Stroke lesion in cortical neural circuits and post-stroke incidence of major depressive episode: A 4-month prospective study

Figures & data

Figure 1. Patient flow.

Table I. Demographic and clinical characteristics of patients with and without major depressive episode after stroke.

	Major depressive episode
	Yes N (%)	No N (%)	P value
Patients	21 (31)	47 (69)
Sex
Female	10 (48)	22 (47)
Male	11 (52)	25 (53)	0.951
Married
yes	15 (71)	29 (62)
no	6 (29)	18 (38)	0.606
Level of educational
≤8 years of schooling	16 (76)	32 (68)
≥9 years of schooling	5 (24)	15 (32)	0.435
Employed
yes	11 (52)	32 (68)
no	10 (48)	15 (32)	0.215
Left hemisphere lesion
yes	13 (62)	28 (59.6)
no	8 (38)	19 (40.4)	0.856
Right hemisphere lesion
yes	9 (42.9)	20 (42.6)
no	12 (57.1)	27 (57.5)	0.981
Handeness^b
Right-handed	21 (100)	44 (93.6)
Left-handed	0 (0)	3 (6.4)	0.547
HTN^c
Yes	12 (57.1)	22 (50)
No	9 (42.9)	22 (50)	0.590
DM^b,c
Yes	6 (28,6)	3 (6.8)
No	15 (71.4)	41 (93.2)	0.048
CHD^b,c
Yes	1 (5)	1 (2.2)
No	19 (95)	44 (97.8)	0.524
Dysphasia^b,d
Yes	1 (4.8)	8 (19)
No	20 (95.2)	34 (81)	0.251
White-matter hyperintensity score^e
PWMH			0.182
PWMH = 0	2 (9.5)	2 (4.3)
PWMH = 1	13 (61.9)	39 (83)
PWMH = 2	5 (23.8)	6 (12.8)
PWMH = 3	1 (4.8)	0 (0)
DWMH			0.486
DWMH = 0	6 (28.6)	12 (25.5)
DWMH = 1	10 (47.6)	23 (48.9)
DWMH = 2	3 (14.3)	11 (23.4)
DWMH = 3	2 (9.5)	1 (2.1)
	Mean (SD)	Mean (SD)
Age, years	53.8 (15.8)	49.8 (12.8)	0.280
NIHSS^a
First time-point	3.7 (3.0)	2.7 (2.7)	0.134
Second time-point	2.8 (2.4)	2.4 (2.7)	0.379
Third time-point	2 (1.8)	1.9 (1.9)	0.825
Barthel Index^a
First time-point	86 (24.8)	92.6 (19.1)	0.123
Second time-point	91.3 (17.4)	93.3 (17.1)	0.366
Third time-point	97.4 (5.4)	96.4 (9.5)	0.901
MMSE
First time-point	23.5 (4.2)	23.7 (4.5)	0.933
Third time-point	24.6 (4.3)	24.4 (3.7)	0.900
HAM-D
First time-point	23 (2.9)	5.7 (3.9)	<0.001
Second time-point	22.2 (6.8)	5.7 (4.6)	<0.001
Third time-point	20.3 (4)	5.1 (5)	<0.001

NIHSS, National Institutes of Health Stroke Scale; MMSE, Mini-Mental State Examination; HAM-D, Hamilton Rating Scale for Depression, 31-item version; HTN, hypertension; DM, diabetes mellitus; CHD, coronary heart disease; PWMH, periventricular hyperintensity; DWMH, deep white-matter hyperintensity.

^aMann Whitney test; ^bFischer's exact test; ^cN = 65, three cases with no data; ^dN = 63, five cases with no data; ^eFazekas Score.

Table II. Association between lesion volume in neural circuits and four-month incidence of major depressive episode after ischemic stroke.

	Major depressive episode^a
	Yes^b	No^c	P value^d
Left hemisphere (N = 39)^e	N = 12 (30.8%)	N = 27 (69.2%)
LCSPT	3,760 (5,840)	660 (3,080)	0.004
	26.21 (314.5)	17.24 (465.5)
OPFN	4,900 (10,080)	1,680 (6,230)	0.037
	25.25 (303)	17.67 (477)
MPFN	4,380 (6,350)	860 (3,170)	0.065
	24.58 (295)	17.96 (485)
Right hemisphere (N = 27)e	N = 8 (29.6%)	N = 19 (70.4%)
LCSPT	1,270 (1,610)	6,170 (15,650)	0.697
	14.88 (119)	13.63 (259)
OPFN	3,900 (4,120)	6,300 (10,830)	0.667
	15.00 (120)	13.58 (258)
MPFN	3,450 (2,720)	7,010 (15,840)	0.435
	15.81 (126.5)	13.24 (251.5)

LCSPT, limbic-cortical-striatal-pallidal-thalamic circuit; OPFN, orbital prefrontal network; MPFN, medial prefrontal network.

^aMeasurement of size is in mm³ (mean ± SD) in the upper line and value of mean rank (rank sum) in the below line.

^bOne patient with bilateral stroke was excluded of this analysis.

^cOne patient with bilateral stroke was excluded of this analysis.

^dMann Whitney test with P values of the Hochberg's recommendations: left sided LCSPT circuit at α = 0.05, left sided OPFN at α = 0.025, left sided MPFN at α = 0.01667, right LCSPT circuit at α = 0.0125, right OPFN at α = 0.01 and right MPFN at α = 0.0083.

^eFinal sample in the group of patients.

Table III. Complementary analysis of the association of lesion volume in areas of the LCSPT in the left hemisphere and incidence of major depressive episode.

	Major depressive episode^a		P value^b
	Yes (N = 12)^c	No (N = 27)^c
Amygdala (BA34)	87 (160)	4 (21)	0.010
	24.08 (289)	18.19 (491)
Ventral anterior cingulate cortex (BA24)	690 (1,990)	0 (0)	0.032
	22.25 (267)	19.00 (513)
Subgenual cortex (BA25)	280 (710)	4 (20)	0.038
	23.00 (276)	18.67 (504)
Hippocampal subiculum (BA28)	39 (130)	0 (0)	0.032
	22.25 (267)	19.00 (513)
Dorsal anterior cingulate cortex (BA32)	740 (2,190)	5 (24)
	22.92 (275)	18.70 (505)	0.043
Hippocampal subiculum (BA36)	40 (120)	0 (0)	0.032
	22.25 (267)	19.00 (513)

BA, Brodmann area.

^aMeasurement of size is in mm³ (mean ± SD) in the upper line and value of mean rank (rank sum) in the below line.

^bMann Whitney test without multiple comparison adjustment.

^cFinal sample in the group of patients.