Neuroimaging Correlates of Post-stroke Fatigue: A Systematic Review and Meta-analysis

Amy A Jolly, Adriana Zainurin, Gillian Mead, Hugh S. Markus

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background
Fatigue is a common and disabling symptom following stroke, but its underlying mechanisms are unknown. Associations with a number of imaging features have been proposed.
Aims
We aimed to assess whether neuroimaging parameters could better inform our understanding of possible causes of post-stroke fatigue (PSF) through systematic review and meta-analysis.
Methods
Using a pre-defined protocol registered with PROSPERO (ID: CRD42022303168), we searched EMBASE, MEDLINE, PubMed and PsycInfo for studies assessing PSF and Computerised Tomography (CT)-, Magnetic Resonance (MR)-, Positron Emission Tomography (PET)- imaging or Diffusion Tensor Imaging (DTI). We extracted neuroimaging parameters and narratively analysed study results to assess any association to PSF. Where there were 3+ similar studies, we carried out a meta-analysis using inverse-variance random-effects model to estimate total association of each neuroimaging parameter on PSF. Risk of bias was assessed using the Newcastle and Ottawa Scale.
Results
We identified 46 studies (N=6,543); in many studies associations with fatigue were secondary or sub-analyses (28.3%). Imaging parameters were assessed across 8 variables: lesion lateralisation, lesion location, lesion volume, brain atrophy, infarct number, cerebral microbleeds, white matter hyperintensities (WMH) and network measures.
Most variables showed no conclusive evidence for any association with fatigue. Meta-analysis where possible showed no association of the following with PSF; left lesion lateralisation (OR: 0.88, 95% CI [0.64, 1. 22], (p=0.45)), infratentorial lesion location (OR: 1.83, 95% CI [0.63, 5.32], (p=0.27)) and WMH (OR: 1.21, 95% CI [0.84, 1.75], (p=0.29)). Many studies assessed lesion location with mixed findings, only one used voxel-symptom lesion-mapping (VSLM). Some small studies suggested association between altered functional brain networks, namely frontal, fronto-striato-thalamic and sensory processing networks, with PSF.
Conclusion
There was little evidence for association between any neuroimaging parameters and PSF. Future studies should utilise advanced imaging techniques to fully understand the role of lesion location in PSF, whilst the role of altered brain networks in mediating PSF merits further research
Original languageEnglish
JournalInternational Journal of Stroke
Early online date24 Jul 2023
DOIs
Publication statusE-pub ahead of print - 24 Jul 2023

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