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Xiang LS, Zhang JN, Xie F, Fei X, Wang Y, Shi Y, Zhang Y. Comparative analysis of the effects of the computer-based and paper-based trail making tests on oxygenation in the prefrontal cortex. BMC Neurosci 2024; 25:39. [PMID: 39187754 PMCID: PMC11348744 DOI: 10.1186/s12868-024-00886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 07/31/2024] [Indexed: 08/28/2024] Open
Abstract
The trail making test (TMT) is a commonly used tool for evaluating executive functions, and the activation of cerebral oxygenation in the prefrontal cortex (PFC) during the test can reflect the participation of executive function. This study aimed to compare the differences in cerebral oxygenation in the PFC between the computer- and paper-based versions of the TMT and provide a theoretical basis for the optimization and clinical application of the computer-based version. A total of 32 healthy adult participants completed the computer- and paper-based TMT Types A and B. Cerebral oxygenation changes in the PFC were monitored during the experiment using near-infrared spectroscopy. Moreover, average changes in oxyhemoglobin (Δoxy-Hb) levels at the baseline and during activation periods in different types of testing were compared and analyzed. The number of correct connections in the computer-based version Type B was less than that in the paper-based version Type B (p < .001). The task time of the computer-based version was longer than that of the paper-based version (p < .001). The B/A ratio of the number of correct connections in the computer-based version was lower than that in the paper-based version (p < .001). The Δoxy-Hb in the PFC of the paper-based version was higher than that of the computer-based version (p < .001). Significant differences in oxygenation in the PFC were observed between the paper- and computer-based versions of TMT. After further improvement and correction in the subsequent development of the computer-based TMT, and taking into account the psychological feelings and preferences of the participants when performing different versions of the TMTs, the computer-based TMT is expected to play a good auxiliary role in clinical evaluation.
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Affiliation(s)
- Li-Sha Xiang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Tianning Area, Changzhou, 213003, China
- Department of Rehabilitation Medicine, School of Clinical Medicine, Soochow University, Soochow, China
| | - Jia-Nan Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Tianning Area, Changzhou, 213003, China
| | - Fan Xie
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Tianning Area, Changzhou, 213003, China
| | - Xiao Fei
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Tianning Area, Changzhou, 213003, China
| | - Ya Wang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Tianning Area, Changzhou, 213003, China
| | - Yue Shi
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Tianning Area, Changzhou, 213003, China
| | - Yi Zhang
- Department of Rehabilitation Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Tianning Area, Changzhou, 213003, China.
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Femminella GD, Canfora F, Musella G, Di Tella GS, Ugga L, Pecoraro G, Leuci S, Coppola N, De Lucia N, Maldonato NM, Liguori S, Aria M, D'Aniello L, Rengo G, Mignogna MD, Adamo D. Cognitive profile in burning mouth syndrome versus mild cognitive impairment: A comparative study. Oral Dis 2024. [PMID: 39076058 DOI: 10.1111/odi.15087] [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: 05/06/2024] [Revised: 06/25/2024] [Accepted: 07/16/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVES This study aims to assess and contrast cognitive and psychological aspects of patients with burning mouth syndrome (BMS-MCI) and geriatric patients (G-MCI) with mild cognitive impairment, focusing on potential predictors like pain, mood disorders, blood biomarkers, and age-related white matter changes (ARWMCs). METHODS The study enrolled 40 BMS-MCI and 40 geriatric G-MCI, matching them by age, gender, and educational background. Participants underwent psychological, sleepiness, and cognitive assessment including the Mini-Mental State Exam (MMSE), Trail Making Test (TMT), Corsi Block-Tapping Task, Rey Auditory Verbal Learning Test, Copying Geometric Drawings Test, Frontal Assessment Battery, and Digit Cancellation Test. RESULTS G-MCI patients exhibited higher ARWMCs scores in right (p = 0.005**) and left (p < 0.001**) temporal regions, which may relate to specific neurodegenerative processes. Conversely, BMS-MCI patients showed higher levels of depression and anxiety and lower MMSE scores(p < 0.001**), also struggling more with tasks requiring processing speed and executive function, as evidenced by their higher TMT-A scores (p < 0.001**). CONCLUSIONS The study highlights particular deficits in global cognition and processing speed for BMS-MCI. The influence of educational background, pain levels, cholesterol, sleep disturbances, and anxiety on these cognitive assessments underscores the need for personalized therapeutic strategies addressing both cognitive and emotional aspects of MCI.
