Characterizing the Neural Bases of Motivational Disorders After Stroke — MOTI-stroke  

Stroke Clinical Trial

Official title: Characterizing the Neural Bases of Motivational Disorders After Stroke

Status Recruiting

Clinical Trial Summary

The aim of the study is to quantify elementary mechanisms of motivation, with innovative tools adapted to clinical settings, in healthy subjects, and in stroke patients, and to investigate their predictive value related to morbimortality, disability, and dependence. The secondary aim of the study is to investigate the neural substrates of motivational mechanisms, and to study the impact of lesions in the grey and the white matter, the influence of lesion site, and the consequences of disconnection in functional networks.

Clinical Trial Description

Disorders of motivation, such as apathy, are among the most prevalent symptoms in neuropsychiatric disorders and during chronic diseases. They have a major impact on patients' physical activity and lifestyle, and on their involvement in their own care. They affect a wide range of morbidity outcomes, alter functional recovery in rehabilitation, impair long-term disability, and prevent patients from returning to an active and independent life. Yet, the neural bases of motivational deficits remain largely unknown. Current diagnostic tools are sparse and cannot distinguish between distinct mechanisms responsible for apathetic syndromes. Besides, current treatments remain extremely limited. However, recent advances in the field of neuroeconomics - the science of decision-making - have provided concept and tools to study the neurobiological bases of elementary cognitive processes underlying motivated behaviors. These theories suggest that the brain implements optimization processes that determine our behaviors by minimizing the cost of our actions while maximizing their expected benefits. The adaptation of tools developed for basic research now enables the assessment of these cognitive mechanisms.

Elementary deficits of motivation will be assessed with a phenotyping battery of motivation tests in 20 healthy subjects (up to 10 healthy subjects can be replaced), 20 patients (up to 10 patients can be replaced) with a stroke in the medial prefrontal cortex, and 20 patients (up to 10 patients can be replaced) with a stroke in the insula. This battery will allow us to characterize, at the patient's level, elementary processes such as the encoding and the learning rate of goal values or effort costs, the modulation of value with delay or episodic context, the modulation of cost with fatigue, and the resolution of cost-benefit trade-offs. We will record morbimortality outcomes, such as functional recovery, disability, quality of life and burden for caregivers. Symptom-Lesion mapping studies and voxel-based morphometry studies will be performed using whole brain MRI measures of structural and functional integrity. ;

Related Conditions & MeSH terms

• Stroke

• NCT number: NCT03741140
• Study type: Interventional
• Source: Institut National de la Santé Et de la Recherche Médicale, France
• Contact: Raphael Le Bouc, PD, PhD
• Phone: +33 (0) 1 42 16 18 54
• Email: raphael.lebouc@icm-institute.org
• Status: Recruiting
• Phase: N/A
• Start date: October 22, 2020
• Completion date: January 2023