Journal of affective disorders · 2026
Right-hemisphere glymphatic dysfunction is associated depressive symptoms in subacute stroke: A diffusion tensor imaging-along the perivascular space index study.
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Qu Jian-Feng, Wang Ming-Zi, Li Yu-Ting, Liu Xiao-Wen, Chen Yang-Kun
Аннотация
BACKGROUND: Depressive symptoms are common in patients with subacute stroke, yet the underlying mechanisms remain unclear. We aimed to investigate the relationship between "along the perivascular space" (ALPS) indices, a measure of glymphatic dysfunction, and depressive symptoms in ischemic stroke patients, considering infarct laterality.
METHODS: A prospective cohort of 104 patients with acute ischemic stroke underwent 3.0-T MRI and clinical assessments at their 3-month follow-up. The 24-item Hamilton Depression Rating Scale (HAMD) was used to assess depressive symptoms (HAMD ≥8). ALPS indices including left (L-ALPS), right (R-ALPS), infarct (I-ALPS), and non-infarct hemispheres (N-ALPS), average across L-ALPS and R-ALPS, and I-ALPS to N-ALPS ratio (I-to-N) were calculated. Logistic regression and mediation analyses were conducted to evaluate associations between ALPS indices and depressive symptoms.
RESULTS: At follow-up, 32.7 % (n = 34) of patients experienced depressive symptoms. R-ALPS, but not I-ALPS or N-ALPS, was the strongest predictor of depressive symptoms (odds ratio = 0.032, 95 % confidence interval: 0.002-0.567, p = 0.019). Additionally, higher fractional anisotropy (p = 0.02) and lower fractional anisotropy (p = 0.049) in the left superior cerebellar peduncle (SCP) were correlated with depressive symptoms. Glymphatic dysfunction was directly linked to depressive symptoms, independent of left SCP metrics (p > 0.05).
CONCLUSION: In subacute stroke patients, glymphatic dysfunction, particularly in the right hemisphere, is independently associated with depressive symptoms, which suggests a lateralized role in subacute mood regulation. Therefore, the ALPS index may serve as a non-invasive biomarker for stratifying patients according to risk of depressive symptoms.
METHODS: A prospective cohort of 104 patients with acute ischemic stroke underwent 3.0-T MRI and clinical assessments at their 3-month follow-up. The 24-item Hamilton Depression Rating Scale (HAMD) was used to assess depressive symptoms (HAMD ≥8). ALPS indices including left (L-ALPS), right (R-ALPS), infarct (I-ALPS), and non-infarct hemispheres (N-ALPS), average across L-ALPS and R-ALPS, and I-ALPS to N-ALPS ratio (I-to-N) were calculated. Logistic regression and mediation analyses were conducted to evaluate associations between ALPS indices and depressive symptoms.
RESULTS: At follow-up, 32.7 % (n = 34) of patients experienced depressive symptoms. R-ALPS, but not I-ALPS or N-ALPS, was the strongest predictor of depressive symptoms (odds ratio = 0.032, 95 % confidence interval: 0.002-0.567, p = 0.019). Additionally, higher fractional anisotropy (p = 0.02) and lower fractional anisotropy (p = 0.049) in the left superior cerebellar peduncle (SCP) were correlated with depressive symptoms. Glymphatic dysfunction was directly linked to depressive symptoms, independent of left SCP metrics (p > 0.05).
CONCLUSION: In subacute stroke patients, glymphatic dysfunction, particularly in the right hemisphere, is independently associated with depressive symptoms, which suggests a lateralized role in subacute mood regulation. Therefore, the ALPS index may serve as a non-invasive biomarker for stratifying patients according to risk of depressive symptoms.