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Affiliation(s)
| | - Federica Canfora
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Gennaro Musella
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | | | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Pecoraro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Stefania Leuci
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Noemi Coppola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Natascia De Lucia
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Simone Liguori
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Massimo Aria
- Department of Economics and Statistics, University of Naples "Federico II", Naples, Italy
| | - Luca D'Aniello
- Department of Social Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
| | - Michele Davide Mignogna
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
| | - Daniela Adamo
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples "Federico II", Naples, Italy
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Tong Y, Wang Q, Wang X, Xiang Y, Cheng L, Hu X, Chen Y, Huo L, Xu Y, Liu S. A scoping review of functional near-infrared spectroscopy biomarkers in late-life depression: Depressive symptoms, cognitive functioning, and social functioning. Psychiatry Res Neuroimaging 2024; 341:111810. [PMID: 38555800 DOI: 10.1016/j.pscychresns.2024.111810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/21/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
Late-life depression is one of the most damaging mental illnesses, disrupting the normal lives of older people by causing chronic illness and cognitive impairment. Patients with late-life depression, accompanied by changes in appetite, insomnia, fatigue and guilt, are more likely to experience irritability, anxiety and somatic symptoms. It increases the risk of suicide and dementia and is a major challenge for the public health systems. The current clinical assessment, identification and effectiveness assessment of late-life depression are primarily based on history taking, mental status examination and scale scoring, which lack subjectivity and precision. Functional near-infrared spectroscopy is a rapidly developing optical imaging technology that objectively reflects the oxygenation of hemoglobin in different cerebral regions during different tasks and assesses the functional status of the cerebral cortex. This article presents a comprehensive review of the assessment of functional near-infrared spectroscopy technology in assessing depressive symptoms, social functioning, and cognitive functioning in patients with late-life depression. The use of functional near-infrared spectroscopy provides greater insight into the neurobiological mechanisms underlying depression and helps to assess these three aspects of functionality in depressed patients. In addition, the study discusses the limitations of previous research and explores potential advances in the field.
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Affiliation(s)
- Yujie Tong
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Qiwei Wang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xiao Wang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuxian Xiang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Long Cheng
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xiaodong Hu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yun Chen
- Department of Geriatrics, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Luyao Huo
- Department of Psychiatry, Children's Hospital of Shanxi, Women Health Center of Shanxi, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorder, First Hospital of Shanxi Medical University, Taiyuan, China.
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Li G, Ma K, Rossbach K, Niu Y, Li Q, Liu Z, Zhang K. Cortical activation for adolescent-onset minor depression and major depressive disorder: an fNIRS study. Ann Gen Psychiatry 2024; 23:17. [PMID: 38724998 PMCID: PMC11084134 DOI: 10.1186/s12991-024-00500-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND While depression is increasing worldwide, some patients are diagnosed as having Major Depressive Disorder (MDD), but others are diagnosed with minor depression, however, the potential neuro mechanism is unknown. METHODS Sixty-two patients with minor depression, 44 adolescents with MDD and 54 healthy adolescents participated in this study. Functional near-infrared spectroscopy (fNIRS), both HAMD and HAMA data were collected from all of the participants. RESULTS The result indicates the pervasively decreased activation of BA, 11, 21, 45 and 46 were observed in the MDD group and reduced activation of BA 45 was observed in the minor depression group. However, cortical activation was not observed between the minor depression or MDD groups. Cortical activation was also not correlated with the depressive/anxious score in the minor and MDD groups separately. CONCLUSIONS Cortical activation was pervasively decreased in the MDD group and slightly reduced in the minor depression group, which may be a potential neural mechanism. As reduced cortical activation in minor depression, interventions in the early stages of minor depression may help slow or even modify the development of the illness.
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Affiliation(s)
- Gaizhi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, No 85 Jiefang Nan Road, Taiyuan, Shanxi Province, 030001, China
- First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Ke Ma
- Department of Orthodontics, First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | | | - Ying Niu
- College of Medical Sciences, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Qiqi Li
- Department of Psychiatry, First Hospital of Shanxi Medical University, No 85 Jiefang Nan Road, Taiyuan, Shanxi Province, 030001, China
| | - Zhifen Liu
- Department of Psychiatry, First Hospital of Shanxi Medical University, No 85 Jiefang Nan Road, Taiyuan, Shanxi Province, 030001, China.
| | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, No 85 Jiefang Nan Road, Taiyuan, Shanxi Province, 030001, China.
