101
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Phillips OR, Nuechterlein KH, Clark KA, Hamilton LS, Asarnow RF, Hageman NS, Toga AW, Narr KL. Fiber tractography reveals disruption of temporal lobe white matter tracts in schizophrenia. Schizophr Res 2009; 107:30-8. [PMID: 19028423 PMCID: PMC2655322 DOI: 10.1016/j.schres.2008.10.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 10/17/2008] [Accepted: 10/21/2008] [Indexed: 10/21/2022]
Abstract
Diffusion tensor imaging (DTI) studies have demonstrated abnormal anisotropic diffusion in schizophrenia. However, examining data with low spatial resolution and/or a low number of gradient directions and limitations associated with analysis approaches sensitive to registration confounds may have contributed to mixed findings concerning the regional specificity and direction of results. This study examined three major white matter tracts connecting lateral and medial temporal lobe regions with neocortical association regions widely implicated in systems-level functional and structural disturbances in schizophrenia. Using DTIstudio, a previously validated regions of interest tractography method was applied to 30 direction diffusion weighted imaging data collected from demographically similar schizophrenia (n=23) and healthy control subjects (n=22). The diffusion tensor was computed at each voxel after intra-subject registration of diffusion-weighted images. Three-dimensional tract reconstruction was performed using the Fiber Assignment by Continuous Tracking (FACT) algorithm. Tractography results showed reduced fractional anisotropy (FA) of the arcuate fasciculi (AF) and inferior longitudinal fasciculi (ILF) in patients compared to controls. FA changes within the right ILF were negatively correlated with measures of thinking disorder. Reduced volume of the left AF was also observed in patients. These results, which avoid registration issues associated with voxel-based analyses of DTI data, support that fiber pathways connecting lateral and medial temporal lobe regions with neocortical regions are compromised in schizophrenia. Disruptions of connectivity within these pathways may potentially contribute to the disturbances of memory, language, and social cognitive processing that characterize the disorder.
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Affiliation(s)
- Owen R. Phillips
- Laboratory of Neuro Imaging, Department of Neurology Geffen School of Medicine at UCLA
| | - Keith H. Nuechterlein
- Department of Psychiatry and Biobehavioral Sciences Geffen School of Medicine at UCLA
| | - Kristi A. Clark
- Ahmanson-Lovelace Brain Mapping Center, Department of Neurology Geffen School of Medicine at UCLA
| | - Liberty S. Hamilton
- Laboratory of Neuro Imaging, Department of Neurology Geffen School of Medicine at UCLA
| | - Robert F. Asarnow
- Department of Psychiatry and Biobehavioral Sciences Geffen School of Medicine at UCLA
| | - Nathan S. Hageman
- Laboratory of Neuro Imaging, Department of Neurology Geffen School of Medicine at UCLA
| | - Arthur W. Toga
- Laboratory of Neuro Imaging, Department of Neurology Geffen School of Medicine at UCLA
| | - Katherine L. Narr
- Laboratory of Neuro Imaging, Department of Neurology Geffen School of Medicine at UCLA
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102
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Reig S, Moreno C, Moreno D, Burdalo M, Janssen J, Parellada M, Zabala A, Desco M, Arango C. Progression of brain volume changes in adolescent-onset psychosis. Schizophr Bull 2009; 35:233-43. [PMID: 18222929 PMCID: PMC2643965 DOI: 10.1093/schbul/sbm160] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Little is known about the changes that take place in the adolescent brain over the first few years following the onset of psychosis. The present longitudinal study builds on an earlier cross-sectional report demonstrating brain abnormalities in adolescent-onset psychosis patients with a recent-onset first episode of psychosis. Magnetic resonance imaging studies were obtained at baseline and 2 years later from 21 adolescents with psychosis and 34 healthy controls matched for age, gender, and years of education. Whole-brain volumes and gray matter (GM) and cerebrospinal fluid (CSF) volumes of the frontal, parietal, temporal, and occipital lobes were measured at baseline and at 2-year follow-up. In the frontal lobe, the rate of GM volume loss was significantly higher in male patients (2.9% and 2.0%, respectively, for left and right) than in controls (1.2% and 0.7%, respectively, for left and right). In the left frontal lobe, male patients showed a significantly higher rate of CSF volume increase than controls (8.6% vs 6.4%). These differences in rates of volume change were observed in male and female patients, although only males showed significant time x diagnosis interactions. This negative finding in females should be interpreted with caution as the study was underpowered to detect change in women due to limited sample size. An exploratory analysis revealed that schizophrenia and nonschizophrenia psychotic disorders showed similar volume change patterns relative to controls. Change in clinical status was not correlated with longitudinal brain changes. Our results support progression of frontal lobe changes in males with adolescent-onset psychosis.
