Association of Brain Age, Lesion Volume, and Functional Outcome in Patients With Stroke.
Association of Brain Age, Lesion Volume, and Functional Outcome in Patients With Stroke.
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DOI：
10.1212/wnl.0000000000207219
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发表时间：
2023-05-16
期刊：
影响因子：
9.9
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中科院分区：
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卒中后的功能结局与局灶性损伤措施密切相关。然而，全球大脑健康的作用还不太清楚。在这项研究中，我们研究了脑年龄的影响，一个衡量神经生物学老化来自全脑结构神经成像，中风后的结果，重点是感觉运动性能。我们假设更多的损伤会导致更老的大脑年龄，这反过来又与更差的结果相关。与此相关，我们预期大脑年龄将介导病变损伤和结果之间的关系。最后，我们假设，脑结构弹性，我们在中风的背景下定义为年轻的大脑年龄相匹配的病变损伤，将区分好与差的结果。我们使用ENIGMA卒中恢复的三维脑结构MRI和临床测量的多位点数据集进行了一项横断面观察性研究。使用岭回归模型从77个神经解剖学特征计算脑年龄，该模型在4，314名健康对照者身上进行了训练和验证。我们使用稳健的混合效应线性回归模型进行了3步中介分析，以检查脑年龄、病变损伤和卒中结局之间的关系。我们使用倾向评分匹配和逻辑回归来检查脑弹性是否预测匹配病变损伤患者的良好与不良结局。我们检查了38个队列的963例患者。更大的损伤与更老的脑年龄有关（β = 0.21; 95% CI 0.04-0.38，p = 0.015），这反过来又与感觉运动领域的不良结局相关（β = −0.28; 95%CI −0.41至−0.15，p < 0.001）和多个功能域（β = −0.14; 95%CI −0.22至−0.06，p < 0.001）。脑年龄介导了15%的病变损伤对感觉运动表现的影响（95% CI 3%-58%，p = 0.01）。更大的大脑弹性解释了为什么人们有更好的结果，考虑到匹配的病变损伤（比值比1.04，95% CI 1.01-1.08，p = 0.004）。我们提供的证据表明，年轻的脑年龄与卒中后上级结局相关，并改变了局灶性损伤的影响。与单独的局灶性损伤措施相比，纳入基于成像的脑年龄和脑弹性评估可能会改善卒中后结局的预测，为潜在的治疗靶点开辟新的可能性。
Functional outcomes after stroke are strongly related to focal injury measures. However, the role of global brain health is less clear. In this study, we examined the impact of brain age, a measure of neurobiological aging derived from whole-brain structural neuroimaging, on poststroke outcomes, with a focus on sensorimotor performance. We hypothesized that more lesion damage would result in older brain age, which would in turn be associated with poorer outcomes. Related, we expected that brain age would mediate the relationship between lesion damage and outcomes. Finally, we hypothesized that structural brain resilience, which we define in the context of stroke as younger brain age given matched lesion damage, would differentiate people with good vs poor outcomes. We conducted a cross-sectional observational study using a multisite dataset of 3-dimensional brain structural MRIs and clinical measures from the ENIGMA Stroke Recovery. Brain age was calculated from 77 neuroanatomical features using a ridge regression model trained and validated on 4,314 healthy controls. We performed a 3-step mediation analysis with robust mixed-effects linear regression models to examine relationships between brain age, lesion damage, and stroke outcomes. We used propensity score matching and logistic regression to examine whether brain resilience predicts good vs poor outcomes in patients with matched lesion damage. We examined 963 patients across 38 cohorts. Greater lesion damage was associated with older brain age (β = 0.21; 95% CI 0.04–0.38, p = 0.015), which in turn was associated with poorer outcomes, both in the sensorimotor domain (β = −0.28; 95% CI −0.41 to −0.15, p < 0.001) and across multiple domains of function (β = −0.14; 95% CI −0.22 to −0.06, p < 0.001). Brain age mediated 15% of the impact of lesion damage on sensorimotor performance (95% CI 3%–58%, p = 0.01). Greater brain resilience explained why people have better outcomes, given matched lesion damage (odds ratio 1.04, 95% CI 1.01–1.08, p = 0.004). We provide evidence that younger brain age is associated with superior poststroke outcomes and modifies the impact of focal damage. The inclusion of imaging-based assessments of brain age and brain resilience may improve the prediction of poststroke outcomes compared with focal injury measures alone, opening new possibilities for potential therapeutic targets.