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Multivariate Lesion-symptom Mapping in Post-stroke Cognitive Impairment
Başlık:
Multivariate Lesion-symptom Mapping in Post-stroke Cognitive Impairment
Yazar:
Zhao, Lei, author.
ISBN:
9780438106376
Yazar Ek Girişi:
Fiziksel Tanımlama:
1 electronic resource (177 pages)
Genel Not:
Source: Dissertation Abstracts International, Volume: 79-10(E), Section: B.
Özet:
Lesion location is an important determinant for post-stroke cognitive impairment (PSCI). A comprehensive map of strategic brain regions for PSCI is needed to help clinicians understand and predict the cognitive impact of ischemic strokes. As chronic neuroimaging signatures of small vessel disease (SVD) are common in stroke patients and cause considerable worsening of cognitive function, the impact of these SVD features should also be considered to draw such a map. In this thesis, we aimed to address these issues with novel perspectives using the proposed multivariate lesion-symptom mapping methods.
Previous voxel-based lesion-symptom mapping (VLSM) studies suffered from limitations in sample size and methodology. We proposed study 1 to determine the strategic infarct locations for PSCI by applying the recently developed multivariate lesion-symptom mapping approach in a large cohort of 410 acute ischemic stroke patients with Montreal Cognitive Assessment (MoCA) examined at 3 to 6 months after stroke. The relation between infarct location and cognition was assessed in multivariate analyses at the voxel-level and the level of regions of interest (ROI) using support vector regression (SVR). These two assumption-free analyses consistently identified the left angular gyrus, left basal ganglia structures and the white matter around the left basal ganglia as strategic structures for global cognitive impairment after stroke. A strategic network involving several overlapping and domain-specific cortical and subcortical structures was also identified for each of the cognitive domains.
In study 2, we proposed a multiple-lesion symptom mapping (MLSM) approach that considers both the presence of white matter hyperintensity (WMH) and acute ischemic lesion (AIL) to measure the additional contribution of WMH locations to PSCI. Seventy-six first-ever stroke patients with AILs in the left hemisphere were examined by MoCA at baseline (3 to 6 months after stroke) and one year after stroke. The association between the location of AIL and WMH and global cognition was investigated by a MLSM model based on SVR on a voxelwise basis. The identified strategic locations of WMH significantly contributed to the prediction of MoCA at baseline and one year after stroke independent of AILs. The significant clusters of WMH for short-term and long-term PSCI were mainly in the corpus callosum, corona radiata, and posterior thalamic radiation. In addition, there were some regions where local WMH burden has larger impact than AIL burden on the long-term PSCI.
As the joint contribution and strategic distribution patterns of multiple types of SVD features in PSCI are still not clear, we investigated 145 first-ever ischemic stroke patients with MRI and MoCA examined at baseline in study 3 to address these issues. The local burdens of AIL, WMH, lacune, enlarged perivascular space (EPVS) and atrophy were quantified and entered into the SVR models to associate with the global and domain scores of MoCA. With this MLSM analysis in ROI-based level, we found that the combination of the neuroimaging features of SVD contributed much more to the MoCA deficits on top of AILs compared with individual SVD features, and the cognitive impact of different individual SVD features were generally similar. The important SVD-affected regions were mainly located in the basal ganglia (BG) and white matter around it, although the specific regions varied for MoCA and its domains.
In summary, study 1 identified the strategic infarct locations for global and domain cognitive functions in ischemic stroke patients. Study 2 and study 3 demonstrated the additional contribution of SVD imaging features to PSCI and highlighted the involved strategic brain regions from different aspects. Future studies should aim to develop even more comprehensive lesion location-based multivariate models for PSCI through multicenter studies, which may help initiate adequate interventions for stroke patients at the earliest possible stage.
Notlar:
School code: 1307
Tüzel Kişi Ek Girişi:
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Yer Numarası | Demirbaş Numarası | Shelf Location | Lokasyon / Statüsü / İade Tarihi |
---|---|---|---|
XX(687336.1) | 687336-1001 | Proquest E-Tez Koleksiyonu | Arıyor... |
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