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Sentis AI, Rasero J, Gianaros PJ, Verstynen TD. Cortical and subcortical brain networks predict prevailing heart rate. Psychophysiology 2024:e14641. [PMID: 38951745 DOI: 10.1111/psyp.14641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 05/27/2024] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
Resting heart rate may confer risk for cardiovascular disease (CVD) and other adverse cardiovascular events. While the brainstem's autonomic control over heart rate is well established, less is known about the regulatory role of higher level cortical and subcortical brain regions, especially in humans. This study sought to characterize the brain networks that predict variation in prevailing heart rate in otherwise healthy adults. We used machine learning approaches designed for complex, high-dimensional data sets, to predict variation in instantaneous heart period (the inter-heartbeat-interval) from whole-brain hemodynamic signals measured by fMRI. Task-based and resting-state fMRI, as well as peripheral physiological recordings, were taken from two data sets that included extensive repeated measurements within individuals. Our models reliably predicted instantaneous heart period from whole-brain fMRI data both within and across individuals, with prediction accuracies being highest when measured within-participants. We found that a network of cortical and subcortical brain regions, many linked to visceral motor and visceral sensory processes, were reliable predictors of variation in heart period. This adds to evidence on brain-heart interactions and constitutes an incremental step toward developing clinically applicable biomarkers of brain contributions to CVD risk.
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Affiliation(s)
- Amy Isabella Sentis
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- Carnegie Mellon Neuroscience Institute, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Javier Rasero
- Carnegie Mellon Neuroscience Institute, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- School of Data Science, University of Virginia, Charlottesville, Virginia, USA
| | - Peter J Gianaros
- Carnegie Mellon Neuroscience Institute, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Timothy D Verstynen
- Carnegie Mellon Neuroscience Institute, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
- Biomedical Engineering, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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2
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Pace SA, Lukinic E, Wallace T, McCartney C, Myers B. Cortical-brainstem circuitry attenuates physiological stress reactivity. J Physiol 2024; 602:949-966. [PMID: 38353989 PMCID: PMC10940195 DOI: 10.1113/jp285627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Exposure to stressful stimuli promotes multi-system biological responses to restore homeostasis. Catecholaminergic neurons in the rostral ventrolateral medulla (RVLM) facilitate sympathetic activity and promote physiological adaptations, including glycaemic mobilization and corticosterone release. While it is unclear how brain regions involved in the cognitive appraisal of stress regulate RVLM neural activity, recent studies found that the rodent ventromedial prefrontal cortex (vmPFC) mediates stress appraisal and physiological stress responses. Thus, a vmPFC-RVLM connection could represent a circuit mechanism linking stress appraisal and physiological reactivity. The current study investigated a direct vmPFC-RVLM circuit utilizing genetically encoded anterograde and retrograde tract tracers. Together, these studies found that stress-activated vmPFC neurons project to catecholaminergic neurons throughout the ventrolateral medulla in male and female rats. Next, we utilized optogenetic terminal stimulation to evoke vmPFC synaptic glutamate release in the RVLM. Photostimulating the vmPFC-RVLM circuit during restraint stress suppressed glycaemic stress responses in males, without altering the female response. However, circuit stimulation decreased corticosterone responses to stress in both sexes. Circuit stimulation did not modulate affective behaviour in either sex. Further analysis indicated that circuit stimulation preferentially activated non-catecholaminergic medullary neurons in both sexes. Additionally, vmPFC terminals targeted medullary inhibitory neurons. Thus, both male and female rats have a direct vmPFC projection to the RVLM that reduces endocrine stress responses, likely by recruiting local RVLM inhibitory neurons. Ultimately, the excitatory/inhibitory balance of vmPFC synapses in the RVLM may regulate stress reactivity and stress-related health outcomes. KEY POINTS: Glutamatergic efferents from the ventromedial prefrontal cortex target catecholaminergic neurons throughout the ventrolateral medulla. Partially segregated, stress-activated ventromedial prefrontal cortex populations innervate the rostral and caudal ventrolateral medulla. Stimulating ventromedial prefrontal cortex synapses in the rostral ventrolateral medulla decreases stress-induced glucocorticoid release in males and females. Stimulating ventromedial prefrontal cortex terminals in the rostral ventrolateral medulla preferentially activates non-catecholaminergic neurons. Ventromedial prefrontal cortex terminals target medullary inhibitory neurons.
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Affiliation(s)
- Sebastian A. Pace
- Biomedical Sciences, Colorado State University, Fort Collins, CO, USA 80523
| | - Ema Lukinic
- Biomedical Sciences, Colorado State University, Fort Collins, CO, USA 80523
| | - Tyler Wallace
- Biomedical Sciences, Colorado State University, Fort Collins, CO, USA 80523
| | - Carlie McCartney
- Biomedical Sciences, Colorado State University, Fort Collins, CO, USA 80523
| | - Brent Myers
- Biomedical Sciences, Colorado State University, Fort Collins, CO, USA 80523
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Prasad R, Tarai S, Bit A. Hybrid computational model depicts the contribution of non-significant lobes of human brain during the perception of emotional stimuli. Comput Methods Biomech Biomed Engin 2024:1-27. [PMID: 38328832 DOI: 10.1080/10255842.2024.2311876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 11/03/2023] [Indexed: 02/09/2024]
Abstract
Emotions are synchronizing responses of human brain while executing cognitive tasks. Earlier studies had revealed strong correlation between specific lobes of the brain to different types of emotional valence. In the current study, a comprehensive three-dimensional mapping of human brain for executing emotion specific tasks had been formulated. A hybrid computational machine learning model customized from Custom Weight Allocation Model (CWAM) and defined as Custom Rank Allocation Model (CRAM). This regression-based hybrid computational model computes the allocated tasks to different lobes of the brain during their respective executive stage. Event Related Potentials (ERP) were obtained with significant effect at P1, P2, P3, N170, N2, and N4. These ERPs were configured at Pz, Cz, F3, and T8 regions of the brain with maximal responses; while regions like Cz, C4 and F4 were also found to make effective contributions to elevate the responses of the brain, and thus these regions were configured as augmented source regions of the brain. In another circumstance of frequent -deviant - equal (FDE) presentation of the emotional stimuli, it was observed that the brain channels C3, C4, P3, P4, O1, O2, and Oz were contributing their emotional quotient to the overall response of the brain regions; whereas, the interaction effect was found presentable at O2, Oz, P3, P4, T8 and C3 regions of brain. The proposed computational model had identified the potential neural pathways during the execution of emotional task.
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Affiliation(s)
| | | | - Arindam Bit
- Department of Biomedical Engineering, NIT Raipur
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4
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Sentis AI, Rasero J, Gianaros PJ, Verstynen TD. Cortical and subcortical brain networks predict prevailing heart rate. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.23.559114. [PMID: 38260308 PMCID: PMC10802251 DOI: 10.1101/2023.09.23.559114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Resting heart rate may confer risk for cardiovascular disease (CVD) and other adverse cardiovascular events. While the brainstem's autonomic control over heart rate is well established, less is known about the regulatory role of higher-level cortical and subcortical brain regions, especially in humans. The present study sought to characterize the brain networks that predict variation in prevailing heart rate in otherwise healthy adults. We used machine learning approaches designed for complex, high-dimensional datasets, to predict variation in instantaneous heart period (the inter-heartbeat-interval) from whole brain hemodynamic signals measured by fMRI. Task-based and resting-state fMRI, as well as peripheral physiological recordings, were taken from two datasets that included extensive repeated measurements within individuals. Our models reliably predicted instantaneous heart period from whole brain fMRI data both within and across individuals, with prediction accuracies being highest when measured within-participants. We found that a network of cortical and subcortical brain regions, many linked to psychological stress, were reliable predictors of variation in heart period. This adds to evidence on brain-heart interactions and constitutes an incremental step towards developing clinically-applicable biomarkers of brain contributions to CVD risk.
