Fractional amplitude of low-frequency fluctuations (fALFF) in post-stroke depression

Abstract

Depression is a common outcome following stroke, associated with reduced quality of life and poorer recovery. Despite attempts to associate depression symptoms with specific lesion sites, the neural basis of post-stroke depression remains poorly understood. Resting state fMRI has provided new insights into the neural underpinnings of post-stroke depression, but has been limited to connectivity analyses exploring interregional correlations in the time-course of activity. Other aspects of resting state BOLD signal remain unexamined. Measuring the amplitude of low frequency fluctuations allows the detection of spontaneous neural activity across the whole brain. It provides complementary information about frequency-specific local neural activity.We calculated the fractional amplitude of low frequency fluctuations (fALFF) in a group of 64 participants scanned 3months post-stroke. Twenty showed depression symptoms when assessed with the Patient Health Questionnaire (PHQ-9). We performed analyses in both the typical 0.01–0.08Hz range, as well as separately in the slow-5 (0.01–0.027Hz) and slow-4 (0.027–0.073Hz) ranges. We found significantly higher fALFF in the depressed compared to non-depressed participants in the left dorsolateral prefrontal cortex (DLPFC) and the right precentral gyrus, and a significant association between higher depression scores and higher fALFF in the left insula. The group differences were detected in the slow-5 fluctuations, while the association with depression severity was observed in the slow-4 range. We conclude that post-stroke depression can be characterised by aberrant spontaneous local neural activity, which in small samples could be a more sensitive measure than lesion volume and location. Keywords: Fractional amplitude of low-frequency fluctuations (fALFF), Post-stroke depression, Stroke, Resting state functional magnetic resonance imaging (rs-fMRI), Insula, Dorsolateral prefrontal cortex (DLPFC)