Virtual Reality Alleviates Post-Stroke Depression by Regulating FGF21

Background: Post-stroke depression(PSD) lacks timely and effective treatment and virtual reality (VR) technology can create a lifelike experience and simulate users' physical presence in an immersive environment. It has been confirmed to have a positive effect on stroke and depression. Data about the efficacy VR on PSD are limited. The intensification of fibroblast growth factor 21(FGF21) can improve depression and other emotional symptoms, but there is no study on its role in PSD.Methods: We enlisted 76 PSD patients (6 lost) and divided into the experimental group and control group randomly. The patient underwent psychological rehabilitation once a week for 50 minutes each time for a total of 12 weeks. The patients in the experimental group received psychological counseling and VR rehabilitation while patients in the control group also took the same pattern but without VR rehabilitation. The Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were evaluated before rehabilitation, in the 4th week and at the end of rehabilitation respectively in two groups for the sake of observing changes in the patients' depression. Then 8 people in each group did functional near-infrared spectroscopy (fNIRS), and blood samples were taken for detection with brain-derived neurotrophic factor (BDNF), IL-6, TNF-α and FGF21 by ELISA.Results: The result of fNIRS showed the hemodynamic activation in the prefrontal region of the experimental group was significantly increased. Both groups of FGF21 increased and compared with the control group, the experimental group has a greater upsurge and a faster increase rate.Conclusions: VR alleviates PSD. FGF21 is closely related to PSD，and it is likely to be a potential pathological mechanism of PSD. It suggests that VR is possible to improve PSD by increasing FGF21.Trial registration: We registered in Chinese Clinical Trial Registry which is the first level registration organization of WHO international clinical trial registration platform. The registration number is ChiCTR1900027987, the date of registration December 7, 2019.

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