ORIGINAL RESEARCH article
Front. Aging Neurosci.
Sec. Neurocognitive Aging and Behavior
Volume 17 - 2025 | doi: 10.3389/fnagi.2025.1583655
This article is part of the Research TopicDecoding Neuroplasticity: Innovations in fMRI Methodologies and Disease InsightsView all articles
Multimodal Neuroimaging Investigation of Post-stroke Fatigue in Middle-aged and Older Adults: Combining Resting-state fMRI and DTI-ALPS Analysis
Provisionally accepted
- 1Department of Nuclear Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- 2School of Medical Imaging, Bengbu Medical University, Bengbu, China
- 3Department of Cardiology,Jinling Hospital, Medical school of Nanjing University, Nanjing, China
- 4MR Research, GE Healthcare, Shanghai, China
- 5Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China Anhui Provincial Hospital, Hefei, Anhui Province, China
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Background ： Post-stroke fatigue (PSF) is a prevalent but often overlooked complication, particularly in middle-aged and older stroke survivors. Neuroimaging studies exploring the neural mechanisms of PSF in this age group are limited. This study aimed to identify imaging markers for PSF in middle-aged and older adults using a multimodal imaging approach. Methods ： This retrospective case-control study analyzed data from patients with first ischemic stroke aged 50 years and above who were treated from January 2021 to June 2022 at the First Hospital of the University of Science and Technology of China. PSF was assessed using the Fatigue Severity Scale (FSS) and diagnostic criteria. All patients underwent resting-state functional MRI (rs-fMRI) and diffusion tensor imaging along perivascular space (DTI-ALPS) to assess brain functional connectivity and glymphatic system function. Results ： The PSF group (mean age 62.7±10.50 years) showed reduced global functional connectivity compared to non-fatigued controls (mean age 58.40±9.20 years) (p<0.05, FDR corrected), with enhanced connectivity between the insula and right inferior frontal gyrus. DTI-ALPS analysis revealed a negative correlation between DTI-ALPS index and fatigue severity (R²=0.40, p<0.001) in the PSF group, suggesting an association between impaired glymphatic clearance and fatigue symptoms in middle-aged and older stroke survivors. Conclusion： This multimodal neuroimaging study highlights altered brain functional connectivity and glymphatic dysfunction as potential neural correlates of PSF in middle-aged and older adults. The findings provide novel insights into the complex pathophysiology of PSF in the aging brain, implicating both functional brain networks and the glymphatic system. Further research is warranted to validate these age-specific findings and explore targeted interventions for PSF in older stroke survivors. Keywords： stroke； Post-stroke fatigue ； multimodal imaging； rs-fMRI ； DTI； middle-aged and older adults
Keywords: Post-stroke fatigue, Multimodal Imaging, RS-fMRI, DTI, Middle-aged and older adults
Received: 26 Feb 2025; Accepted: 28 Apr 2025.
Copyright: © 2025 Sun, Tang, Wang, Zhang, Ji and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Hengshan Ji, Department of Nuclear Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
Peng Wang, Division of Life Sciences and Medicine, The First Affiliated Hospital of University of Science and Technology of China Anhui Provincial Hospital, Hefei, 230001, Anhui Province, China
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