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Affiliation(s)
| | - Carmen Moreno
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dolores Moreno
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Maite Burdalo
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Joost Janssen
- Department of Experimental Medicine,Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Mara Parellada
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Arantzazu Zabala
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Celso Arango
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain,To whom correspondence should be addressed; Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Dr Esquerdo 46, Madrid 28007, Spain; tel: 34-914265057, fax: 34-914265108, e-mail:
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103
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Meta-analysis of gray matter anomalies in schizophrenia: application of anatomic likelihood estimation and network analysis. Biol Psychiatry 2008; 64:774-81. [PMID: 18486104 PMCID: PMC5441233 DOI: 10.1016/j.biopsych.2008.03.031] [Citation(s) in RCA: 482] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 03/12/2008] [Accepted: 03/14/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although structural neuroimaging methods have been widely used to study brain morphology in schizophrenia, synthesizing this literature has been difficult. With the increasing popularity of voxel-based morphometric (VBM) methods in which group differences are reported in standardized coordinates, it is possible to apply powerful meta-analytic techniques initially designed for functional neuroimaging. In this study, we performed a voxelwise, coordinate-based meta-analysis to better conceptualize the neuroanatomic correlates of schizophrenia. METHODS Thirty-one peer-reviewed articles, with a total of 1195 patients with schizophrenia contrasted with 1262 healthy volunteers, were included in the meta-analysis. Coordinates from each article were used to create a statistical map that estimated the likelihood of between-group gray matter density differences at every brain voxel. These results were subsequently entered into a network analysis. RESULTS Patients had reduced gray matter density relative to control subjects in a distributed network of regions, including bilateral insular cortex, anterior cingulate, left parahippocampal gyrus, left middle frontal gyrus, postcentral gyrus, and thalamus. Network analysis grouped these regions into four distinct networks that potentially represent different pathologic processes. Patients had increased gray matter density in striatal regions. CONCLUSIONS This study expands on previous meta-analyses of the neuroanatomy of schizophrenia by elucidating a series of brain networks disrupted by the illness. Because it is possible that these networks are influenced by independent etiologic factors, this work should foster more detailed neural models of the illness and focus research designed to discover the mechanisms of gray matter reduction in schizophrenia.
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104
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Kirkpatrick B, Messias E, Harvey PD, Fernandez-Egea E, Bowie CR. Is schizophrenia a syndrome of accelerated aging? Schizophr Bull 2008; 34:1024-32. [PMID: 18156637 PMCID: PMC2632500 DOI: 10.1093/schbul/sbm140] [Citation(s) in RCA: 227] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Schizophrenia is associated with a number of anatomical and physiological abnormalities outside of the brain, as well as with a decrease in average life span estimated at 20% in the United States. Some studies suggest that this increased mortality is not entirely due to associated causes such as suicide and the use of psychotropic medications. In this article, in order to focus greater attention on the increased mortality associated with schizophrenia, we present a special case of the hypothesis that physiological abnormalities associated with schizophrenia make a contribution to the increased mortality of schizophrenia: specifically, the hypothesis that schizophrenia is a syndrome of accelerated aging. Evidence consistent with this hypothesis comes from several areas. The biological plausibility of the hypothesis is supported by the existence of established syndromes of accelerated aging and by the sharing of risk factors between schizophrenia and other age-related conditions. We propose methods for testing the hypothesis.
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Affiliation(s)
- Brian Kirkpatrick
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA, USA.
