# Behavioral Monitoring in Transient Ischemic Attack and Stroke Patients: Exploratory Micro- and Macrostructural Imaging Insights for Identifying Post-Stroke Depression with Accelerometers in UK Biobank

## TL;DR

This study explores how brain structure and physical activity relate to depression in stroke patients using data from UK Biobank.

## Contribution

The study provides new insights into the link between brain imaging features and post-stroke depression using accelerometer data and MRI scans.

## Key findings

- Depression was associated with increased white matter hyperintensities and reduced microstructural integrity in commissural fibers.
- More light physical activity and sleep during early morning were linked to lower odds of depression.
- The study suggests multimodal data can help identify stroke patients at risk for depression.

## Abstract

To examine the association between post-stroke depression (PSD) and macrostructural and microstructural brain measures, and to explore whether changes in accelerometer-measured physical activity (PA) are associated with PSD, we conducted an exploratory study in UK Biobank with dementia-free participants diagnosed with at least one prior stroke. Eligible participants (n = 1186) completed an MRI scan. Depression was classified based on positive depression screening scores (PHQ-2 ≥ 3). Multivariate linear regression models assessed the relationships between depression and structural and diffusion measures generated from brain MRI scans. Logistic regression models were used to examine the relationship between accelerometer-measured daily PA and future depression (n = 367). Depression was positively associated with total white matter hyperintensities (WMHs) volume (standardized β [95% CI]—0.1339 [0.012, 0.256]; FDR-adjusted p-value—0.039), periventricular WMHs volume (standardized β [95% CI]—0.1351 [0.020, 0.250]; FDR-adjusted p-value—0.027), and reduced MD for commissural fibers (standardized β [95% CI]—−0.139 [−0.255, −0.024]; adjusted p-value—0.045). The odds of depression decreased by 0.3% for each daily minute spent in objectively measured light PA, while each minute spent in sleep from midnight to 6:00 AM was associated with a 0.9% decrease in the odds of depression. This early-stage analysis using a population cohort offers a scientific rationale for researchers using multimodal data sources to investigate the heterogenous nature of PSD and, potentially, identify stroke patients at risk of poor outcomes.