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Affiliation(s)
- Amy Isabella Sentis
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
- Carnegie Mellon Neuroscience Institute, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
| | - Javier Rasero
- Carnegie Mellon Neuroscience Institute, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
- School of Data Science, University of Virginia, Charlottesville, VA, USA
| | - Peter J Gianaros
- Carnegie Mellon Neuroscience Institute, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Timothy D Verstynen
- Carnegie Mellon Neuroscience Institute, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, USA
- Biomedical Engineering, Carnegie Mellon University, Pittsburgh, PA, USA
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5
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Mishra B, Tarai S, Ratre V, Bit A. Processing of attentional and emotional stimuli depends on retrospective response of foot pressure: Conceptualizing neuron-cognitive distribution in human brain. Comput Biol Med 2023; 164:107186. [PMID: 37480678 DOI: 10.1016/j.compbiomed.2023.107186] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/24/2023]
Abstract
Cognitive function of human brain requires temporal execution of emotional or attentional tasks, or their inter-dependence influences. Smooth execution of such tasks requires spontaneous distribution of cognitive load at specific regions of brain based on its classification. A strong connectivity between peripheral sensors and central nervous system is thought to assist the cognitive load distribution effectively. Novelty of current study evaluates the modulation of foot pressure and its mapping with distributed cognitive load while executing attentional biased emotional tasks. Emotional stimulus in form of happy and sad faces with attentional paradigm drawn on them were used in the study. Behavioral results were measured with respect to the analysis of response time (RT) and response accuracy (%). Neurological signals were acquired using 10-channel EEG data acquisition system, whereas, another 6 channels were used to measure foot pressure in the left and right feet at three different locations of foot. Acquired signals were further analyzed in time and frequency domains to interpret the cognitive load distribution, and the influence of foot pressure on distribution of cognitive loads. We found that the foot pressure accelerated the response accuracy rate in attending the local scope of attention, which was not in the case of global scope of attention. This means that the global attention does not require any pressure from peripheral sensory neurons. Our event related potential (ERP) results revealed that the early sensory negative N100 characterized the processing of global scope of attention coupled with high-foot pressure. However, the late positive peak of P300 and P600 associated with local scope of attention along with high-foot pressure. The global scope of attention with low-foot pressure modulates delta and theta oscillations. These results largely contribute to the literature on cognitive neuroscience of attention and it corelation with the peripheral sensory foot pressure.
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Affiliation(s)
- Bharti Mishra
- Department of Biomedical Engineering, National Institute of Technology, Raipur, India
| | - Shashikanta Tarai
- Department of Humanities and Social Sciences, National Institute of Technology, Raipur, India
| | - Vinod Ratre
- Department of Biomedical Engineering, National Institute of Technology, Raipur, India
| | - Arindam Bit
- Department of Biomedical Engineering, National Institute of Technology, Raipur, India.
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Dyńka D, Kowalcze K, Charuta A, Paziewska A. The Ketogenic Diet and Cardiovascular Diseases. Nutrients 2023; 15:3368. [PMID: 37571305 PMCID: PMC10421332 DOI: 10.3390/nu15153368] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/24/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
The most common and increasing causes of death worldwide are cardiovascular diseases (CVD). Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD prevention and therapy. The aim of this article is to assess the potential of the ketogenic diet in the prevention and treatment of CVD. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available. The ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of CVD. Among other aspects, it has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates and the supply of omega-3 fatty acids. In addition, ketone bodies provide "rescue fuel" for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature ageing. The ketogenic diet has a beneficial effect on blood pressure and other CVD risk factors through, among other aspects, weight loss. The evidence cited is often superior to that for standard diets, making it likely that the ketogenic diet shows advantages over other dietary models in the prevention and treatment of cardiovascular diseases. There is a legitimate need for further research in this area.
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Affiliation(s)
| | | | | | - Agnieszka Paziewska
- Institute of Health Sciences, Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; (D.D.); (K.K.); (A.C.)
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Luettich A, Sievers C, Alfaro Almagro F, Allen M, Jbabdi S, Smith SM, Pattinson KTS. Functional connectivity between interoceptive brain regions is associated with distinct health-related domains: A population-based neuroimaging study. Hum Brain Mapp 2023; 44:3210-3221. [PMID: 36939141 PMCID: PMC10171512 DOI: 10.1002/hbm.26275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/08/2023] [Accepted: 02/27/2023] [Indexed: 03/21/2023] Open
Abstract
Interoception is the sensation, perception, and integration of signals from within the body. It has been associated with a broad range of physiological and psychological processes. Further, interoceptive variables are related to specific regions and networks in the human brain. However, it is not clear whether or how these networks relate empirically to different domains of physiological and psychological health at the population level. We analysed a data set of 19,020 individuals (10,055 females, 8965 males; mean age: 63 years, age range: 45-81 years), who have participated in the UK Biobank Study, a very large-scale prospective epidemiological health study. Using canonical correlation analysis (CCA), allowing for the examination of associations between two sets of variables, we related the functional connectome of brain regions implicated in interoception to a selection of nonimaging health and lifestyle related phenotypes, exploring their relationship within modes of population co-variation. In one integrated and data driven analysis, we obtained four statistically significant modes. Modes could be categorised into domains of arousal and affect and cardiovascular health, respiratory health, body mass, and subjective health (all p < .0001) and were meaningfully associated with distinct neural circuits. Circuits represent specific neural "fingerprints" of functional domains and set the scope for future studies on the neurobiology of interoceptive involvement in different lifestyle and health-related phenotypes. Therefore, our research contributes to the conceptualisation of interoception and may lead to a better understanding of co-morbid conditions in the light of shared interoceptive structures.
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Affiliation(s)
- Alexander Luettich
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Carolin Sievers
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Fidel Alfaro Almagro
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Micah Allen
- Center of Functionally Integrative NeuroscienceAarhus UniversityAarhusDenmark
- Aarhus Institute of Advanced StudiesAarhus UniversityAarhusDenmark
- Cambridge PsychiatryUniversity of CambridgeCambridgeUK
| | - Saad Jbabdi
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Stephen M. Smith
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
| | - Kyle T. S. Pattinson
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
- Wellcome Centre for Integrative NeuroimagingUniversity of OxfordOxfordUK
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Bremner JD, Piccinelli M, Garcia EV, Moncayo VM, Elon L, Nye JA, Cooke CD, Washington BP, Ortega RA, Desai SR, Okoh AK, Cheung B, Soyebo BO, Shallenberger LH, Raggi P, Shah AJ, Daaboul O, Jajeh MN, Ziegler C, Driggers EG, Murrah N, De Cecco CN, van Assen M, Krafty RT, Quyyumi AA, Vaccarino V. A Pilot Study of Neurobiological Mechanisms of Stress and Cardiovascular Risk. MEDICAL RESEARCH ARCHIVES 2023; 11:3787. [PMID: 37484871 PMCID: PMC10361343 DOI: 10.18103/mra.v11i4.3787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Objective Coronary heart disease is a leading cause of death and disability. Although psychological stress has been identified as an important potential contributor, mechanisms by which stress increases risk of heart disease and mortality are not fully understood. The purpose of this study was to assess mechanisms by which stress acts through the brain and heart to confer increased CHD risk. Methods Coronary Heart Disease patients (N=10) underwent cardiac imaging with [Tc-99m] sestamibi single photon emission tomography at rest and during a public speaking mental stress task. Patients returned for a second day and underwent positron emission tomography imaging of the brain, heart, bone marrow, aorta (indicating inflammation) and subcutaneous adipose tissue, after injection of [18F]2-fluoro-2-deoxyglucose for assessment of glucose uptake followed mental stress. Patients with (N=4) and without (N=6) mental stress-induced myocardial ischemia were compared for glucose uptake in brain, heart, adipose tissue and aorta with mental stress. Results Patients with mental stress-induced ischemia showed a pattern of increased uptake in the heart, medial prefrontal cortex, and adipose tissue with stress. In the heart disease group as a whole, activity increase with stress in the medial prefrontal brain and amygdala correlated with stress-induced increases in spleen (r=0.69, p=0.038; and r=0.69, p=0.04 respectfully). Stress-induced frontal lobe increased uptake correlated with stress-induced aorta uptake (r=0.71, p=0.016). Activity in insula and medial prefrontal cortex was correlated with post-stress activity in bone marrow and adipose tissue. Activity in other brain areas not implicated in stress did not show similar correlations. Increases in medial prefrontal activity with stress correlated with increased cardiac glucose uptake with stress, suggestive of myocardial ischemia (r=0.85, p=0.004). Conclusions These findings suggest a link between brain response to stress in key areas mediating emotion and peripheral organs involved in inflammation and hematopoietic activity, as well as myocardial ischemia, in Coronary Heart Disease patients.