| | - Erick Messias
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta, GA
| | - Philip D. Harvey
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Emilio Fernandez-Egea
- Department of Psychiatry, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
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105
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Wozniak JR, Block EE, White T, Jensen JB, Schulz SC. Clinical and neurocognitive course in early-onset psychosis: a longitudinal study of adolescents with schizophrenia-spectrum disorders. Early Interv Psychiatry 2008; 2:169-77. [PMID: 21352150 PMCID: PMC5674519 DOI: 10.1111/j.1751-7893.2008.00075.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM Adolescents with psychotic disorders show deficits in IQ, attention, learning and memory, executive functioning, and processing speed that are related to important clinical variables including negative symptoms, adaptive functioning and academics. Previous studies have reported relatively consistent deficits with varying relationships to illness status and symptoms. The goals of this study were to examine these relationships in a larger sample at baseline, and also to examine the longitudinal course of these deficits in a smaller subset of adolescents. METHOD Thirty-six subjects, aged 10 to 17 years, were included at baseline. All had Diagnostic and Statistical Manual-Fourth Edition diagnoses of schizophrenia, schizoaffective disorder, schizophreniform disorder and psychosis - not otherwise specified, as determined by Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children structured interviews. Patients were administered a neuropsychological battery, and Positive and Negative Syndrome Scale ratings were completed at baseline and again at 1 year (n = 14). Most participants were inpatients at baseline, and 13 of 14 were on atypical antipsychotic medication during both sessions. RESULTS At baseline, the patients demonstrated impairments in working memory, processing speed, executive function and verbal learning. No significant cognitive change was detected at 1-year follow-up. In contrast, clinical symptoms were variable across 1 year, with an improvement in positive symptoms at 1 year. No relationships between clinical and cognitive symptoms were observed, with the exception of baseline IQ predicting negative symptoms at 1 year. CONCLUSIONS Young patients with schizophrenia-spectrum disorders displayed neurocognitive impairments at baseline. Despite measurable fluctuations in clinical symptoms over the year, no significant changes were measured in cognition. Lower IQ at baseline was predictive of more negative symptoms at 1 year.
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Affiliation(s)
- Jeffrey R Wozniak
- Department of Psychiatry, University of Minnesota Medical Center-Twin Cities, Minneapolis, Minnesota 55454, USA.
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106
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Ellison-Wright I, Glahn DC, Laird AR, Thelen SM, Bullmore E. The anatomy of first-episode and chronic schizophrenia: an anatomical likelihood estimation meta-analysis. Am J Psychiatry 2008; 165:1015-23. [PMID: 18381902 PMCID: PMC2873788 DOI: 10.1176/appi.ajp.2008.07101562] [Citation(s) in RCA: 470] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to map gray matter changes in first-episode schizophrenia and to compare these with the changes in chronic schizophrenia. They postulated that the data would show a progression of changes from hippocampal deficits in first-episode schizophrenia to include volume reductions in the amygdala and cortical gray matter in chronic schizophrenia. METHOD A systematic search was conducted for voxel-based structural MRI studies of patients with first-episode schizophrenia and chronic schizophrenia in relation to comparison groups. Meta-analyses of the coordinates of gray matter differences were carried out using anatomical likelihood estimation. Maps of gray matter changes were constructed, and subtraction meta-analysis was used to compare them. RESULTS A total of 27 articles were identified for inclusion in the meta-analyses. A marked correspondence was observed in regions affected by both first-episode schizophrenia and chronic schizophrenia, including gray matter decreases in the thalamus, the left uncus/amygdala region, the insula bilaterally, and the anterior cingulate. In the comparison of first-episode schizophrenia and chronic schizophrenia, decreases in gray matter volume were detected in first-episode schizophrenia but not in chronic schizophrenia in the caudate head bilaterally; decreases were more widespread in cortical regions in chronic schizophrenia. CONCLUSIONS Anatomical changes in first-episode schizophrenia broadly coincide with a basal ganglia-thalamocortical circuit. These changes include bilateral reductions in caudate head gray matter, which are absent in chronic schizophrenia. Comparing first-episode schizophrenia and chronic schizophrenia, the authors did not find evidence for the temporolimbic progression of pathology from hippocampus to amygdala, but there was evidence for progression of cortical changes.
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Affiliation(s)
- Ian Ellison-Wright
- Avon and Wiltshire Mental Health Partnership NHS Trust, Beechlydene Ward, Fountain Way, Wilton Rd., Salisbury SP2 7EP, United Kingdom.
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107
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Arango C, Moreno C, Martínez S, Parellada M, Desco M, Moreno D, Fraguas D, Gogtay N, James A, Rapoport J. Longitudinal brain changes in early-onset psychosis. Schizophr Bull 2008; 34:341-53. [PMID: 18234701 PMCID: PMC2632400 DOI: 10.1093/schbul/sbm157] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Progressive losses of cortical gray matter volumes and increases in ventricular volumes have been reported in patients with childhood-onset schizophrenia (COS) during adolescence. Longitudinal studies suggest that the rate of cortical loss seen in COS during adolescence plateaus during early adulthood. Patients with first-episode adolescent-onset schizophrenia show less marked progressive changes, although the number of studies in this population is small. Some studies show that, although less exaggerated, progressive changes are also present in nonschizophrenia early-onset psychosis. The greater loss of brain tissue seen in COS, even some years after the first episode, as compared to adolescent- or adult-onset schizophrenia may be due to variables such as sample bias (more severe, treatment refractory sample of childhood-onset patients studied), a process uniquely related to adolescent development in COS, differential brain effects of drug treatment in this population, clinical outcome, or interactions among these variables. Findings from both cross-sectional studies of first-episode patients and longitudinal studies in COS and adolescent onset support the concept of early-onset schizophrenia as a progressive neurodevelopmental disorder with both early and late developmental abnormalities. Future studies should look for correlates at a cellular level and for pathophysiological explanations of volume changes in these populations. The association of risk genes involved in circuitries associated with schizophrenia and their relationship to developmental trajectories is another promising area of future research.