- First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi Province, China.
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Wu H, Lu B, Zhang Y, Li T. Differences in prefrontal cortex activation in Chinese college students with different severities of depressive symptoms: A large sample of functional near-infrared spectroscopy (fNIRS) findings. J Affect Disord 2024; 350:521-530. [PMID: 38237870 DOI: 10.1016/j.jad.2024.01.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 11/23/2023] [Accepted: 01/03/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Previous studies proposed that functional near-infrared spectroscopy (fNIRS) can be used to distinguish between not only different severities of depressive symptoms but also different subgroups of depression, such as anxious and non-anxious depression, bipolar and unipolar depression, and melancholia and non-melancholia depression. However, the differences in brain haemodynamic activation between depression subgroups (such as confirmed depression [CD] and suspected depression [SD]) with different symptom severities and the possible correlation between symptom severity and haemodynamic activation in specific brain regions using fNIRS have yet to be clarified. METHODS The severity of depression symptoms was classified using the Hospital Anxiety and Depression scale (HADS) and the Mini International Neuropsychiatric Interview by psychiatrists. We recruited 654 patients with depression who had varying severities of depressive symptoms, including 276 with SD and 378 with CD, and 317 with HCs from among Chinese college students. The 53-channel fNIRS was used to detect the cerebral hemodynamic difference of the three groups during the VFT (verbal fluency task). RESULTS Compared with the HC, region-specific fNIRS leads indicate CD patients had significant lower haemodynamic activation in three particular prefrontal regions: 1) right dorsolateral prefrontal cortex (DLPFC), 2) bilateral frontopolar cortex (FPC), and 3) right Broca's area (BA). SD vs. HC comparisons revealed only significant lower haemodynamic activation in the right FPC area. Compared to SD patients, CD patients exhibited decreased hemodynamic activation changes in the right DLPFC and the right BA. Correlation analysis established a significant negative correlation between the hemodynamic changes in the bilateral FPC and the severity of depressive symptoms. CONCLUSIONS The right DLPFC and right BA are expected to be physiological mechanisms to distinguish depression subgroups (CD, SD) with different symptom severities. The haemodynamic changes in the bilateral FPC was nagatively associated with the symptom severity of depression.
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Affiliation(s)
- Huifen Wu
- School of Education and psychology, Hubei Engineering University, Xiaogan, China
| | - Baoquan Lu
- School of Education and psychology, Hubei Engineering University, Xiaogan, China.
| | - Yan Zhang
- School of Education, Huazhong University of Science and Technology, Wuhan, China.
| | - Taiping Li
- School of Education and psychology, Hubei Engineering University, Xiaogan, China.
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Shin JE, Lee YS, Park SY, Jeong MY, Choi JK, Cha JH, Lee YJ. The Relationship between Depression Severity and Prefrontal Hemodynamic Changes in Adolescents with Major Depression Disorder: A Functional Near-infrared Spectroscopy Study. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:118-128. [PMID: 38247418 PMCID: PMC10811388 DOI: 10.9758/cpn.23.1073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/17/2023] [Accepted: 06/17/2023] [Indexed: 01/23/2024]
Abstract
Objective : Numerous studies have identified hemodynamic changes in adults with major depressive disorder (MDD) by using functional near-infrared spectroscopy (fNIRS). However, studies on adolescents with MDD are limited. As adolescence is a stage of rapid brain development, differences may occur depending on age. This study used fNIRS as an objective tool to investigate hemodynamic changes in the frontal lobe according to depression severity and age in adolescents with MDD. Methods : Thirty adolescents (12 aged 12-15 years and 18 aged 16-18 years) were retrospectively investigated. The Children's Depression Inventory was used as a psychiatric evaluation scale, fNIRS was used as an objective brain function evaluation tool, and the Verbal Fluency Test was performed. Results : During the Verbal Fluency Test, in the younger MDD group, oxygenated-hemoglobin concentration increased in the right dorsolateral prefrontal cortex region as the severity of depression increased. In the older MDD group, the oxygenated-hemoglobin concentration decreased in the right dorsolateral prefrontal cortex region as the severity of depression increased. Conclusion : These results suggest that fNIRS may be an objective tool for identifying age differences among adolescents with MDD. To generalize the results and verify fNIRS as a potential biomarker tool, follow-up studies with a larger sample group should be conducted.