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Affiliation(s)
- J. Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Marina Piccinelli
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Ernest V. Garcia
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Valeria M. Moncayo
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Lisa Elon
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Jonathon A. Nye
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - C. David Cooke
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Brianna P. Washington
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Rebeca Alvarado Ortega
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Shivang R. Desai
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Alexis K. Okoh
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Brian Cheung
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Britt O. Soyebo
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Paolo Raggi
- Mazankowski Alberta Heart Institute and the Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Amit J. Shah
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - Obada Daaboul
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Carrie Ziegler
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Nancy Murrah
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Carlo N. De Cecco
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Department Biomedical Informatics, Emory University School of Medicine, Atlanta, GA
| | - Marly van Assen
- Department Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Robert T. Krafty
- Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Arshed A. Quyyumi
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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Henein MY, Vancheri S, Longo G, Vancheri F. The Role of Inflammation in Cardiovascular Disease. Int J Mol Sci 2022; 23:12906. [PMID: 36361701 PMCID: PMC9658900 DOI: 10.3390/ijms232112906] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/15/2022] [Accepted: 10/24/2022] [Indexed: 07/21/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory disease, in which the immune system has a prominent role in its development and progression. Inflammation-induced endothelial dysfunction results in an increased permeability to lipoproteins and their subendothelial accumulation, leukocyte recruitment, and platelets activation. Recruited monocytes differentiate into macrophages which develop pro- or anti-inflammatory properties according to their microenvironment. Atheroma progression or healing is determined by the balance between these functional phenotypes. Macrophages and smooth muscle cells secrete inflammatory cytokines including interleukins IL-1β, IL-12, and IL-6. Within the arterial wall, low-density lipoprotein cholesterol undergoes an oxidation. Additionally, triglyceride-rich lipoproteins and remnant lipoproteins exert pro-inflammatory effects. Macrophages catabolize the oxidized lipoproteins and coalesce into a lipid-rich necrotic core, encapsulated by a collagen fibrous cap, leading to the formation of fibro-atheroma. In the conditions of chronic inflammation, macrophages exert a catabolic effect on the fibrous cap, resulting in a thin-cap fibro-atheroma which makes the plaque vulnerable. However, their morphology may change over time, shifting from high-risk lesions to more stable calcified plaques. In addition to conventional cardiovascular risk factors, an exposure to acute and chronic psychological stress may increase the risk of cardiovascular disease through inflammation mediated by an increased sympathetic output which results in the release of inflammatory cytokines. Inflammation is also the link between ageing and cardiovascular disease through increased clones of leukocytes in peripheral blood. Anti-inflammatory interventions specifically blocking the cytokine pathways reduce the risk of myocardial infarction and stroke, although they increase the risk of infections.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- Institute of Environment & Health and Societies, Brunel University, Middlesex SW17 0RE, UK
- Molecular and Clinical Sciences Research Institute, St. George’s University, London UB8 3PH, UK
| | - Sergio Vancheri
- Interventional Neuroradiology Department, Besançon University Hospital, 25000 Besançon, France
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, 93100 Caltanissetta, Italy
| | - Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, 93100 Caltanissetta, Italy
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10
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Henein MY, Vancheri S, Longo G, Vancheri F. The Impact of Mental Stress on Cardiovascular Health—Part II. J Clin Med 2022; 11:jcm11154405. [PMID: 35956022 PMCID: PMC9369438 DOI: 10.3390/jcm11154405] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 12/03/2022] Open
Abstract
Endothelial dysfunction is one of the earliest manifestations of atherosclerosis, contributing to its development and progression. Mental stress induces endothelial dysfunction through increased activity of the sympathetic nervous system, release of corticotropin-releasing hormone from the hypothalamus, inhibition of nitric oxide (NO) synthesis by cortisol, and increased levels of pro-inflammatory cytokines. Mental-stress-induced increased output of the sympathetic nervous system and concomitant withdrawal of the parasympathetic inflammatory reflex results in systemic inflammation and activation of a neural–hematopoietic–arterial axis. This includes the brainstem and subcortical regions network, bone marrow activation, release of leukocytes into the circulation and their migration to the arterial wall and atherosclerotic plaques. Low-grade, sterile inflammation is involved in all steps of atherogenesis, from coronary plaque formation to destabilisation and rupture. Increased sympathetic tone may cause arterial smooth-muscle-cell proliferation, resulting in vascular hypertrophy, thus contributing to the development of hypertension. Emotional events also cause instability of cardiac repolarisation due to brain lateralised imbalance of cardiac autonomic nervous stimulation, which may lead to asymmetric repolarisation and arrhythmia. Acute emotional stress can also provoke severe catecholamine release, leading to direct myocyte injury due to calcium overload, known as myocytolysis, coronary microvascular vasoconstriction, and an increase in left ventricular afterload. These changes can trigger a heart failure syndrome mimicking acute myocardial infarction, characterised by transient left ventricular dysfunction and apical ballooning, known as stress (Takotsubo) cardiomyopathy. Women are more prone than men to develop mental-stress-induced myocardial ischemia (MSIMI), probably reflecting gender differences in brain activation patterns during mental stress. Although guidelines on CV prevention recognise psychosocial factors as risk modifiers to improve risk prediction and decision making, the evidence that their assessment and treatment will prevent CAD needs further evaluation.
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Affiliation(s)
- Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden;
- Brunel University, Middlesex, London UB8 3PH, UK
- St. George’s University, London SW17 0RE, UK
| | - Sergio Vancheri
- Radiology Department, I.R.C.C.S. Policlinico San Matteo, 27100 Pavia, Italy;
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S. Elia Hospital, 93100 Caltanissetta, Italy;
| | - Federico Vancheri
- Department of Internal Medicine, S. Elia Hospital, 93100 Caltanissetta, Italy
- Correspondence:
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Pathways linking hypertension and depression with mild cognitive impairment in older adults. Int Psychogeriatr 2022; 34:515-517. [PMID: 35287769 DOI: 10.1017/s1041610222000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Gianaros PJ, Rasero J, DuPont CM, Kraynak TE, Gross JJ, McRae K, Wright AG, Verstynen TD, Barinas-Mitchell E. Multivariate Brain Activity while Viewing and Reappraising Affective Scenes Does Not Predict the Multiyear Progression of Preclinical Atherosclerosis in Otherwise Healthy Midlife Adults. AFFECTIVE SCIENCE 2022; 3:406-424. [PMID: 36046001 PMCID: PMC9382946 DOI: 10.1007/s42761-021-00098-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/17/2021] [Indexed: 06/03/2023]
Abstract
Cognitive reappraisal is an emotion regulation strategy that is postulated to reduce risk for atherosclerotic cardiovascular disease (CVD), particularly the risk due to negative affect. At present, however, the brain systems and vascular pathways that may link reappraisal to CVD risk remain unclear. This study thus tested whether brain activity evoked by using reappraisal to reduce negative affect would predict the multiyear progression of a vascular marker of preclinical atherosclerosis and CVD risk: carotid artery intima-media thickness (CA-IMT). Participants were 176 otherwise healthy adults (50.6% women; aged 30-51 years) who completed a functional magnetic resonance imaging task involving the reappraisal of unpleasant scenes from the International Affective Picture System. Ultrasonography was used to compute CA-IMT at baseline and a median of 2.78 (interquartile range, 2.67 to 2.98) years later among 146 participants. As expected, reappraisal engaged brain systems implicated in emotion regulation. Reappraisal also reduced self-reported negative affect. On average, CA-IMT progressed over the follow-up period. However, multivariate and cross-validated machine-learning models demonstrated that brain activity during reappraisal failed to predict CA-IMT progression. Contrary to hypotheses, brain activity during cognitive reappraisal to reduce negative affect does not appear to forecast the progression of a vascular marker of CVD risk. Supplementary Information The online version contains supplementary material available at 10.1007/s42761-021-00098-y.
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Affiliation(s)
- Peter J. Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
| | - Javier Rasero
- Department of Psychology, Carnegie Mellon University, 3131 Sennott Square, 210 S. Bouquet St, Pittsburgh, PA USA
| | - Caitlin M. DuPont
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
| | - Thomas E. Kraynak
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
| | - James J. Gross
- Department of Psychology, Stanford University, Stanford, CA USA
| | - Kateri McRae
- Department of Psychology, University of Denver, Denver, CO USA
| | - Aidan G.C. Wright
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA USA
| | - Timothy D. Verstynen
- Department of Psychology, Carnegie Mellon University, 3131 Sennott Square, 210 S. Bouquet St, Pittsburgh, PA USA
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13
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Smith TW. Intimate Relationships and Coronary Heart Disease: Implications for Risk, Prevention, and Patient Management. Curr Cardiol Rep 2022; 24:761-774. [PMID: 35380384 PMCID: PMC8981884 DOI: 10.1007/s11886-022-01695-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2022] [Indexed: 12/15/2022]
Abstract
Purpose of Review Research and clinical services addressing psychosocial aspects of coronary heart disease (CHD) typically emphasize individuals, focusing less on the context of intimate relationships such as marriage and similar partnerships. This review describes current evidence regarding the role of intimate relationships in the development, course, and management of CHD. Recent Findings Having an intimate partner is associated with reduced risk of incident CHD and a better prognosis among patients, but strain (e.g., conflict) and disruption (i.e., separation, divorce) in these relationships are associated with increased risk and poor outcomes. These associations likely reflect mechanisms involving health behavior and the physiological effects of emotion and stress. Importantly, many other well-established psychosocial risk and protective factors (e.g., low SES, job stress, depression, and optimism) are strongly related to the quality of intimate relationships, and these associations likely contribute to the effects of those other psychosocial factors. For better or worse, intimate partners can also affect the outcome of efforts to alter health behaviors (physical activity, diet, smoking, and medication adherence) central in the prevention and management CHD. Intimate partners also influence—and are influenced by—stressful aspects of acute coronary crises and longer-term patient adjustment and management. Summary Evidence on each of these roles of intimate relationships in CHD is considerable, but direct demonstrations of the value of couple assessments and interventions are limited, although preliminary research is promising. Research needed to close this gap must also address issues of diversity, disparities, and inequity that have strong parallels in CHD and intimate relationships.
