Network analysis of neuropsychiatric, cognitive, and functional complications of stroke: implications for novel treatment targets.

IF 5 3区 医学 Q1 CLINICAL NEUROLOGY Psychiatry and Clinical Neurosciences Pub Date : 2024-04-01 Epub Date: 2024-01-29 DOI:10.1111/pcn.13633
Lena K L Oestreich, Jessica W Lo, Maria A Di Biase, Perminder S Sachdev, Alice H Mok, Paul Wright, John D Crawford, Ben Lam, Latchezar Traykov, Sebastian Köhler, Julie E A Staals, Robert van Oostenbrugge, Christopher Chen, David W Desmond, Kyung-Ho Yu, Minwoo Lee, Aleksandra Klimkowicz-Mrowiec, Régis Bordet, Michael J O'Sullivan, Andrew Zalesky
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Abstract

Aim: Recovery from stroke is adversely affected by neuropsychiatric complications, cognitive impairment, and functional disability. Better knowledge of their mutual relationships is required to inform effective interventions. Network theory enables the conceptualization of symptoms and impairments as dynamic and mutually interacting systems. We aimed to identify interactions of poststroke complications using network analysis in diverse stroke samples.

Methods: Data from 2185 patients were sourced from member studies of STROKOG (Stroke and Cognition Consortium), an international collaboration of stroke studies. Networks were generated for each cohort, whereby nodes represented neuropsychiatric symptoms, cognitive deficits, and disabilities on activities of daily living. Edges characterized associations between them. Centrality measures were used to identify hub items.

Results: Across cohorts, a single network of interrelated poststroke complications emerged. Networks exhibited dissociable depression, apathy, fatigue, cognitive impairment, and functional disability modules. Worry was the most central symptom across cohorts, irrespective of the depression scale used. Items relating to activities of daily living were also highly central nodes. Follow-up analysis in two studies revealed that individuals who worried had more densely connected networks than those free of worry (CASPER [Cognition and Affect after Stroke: Prospective Evaluation of Risks] study: S = 9.72, P = 0.038; SSS [Sydney Stroke Study]: S = 13.56, P = 0.069).

Conclusion: Neuropsychiatric symptoms are highly interconnected with cognitive deficits and functional disabilities resulting from stroke. Given their central position and high level of connectedness, worry and activities of daily living have the potential to drive multimorbidity and mutual reinforcement between domains of poststroke complications. Targeting these factors early after stroke may have benefits that extend to other complications, leading to better stroke outcomes.

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中风的神经精神、认知和功能并发症的网络分析:对新型治疗目标的影响。
目的:中风后的康复受到神经精神并发症、认知障碍和功能障碍的不利影响。需要更好地了解它们之间的相互关系,以便采取有效的干预措施。网络理论可将症状和损伤概念化为动态和相互影响的系统。我们旨在利用网络分析法在不同的中风样本中识别中风后并发症的相互作用:方法:2185 名患者的数据来自 STROKOG(国际中风研究合作组织)的成员研究。为每个队列生成了网络,其中节点代表神经精神症状、认知障碍和日常生活障碍。边代表它们之间的关联。中心性测量用于识别中心项:结果:在所有队列中,出现了一个由中风后并发症相互关联的单一网络。该网络显示了可分离的抑郁、冷漠、疲劳、认知障碍和功能障碍模块。无论使用哪种抑郁量表,"担忧 "都是各组人群最主要的症状。与日常生活活动有关的项目也是高度中心化的节点。两项研究的后续分析表明,与没有忧虑的人相比,有忧虑的人的网络连接更密集(CASPER 研究:S=9.72,p=0.038;悉尼卒中研究:结论:结论:神经精神症状与中风导致的认知障碍和功能障碍密切相关。结论:神经精神症状与卒中导致的认知障碍和功能障碍高度相关。鉴于其中心位置和高度关联性,忧虑和日常生活活动有可能导致卒中后并发症的多病症和各领域之间的相互强化。在中风后早期针对这些因素进行治疗可能会使其他并发症受益,从而改善中风预后。本文受版权保护。保留所有权利。
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来源期刊
CiteScore
7.40
自引率
4.20%
发文量
181
审稿时长
6-12 weeks
期刊介绍: PCN (Psychiatry and Clinical Neurosciences) Publication Frequency: Published 12 online issues a year by JSPN Content Categories: Review Articles Regular Articles Letters to the Editor Peer Review Process: All manuscripts undergo peer review by anonymous reviewers, an Editorial Board Member, and the Editor Publication Criteria: Manuscripts are accepted based on quality, originality, and significance to the readership Authors must confirm that the manuscript has not been published or submitted elsewhere and has been approved by each author
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