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Affiliation(s)
- Jeong Eun Shin
- Department of Medical Sciences, Graduate School of Soonchunhyang University, Asan, Korea
| | - Yun Sung Lee
- Sejong Special Self-Governing City Mental Health Welfare Center, Sejong, Korea
| | - Seo Young Park
- Sejong Special Self-Governing City Mental Health Welfare Center, Sejong, Korea
| | - Mi Young Jeong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | - Yeon Jung Lee
- Department of Psychiatry, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Lyu H, Zhao M, Xu P, Li Y, Jiang C, Zhao H, Shen W, Hu X, Wang K, Xu Y, Huang M. Gender differences in brain region activation during verbal fluency task as detected by fNIRS in patients with depression. World J Biol Psychiatry 2024; 25:141-150. [PMID: 37998167 DOI: 10.1080/15622975.2023.2287735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/21/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Gender plays a role in the mechanisms of depression, but fewer studies have focused on gender differences in the abnormal activation of brain regions when patients perform specific cognitive tasks. METHODS A total of 110 major depressive disorder (MDD) patients and 106 healthy controls were recruited. The relative change in oxygen-haemoglobin (oxy-Hb) concentration during the verbal fluency task were measured by a 52-channel near-infra-red spectroscopy (NIRS) system. Differences in brain region activation between patients and healthy controls and between genders of depression patients were compared. RESULTS MDD patients demonstrated significantly decreased [oxy-Hb] changes in the right inferior frontal gyrus (p = 0.043) compared to healthy controls. A marked increase in leftward functional language lateralisation in the inferior frontal gyrus was observed in the MDD group in contrast to the HC group (p = 0.039). Furthermore, female patients in the MDD group exhibited significant reductions in [oxy-Hb] changes in the right frontal region (specifically, the superior and middle frontal gyrus; p = 0.037) compared with male patients. CONCLUSIONS Gender impacts depression-related brain activation during cognitive tasks, potentially influencing depression's pathogenesis.
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Affiliation(s)
- Hailong Lyu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
- Brain Research Institute of Zhejiang University, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Miaomiao Zhao
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
- Brain Research Institute of Zhejiang University, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Pengfeng Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
- Brain Research Institute of Zhejiang University, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Ying Li
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
- Brain Research Institute of Zhejiang University, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Chaonan Jiang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
- Brain Research Institute of Zhejiang University, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Haoyang Zhao
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
- Brain Research Institute of Zhejiang University, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Wenjing Shen
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
- Department of Psychiatry, The Second People's Hospital of Lishui, Lishui, China
| | - Xiaohan Hu
- Department of Psychiatry, Wen Zhou seventh People's Hospital, Wenzhou, China
| | - Kaiqi Wang
- Department of Psychiatry, Ningbo Psychiatric Hospital, Ningbo, China
| | - Yi Xu
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
- Brain Research Institute of Zhejiang University, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
| | - Manli Huang
- Department of Psychiatry, The First Affiliated Hospital, Zhejiang University School of Medicine, Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
- Brain Research Institute of Zhejiang University, Hangzhou, China
- Zhejiang Engineering Center for Mathematical Mental Health, Hangzhou, China
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Park KR, Kim H, Seong S, Kim MJ, Choi JK, Jeon HJ. A study on the functional near-infrared spectroscopy on impaired prefrontal activation and impulsivity during cognitive task in patients with major depressive disorder. J Affect Disord 2023; 339:548-554. [PMID: 37437724 DOI: 10.1016/j.jad.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/04/2023] [Accepted: 07/08/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND This study aimed to examine the association between prefrontal activation during a verbal fluency task (VFT) and impulsivity among patients with major depressive disorder (MDD), using functional near-infrared spectroscopy (fNIRS). METHODS We enrolled a total of 119 participants, 60 with MDD patients and 59 with healthy controls (HCs), aged 18 to 34 years. The Barratt Impulsiveness Scale-11 (BIS-11) was used to assess impulsivity after completing baseline demographic, clinical, and physical assessments. A VFT was used to examine prefrontal activation during cognitive executions while fNIRS was monitored. The changing values of oxygenated hemoglobin (oxy-Hb) and their associations with the BIS-11 score were analyzed. RESULTS The data analysis comprised 109 participants in total (54 MDD; 55 HCs). Spearman's correlation analysis of the MDD group showed a negative correlation between changes in oxy-Hb and BIS-11 values in the right prefrontal cortex, notably the right frontopolar cortex (FPC) and ventromedial prefrontal cortex (VMPFC). After adjusting for sex, age, years of education, and Hamilton Depression Rating Scale (HAMD), significance was maintained in the right FPC [ρ = -0.317, p = 0.027], and the right VMPFC [ρ = -0.327, p = 0.022]. Furthermore, multivariate linear regression suggested a significant association in the right prefrontal cortex with BIS-11 score [β = -1.904, SE = 0.799, p = 0.0214]. CONCLUSIONS Impaired prefrontal activation during a verbal fluency task, led to higher impulsivity in patients with MDD.