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Affiliation(s)
- Celso Arango
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Carmen Moreno
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Salvador Martínez
- Instituto de Neurociencias, Universidad Miguel Hernandez, Alicante, Spain
| | - Mara Parellada
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Manuel Desco
- Unidad de Medicina y Cirugía Experimental, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - David Fraguas
- Adolescent Unit, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Nitin Gogtay
- Child Psychiatry Branch, National Institute of Mental Health, Room 3N202, Building 10, Center Drive, Bethesda, MD 20892
| | - Anthony James
- Highfield Adolescent Unit, Warneford Hospital, Oxford, UK
| | - Judith Rapoport
- Child Psychiatry Branch, National Institute of Mental Health, Room 3N202, Building 10, Center Drive, Bethesda, MD 20892
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108
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Karlsgodt KH, van Erp TGM, Poldrack RA, Bearden CE, Nuechterlein KH, Cannon TD. Diffusion tensor imaging of the superior longitudinal fasciculus and working memory in recent-onset schizophrenia. Biol Psychiatry 2008; 63:512-8. [PMID: 17720147 DOI: 10.1016/j.biopsych.2007.06.017] [Citation(s) in RCA: 260] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Revised: 06/12/2007] [Accepted: 06/14/2007] [Indexed: 11/15/2022]
Abstract
BACKGROUND Structural and functional abnormalities in frontal-parietal circuitry are thought to be associated with working memory (WM) deficits in patients with schizophrenia. This study examines whether recent-onset schizophrenia is associated with anatomical changes in the superior longitudinal fasciculus (SLF), the main frontal-parietal white matter connection, and whether the integrity of the SLF is related to WM performance. METHODS We applied a novel registration approach (Tract-Based Spatial Statistics [TBSS]) to diffusion tensor imaging data to examine fractional anisotropy (FA) in the left and right SLF in 12 young adult patients with recent-onset schizophrenia and 17 matched control subjects. RESULTS Schizophrenia patients showed lower FA values than control subjects across the entire SLF, with particular deficits on the left SLF. Fractional anisotropy values were correlated with performance on a verbal WM task in both patient and control groups in the left but not right SLF. CONCLUSIONS Recent-onset schizophrenia patients show deficits in frontal-parietal connections, key components of WM circuitry. Moreover, the integrity of this physiological connection predicted performance on a verbal WM task, indicating that this structural change may have important functional implications. These findings support the view that schizophrenia is a disorder of brain connectivity and implicate white matter changes detectable in the early phases of the illness as one source of this dysfunction.
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Affiliation(s)
- Katherine H Karlsgodt
- Department of Psychology, University of California, Los Angeles, California 90095-1563, USA.
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109
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Affiliation(s)
- Celso Arango
- Unidad de Adolescentes, Department of Psychiatry, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - René Kahn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands
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110
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DeLisi LE. The concept of progressive brain change in schizophrenia: implications for understanding schizophrenia. Schizophr Bull 2008; 34:312-21. [PMID: 18263882 PMCID: PMC2632405 DOI: 10.1093/schbul/sbm164] [Citation(s) in RCA: 145] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Kraepelin originally defined dementia praecox as a progressive brain disease, although this concept has received various degrees of acceptance and rejection over the years since his famous published textbooks appeared. This article places an historical perspective on the current renewal of Kraepelin's concept in brain imaging literature that supports progressive brain change in schizophrenia from its earliest stages through its chronic course. It is concluded that a great deal of future research is needed focusing on the longitudinal course of change, the extent to the regions of change within each individual and the underlying mechanism and implications of brain change through functional and neurochemical imaging, combined with structural studies in the same individuals.
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Affiliation(s)
- Lynn E DeLisi
- New York University School of Medicine, 650 First Avenue, New York, NY 1006, USA.
