Brief report
Cerebellum involvement in post-stroke mood: A combined ecological and MRI study

https://doi.org/10.1016/j.pscychresns.2013.01.003Get rights and content

Abstract

This study evaluated a new approach combining magnetic resonance imaging and the experience sampling method in the understanding of post-stroke mood pathophysiology. Findings revealed that emotional cognition after stroke may be related to phenotypic characteristics such as cerebellar volume, thereby suggesting that this combined approach could provide new insights into the pathophysiology of post-stroke mood disorders as well as other forms of comorbidity.

Introduction

One-third of patients surviving stroke will experience post-stroke depression (PSD). Research into the determinants of PSD has to a large extent focused on specific lesion-related factors such as infarct location and volume but failed to demonstrate clear associations (Lenzi et al., 2008). Conversely, pre-existing brain parenchymal characteristics may act as susceptibility factors for the development of mood disorders or changes following the cerebro-vascular event. Supporting this view, Amico et al. reported prefrontal atrophy in patients at risk for depression, indicating that structural brain changes may confer an increased susceptibility to this disorder (Amico et al., 2011). These data suggest that the measurement of brain volume early after stroke should provide important information for understanding the influence of pre-stroke brain structure on the risk of PSD. While few studies have examined the possible link between brain volume and the risk of PSD, Fu and colleagues found in patients with lacunar stroke that an atrophy of the left inferior frontal gyrus was a risk factor of PSD when evaluated using standardized scales (Fu et al., 2010). However, traditional depression scales produce a single score that may mask considerable heterogeneity in the depression symptom profile, and are conducted in a single environment as well as at a given point in time, thereby preventing evaluation of depressive symptoms as they express themselves in natural contexts. The emergence of new ecological methods of data collection such as the experience sampling method (ESM) overcomes these barriers of time and context through the use of repeated ambulatory monitoring via mobile technologies. Recently, we observed a common symptom profile using ESM in patients at risk for PSD 3 months following stroke (Sibon et al., 2012). The aim of the present study is to explore the associations between depression symptoms in daily life and cerebral atrophy using magnetic resonance imaging (MRI) with voxel-based morphometry in patients with first-ever ischemic stroke.

Section snippets

Subjects

Twelve patients aged 18–80 years with a first ischemic stroke were consecutively recruited through a hospital-based stroke center. Exclusion criteria were aphasia, presence of cerebellar lesion, past history of psychiatric or neurological disorder, and visual or motor handicaps preventing adequate use of the ambulatory monitoring device. All patients provided informed written consent to participate.

Procedure

Brain MRI was performed at 10 days after stroke on a 1.5 T Intera Philips MRI scanner using a

Results

The main clinical and radiological characteristics of the sample are summarized in Table 1. The mean age of the sample was 58 years (S.D.=13.2) and 66% were male. The frequency of positive thoughts and the degree of emotional well-being were negatively correlated with cerebellar grey matter volume (Fig. 1). Conversely, a positive correlation between negative thoughts and cerebellar grey matter volume was observed. No significant association between daily-life parameters and white matter volume

Discussion

The findings underscore the value of linking hospital-based tools of modern neurology with information concerning daily-life experiences over time and across contexts through the use of mobile technologies. Due to the modest sample size, the results should be interpreted as an illustration of the potential of combining structural MRI and ecological assessment of psychiatric symptoms. The main findings indicate an association between cerebellar volume and emotional valence of thoughts evaluated

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