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Affiliation(s)
- Ka Ram Park
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Sisu Seong
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Min-Ji Kim
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | | | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Department of Health Sciences & Technology and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea; Meditrix Co., Ltd., Seoul, South Korea.
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Ramos-Henderson M, Calderón C, Domic-Siede M. Education bias in typical brief cognitive tests used for the detection of dementia in elderly population with low educational level: a critical review. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36519252 DOI: 10.1080/23279095.2022.2155521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Dementia is a significant decline in cognition that interfere with independent, daily functioning. Dementia is a syndrome caused by a myriad and include primary neurologic, neuropsychiatric, and medical conditions. It has been projected that the prevalence of dementia will triple in the elderly population by the year 2050. Despite the benefits of early diagnosis, there is an effective under-detection of around 62% of people with mild cognitive impairment (MCI) or dementia. One of the factors associated with this problem is that diagnostic techniques are affected by the educational level of those evaluated. This is an important aspect to consider in the use of brief cognitive tests for the detection of dementia. This review presents and critically analyzes the available evidence regarding the effect of educational level on the diagnostic utility of three of the most widely used tools in the clinical setting: the Mini-mental Test Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Addenbrooke's Cognitive Examination (ACE). Previous evidence shows that the tasks that require reading, writing, calculation, phonological fluency, and visuoconstruction are affected by educational level. These results lead to discourage the use of these tests in older people with less than 6 years of schooling. The development of brief cognitive tests appropriate for people with a low educational level is recommended. We posit that adequate cognitive tests should not consider tasks or items that resemble characteristics of academic contexts and should be more analogous to daily activities situations.
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Affiliation(s)
- Miguel Ramos-Henderson
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
- Centro de Investigación e Innovación en Gerontología Aplicada CIGAP, Facultad de Salud, Universidad Santo Tomás, Antofagasta, Chile
| | - Carlos Calderón
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
| | - Marcos Domic-Siede
- Laboratorio de Neurociencia Cognitiva, Escuela de Psicología, Facultad de Humanidades, Universidad Católica del Norte, Antofagasta, Chile
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10
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The Role of Depressive Disorders in Autonomic Cardiovascular Dysregulation in Fibromyalgia. Psychosom Med 2022; 84:793-802. [PMID: 35796593 DOI: 10.1097/psy.0000000000001097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous research revealed aberrances in autonomic cardiovascular regulation in fibromyalgia, which may be relevant to symptoms genesis and the increased risk of cardiovascular disorders in individuals with fibromyalgia. This study investigated the role of comorbid depression in autonomic cardiovascular dysregulations in fibromyalgia. METHODS Cardiovascular recordings were obtained in 53 participants with fibromyalgia who also had depression ( n = 27), in participants with fibromyalgia without depression ( n = 26), and in 29 healthy controls, at rest and during a cold pressor test and an arithmetic task. Assessed parameters included interbeat interval, blood pressure, heart rate variability, baroreflex sensitivity, stroke volume, preejection period, left ventricular ejection time, Heather index, and total peripheral resistance. RESULTS Participants with both fibromyalgia and depression displayed lower tonic interbeat interval, baroreflex sensitivity, and heart rate variability compared with participants with fibromyalgia without depression and controls ( p values < .012, d values = 0.71-1.06). Participants with fibromyalgia but without depression did not differ from controls in these variables. Moreover, participants with fibromyalgia who also had depression, but not those without depression, exhibited lower Heather index, stroke volume, and left ventricular ejection time compared with controls ( p values < .013, d values = 0.62-0.78). No group differences arose for preejection period or total peripheral resistance. Stress reactivity was reduced in participants with fibromyalgia, independently of depression, for diastolic blood pressure, interbeat interval, left ventricular ejection time, and heart rate variability, than in controls. CONCLUSIONS The role of depression in the autonomic dysregulation in fibromyalgia involves chronotropic cardiac control rather than adrenergic influences on contractility and vascular tone. Blunted cardiovascular reactivity may be ascribable to pathological factors inherent to fibromyalgia. These results underline the importance of diagnostics and treatment of comorbid depressive disorders in the management of fibromyalgia.