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111
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Zipparo L, Whitford TJ, Redoblado Hodge MA, Lucas S, Farrow TFD, Brennan J, Gomes L, Williams LM, Harris AWF. Investigating the neuropsychological and neuroanatomical changes that occur over the first 2-3 years of illness in patients with first-episode schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:531-8. [PMID: 18061326 DOI: 10.1016/j.pnpbp.2007.10.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 10/03/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE This study explored the concurrent courses of the neuroanatomical and neuropsychological changes that occurred over the first 2-3 years of illness in patients with first-episode schizophrenia (FES). METHODS Fifty-two patients with FES underwent neuropsychological testing and a structural magnetic resonance imaging (sMRI) scan within three months of their first presentation to mental health services with psychotic symptoms (time1). Patients' cognitive performance was evaluated via an extensive neuropsychological test battery, which assessed 9 cognitive domains. Of the 52 patients at time1, 32 returned 2-3 years later (time2) for follow-up neuropsychological testing, and 20 of these also underwent follow-up sMRI. MR images were preprocessed in SPM99. Grey matter volumes of patients' whole-brain, frontal lobes and temporal lobes were calculated by convolving the preprocessed images with manually-drawn binary masks. RESULTS Patients exhibited longitudinal improvements in full-scale IQ, performance IQ and visual memory. In contrast, concurrent reductions in grey matter were observed for the whole-brain (3% reduction) and the frontal lobe (3.65% reduction). Furthermore, the extent of patients' whole-brain and frontal-lobe grey matter changes were positively correlated with longitudinal changes in verbal learning and memory. DISCUSSION The results of this study suggest that while the early stages of schizophrenia are associated with a mild improvement in patients' overall cognitive functioning, they are also associated with progressive grey matter atrophy.
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Affiliation(s)
- Lisa Zipparo
- Department of Psychology, Macquarie University, North Ryde, NSW, Australia.
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112
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Nesvåg R, Lawyer G, Varnäs K, Fjell AM, Walhovd KB, Frigessi A, Jönsson EG, Agartz I. Regional thinning of the cerebral cortex in schizophrenia: effects of diagnosis, age and antipsychotic medication. Schizophr Res 2008; 98:16-28. [PMID: 17933495 DOI: 10.1016/j.schres.2007.09.015] [Citation(s) in RCA: 175] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 09/03/2007] [Accepted: 09/12/2007] [Indexed: 11/18/2022]
Abstract
Morphological abnormalities of the cerebral cortex have been reported in a number of MRI-studies in schizophrenia. Uncertainty remains regarding cause, mechanism and progression of the alterations. It has been suggested that antipsychotic medication reduces total gray matter volumes, but results are inconsistent. In the present study differences in regional cortical thickness between 96 patients with a DSM-IV diagnosis of schizophrenia (n=81) or schizoaffective disorder (n=15) and 107 healthy subjects (mean age 42 years, range 17-57 years) were investigated using MRI and computer image analysis. Cortical thickness was estimated as the shortest distance between the gray/white matter border and the pial surface at numerous points across the entire cortical mantle. The influence of age and antipsychotic medication on variation in global and regional cortical thickness was explored. Thinner cortex among patients than controls was found in prefrontal and temporal regions of both hemispheres, while parietal and occipital regions were relatively spared. Some hemispheric specificity was noted, as regions of the prefrontal cortex were more affected in the right hemisphere, and regions of the temporal cortex in the left hemisphere. No significant interaction effect of age and diagnostic group on variation in cortical thickness was demonstrated. Among patients, dose or type of antipsychotic medication did not affect variation in cortical thickness. The results from this hitherto largest study on the topic show that prefrontal and temporal cortical thinning in patients with schizophrenia compared to controls is as pronounced in older as in younger subjects. The lack of significant influence from antipsychotic medication supports that regional cortical thinning is an inherent feature of the neurobiological disease process in schizophrenia.
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Affiliation(s)
- Ragnar Nesvåg
- Department of Psychiatric Research, Diakonhjemmet Hospital, and Institute of Psychiatry, University of Oslo, Norway.
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113
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Keller SS, Roberts N. Voxel-based morphometry of temporal lobe epilepsy: an introduction and review of the literature. Epilepsia 2007; 49:741-57. [PMID: 18177358 DOI: 10.1111/j.1528-1167.2007.01485.x] [Citation(s) in RCA: 322] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We review the applications and results of voxel-based morphometry (VBM) studies that have reported brain changes associated with temporal lobe epilepsy (TLE). A PubMed search yielded 18 applications of VBM to study brain abnormalities in patients with TLE up to May 2007. Across studies, 26 brain regions were found to be significantly reduced in volume relative to healthy controls. There was a strong asymmetrical distribution of temporal lobe abnormalities preferentially observed ipsilateral to the seizure focus, particularly of the hippocampus (82.35% of all studies), parahippocampal gyrus (47.06%), and entorhinal (23.52%) cortex. The contralateral hippocampus was reported as abnormal in 17.65% of studies. There was a much more bilateral distribution of extratemporal lobe atrophy, preferentially affecting the thalamus (ipsilateral = 61.11%, contralateral = 50%) and parietal lobe (ipsilateral = 47.06%, contralateral = 52.94%). VBM generally reveals a distribution of brain abnormalities in patients with TLE consistent with the region-of-interest neuroimaging and postmortem literature. It is unlikely that VBM has any clinical utility given the lack of robustness for individual comparisons. However, VBM may help elucidate some unresolved important research questions such as how recurrent temporal lobe seizures affect hippocampal and extrahippocampal morphology using serial imaging acquisitions.