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Affiliation(s)
- Timothy W Smith
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
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14
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Xu L, Zimmermann M, Forkey H, Griffin J, Wilds C, Morgan WS, Byatt N, McNeal CJ. How to Mitigate Risk of Premature Cardiovascular Disease Among Children and Adolescents with Mental Health Conditions. Curr Atheroscler Rep 2022; 24:253-264. [PMID: 35320835 PMCID: PMC8940585 DOI: 10.1007/s11883-022-00998-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
Purpose of Review The goal of this article is to characterize the myriad of ways that children with mental health conditions can be at risk for premature cardiovascular disease (CVD) and various modalities to ameliorate this risk in childhood in order to improve the life course of these children. Review Findings Child and adolescent mental health conditions are a common yet underrecognized risk factor for premature CVD. The American Heart Association has recently included psychiatric conditions as a CVD risk factor (CVDRF) and the evidence linking childhood adversity to cardiometabolic disease. There are bidirectional and additive effects from the intrinsic emotional dysregulation and inflammatory changes from the mental health condition, the associations with risky health behaviors, and in some cases, metabolic side effects from pharmacotherapy. These pathways can be potentiated by toxic stress, a physiologic response to stressors from childhood adversity. Toxic stress is also associated with development of mental health conditions with epigenetic effects that can result in transgenerational inheritance of cardiometabolic risk. Exposure to toxic stress and mental health conditions in isolation sometimes compounded by pharmacotherapies used in treatment increase the risk of cardiometabolic diseases in childhood. The multiple pathways, which adversely influence cardiometabolic outcomes, encourage clinicians to consider strategies to mitigate these factors and justify the importance of early screening and treatment for CVDRFs. Summary Mental health, health behaviors, and environmental factors co-occur and intersect in complex pathways that can increase CVD risk over the lifespan. Early detection and response can mitigate the risks associated with premature development of CVD.
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Affiliation(s)
- Lulu Xu
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Martha Zimmermann
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Heather Forkey
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Jessica Griffin
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
- Department of Pediatrics, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Caitlin Wilds
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
- Boston Child Study Center, Boston, MA, 02116, USA
| | - Wynne S Morgan
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Nancy Byatt
- Department of Psychiatry, UMass Chan Medical School, Worcester, MA, 01655, USA
| | - Catherine J McNeal
- Division of Cardiology, Department of Internal Medicine, Baylor Scott & White Health, Temple, TX, 76508, USA.
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15
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Quadt L, Critchley H, Nagai Y. Cognition, emotion, and the central autonomic network. Auton Neurosci 2022; 238:102948. [PMID: 35149372 DOI: 10.1016/j.autneu.2022.102948] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/05/2021] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
Abstract
The demands of both mental and physical activity are integrated with the dynamic control of internal bodily states. The set of neural interactions that supports autonomic regulation extends beyond afferent-efferent homeostatic reflexes (interoceptive feedback, autonomic action) to encompass allostatic policies reflecting more abstract and predictive mental representations, often accessed as conscious thoughts and feelings. Historically and heuristically, reason is contrasted with passion, cognition with emotion, and 'cold' with 'hot' cognition. These categories are themselves arbitrary and blurred. Investigations of psychological processes have been generally pursued during states of musculoskeletal quiescence and are thus relatively insensitive to autonomic interaction with attentional, perceptual, mnemonic and decision-making processes. Autonomic psychophysiology has nevertheless highlighted the bidirectional coupling of distinct cognitive domains to the internal states of bodily arousal. More powerfully perhaps, in the context of emotion, autonomically mediated changes in inner bodily physiological states are viewed as intrinsic constituents of the expression of emotions, while their feedback representation is proposed to underpin emotional and motivational feelings. Here, we review the brain systems, encapsulated by the notion of central autonomic network, that provide the interface between cognitive, emotional and autonomic state. These systems span the neuraxis, overlap with the more general governance of behaviour, and represent district levels of proximity to survival-related imperatives. We touch upon the conceptual relevance of prediction and surprise to understanding the integration of cognition and emotion with autonomic control.
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Affiliation(s)
- Lisa Quadt
- BSMS Department of Neuroscience, University of Brighton and University of Sussex, UK; Sussex Neuroscience, University of Sussex, UK
| | - Hugo Critchley
- BSMS Department of Neuroscience, University of Brighton and University of Sussex, UK; Sussex Neuroscience, University of Sussex, UK; Sackler Centre for Consciousness Science, University of Sussex, UK; Sussex Partnership NHS Foundation Trust, UK.
| | - Yoko Nagai
- BSMS Department of Neuroscience, University of Brighton and University of Sussex, UK; Sussex Neuroscience, University of Sussex, UK
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16
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Oliveira LA, Carvalho II, Kurokawa RY, Duarte JDO, Busnardo C, Crestani CC. Differential roles of prelimbic and infralimbic cholinergic neurotransmissions in control of cardiovascular responses to restraint stress in rats. Brain Res Bull 2022; 181:175-182. [DOI: 10.1016/j.brainresbull.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 01/07/2022] [Accepted: 02/02/2022] [Indexed: 11/02/2022]
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17
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Poppa T, Benschop L, Horczak P, Vanderhasselt MA, Carrette E, Bechara A, Baeken C, Vonck K. Auricular transcutaneous vagus nerve stimulation modulates the heart-evoked potential. Brain Stimul 2021; 15:260-269. [PMID: 34933143 DOI: 10.1016/j.brs.2021.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/28/2021] [Accepted: 12/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is active interest in biomarker discovery for transcutaneous auricular vagus nerve stimulation (taVNS). However, greater understanding of the neurobiological mechanisms is needed to identify candidate markers. Accumulating evidence suggests that taVNS influences activity in solitary and parabrachial nuclei, the primary brainstem relays for the transmission of visceral sensory afferents to the insula. The insula mediates interoception, which concerns the representation and regulation of homeostatic bodily states. Consequently, interoceptive pathways may be relevant to taVNS mechanisms of action. HYPOTHESES We hypothesized that taVNS would modulate an EEG-derived marker of interoceptive processing known as the heart-evoked potential (HEP). We also hypothesized that taVNS-induced HEP effects would be localizable to the insula. METHODS Using a within-subject, sham-controlled design in 43 healthy adults, we recorded EEG and ECG concurrent to taVNS. Using ECG and EEG data, we extracted HEPs. Estimation of the cortical sources of the taVNS-dependent HEP responses observed at the scalp were computed using the Boundary Element Method and weighted Minimum Norm Estimation. Statistics were calculated using cluster-based permutation methods. RESULTS taVNS altered HEP amplitudes at frontocentral and centroparietal electrode sites at various latencies. The taVNS-dependent HEP effect was localized to the insula, operculum, somatosensory cortex, and orbital and ventromedial prefrontal regions. CONCLUSION The results support the hypothesis that taVNS can access the insula as well as functionally and anatomically connected ventral prefrontal regions. HEPs may serve as an objective, non-invasive outcome parameter for the cortical effects of taVNS.