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Bair A, Marksteiner J, Stöcklein T, Reyes del Paso GA, Duschek S. Parasympathetic cardiac control during attentional focus and worry in major depressive disorder. Int J Psychophysiol 2022; 177:1-10. [DOI: 10.1016/j.ijpsycho.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/06/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
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Liu X, Cheng F, Hu S, Wang B, Hu C, Zhu Z, Zhuang W, Mei X, Li X, Zhou Q, Zhang W, Tang Y, Zhou D. Cortical activation and functional connectivity during the verbal fluency task for adolescent-onset depression: A multi-channel NIRS study. J Psychiatr Res 2022; 147:254-261. [PMID: 35074741 DOI: 10.1016/j.jpsychires.2022.01.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/08/2021] [Accepted: 01/13/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Depression disorder is accompanied by cognitive impairments. However, there is limited research focused on cognitive impairments and their neurological mechanism in adolescents with depression. The purpose of the current study is to illustrate the differences in brain activity patterns between depressed adolescents and healthy controls (HCs). METHOD A total of 72 adolescents with depression, as well as 74 HCs, were recruited. We utilized functional near-infrared spectroscopy (fNIRS) to monitor the concentrations of oxyhemoglobin (Oxy-Hb) in the brains of participants while they performed the verbal fluency task (VFT) to examine cognitive impairment in adolescents with depression. RESULTS Our study demonstrated that adolescents with depression had significantly less cortical activation in the hemodynamic responses of Oxy-Hb at channels mainly located in the prefrontal cortex (PFC) than HCs during the 60-s task period (false discovery rate (FDR)-corrected p < 0.05). The mean channel-to-channel connectivity was 0.400 for HCs (SD = 0.149) and 0.303 (SD = 0.138) for adolescents with depression, and the HC group had a higher mean channel-to-channel connectivity strength than the depression group (t = -15.586, p < 0.001). For the patient group, we found significant negative correlations between HAMD scores and mean Oxy-Hb changes in Channel 38 (r = -0.33, p < 0.01), Channel 39 (r = -0.34, p < 0.01), Channel 41 (r = -0.25, p < 0.05), Channel 42 (r = -0.28, p < 0.05), and Channel 44 (r = -0.27, p < 0.05), and these channels were mainly located in areas with little difference between groups. CONCLUSIONS Our study provides neurological evidence about the executive function (EF) in depressed adolescents. Adolescents with depression exhibited an abnormal activation pattern and decreased task-related functional connectivity compared to HCs. The changed Oxy-Hb concentration of PFC during VFT was not sensitive to depression symptoms.
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Affiliation(s)
- Xiaoli Liu
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Fang Cheng
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Shasha Hu
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Beini Wang
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Changzhou Hu
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Zhenzhen Zhu
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Wenhao Zhuang
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Xi Mei
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Xingxing Li
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Qi Zhou
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China
| | - Wenwu Zhang
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China.
| | - Yiping Tang
- Taizhou Second People's Hospital, Taizhou, Zhejiang, 317200, China.
| | - Dongsheng Zhou
- Ningbo Kangning Hospital, Ningbo Key Laboratory of Sleep Medicine, Affiliated Tongyi Hospital of Medical College of Ningbo University, Ningbo, Zhejiang, China.
