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    Microstructural degeneration and cerebrovascular risk burden underlying executive dysfunction after stroke

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    Author
    Veldsman, M; Werden, E; Egorova, N; Khlif, MS; Brodtmann, A
    Date
    2020-10-21
    Source Title
    Scientific Reports
    Publisher
    NATURE RESEARCH
    University of Melbourne Author/s
    Egorova, Natalia
    Affiliation
    Melbourne School of Psychological Sciences
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Veldsman, M., Werden, E., Egorova, N., Khlif, M. S. & Brodtmann, A. (2020). Microstructural degeneration and cerebrovascular risk burden underlying executive dysfunction after stroke. SCIENTIFIC REPORTS, 10 (1), https://doi.org/10.1038/s41598-020-75074-w.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/251709
    DOI
    10.1038/s41598-020-75074-w
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578057
    Abstract
    Executive dysfunction affects 40% of stroke patients, but is poorly predicted by characteristics of the stroke itself. Stroke typically occurs on a background of cerebrovascular burden, which impacts cognition and brain network structural integrity. We used structural equation modelling to investigate whether measures of white matter microstructural integrity (fractional anisotropy and mean diffusivity) and cerebrovascular risk factors better explain executive dysfunction than markers of stroke severity. 126 stroke patients (mean age 68.4 years) were scanned three months post-stroke and compared to 40 age- and sex-matched control participants on neuropsychological measures of executive function. Executive function was below what would be expected for age and education level in stroke patients as measured by the organizational components of the Rey Complex Figure Test, F(3,155) = 17, R2 = 0.25, p < 0.001 (group significant predictor at p < 0.001) and the Trail-Making Test (B), F(3,157) = 3.70, R2 = 0.07, p < 0.01 (group significant predictor at p < 0.001). A multivariate structural equation model illustrated the complex relationship between executive function, white matter integrity, stroke characteristics and cerebrovascular risk (root mean square error of approximation = 0.02). Pearson's correlations confirmed a stronger relationship between executive dysfunction and white matter integrity (r = - 0.74, p < 0.001), than executive dysfunction and stroke severity (r = 0.22, p < 0.01). The relationship between executive function and white matter integrity is mediated by cerebrovascular burden. White matter microstructural degeneration of the superior longitudinal fasciculus in the executive control network better explains executive dysfunction than markers of stroke severity. Executive dysfunction and incident stroke can be both considered manifestations of cerebrovascular risk factors.

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