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Affiliation(s)
- Tasha Poppa
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium; Department of Psychology, University of Southern California, Los Angeles, CA, USA.
| | - Lars Benschop
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium
| | - Paula Horczak
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium
| | - Marie-Anne Vanderhasselt
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium
| | - Evelien Carrette
- 4Brain, Neurology, Department of Head and Skin, Ghent University Hospital, Belgium
| | - Antoine Bechara
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Chris Baeken
- Ghent Experimental Psychiatry Lab, Psychiatry and Medical Psychology, Department of Head and Skin, Ghent University Hospital, Belgium; Department of Psychiatry, Brussels University Hospital, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, the Netherlands
| | - Kristl Vonck
- 4Brain, Neurology, Department of Head and Skin, Ghent University Hospital, Belgium
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18
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PSYChosomatic Medicine in ONcologIc and Cardiac Disease (PSYCHONIC) Study-A Retrospective and Prospective Observational Research Protocol. J Clin Med 2021; 10:jcm10245786. [PMID: 34945081 PMCID: PMC8709231 DOI: 10.3390/jcm10245786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
Psychosocial factors play an important role in non-communicable diseases (NCDs). This observational study is primarily aimed at assessing the relationship of psychological characteristics of patients with the outcomes of different NCDs, and to assess short-term psychotherapy (STP) efficacy in the real world. Methods: One hundred and forty patients with recent acute myocardial infarction, Takotsubo syndrome, or non-metastatic breast cancer and a control group of 140 age and sex-matched healthy subjects, will be enrolled. All subjects will be administered psychometric tests, quality of life tests, a specific body perception questionnaire, a dream questionnaire, and a projective test, the Six Drawing test at baseline and follow-up. All subjects with medical conditions will be asked to freely choose between an ontopsychological STP along with standard medical therapy and, whenever indicated, rehabilitation therapy or medical therapy plus rehabilitation alone. The study endpoints will be to evaluate: the relationship of the psychological characteristics of enrolled subjects with the outcomes of different NCDs, predictors of the choice of psychotherapy, and the efficacy of ontopsychological intervention on psychological and medical outcomes. Conclusion: This study will generate data on distinctive psychological characteristics of patients suffering from different CDs and their relationship with medical outcomes, as well as explore the efficacy of ontopsychological STP in these patients in the real world. (Number of registration: NCT03437642).
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19
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Wittbrodt MT, Gurel NZ, Nye JA, H. Shandhi M, Gazi AH, Shah AJ, Pearce BD, Murrah N, Ko YA, Shallenberger LH, Vaccarino V, Inan OT, Bremner JD. Noninvasive Cervical Vagal Nerve Stimulation Alters Brain Activity During Traumatic Stress in Individuals With Posttraumatic Stress Disorder. Psychosom Med 2021; 83:969-977. [PMID: 34292205 PMCID: PMC8578349 DOI: 10.1097/psy.0000000000000987] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a disabling condition affecting a large segment of the population; however, current treatment options have limitations. New interventions that target the neurobiological alterations underlying symptoms of PTSD could be highly beneficial. Transcutaneous cervical (neck) vagal nerve stimulation (tcVNS) has the potential to represent such an intervention. The goal of this study was to determine the effects of tcVNS on neural responses to reminders of traumatic stress in PTSD. METHODS Twenty-two participants were randomized to receive either sham (n = 11) or active (n = 11) tcVNS stimulation in conjunction with exposure to neutral and personalized traumatic stress scripts with high-resolution positron emission tomography scanning with radiolabeled water for brain blood flow measurements. RESULTS Compared with sham, tcVNS increased brain activations during trauma scripts (p < .005) within the bilateral frontal and temporal lobes, left hippocampus, posterior cingulate, and anterior cingulate (dorsal and pregenual), and right postcentral gyrus. Greater deactivations (p < .005) with tcVNS were observed within the bilateral frontal and parietal lobes and left thalamus. Compared with tcVNS, sham elicited greater activations (p < .005) in the bilateral frontal lobe, left precentral gyrus, precuneus, and thalamus, and right temporal and parietal lobes, hippocampus, insula, and posterior cingulate. Greater (p < .005) deactivations were observed with sham in the right temporal lobe, posterior cingulate, hippocampus, left anterior cingulate, and bilateral cerebellum. CONCLUSIONS tcVNS increased anterior cingulate and hippocampus activation during trauma scripts, potentially indicating a reversal of neurobiological changes with PTSD consistent with improved autonomic control.Trial Registration: No. NCT02992899.
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Affiliation(s)
- Matthew T. Wittbrodt
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Nil Z. Gurel
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta GA
| | - Jonathon A. Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Mobashir H. Shandhi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta GA
| | - Asim H. Gazi
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta GA
| | - Amit J Shah
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA
| | - Bradley D. Pearce
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Nancy Murrah
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta GA
| | - Lucy H. Shallenberger
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Viola Vaccarino
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta GA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA
| | - J. Douglas Bremner
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Atlanta VA Medical Center, Decatur, GA
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20
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O'Donnell CJ, Schwartz Longacre L, Cohen BE, Fayad ZA, Gillespie CF, Liberzon I, Pathak GA, Polimanti R, Risbrough V, Ursano RJ, Vander Heide RS, Yancy CW, Vaccarino V, Sopko G, Stein MB. Posttraumatic Stress Disorder and Cardiovascular Disease: State of the Science, Knowledge Gaps, and Research Opportunities. JAMA Cardiol 2021; 6:1207-1216. [PMID: 34259831 DOI: 10.1001/jamacardio.2021.2530] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by a persistent maladaptive reaction after exposure to severe psychological trauma. Traumatic events that may precipitate PTSD include violent personal assaults, natural and human-made disasters, and exposure to military combat or warfare. There is a growing body of evidence for associations of PTSD with major risk factors for cardiovascular disease (CVD), such as hypertension and diabetes, as well as with major CVD outcomes, such as myocardial infarction and heart failure. However, it is unclear whether these associations are causal or confounded. Furthermore, the biological and behavioral mechanisms underlying these associations are poorly understood. Here, the available evidence on the association of PTSD with CVD from population, basic, and genomic research as well as from clinical and translational research are reviewed, seeking to identify major research gaps, barriers, and opportunities in knowledge acquisition and technology as well as research tools to support and accelerate critical research for near-term and longer-term translational research directions. Large-scale, well-designed prospective studies, capturing diverse and high-risk populations, are warranted that include uniform phenotyping of PTSD as well as broad assessment of biological and behavioral risk factors and CVD outcomes. Available evidence from functional brain imaging studies demonstrates that PTSD pathophysiology includes changes in specific anatomical brain regions and circuits, and studies of immune system function in individuals with PTSD suggest its association with enhanced immune inflammatory activity. However, establishment of animal models and human tissue biobanks is also warranted to elucidate the potential causal connection of PTSD-induced brain changes and/or inflammation with CVD pathophysiology. Emerging large-scale genome-wide association studies of PTSD will provide an opportunity to conduct mendelian randomization studies that test hypotheses regarding the presence, magnitude, and direction of causal associations between PTSD and CVD outcomes. By identifying research gaps in epidemiology and genomics, animal, and human translational research, opportunities to better justify and design future interventional trials are highlighted that may test whether treatment of PTSD or underlying neurobiological or immune dysregulation may improve or prevent CVD risk or outcomes.
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Affiliation(s)
- Christopher J O'Donnell
- Cardiology Section, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lisa Schwartz Longacre
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Beth E Cohen
- UCSF Department of Medicine, University of California, San Francisco
| | - Zahi A Fayad
- Biomedical Engineering and Medical Institute, Icahn Mount Sinai School of Medicine, New York, New York.,Department of Cardiology, Icahn Mount Sinai School of Medicine, New York, New York
| | | | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, College Station
| | - Gita A Pathak
- Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven
| | - Renato Polimanti
- Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven
| | - Victoria Risbrough
- Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla.,VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - Robert J Ursano
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland
| | | | - Clyde W Yancy
- Department of Cardiology, Northwestern Medicine, Chicago, Illinois.,Deputy Editor, JAMA Cardiology
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - George Sopko
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Murray B Stein
- Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.,VA San Diego Healthcare System, San Diego, California
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21
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Gianaros PJ, Kraynak TE, Kuan DCH, Gross JJ, McRae K, Hariri AR, Manuck SB, Rasero J, Verstynen TD. Affective brain patterns as multivariate neural correlates of cardiovascular disease risk. Soc Cogn Affect Neurosci 2021; 15:1034-1045. [PMID: 32301993 PMCID: PMC7657455 DOI: 10.1093/scan/nsaa050] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 01/27/2023] Open
Abstract
This study tested whether brain activity patterns evoked by affective stimuli relate to individual differences in an indicator of pre-clinical atherosclerosis: carotid artery intima-media thickness (CA-IMT). Adults (aged 30-54 years) completed functional magnetic resonance imaging (fMRI) tasks that involved viewing three sets of affective stimuli. Two sets included facial expressions of emotion, and one set included neutral and unpleasant images from the International Affective Picture System (IAPS). Cross-validated, multivariate and machine learning models showed that individual differences in CA-IMT were partially predicted by brain activity patterns evoked by unpleasant IAPS images, even after accounting for age, sex and known cardiovascular disease risk factors. CA-IMT was also predicted by brain activity patterns evoked by angry and fearful faces from one of the two stimulus sets of facial expressions, but this predictive association did not persist after accounting for known cardiovascular risk factors. The reliability (internal consistency) of brain activity patterns evoked by affective stimuli may have constrained their prediction of CA-IMT. Distributed brain activity patterns could comprise affective neural correlates of pre-clinical atherosclerosis; however, the interpretation of such correlates may depend on their psychometric properties, as well as the influence of other cardiovascular risk factors and specific affective cues.