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Affiliation(s)
- Simon Sean Keller
- The Magnetic Resonance and Image Analysis Research Centre, University of Liverpool, Liverpool, United Kingdom.
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114
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Moorhead TWJ, McKirdy J, Sussmann JED, Hall J, Lawrie SM, Johnstone EC, McIntosh AM. Progressive gray matter loss in patients with bipolar disorder. Biol Psychiatry 2007; 62:894-900. [PMID: 17617385 DOI: 10.1016/j.biopsych.2007.03.005] [Citation(s) in RCA: 231] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 03/07/2007] [Accepted: 03/08/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Structural brain abnormalities of the medial temporal lobe have been found in people with bipolar disorder (BPD). It is not known whether these abnormalities progress over the course of the illness or how they relate to neuropsychologic functioning. We sought to address these uncertainties in a prospective cohort study of people with bipolar I disorder. METHODS Twenty patients with bipolar I disorder and 21 control subjects were recruited from the community. Participants were group matched for age, sex, and premorbid IQ. Longitudinal change in gray matter density was assessed using magnetic resonance imaging and evaluated using the technique of tensor-based morphometry with SPM2 software. Changes in gray and white matter density were estimated and compared with changes in cognitive function and clinical outcome. RESULTS Patients with BPD showed a larger decline in hippocampal, fusiform, and cerebellar gray matter density over 4 years than control subjects. No significant changes in white matter density were found. Reductions in temporal lobe gray matter correlated with decline in intellectual function and with the number of intervening mood episodes over the follow-up period. CONCLUSIONS Patients with BPD lose hippocampal, fusiform and cerebellar gray matter at an accelerated rate compared with healthy control subjects. This tissue loss is associated with deterioration in cognitive function and illness course.
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Affiliation(s)
- T William J Moorhead
- Division of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, United Kingdom
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115
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Abstract
Neuroimaging and electrophysiological investigations have demonstrated numerous differences in brain morphology and function of chronic schizophrenia patients compared to healthy controls. Studying patients at the beginning of their disease without the confounding effects of chronicity, medication, and institutionalization may provide a better understanding of schizophrenia. Recently, at many institutions around the world, special projects have been launched for specialized treatment and research of this interesting patient group. Using the PubMed search engine in this update, the authors summarize recent investigations between January 2002 and September 2006 that focus on whether signs of disconnectivity already exist early in the disease process. They discuss gray and white matter changes, their impact on symptomatology, electroencephalogram-based studies on connectivity, and possible influences of medication. NEUROSCIENTIST 14(1):19—45, 2008. DOI: 10.1177/1073858406298391
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Affiliation(s)
- S Begré
- Department of General Internal Medicine, Division of Psychosomatic Medicine, University Hospital Bern, Switzerland.
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116
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Rockstroh BS, Wienbruch C, Ray WJ, Elbert T. Abnormal oscillatory brain dynamics in schizophrenia: a sign of deviant communication in neural network? BMC Psychiatry 2007; 7:44. [PMID: 17760978 PMCID: PMC2034549 DOI: 10.1186/1471-244x-7-44] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Accepted: 08/30/2007] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Slow waves in the delta (0.5-4 Hz) frequency range are indications of normal activity in sleep. In neurological disorders, focal electric and magnetic slow wave activity is generated in the vicinity of structural brain lesions. Initial studies, including our own, suggest that the distribution of the focal concentration of generators of slow waves (dipole density in the delta frequency band) also distinguishes patients with psychiatric disorders such as schizophrenia, affective disorders, and posttraumatic stress disorder. METHODS The present study examined the distribution of focal slow wave activity (ASWA: abnormal slow wave activity) in 116 healthy subjects, 76 inpatients with schizophrenic or schizoaffective diagnoses and 42 inpatients with affective (ICD-10: F3) or neurotic/reactive (F4) diagnoses using a newly refined measure of dipole density. Based on 5-min resting magnetoencephalogram (MEG), sources of activity in the 1-4 Hz frequency band were determined by equivalent dipole fitting in anatomically defined cortical regions. RESULTS Compared to healthy subjects the schizophrenia sample was characterized by significantly more intense slow wave activity, with maxima in frontal and central areas. In contrast, affective disorder patients exhibited less slow wave generators mainly in frontal and central regions when compared to healthy subjects and schizophrenia patients. In both samples, frontal ASWA were related to affective symptoms. CONCLUSION In schizophrenic patients, the regions of ASWA correspond to those identified for gray matter loss. This suggests that ASWA might be evaluated as a measure of altered neuronal network architecture and communication, which may mediate psychopathological signs.
