Exploring the Association Between Cerebellar Regional Volumes and Health-Related Quality of Life in Patients with Ischemic Stroke: A Prospective Cohort Study

The roles of cerebellum after ischemic stroke remains unclear. This study aimed to assess the influence of cerebellar regional volumes on health-related quality of life (HRQoL) outcomes in patients with ischemic stroke. Using data from the China National Stroke Registry III (CNSR-III) cohort, patients having supratentorial ischemic stroke (SIS) with complete clinical and neuroimaging data were included. Volumes of 39 cerebellar regions, derived from structural magnetic resonance imaging via anatomical segmentation, were evaluated as exposures. The European Quality of Life five-dimension three-level questionnaire, defined short- and long-term multidimensional HRQoL outcomes at 3 and 12 months post-SIS respectively, further categorized into mobility, self-care, usual activity, and anxiety/depression dimensions. The population proportion of moderate and severe problems in 3-month HRQoL outcomes was higher than that in 12-month outcomes in the CNSR-III. Among 8,210 patients with SIS, the mean age was 62.39 ± 11.12 years, and 67.64% were male. Reduced volumes in left Crus I (OR[Odds ratio]_mobility = 0.885, 95% CI[Confidence interval]_mobility 0.827-0.946, p_mobility = 0.0004; OR_self-care = 0.867, 95% CI_self-care 0.807-0.933, p_self-care = 0.0001; OR_{usual activity} = 0.856, 95% CI_{usual activity} 0.801-0.914, p_{usual activity} < 0.0001) and right VIIb (OR_mobility = 0.902, 95% CI_mobility 0.851-0.957, p_mobility = 0.0006; OR_self-care = 0.877, 95% CI_self-care 0.823-0.934, p_self-care < 0.0001; OR_{usual activity} = 0.883, 95% CI_{usual activity} 0.834-0.936, p_{usual activity} < 0.0001) lobules were significantly associated with poorer 12-month motor and social functions after SIS. Reduced left I-IV lobular volume was associated with 12-month affective disorder (OR = 0.838, 95% CI 0.761-0.922, p = 0.0003). This study highlights the importance of cerebellar specific-regional structural reserve in the prognosis of SIS, providing new insights into SIS recovery targeting the cerebellum.