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Affiliation(s)
- Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Thomas E Kraynak
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Dora C-H Kuan
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
| | - Kateri McRae
- Department of Psychology, University of Denver, Denver, CO, 80208, USA
| | - Ahmad R Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, NC, 27708, USA
| | - Stephen B Manuck
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Javier Rasero
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Timothy D Verstynen
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA.,Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
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22
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Basu-Ray I. A Mechanistic Model for Yoga as a Preventive and Therapeutic Modality. Int J Yoga 2021; 14:152-157. [PMID: 34188388 PMCID: PMC8191226 DOI: 10.4103/ijoy.ijoy_136_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/06/2021] [Accepted: 02/28/2021] [Indexed: 11/04/2022] Open
Abstract
Yoga is an ancient Indian technique of healthy living. Numerous studies have corroborated yoga's beneficial effects, including a favorable influence on autonomic function and negative emotions. Extensive research in the last few decades has revealed the critical role that yoga can play in eradicating stress. This has laid to the foundation for a scientific understanding of pathophysiological changes attributed to stress, particularly at the molecular and genetic levels. This primarily has helped understand the epigenetic and genetic mechanism at play to induce and alleviate stress, particularly those related to emotional aberrations. As research has indicated, negative emotions are translated into vascular inflammation appropriately accentuated by a sympathetic predominant autonomic function. This cascade is bolstered by multiple factors, including activation of “stressor” genes and elaborating hormones, including steroids with sometimes nocuous consequences, particularly when chronic. Yoga has been categorically found to have inhibited each and every one of these baneful effects of stress. In fact, it also changes the neuronal circuits that potentiate such a plethora of pathological changes. This, in turn, has accentuated yoga's relevance as a powerful preventive intervention in noncommunicable diseases (NCD). NCDs, including heart disease, stroke, and rheumatological disorders, are essentially inflammatory diseases that perpetuate inflammation in different beds like vascular or joint spaces. The precise mechanism by which yoga induces such beneficial changes is yet to be delineated. However, a cornucopia of pointers indicates that neural, endocrine, immunological, cellular, genetic, and epigenetic mechanisms are at play. This article attempts to cobble together newfangled research to delineate a medical model for this 5000-year-old practice from India. This is imperative, as a mechanistic model of this ancient-but-complex system would enable a more comprehensive understanding of its mechanism and reveal its yet-undiscovered positive health effects.
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Affiliation(s)
- Indranill Basu-Ray
- Memphis VA Medical Center, The University of Memphis, Memphis, TN, USA.,Deparment of Cardiology, The University of Memphis, Memphis, TN, USA.,Integrative Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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23
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The self in context: brain systems linking mental and physical health. Nat Rev Neurosci 2021; 22:309-322. [PMID: 33790441 PMCID: PMC8447265 DOI: 10.1038/s41583-021-00446-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 02/01/2023]
Abstract
Increasing evidence suggests that mental health and physical health are linked by neural systems that jointly regulate somatic physiology and high-level cognition. Key systems include the ventromedial prefrontal cortex and the related default-mode network. These systems help to construct models of the 'self-in-context', compressing information across time and sensory modalities into conceptions of the underlying causes of experience. Self-in-context models endow events with personal meaning and allow predictive control over behaviour and peripheral physiology, including autonomic, neuroendocrine and immune function. They guide learning from experience and the formation of narratives about the self and one's world. Disorders of mental and physical health, especially those with high co-occurrence and convergent alterations in the functionality of the ventromedial prefrontal cortex and the default-mode network, could benefit from interventions focused on understanding and shaping mindsets and beliefs about the self, illness and treatment.
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24
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Fuligni AJ, Chiang JJ, Tottenham N. Sleep disturbance and the long-term impact of early adversity. Neurosci Biobehav Rev 2021; 126:304-313. [PMID: 33757816 DOI: 10.1016/j.neubiorev.2021.03.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/04/2021] [Accepted: 03/18/2021] [Indexed: 12/24/2022]
Abstract
Sleep disturbance may be a central, yet underappreciated mechanism by which early adversity has a long-term impact upon mental and physical health. The fundamental regulatory processes shaped by early adversity - neural, neuroendocrine, and immune - are also central to sleep. Sleep problems, in turn, lead to a similar constellation of chronic health problems that have been linked to early adversity. We bring together work from the fields of early adversity and sleep in order to suggest a model by which sleep disturbance plays a critical role in the far-reaching impacts of early adversity on health. Future research should employ more longitudinal designs and pay particular attention to the impact of developmental periods such as adolescence and midlife when maturational and environmental factors conspire to create a unique time of sleep disturbance. We also suggesting that intervening to minimize sleep disturbance may be a promising means by which to test the model, as well as potentially blunt the long-term impact of early adversity on health.
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25
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Barbieri L, Galli F, Conconi B, Gregorini T, Lucreziotti S, Mafrici A, Pravettoni G, Sommaruga M, Carugo S. Takotsubo syndrome in COVID-19 era: Is psychological distress the key? J Psychosom Res 2021; 140:110297. [PMID: 33242703 PMCID: PMC7666871 DOI: 10.1016/j.jpsychores.2020.110297] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/20/2022]
Abstract
Covid-19 pandemic, starting from Wuhan, China spread all over the world and Italy was one of the most affected countries, especially in Lombardy, where, on February 20, the first confirmed case was detected. Italian Government ordered a national lockdown on the 9 th March 2020, forcing the population to severe restrictive isolation measures. The burden on mental health of the medical emergency related to COVID19 is progressively been revealed. Takotsubo syndrome (TTS), is estimated to represent 1-3% of patients admitted with suspected STEMI, mostly affecting elderly women with emotional stress and/or acute illness preceding the presentation. Comparing patients hospitalised from February to May 2020 with those of the corresponding period in 2019 we observed a significantly increased number of TTS diagnosis in 2020 (11 patients vs 3 in 2019), especially during the first period of lockdown. The only two males were patients with COVID-19 and were the only two who died in hospital. At psychological examination all patients enrolled report to have lived a particularly stressful experience at IES-R in the last year, without presenting the symptoms of a post-traumatic stress disorder. Most patients were positive to the allostatic overload. Only one patient showed a clinical cut-off for HADS and no one for the Fear COVID-19 scale. We finally concluded that subjects with pre-pandemic psychological distress may have experienced additional psychological overload, opening the door to TTS by a series of physiological alterations as the secretion of cortisol and catecholamines, making the subject more vulnerable to the onset of TTS.
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Affiliation(s)
- Lucia Barbieri
- Division of Cardiology, ASST Santi Paolo e Carlo, Milan, Italy.
