title: Neuroanatomic pathways associated with monoaminergic dysregulation after stroke.
abstract: We examined the complex relationship between lesion location, symptoms of depression (affective and apathetic), and monoamine dysfunction after stroke.
  
  
  
  Magnetic resonance imaging was performed on 48 post-stroke patients that had been assessed for affective and apathetic symptoms using the Hospital Anxiety and Depression Scale and the Apathy Scale, respectively. Noradrenalin (NA), dopamine (DA), their metabolites, and a metabolite of serotonin (5-HT) were measured using 24-h urine samples, and 5-HT and 3-methoxy-4-hydroxyphenylglycol were measured using blood samples. We developed a statistical parametric map that displayed the associations between lesion location and both positive and negative alterations of monoamines and their metabolites.
  
  
  
  Multivariate analysis indicated that basal ganglia lesions and 5-HT showed relationships with affective symptoms, whereas homovanillic acid was related to apathetic symptoms. Univariate analysis showed no such relationships. However, decreases in NA and DA and increases in NA and DA turnover were related to lesions in the brainstem, whereas increases in NA and DA as well as decreases in NA and DA turnover were related to cortical and/or striatum lesions. 5-HT turnover data showed a pattern opposite to that seen for NA and DA turnover.
  
  
  
  Monoaminergic neuronal pathways are controlled by both receptor-mediated feedback mechanisms and turnover; thus, depletion of monoamines is not the only cause of depression and apathy. Moreover, the monoamine neuronal network might be divided into two branches, catecholamine (NA and DA) and 5-HT, both of which are anatomically and functionally interconnected and could respectively influence apathetic and affective symptoms of depression.
authors.affiliation: Department of Rehabilitation, Hibino Hospital, Hiroshima, Japan.|Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Hama
authors.affiliation: Department of Neurosurgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan.
authors.forename: Taro
authors.initials: T
authors.lastname: Murakami
authors.affiliation: Department of Psychiatry and Neuroscience, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
authors.forename: Hidehisa
authors.initials: H
authors.lastname: Yamashita
authors.affiliation: Department of Neurology, Shimane University, Izumo-shi, Shimane, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Onoda
authors.affiliation: Department of Psychiatry and Neuroscience, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Yamawaki
authors.affiliation: Department of Neurosurgery, Graduate School of Biomedical and Health Science, Hiroshima University, Hiroshima, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kurisu
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D057565:Apathy; D001479:Basal Ganglia / Q000473:pathology*; D015306:Biogenic Monoamines / Q000378:metabolism*; D003863:Depression / Q000378:metabolism / Q000473:pathology; D004298:Dopamine / Q000652:urine; D005260:Female; D006719:Homovanillic Acid / Q000652:urine; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008734:Methoxyhydroxyphenylglycol / Q000097:blood; D008875:Middle Aged; D015999:Multivariate Analysis; D009434:Neural Pathways / Q000473:pathology*; D009638:Norepinephrine / Q000652:urine; D012701:Serotonin / Q000652:urine; D020521:Stroke / Q000378:metabolism / Q000473:pathology
chemical_list: D015306:Biogenic Monoamines; D012701:Serotonin; D008734:Methoxyhydroxyphenylglycol; D004298:Dopamine; D009638:Norepinephrine; D006719:Homovanillic Acid
keywords: affective symptom; apathetic symptom; dopamine; monoamine; neuroanatomic pathway; noradrenalin; post-stroke depression; serotonin; statistical parametric mapping