title: The association of post-stroke anhedonia with salivary cortisol levels and stroke lesion in hippocampal/parahippocampal region.
abstract: BACKGROUND
  Anhedonia constitutes a coherent construct, with neural correlates and negative clinical impact, independent of depression. However, little is known about the neural correlates of anhedonia in stroke patients. In this study, we investigated the association of post-stroke anhedonia with salivary cortisol levels and stroke location and volume.
  
  
  METHODS
  A psychiatrist administered the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition to identify anhedonia in 36 inpatients, without previous depression, consecutively admitted in a neurology clinic in the first month after a first-ever ischemic stroke. Salivary cortisol levels were assessed in the morning, evening, and after a dexamethasone suppression test. We used magnetic resonance imaging and a semi-automated brain morphometry method to assess stroke location, and the MRIcro program according to the Brodmann Map to calculate the lesion volume.
  
  
  RESULTS
  Patients with anhedonia had significantly larger diurnal variation (P-value =0.017) and higher morning levels of salivary cortisol (1,671.9±604.0 ng/dL versus 1,103.9±821.9 ng/dL; P-value =0.022), and greater stroke lesions in the parahippocampal gyrus (Brodmann area 36) compared to those without anhedonia (10.14 voxels; standard deviation ±17.72 versus 0.86 voxels; standard deviation ±4.64; P-value =0.027). The volume of lesion in the parahippocampal gyrus (Brodmann area 36) was associated with diurnal variation of salivary cortisol levels (rho=0.845; P-value =0.034) only in anhedonic patients.
  
  
  CONCLUSIONS
  Our findings suggest that anhedonia in stroke patients is associated with the volume of stroke lesion in the parahippocampal gyrus and with dysfunction of the hypothalamic-pituitary-adrenal axis.
authors: Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Luisa
authors: L
authors: Terroni
authors: Department of Radiology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Edson
authors: E
authors: Amaro
authors: Mood and Anxiety Disorders Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors: Dan V
authors: DV
authors: Iosifescu
authors: Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
authors: Patricia
authors: P
authors: Mattos
authors: Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Fabio I
authors: FI
authors: Yamamoto
authors: Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Gisela
authors: G
authors: Tinone
authors: Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Adriana B
authors: AB
authors: Conforto
authors: Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Matildes Fm
authors: MF
authors: Sobreiro
authors: Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Valeri D
authors: VD
authors: Guajardo
authors: Division of Psychology, Central Institute, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Mara Cristina S
authors: MC
authors: De Lucia
authors: Department of Medicine, University of São Paulo, School of Medicine, Ribeirão Preto, Brazil.
authors: Ayrton C
authors: AC
authors: Moreira
authors: Department of Neurology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Milberto
authors: M
authors: Scaff
authors: Department of Radiology, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Claudia C
authors: CC
authors: Leite
authors: Consultation-Liaison Psychiatry Group, Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo School of Medicine, São Paulo, Brazil.
authors: Renerio
authors: R
authors: Fraguas
keywords: anhedonia; depression; glucocorticoids; hippocampus; parahippocampal; stroke