Neural principles of the interaction between post-stroke depression and motor rehabilitation after stroke

脑卒中后抑郁与脑卒中后运动康复相互作用的神经原理

• 批准号: 310098283
• 负责人: Professor Dr. Christian Grefkes-Hermann, since 8/2022
• 金额: --
• 依托单位: Klinik und Poliklinik für Neurologie
• 依托单位国家: 德国
• 项目类别: Research Grants
• 财政年份: 2016
• 资助国家: 德国
• 起止时间: 2015-12-31 至 2022-12-31
• 项目状态: 已结题
• 来源: https://gepris.dfg.de/gepris/projekt/310098283?language=en
• 关键词: Neural; principles; interaction; between; post

Post-stroke depression (PSD) represents a common consequence of stroke that affects about 30% of the patients. PSD is frequently associated with poor motor outcome and recovery. Previous studies showed that the diagnosis of PSD can be based on both, emotional (anhedonia) and motivational symptoms (apathy, fatigue). To date, the changes in neural networks underlying each of the two symptoms remain largely unknown. This project aims at identifying neural correlates of the interaction between affective symptoms and motor deficits after stroke and their influence on motor recovery. The project further addresses the question whether different PSD symptoms (emotional, motivational) are differentially related to motor networks after stroke. To this end, the project includes three studies with behavioral assessments of PSD and motor function as well as functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). Experimental groups consist of stroke patients with and without PSD and/or motor deficits, age-matched healthy subjects and patients with Major Depression without any evidence for stroke. Study 1 aims at examining the functional connectivity (using resting-state fMRI) and the structural connectivity (using DTI parameters) in affective and motor brain networks in acute stroke patients. Dysfunctional interactions and disrupted connectivity will be tested using comparisons with healthy subjects. Furthermore, specific dysfunctions and associations between affective and motor networks will be investigated in contrast to patients with Major Depression to disentangle the effects of depression and of the stroke lesion on neural networks. The predictive value of network changes following acute stroke and motor outcome at the chronic stage will be tested using multivariate pattern classification at the level of single patients. Study 2 represents a more detailed experiment on the relationship between emotion processing and motor behavior at the chronic stage post-stroke. To this end, an fMRI motor task and an emotion processing task are used to examine interactions between brain regions that are commonly engaged in emotion processing and motor planning and execution. Again, the effect of PSD on these network interactions will be tested by comparisons with healthy subjects and patients with Major Depression. Changes in effective connectivity will be tested using Dynamic Causal Modeling (DCM). Study 3 tests the effect of motivational incentives on the subsequent motor performance in chronic stroke patients with basal ganglia lesions and motivational symptoms of PSD (or apathy) in contrast to healthy subjects and patients with Major depression. This study uses DCM to test whether regional interactions translating incentive motivation into motor effort may reflect negative effects of reduced motivation on motor recovery in stroke patients.

卒中后抑郁（PSD）是卒中的常见后果，影响约30%的患者。PSD通常与不良的运动结果和恢复相关。先前的研究表明，PSD的诊断可以基于情感（快感缺乏）和动机症状（冷漠，疲劳）。到目前为止，这两种症状背后的神经网络变化在很大程度上仍然未知。本研究旨在探讨脑卒中后情感症状与运动障碍之间的相互作用及其对运动恢复的影响。该项目进一步解决了不同的PSD症状（情绪，动机）是否与中风后的运动网络有差异的问题。为此，该项目包括三项研究，包括PSD和运动功能的行为评估以及功能性磁共振成像（fMRI）和扩散张量成像（DTI）。实验组包括有和没有PSD和/或运动缺陷的中风患者，年龄匹配的健康受试者和没有任何中风证据的重度抑郁症患者。研究1旨在研究急性脑卒中患者情感和运动脑网络的功能连接（使用静息态fMRI）和结构连接（使用DTI参数）。将通过与健康受试者进行比较来检测功能障碍性相互作用和连接中断。此外，特定的功能障碍和情感和运动网络之间的关联将进行调查，与重度抑郁症患者解开抑郁症和中风病变对神经网络的影响。将在单个患者的水平上使用多变量模式分类来测试急性卒中后网络变化和慢性期运动结果的预测值。研究二是对脑卒中后慢性期情绪加工与运动行为关系的一个更详细的实验。为此，使用fMRI运动任务和情绪处理任务来检查通常参与情绪处理和运动规划和执行的大脑区域之间的相互作用。同样，PSD对这些网络相互作用的影响将通过与健康受试者和重度抑郁症患者进行比较来测试。有效连接的变化将使用动态因果模型（DCM）进行测试。研究3测试了与健康受试者和重度抑郁症患者相比，动机激励对基底神经节病变和PSD（或冷漠）动机症状的慢性卒中患者随后运动表现的影响。本研究使用DCM测试是否区域相互作用转化为运动努力的动机动机减少运动恢复中风患者可能反映了负面影响。