| | - Federica Galli
- Division of Cardiology, ASST Santi Paolo e Carlo, Milan, Italy,Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - Barbara Conconi
- Division of Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | | | | | - Antonio Mafrici
- Division of Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Unit for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy,Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | | | - Stefano Carugo
- Division of Cardiology, ASST Santi Paolo e Carlo, Milan, Italy
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26
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Tabibnia G. An affective neuroscience model of boosting resilience in adults. Neurosci Biobehav Rev 2020; 115:321-350. [DOI: 10.1016/j.neubiorev.2020.05.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 05/09/2020] [Accepted: 05/10/2020] [Indexed: 12/11/2022]
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27
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Wittbrodt MT, Gurel NZ, Nye JA, Ladd S, Shandhi MMH, Huang M, Shah AJ, Pearce BD, Alam ZS, Rapaport MH, Murrah N, Ko YA, Haffer AA, Shallenberger LH, Vaccarino V, Inan OT, Bremner JD. Non-invasive vagal nerve stimulation decreases brain activity during trauma scripts. Brain Stimul 2020; 13:1333-1348. [PMID: 32659483 PMCID: PMC8214872 DOI: 10.1016/j.brs.2020.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 06/08/2020] [Accepted: 07/01/2020] [Indexed: 12/30/2022] Open
Abstract
Background: Traumatic stress can have lasting effects on neurobiology and result in psychiatric conditions such as posttraumatic stress disorder (PTSD). We hypothesize that non-invasive cervical vagal nerve stimulation (nVNS) may alleviate trauma symptoms by reducing stress sympathetic reactivity. This study examined how nVNS alters neural responses to personalized traumatic scripts. Methods: Nineteen participants who had experienced trauma but did not have the diagnosis of PTSD completed this double-blind sham-controlled study. In three sequential time blocks, personalized traumatic scripts were presented to participants immediately followed by either sham stimulation (n = 8; 0–14 V, 0.2 Hz, pulse width = 5s) or active nVNS (n = 11; 0–30 V, 25 Hz, pulse width = 40 ms). Brain activity during traumatic scripts was assessed using High Resolution Positron Emission Tomography (HR-PET) with radiolabeled water to measure brain blood flow. Results: Traumatic scripts resulted in significant activations within the bilateral medial and orbital prefrontal cortex, premotor cortex, anterior cingulate, thalamus, insula, hippocampus, right amygdala, and right putamen. Greater activation was observed during sham stimulation compared to nVNS within the bilateral prefrontal and orbitofrontal cortex, premotor cortex, temporal lobe, parahippocampal gyrus, insula, and left anterior cingulate. During the first exposure to the trauma scripts, greater activations were found in the motor cortices and ventral visual stream whereas prefrontal cortex and anterior cingulate activations were more predominant with later script presentations for those subjects receiving sham stimulation. Conclusion: nVNS decreases neural reactivity to an emotional stressor in limbic and other brain areas involved in stress, with changes over repeated exposures suggesting a shift from scene appraisal to cognitively processing the emotional event.
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Affiliation(s)
- Matthew T Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Nil Z Gurel
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Jonathon A Nye
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stacy Ladd
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Md Mobashir H Shandhi
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Minxuan Huang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Amit J Shah
- Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA
| | - Bradley D Pearce
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Zuhayr S Alam
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mark H Rapaport
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy Murrah
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ammer A Haffer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Viola Vaccarino
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA; Department of Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA, USA
| | - Omer T Inan
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA
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28
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Wittbrodt MT, Moazzami K, Shah AJ, Lima BB, Hammadah M, Mehta PK, Quyyumi AA, Vaccarino V, Nye JA, Bremner JD. Neural responses during acute mental stress are associated with angina pectoris. J Psychosom Res 2020; 134:110110. [PMID: 32345456 PMCID: PMC8082434 DOI: 10.1016/j.jpsychores.2020.110110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/31/2022]
Abstract
UNLABELLED Angina pectoris is associated with increased risk of adverse cardiovascular events in coronary artery disease (CAD) patients, an effect not entirely attributable to the severity of CAD. OBJECTIVE Examine brain correlates of mental stress in patients with CAD with and without a history of angina. METHODS Participants (n = 170) with stable CAD completed the Seattle Angina Questionnaire along with other psychometric assessments. In this cross-sectional study, participants underwent laboratory-based mental stress testing using mental arithmetic and public speaking tasks along with control conditions in conjunction with positron emission tomography brain imaging using radiolabeled water. Brain activity during mental stress was compared between participants who did or did not report chest pain/angina in the previous month. A factor analysis was coupled with dominance analysis to identify brain regions associated with angina. RESULTS Participants reporting angina in the past month experienced greater (p < .005) activations within the left: frontal lobe (z = 4.01), temporal gyrus (z = 3.32), parahippocampal gyrus (z = 3.16), precentral gyrus (z = 3.14), right fusiform gyrus (z = 3.07), and bilateral cerebellum (z = 3.50) and deactivations within the right frontal gyrus (z = 3.67), left precuneus (z = 3.19), and left superior temporal gyrus (z = 3.11) during mental stress. A factor containing the left motor areas, inferior frontal lobe, and operculum (average McFadden's number addition = 0.057) in addition to depression severity (0.10) and adulthood trauma exposure (0.064) correlated with angina history. CONCLUSIONS Self-reported angina in patients with stable CAD is associated with increased neural responses to stress in a network including the inferior frontal lobe, motor areas, and operculum, potentially indicating an upregulated pain perception response.
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Affiliation(s)
- Matthew T. Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America,Corresponding author at: 1821 Clifton Rd, Room 214, Atlanta, GA 30307, United States of America. (M.T. Wittbrodt)
| | - Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America,Atlanta VA Medical Center, Decatur, GA, United States of America
| | - Bruno B. Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Muhammad Hammadah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Puja K. Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Jonathon A. Nye
- Department of Radiology, Emory University School of Medicine, United States of America
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America,Department of Radiology, Emory University School of Medicine, United States of America,Atlanta VA Medical Center, Decatur, GA, United States of America
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Abstract
OBJECTIVE This study aimed to investigate the relationship between waist circumference as a measure of abdominal obesity and brain responses to stress among patients with coronary artery disease (CAD). METHODS Patients with CAD (N = 151) underwent acute mental stress tasks in conjunction with high-resolution positron emission tomography and radiolabeled water imaging of the brain. Brain responses to mental stress were correlated with waist circumference. RESULTS Waist circumference was positively correlated with increased activation in the right and left frontal lobes (β values ranging from 2.81 to 3.75 in the paracentral, medial, and superior gyri), left temporal lobe, left hippocampal, left amygdala, left uncus, and left anterior and posterior cingulate gyri (β values ranging from 2.93 to 3.55). Waist circumference was also negatively associated with the left and right parietal lobes, right superior temporal gyrus, and right insula and precuneus (β values ranging from 2.82 to 5.20). CONCLUSION Increased brain activation in the brain regions involved in the stress response and autonomic regulation of the cardiovascular system during psychological stress may underlie stress-induced overeating and abdominal obesity in patients with CAD.
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30
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Andreescu C, Ajilore O, Aizenstein HJ, Albert K, Butters MA, Landman BA, Karim HT, Krafty R, Taylor WD. Disruption of Neural Homeostasis as a Model of Relapse and Recurrence in Late-Life Depression. Am J Geriatr Psychiatry 2019; 27:1316-1330. [PMID: 31477459 PMCID: PMC6842700 DOI: 10.1016/j.jagp.2019.07.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/26/2019] [Accepted: 07/29/2019] [Indexed: 12/29/2022]
Abstract
The significant public health burden associated with late-life depression (LLD) is magnified by the high rates of recurrence. In this manuscript, we review what is known about recurrence risk factors, conceptualize recurrence within a model of homeostatic disequilibrium, and discuss the potential significance and challenges of new research into LLD recurrence. The proposed model is anchored in the allostatic load theory of stress. We review the allostatic response characterized by neural changes in network function and connectivity and physiologic changes in the hypothalamic-pituitary-adrenal axis, autonomic nervous system, immune system, and circadian rhythm. We discuss the role of neural networks' instability following treatment response as a source of downstream disequilibrium, triggering and/or amplifying abnormal stress response, cognitive dysfunction and behavioral changes, ultimately precipitating a full-blown recurrent episode of depression. We propose strategies to identify and capture early change points that signal recurrence risk through mobile technology to collect ecologically measured symptoms, accompanied by automated algorithms that monitor for state shifts (persistent worsening) and variance shifts (increased variability) relative to a patient's baseline. Identifying such change points in relevant sensor data could potentially provide an automated tool that could alert clinicians to at-risk individuals or relevant symptom changes even in a large practice.
