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神经损伤与再生
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神经损伤与再生  

左背外侧前额皮质萎缩的脑卒中老年女性语言流畅性差一文的图片
(Volume 8 Number 4 February 2013)


Cite this article:
Yang-Kun Chen, Wei-Min Xiao, Defeng Wang, Lin Shi, Winnie CW Chu, Vincent CT Mok, Ka Sing Wong, Gabor S Ungvari, Wai Kwong Tang. Atrophy of the left dorsolateral prefrontal cortex is associated with poor performance in verbal fluency in elderly poststroke women[J]. Neural Regeneration Research, 2013, 8(4): 346-356.

 


 
Quantitative analysis of subjects
Eighty-three elderly patients with acute ischemic stroke, 50 males and 33 females, were initially included in this study. Among the 33 female patients, 30 passed the baseline assessment and neuropsychological testing. From the initial group of 50 males, 30 age-matched male patients who passed the baseline assessment and neuropsychological testing were selected as controls. Finally, 60 patients with acute ischemic stroke were suitable for final analysis.
 
Baseline data and MRI variables between male and female patients with acute ischemic stroke
The demographic, clinical, and radiological features of the subjects according to sex are shown in Table 1.

Table 1 Comparisons of demographic, clinical, neuropsychological and radiological characteristics between male and female patients with acute ischemic stroke

There were no significant differences in terms of demographic and clinical variables between male and female patients except that female patients had less education, more severe diabetes mellitus, lower Mini- Mental Status Examination and Frontal Assessment Battery scores. Verbal Fluency Test score did not differ significantly between male and female patients. In terms of MRI variables, female patients also had a significantly higher volume of right orbitofrontal cortex and right anterior cingulate cortex (Table 2).

Table 2 Comparisons of MRI variables between male and female patients with acute ischemic stroke

 
Associations between Verbal Fluency Test score and MRI variables (3 months poststroke)
At 3 months poststroke, the left dorsolateral prefrontal cortex volume was significantly correlated with the Verbal Fluency Test score in female patients but not in male patients (Table 3 and Figure 1A).
 
Variables which differed between male and females, as well as age and the National Institutes of Health Stroke Scale scores, were adjusted by subsequent partial correlation. After controlling for age, education, National Institutes of Health Stroke Scale scores, Mini-Mental Status Examination scores at 3 months, diabetes mellitus, volume of infarcts, presence of basal ganglia infarcts, and white matter lesions volume, the correlation between the left dorsolateral prefrontal cortex volume and the Verbal Fluency Test in the female patients remained significant in partial correlation (partial coefficient = 0.453, P = 0.045).

Table 3 Correlations between volumetric MRI variables and cognitive tests in male and female patients 3 months poststroke

 
Associations between Verbal Fluency Test score and MRI variables (15 months poststroke)
At 15 months poststroke, the left dorsolateral prefrontal cortex and prefrontal cortex volumes were significantly correlated (Pearson’s correlation) with the Verbal Fluency Test score in female patients but not in male patients (Table 4).

 
Table 4 Correlations between the volumetric MRI variables and cognitive tests in male and female patients 15 months poststroke


There was still a significant association between the left dorsolateral prefrontal cortex and Verbal Fluency Test (partial coefficient = 0.661, P = 0.001; Figure 1B) and between the left prefrontal cortex and Verbal Fluency Test (partial coefficient = 0.573, P = 0.004) after the same adjustment (Table 5).

Table 5 Partial correlation of left DLPFC and left PFC standardized volumes and Verbal Fluency Test scores in elderly poststroke women

 
Associations between Frontal Assessment Battery score and MRI variables
The Frontal Assessment Battery score was significantly correlated with the volume of white matter lesions, but not with the volume of the prefrontal cortex or its subdivisions; this was at both 3 and 15 months poststroke in elderly female patients. However, partial correlations for these associations, with the same adjustments as above, became insignificant (3 months poststroke: partial correlation coefficient = –0.406, P = 0.076; 15 months poststroke: partial correlation coefficient = –0.222, P = 0.347). In elderly male patients with ischemic stroke, Frontal Assessment Battery and Verbal Fluency Test scores did not correlate with any MRI variables in bivariate correlations (Tables 4, 5).

 
Figure 1 Scatter plots of the correlation between standardized volume of the left dorsolateral prefrontal cortex and Verbal Fluency Test score.
(A) 3 months after stroke; (B) 15 months after stroke.
 
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