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Affiliation(s)
- Brigitte S Rockstroh
- Department of Psychology, University of Konstanz, PO Box D23 D-78457, Konstanz, Germany
| | - Christian Wienbruch
- Department of Psychology, University of Konstanz, PO Box D23 D-78457, Konstanz, Germany
| | - William J Ray
- Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, PO Box D23 D-78457, Konstanz, Germany
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Razafimandimby A, Maïza O, Hervé PY, Lecardeur L, Delamillieure P, Brazo P, Mazoyer B, Tzourio-Mazoyer N, Dollfus S. Stability of functional language lateralization over time in schizophrenia patients. Schizophr Res 2007; 94:197-206. [PMID: 17570644 DOI: 10.1016/j.schres.2007.04.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 04/10/2007] [Accepted: 04/14/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cross-sectional functional imaging studies have shown a reduced leftward language lateralization in schizophrenic patients. An unanswered question is whether this reduced leftward lateralization is stable over time or is modified over the course of the illness. METHODS Ten right-handed (RH) patients (DSM-IV) and 10 RH controls were matched one-to-one for sex, age, and level of education. The subjects underwent two separate fMRI sessions while engaged in a story listening task, 21 months apart. After each session, story comprehension (task performance) was assessed through a 12-item questionnaire. The stability of the decreased asymmetry indices in the semantic region of interest (LANG) was investigated with an ANOVA to compare groups and sessions. In order to test the evolution of functional asymmetry indices at an individual level, a linear correlation between both fMRI session asymmetry indices was calculated in all subjects. Correlations between asymmetry indices and the severity of psychotic symptoms or task performances were computed. RESULTS The asymmetry indices of the LANG were significantly reduced in patients as compared to controls and strongly correlated between sessions. Values of asymmetry indices were unrelated to either psychotic symptoms or task performances. CONCLUSIONS This reduced leftward lateralization for language did not vary over time and was not influenced by the psychosis severity or the task performances. This result reinforces the hypothesis that schizophrenia is characterized by a particular organization of language.
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Affiliation(s)
- Annick Razafimandimby
- Groupe d'Imagerie Neurofonctionnelle, UMR 6194 CNRS/CEA/Universités de Caen et Paris 5, GIP Cyceron, Bld Henri Becquerel, 14074 Caen Cedex, France
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118
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Gordon E. Integrating genomics and neuromarkers for the era of brain-related personalized medicine. Per Med 2007; 4:201-215. [DOI: 10.2217/17410541.4.2.201] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The harsh reality is that many medical treatments do not work as expected in a significant percentage of patients, and occasionally there are serious side effects. A new paradigm of personalized medicine is emerging, which proactively tailors treatment to each individual’s biological and psychological profile. The first proof-of-concept phase of personalized medicine has now been achieved. However, it has thus far focused on the use of genomic markers and on disorders of the body. The complexity of the brain is likely to require a shift from a single genetic marker focus to a more integrated approach in which additional brain-related information (neuromarkers) is taken into account. Codevelopment of genomic neuromarkers with new compounds in a personalized medicine approach will lead to increased drug R&D and treatment benefits. The emerging genomic neuromarker potential has begun to be incorporated into the template for the next version of the Diagnostic and Statistical Manual (DSM-V). The statistical power of large subject numbers in databases in general (and standardized databases in particular) provides an ideal source for elucidating the best genomic–neuromarker profiles (explaining most of the main-effects variance), which will empower a brain-related personalized medicine into mainstream clinical practice.