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Affiliation(s)
| | | | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh,Department of Bioengineering, University of Pittsburgh
| | - Kimberly Albert
- The Center for Cognitive Medicine, the Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center
| | | | - Bennett A. Landman
- Departments of Computer Science, Electrical Engineering, and Biomedical Engineering, Vanderbilt University; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center
| | | | - Robert Krafty
- Department of Biostatistics, University of Pittsburgh
| | - Warren D. Taylor
- The Center for Cognitive Medicine, the Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center,Geriatric Research, Education and Clinical Center, Department of Veterans Affairs Medical Center, Tennessee Valley Healthcare System
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31
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Retrospectively reported childhood physical abuse, systemic inflammation, and resting corticolimbic connectivity in midlife adults. Brain Behav Immun 2019; 82:203-213. [PMID: 31445966 PMCID: PMC6956859 DOI: 10.1016/j.bbi.2019.08.186] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/07/2019] [Accepted: 08/21/2019] [Indexed: 12/24/2022] Open
Abstract
Childhood abuse confers risk for psychopathology and pathophysiology in midlife through intermediate pathways that remain unclear. Systemic inflammation was tested in the present study as one pathway that may link physical abuse in childhood to the adult functioning of corticolimbic brain circuits broadly implicated in risk for poor mental and physical health. Midlife adults (N = 303; 30-51 years of age; 149 women) without psychiatric, immune, or cardiovascular diagnoses provided retrospective reports of childhood physical abuse. Functional connectivity between corticolimbic brain areas (amygdala, hippocampus, ventromedial prefrontal cortex [vmPFC], anterior cingulate cortex [ACC]) was measured at rest using functional magnetic resonance imaging. Circulating levels of interleukin(IL)-6, a pro-inflammatory cytokine previously linked to childhood abuse and corticolimbic functionality, were measured via blood draw. Consistent with prior studies, retrospectively reported childhood physical abuse was associated positively with circulating IL-6, and negatively with connectivity between the amygdala and vmPFC. IL-6 was also associated negatively with several corticolimbic functional connections, including amygdala-vmPFC connectivity. Moreover, path analyses revealed an indirect effect of IL-6 that partially explained the association between childhood physical abuse and adult amygdala-vmPFC connectivity. Consistent with recent neurobiological models of early life influences on disease risk across the lifespan, associations between childhood physical abuse and adulthood corticolimbic circuit functionality may be partially explained by inflammatory processes.
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32
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Mulcahy JS, Larsson DEO, Garfinkel SN, Critchley HD. Heart rate variability as a biomarker in health and affective disorders: A perspective on neuroimaging studies. Neuroimage 2019; 202:116072. [PMID: 31386920 DOI: 10.1016/j.neuroimage.2019.116072] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/28/2019] [Accepted: 08/02/2019] [Indexed: 12/30/2022] Open
Abstract
The dynamic embodiment of psychological processes is evident in the association of health outcomes, behavioural traits and psychological functioning with Heart Rate Variability (HRV). The dominant high-frequency component of HRV is an index of the central neural control of heart rhythm, mediated via the parasympathetic vagus nerve. HRV provides a potential objective measure of action policies for the adaptive and predictive allostatic regulation of homeostasis within the cardiovascular system. In its support, a network of brain regions (referred to as the 'central autonomic network') maps internal state, and controls autonomic responses. This network includes regions of prefrontal cortex, anterior cingulate cortex, insula, amygdala, periaqueductal grey, pons and medulla. Human neuroimaging studies of neural activation and functional connectivity broadly endorse this architecture, and its link with cardiac regulation at rest and dysregulation in clinical states that include affective disorders. In this review, we appraise neuroimaging research and related evidence for HRV as an informative marker of autonomic integration with affect and cognition, taking a perspective on function and organisation. We consider evidence for the utility of HRV as a metric to inform targeted interventions to improve autonomic and affective dysregulation, and suggest research questions for further investigation.
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Affiliation(s)
- James S Mulcahy
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK.
| | | | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, BN1 9RR, UK; Sussex Partnership NHS Foundation Trust, Brighton, BN2 3EW, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Falmer, BN1 9RY, UK; Sackler Centre for Consciousness Science, University of Sussex, Falmer, BN1 9RR, UK; Sussex Partnership NHS Foundation Trust, Brighton, BN2 3EW, UK
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33
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Wittbrodt MT, Moazzami K, Lima BB, Alam ZS, Corry D, Hammadah M, Campanella C, Ward L, Quyyumi AA, Shah AJ, Vaccarino V, Nye JA, Bremner JD. Early childhood trauma alters neurological responses to mental stress in patients with coronary artery disease. J Affect Disord 2019; 254:49-58. [PMID: 31103906 PMCID: PMC6592739 DOI: 10.1016/j.jad.2019.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/08/2019] [Accepted: 05/11/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND Early childhood trauma is known to independently increase adverse outcome risk in coronary artery disease (CAD) patients, although the neurological correlates are not well understood. The purpose of this study was to examine whether early childhood trauma alters neural responses to acute mental stress in CAD patients. METHODS Participants (n = 152) with CAD underwent brain imaging with High Resolution Positron Emission Tomography and radiolabeled water during control (verbal counting, neutral speaking) and mental stress (mental arithmetic, public speaking). Traumatic events in childhood were assessed with the Early Trauma Inventory (ETI-SR-SF) and participants were separated by presence (ETI+) or absence (ETI-) of early childhood trauma. Brain activity during mental stress was compared between ETI+ and ETI-. RESULTS Compared to ETI-, ETI+ experienced greater (p < 0.005) activations during mental stress within the left anterior cingulate, bilateral frontal lobe and deactivations (p < 0.005) within the left insula, left parahippocampal gyrus, right dorsal anterior cingulate, bilateral cerebellum, bilateral fusiform gyrus, left inferior temporal gyrus, and right parietal lobe. Significant (p < 0.005) positive correlations between brain activation and ETI-SR-SF scores were observed within the left hippocampus, bilateral frontal lobe, left occipital cuneus, and bilateral temporal lobe. LIMITATIONS Results in non-CAD samples may differ and ETI may be subject to recall bias. CONCLUSION Early childhood trauma exacerbated activations in stress-responsive limbic and cognitive brain areas with direct and indirect connections to the heart, potentially contributing to adverse outcomes in CAD patients.
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Affiliation(s)
- Matthew T. Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Bruno B. Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Zuhayr S. Alam
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA
| | - Daniel Corry
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Muhammad Hammadah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Carolina Campanella
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Laura Ward
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA,Atlanta VA Medical Center, Decatur, GA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Jonathon A. Nye
- Department of Radiology, Emory University School of Medicine
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA,Department of Radiology, Emory University School of Medicine,Atlanta VA Medical Center, Decatur, GA
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34
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Shaked D, Millman ZB, Moody DLB, Rosenberger WF, Shao H, Katzel LI, Davatzikos C, Gullapalli RP, Seliger SL, Erus G, Evans MK, Zonderman AB, Waldstein SR. Sociodemographic disparities in corticolimbic structures. PLoS One 2019; 14:e0216338. [PMID: 31071128 PMCID: PMC6508895 DOI: 10.1371/journal.pone.0216338] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 04/18/2019] [Indexed: 12/29/2022] Open
Abstract
This study sought to examine the interactive relations of socioeconomic status and race to corticolimbic regions that may play a key role in translating stress to the poor health outcomes overrepresented among those of lower socioeconomic status and African American race. Participants were 200 community-dwelling, self-identified African American and White adults from the Healthy Aging in Neighborhoods of Diversity across the Life Span SCAN study. Brain volumes were derived using T1-weighted MP-RAGE images. Socioeconomic status by race interactions were observed for right medial prefrontal cortex (B = .26, p = .014), left medial prefrontal cortex (B = .26, p = .017), left orbital prefrontal cortex (B = .22, p = .037), and left anterior cingulate cortex (B = .27, p = .018), wherein higher socioeconomic status Whites had greater volumes than all other groups. Additionally, higher versus lower socioeconomic status persons had greater right and left hippocampal (B = -.15, p = .030; B = -.19, p = .004, respectively) and amygdalar (B = -.17, p = .015; B = -.21; p = .002, respectively) volumes. Whites had greater right and left hippocampal (B = -.17, p = .012; B = -.20, p = .003, respectively), right orbital prefrontal cortex (B = -.34, p < 0.001), and right anterior cingulate cortex (B = -.18, p = 0.011) volumes than African Americans. Among many factors, the higher levels of lifetime chronic stress associated with lower socioeconomic status and African American race may adversely affect corticolimbic circuitry. These relations may help explain race- and socioeconomic status-related disparities in adverse health outcomes.
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Affiliation(s)
- Danielle Shaked
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, Maryland, United States of America
- * E-mail:
| | - Zachary B. Millman
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
| | - Danielle L. Beatty Moody
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
| | - William F. Rosenberger
- Department of Statistics, George Mason University, Fairfax, Virginia, United States of America
| | - Hui Shao
- Department of Statistics, George Mason University, Fairfax, Virginia, United States of America
| | - Leslie I. Katzel
- Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, United States of America
- Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Christos Davatzikos
- Section for Biomedical Image Analysis, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Rao P. Gullapalli
- Department of Diagnostic Radiology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Stephen L. Seliger
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Guray Erus
- Section for Biomedical Image Analysis, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, Maryland, United States of America
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging Intramural Research Program, Baltimore, Maryland, United States of America
| | - Shari R. Waldstein
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, Maryland, United States of America
- Geriatric Research Education and Clinical Center, Baltimore VA Medical Center, Baltimore, Maryland, United States of America
- Division of Gerontology & Geriatric Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
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