focused phase, where measurements were derived from regions identified in the discovery phase, using targeted volumetric measurements or tractography. Evaluation of the cholinergic basal forebrain, based on a validated atlas-based approach, was included given prior evidence of a role in neural plasticity. The status of the fornix, cholinergic basal forebrain and a set of hippocampal subfields were found to predict improvement in long-term memory performance. In contrast to prior expectation, the same pattern was found for short-term and working memory, suggesting that these regions are part of a common infrastructure that supports recovery across cognitive domains. Associations between cholinergic basal forebrain volume and cognitive recovery were found primarily in subregions associated with the nucleus basalis of Meynert, suggesting that it is the cholinergic outflow to the neocortex that enables recovery. Support vector regression models derived from baseline measurements of fornix, cholinergic basal forebrain and hippocampal subfields were able to explain 62% of change in long-term episodic and 41% of change in working memory performance over the subsequent 9 months. The results suggest that the cholinergic system and extended hippocampal network play key roles in cognitive recovery after stroke. Evaluation of these systems early after stroke may inform personalized therapeutic strategies to enhance recovery. The basis for spontaneous recovery of cognitive function after stroke is unclear. O’Sullivan et al. show that the structure of cholinergic and hippocampal systems in the months after stroke predict improvements in cognition over the first year. These systems form part of a common architecture supporting cross-domain recovery. See Geranmayeh (https://doi.org/10.1093/brain/awac142) for a scientific commentary on this article.
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影响因子：
16.2
作者：
Conner, JM;Chiba, AA;Tuszynski, MH
通讯作者：
Tuszynski, MH
DOI：
10.1016/j.jstrokecerebrovasdis.2010.12.009
发表时间：
2011-05-01
影响因子：
2.5
作者：
Barrett, Kevin M.;Brott, Thomas G.;Meschia, James F.
通讯作者：
Meschia, James F.
影响因子：
5.7
作者：
Avants BB;Tustison NJ;Song G;Cook PA;Klein A;Gee JC
通讯作者：
Gee JC
影响因子：
3.5
作者：
Hillman, Kristin L.;Wall, Hannah J.;Clarkson, Andrew N.
通讯作者：
Clarkson, Andrew N.
影响因子：
9.9
作者：
FAZEKAS, F;KLEINERT, R;LECHNER, H
通讯作者：
LECHNER, H