Strategic Infarct Location for Post-Stroke
Behavioral Dysexecutive Symptoms:
A Lesion-Symptom Mapping
Lisha Wang1, Wai-Kwong Tang1,2
1 Department of Psychiatry, Shatin Hospital,
Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
2 CUHK Shenzhen research institute, Shenzhen, China.
Abstract
Introduction
Behavioural dysexecutive symptoms are common in stroke patients and have detrimental effects on survivor’s quality of life 1, 2. Some case reports and small sample sized studies suggest behavioural dysexecutive symptoms relate to infarct locations3, 4. However, it remains unclear which strategic infarcts are involved. This study aimed to perform region-wise lesion symptom mapping (RLSM) to identify anatomical correlates of behavioral dysexecutive symptoms.
Methods
The study sample comprised 166 patients (age 66.5±9.3 years, 64.5% male) with first-ever acute ischemic stroke. Behavioral dysexecutive symptoms were measured by the self-rated version of Dysexecutive Questionnaire (DEX) at 3 months after stroke. The brain was parcellated in 189 regions using the JHU-MNI atlas and only regions where at least 10 participants had damage were included in the study. A General Linear Model (pooled variance t-test) with lesion volume as covariates was used to investigate the relationship between lesion locations and DEX total and 4 subscores (executive cognitive scale, DEX-EC; metacognitive scale, DEX-MC; behavioral-emotional selfregulation scale, DEX-BESR; social convention scale, DEX-SC).
Results
The lesion overlay map was shown in figure 1. After the exclusion of regions where less than 10 participants had damage, 61 regions were included in the RLSM analysis (figure 2). Only lesions in the left cerebral peduncle were significantly associated with the DEX total score (z=3.336), DEX-BESR (z=3.360) and DEX-SC subscore (z=3.360)(figure 3). .
Conclusion
The result demenstrate the importance of left cerebral peduncle in behavioral dysexecutive symptoms pathology, especially on the behavioral-emotional selfregulation and social convention aspects.
Acknowledgements
This work was supported by the National Natural Science Foundation of China, China (grant reference number: 81371460) and Health and Medical Research Fund, Hong Kong SAR (grant reference number: 02130726).
References
1. Godefroy, O. , et al. Dysexecutive disorders and their diagnosis: A position paper. Cortex 109(2018).
2. Liang, Yannis Yan , et al. Association Between Behavioral Dysexecutive Syndrome and the Health-Related Quality of Life Among Stroke Survivors. Frontiers in Psychiatry 11(2020):563930.
3. Lvstad, M. , et al. Executive functions after orbital or lateral prefrontal lesions: Neuropsychological profiles and self-reported executive functions in everyday living. Brain Injury 26.13-14(2011).
4. AE Ioannidis, et al. Apathy, cognitive dysfunction and impaired social cognition in a patient with bilateral thalamic infarction. Neurocase 19.5(2013):513-520.
Figures are excluded due to copyright protection.