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Affiliation(s)
- Evian Gordon
- Brain Resource Company and Brain Resource International Database, NSW 2007, Australia
- University of Sydney, Brain Dynamics Centre, Westmead Millenium Institute, Westmead Hospital and Western Clinical School, NSW 2145, Australia
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119
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Whitford TJ, Farrow TFD, Rennie CJ, Grieve SM, Gomes L, Brennan J, Harris AWF, Williams LM. Longitudinal changes in neuroanatomy and neural activity in early schizophrenia. Neuroreport 2007; 18:435-9. [PMID: 17496799 DOI: 10.1097/wnr.0b013e3280119d31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although there is substantial evidence indicating that patients with first-episode schizophrenia exhibit both anatomical and electrophysiological abnormalities, there has been little research investigating the relationship between these two indices. We acquired structural magnetic resonance images and resting electroencephalographic recordings from 19 patients with schizophrenia, both at the time of their first presentation to mental health services and 2-3 years subsequently. Patients' grey matter images were parcellated into four brain lobes, and slow-wave, alpha- and beta-electroencephalographic power was calculated in four corresponding cortical regions. Although grey matter volume decreased longitudinally, particularly fronto-parietally, electroencephalographic power increased in the slow-wave and beta-frequency bands. These results suggest that first-episode schizophrenia may be associated with abnormally elevated levels of neural synchrony.
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Affiliation(s)
- Thomas J Whitford
- The Brain Dynamics Centre, Westmead Millennium Institute and University of Sydney, and Acacia House, Westmead Hospital, New South Wales, Australia.
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Gordon E, Liddell BJ, Brown KJ, Bryant R, Clark CR, DAS P, Dobson-Stone C, Falconer E, Felmingham K, Flynn G, Gatt JM, Harris A, Hermens DF, Hopkinson PJ, Kemp AH, Kuan SA, Lazzaro I, Moyle J, Paul RH, Rennie CJ, Schofield P, Whitford T, Williams LM. INTEGRATING OBJECTIVE GENE-BRAIN-BEHAVIOR MARKERS OF PSYCHIATRIC DISORDERS. J Integr Neurosci 2007; 6:1-34. [PMID: 17472223 DOI: 10.1142/s0219635207001465] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 02/28/2007] [Indexed: 11/18/2022] Open
Abstract
There is little consensus about which objective markers should be used to assess major psychiatric disorders, and predict/evaluate treatment response for these disorders. Clinical practice relies instead on subjective signs and symptoms, such that there is a "translational gap" between research findings and clinical practice. This gap arises from: a) a lack of integrative theoretical models which provide a basis for understanding links between gene-brain-behavior mechanisms and clinical entities; b) the reliance on studying one measure at a time so that linkages between markers are their specificity are not established; and c) the lack of a definitive understanding of what constitutes normative function. Here, we draw on a standardized methodology for acquiring multiple sources of genomic, brain and behavioral data in the same subjects, to propose candidate markers of selected psychiatric disorders: depression, post-traumatic stress disorder, schizophrenia, attention-deficit/hyperactivity disorder and dementia disorders. This methodology has been used to establish a standardized international database which provides a comprehensive framework and the basis for testing hypotheses derived from an integrative theoretical model of the brain. Using this normative base, we present preliminary findings for a number of disorders in relation to the proposed markers. Establishing these objective markers will be the first step towards determining their sensitivity, specificity and treatment prediction in individual patients.
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Affiliation(s)
- Evian Gordon
- The Brain Resource International Database and the Brain Resource Company, Sydney, NSW 2007, Australia.
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Pagani E, Horsfield MA, Rocca MA, Filippi M. Assessing atrophy of the major white matter fiber bundles of the brain from diffusion tensor MRI data. Magn Reson Med 2007; 58:527-34. [PMID: 17763353 DOI: 10.1002/mrm.21346] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Brain atrophy is a typical feature of many neurological conditions. Therefore, quantitative evaluation and spatial characterization of atrophy are potentially useful for monitoring the evolution of central nervous system (CNS) disorders. In this study, a method for measuring atrophy of the major white matter (WM) fiber bundles in the brain using diffusion tensor (DT) MRI data is developed. To this end, an atlas was created from sets of diffusion anisotropy images from normal subjects, and the deformations necessary to match single subject anisotropy images to this atlas were then computed. Because diffusion anisotropy images were used, this approach should be sensitive to fiber bundle volume changes in the same way that using T1-weighted images allows gray matter volume changes to be measured. The Jacobian determinant of the deformation field for each subject was then used as a measure of contraction or expansion of the tissue at each image voxel. An overview of the nonlinear registration problem is given; then an optimization of the parameters for the chosen algorithm is performed and the method for producing the atlas is described. The effectiveness of the method was then tested on data from five patients with multiple sclerosis (MS) and two patients with amyotrophic lateral sclerosis (ALS).
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Affiliation(s)
- Elisabetta Pagani
- Neuroimaging Research Unit, Department of Neurology, Scientific Institute and University Ospedale San Raffaele, Milan, Italy
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