# Neuropsychiatric changes following striatal stroke– results from the observational PostPsyDis study

## TL;DR

This study found that stroke patients with lesions in the striatum may experience more neuropsychiatric symptoms, like depression, compared to those with non-striatal lesions.

## Contribution

The study is the first to investigate the specific role of striatal lesions in post-stroke depression and PTSD using a functional connectome approach.

## Key findings

- Patients with striatal lesions had higher depression scores 90 days post-stroke.
- Lesion connectivity analysis did not alter the observed associations between striatal lesions and neuropsychiatric symptoms.
- Female sex was independently associated with greater PTSD severity after stroke.

## Abstract

Ischemic stroke can lead to neuropsychiatric sequelae such as depression and post-traumatic stress disorder (PTSD), resulting in poorer functional outcomes. The POST-stroke PSYchological DIStress PostPsyDis; NCT01187342) study aimed to investigate whether ischemic lesions in the striatum increase the risk of depression and PTSD after stroke.

This monocenter, observational, case-control study included 84 ischemic stroke patients with striatal (n = 54) and non-striatal ischemic brain lesions (n = 30). Primary study endpoints included symptoms of depression (assessed via the Geriatric Depression Scale; GDS-30) and PTSD (assessed via the Posttraumatic Symptom Scale; PTSS-10) 90 days post-stroke. A normative functional connectome was used to obtain a measure of striatal connectivity to the rest of the brain (“striatal network”). Network damage scores were used to estimate damage of each lesion to the striatal network.

Patients with striatal lesions had higher GDS-30 scores at 90 days post-stroke (median 5.6 vs. 3.0; Cohen’s d = 0.39; p = 0.057), indicating a small to moderate effect. However, no meaningful group differences were observed in the incidence of depression or PTSD. In multivariable regression analyses, striatal infarction had an adjusted beta coefficient (β) of 1.9 (95%CI 0.19–3.7; p = 0.076) for GDS-10 and 1.8 (95%CI -1.9–5.5; p = 0.25) for PTSS-10 scores after 90 days. Only female sex was independently associated with PTSD severity (adjusted β = 5.1, 95% CI 1.3–8.8; p = 0.008). Analyzing lesion connectivity to the striatal network did not change these findings.

Taken together, the PostPsyDis study suggests a high rate of psychiatric morbidity in stroke patients. Moreover, the study suggests increased neuropsychiatric symptoms in patients with striatal lesions. There is a clear need for larger studies to investigate the role of the striatum in post-stroke neuropsychiatric disorders.

ClinicalTrials.gov (NCT01187342) Registered 23 August 2009, https://clinicaltrials.gov/study/NCT01187342.

The online version contains supplementary material available at 10.1186/s42466-025-00390-3.