Loss of empathy in stroke

Background: Loss of empathy (LoE) is common among stroke survivors, yet often undiagnosed and thus untreated. LoE is related to the loss of a caring marital relationship, higher care burden and poorer quality of life in carers. The present study will evaluate the clinical and MRI correlates of LoE in a cohort of stroke survivors. The secondary objective is to describe the 12-month course of LoE.

Methods: The current study is a prospective cohort study. We will recruit 246 subjects. Subjects and carers will receive a detailed assessment at a research clinic at 3, 9, and 15 months after stroke onset (T1/T2/T3). The Chinese version of the Interpersonal Reactivity Index (IRI), a 28-item personality assessment tool, will be completed by a carer for each subject. LoE is defined as an IRI total score of 39 or less. Patients will be examined by MRI including diffusion weighted imaging (DWI) within 1 week after the onset of stroke. A stepwise logistic regression will be performed to assess the importance of lesions in the regions of interest. To examine the predictors of LoE remission, the demographic, clinical and MRI variables of remitters and non-remitters at T2/T3 will be examined by logistic regression.

Discussion: This project will be the first longitudinal study on LoE in stroke survivors. The results will shed light on the association between prefrontal cortex and subcortical lesions and LoE risk, symptom severity and outcome. The findings will provide data to advance our understanding of the pathogenesis and clinical course of LoE in stroke as well as other neurological conditions. They are thus likely to be applicable to the large population of neurological patients at risk of LoE and should also stimulate further research in this field.