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Investigating the association between depression and cerebral haemodynamics-A systematic review and meta-analysis. J Affect Disord 2022; 299:144-158. [PMID: 34800572 DOI: 10.1016/j.jad.2021.11.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/25/2021] [Accepted: 11/14/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Vascular mechanisms may play a role in depression. The aim of this review is to summarise the evidence on alterations in cerebral haemodynamics in depression. METHODS MEDLINE (1946- present), Embase (1947-present), Web of Science (1970-present), PsycINFO (1984-present), CINAHL (1976-present) and CENTRAL were searched using a predefined search strategy. A meta-analysis was conducted in four groups: 1) global cerebral blood flow (CBF) in ml/min/100 g, 2) CBF velocity (CBFv) in cm/s (maximum flow of left middle cerebral artery, 3) combined CBF and CBFv, 4) Ratio of uptake of Tc 99 m HMPAO (region of interest compared to whole brain). Data are presented as mean difference or standardised mean difference and 95% confidence interval (95% CI). A narrative synthesis of the remaining studies was performed. RESULTS 87 studies were included. CBF was significantly reduced in depressed patients compared to HC [15 studies, 538 patients, 416 HC, MD: -2.24 (95% CI -4.12, -0.36), p = 0.02, I2 = 64%]. There were no statistically significant differences in other parameters. The narrative synthesis revealed variable changes in CBF in depressed patients, particularly affecting the anterior cingulate and prefrontal cortices. LIMITATIONS There were various sources of heterogeneity including the severity of depression, use of antidepressant medication, imaging modality used and reporting of outcomes. All of these factors made direct comparisons between studies difficult. CONCLUSIONS The reduction in CBF in depressed patients compared to HCs may indicate a role for assessment and CBF altering interventions in high-risk groups. However, results were inconsistent across studies, warranting further work to investigate specific subgroups.
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Tassi E, Boscutti A, Mandolini GM, Moltrasio C, Delvecchio G, Brambilla P. A scoping review of near infrared spectroscopy studies employing a verbal fluency task in bipolar disorder. J Affect Disord 2022; 298:604-617. [PMID: 34780861 DOI: 10.1016/j.jad.2021.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/02/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deficits in cognitive functioning, including attention, memory, and executive functions, along with impairments in language production, are present in patients with bipolar disorder (BD) patients during mood phases, but also during euthymia.Verbal fluency tasks (VFTs), being able to evaluate integrity of a wide range of cognitive domains and represent, can be used to screen for these disturbances. Neuroimaging studies, including Near-InfraRed Spectroscopy (NIRS), have repeatedly showed widespread alterations in the prefrontal and temporal cortex during the performance of VFTs in BD patients. This review aims to summarize the results of NIRS studies that evaluated hemodynamic responses associated with the VFTs in prefrontal and temporal regions in BD patients. METHODS We performed a scoping review of studies evaluating VFT-induced activation in prefrontal and temporal regions in BD patients, and the relationship between NIRS data and various clinical variables. RESULTS 15 studies met the inclusion criteria. In BD patients, compared to healthy controls, NIRS studies showed hypoactivation of the dorsolateral prefrontal cortex, ventrolateral prefrontal cortex and anterior temporal regions. Moreover, clinical variables, such as depressive and social adaptation scores, were negatively correlated with hemodynamic responses in prefrontal and temporal regions, while a positive correlation were reported for measures of manic symptoms and impulsivity. LIMITATIONS The heterogeneity of the studies in terms of methodology, study design and clinical characteristics of the samples limited the comparability of the findings. CONCLUSIONS Given its non-invasiveness, good time-resolution and no need of posturalconstraint, NIRS technique could represent a useful tool for the evaluation of prefrontal and temporal haemodynamic correlates of cognitive performances in BD patients.
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Affiliation(s)
- Emma Tassi
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy
| | - Andrea Boscutti
- Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
| | - Gian Mario Mandolini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy
| | - Chiara Moltrasio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy.
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, via F. Sforza 35, Milan 20122, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan 20122, Italy
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Kim H, Choi J, Jeong B, Fava M, Mischoulon D, Park MJ, Kim HS, Jeon HJ. Impaired Oxygenation of the Prefrontal Cortex During Verbal Fluency Task in Young Adults With Major Depressive Disorder and Suicidality: A Functional Near-Infrared Spectroscopy Study. Front Psychiatry 2022; 13:915425. [PMID: 35815016 PMCID: PMC9260011 DOI: 10.3389/fpsyt.2022.915425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few previous studies have focused on prefrontal activation in young adults diagnosed with major depressive disorder (MDD) and suicidality via functional near-infrared spectroscopy (fNIRS). MATERIALS AND METHODS A total of 59 healthy controls (HCs), 35 patients with MDD but without suicidality, and 25 patients with MDD and suicidality, between the ages of 18-34 years, were enrolled. Changes in oxygenated hemoglobin (oxy-Hb) levels of the prefrontal cortex at baseline, 4 weeks, and 8 weeks, were evaluated using a protocol consisting of three consecutively repeated trials of rest, speech, and verbal fluency test (VFT) via fNIRS. MDD was diagnosed and suicidality was evaluated based on Mini International Neuropsychiatric Interview (MINI). RESULTS Oxy-Hb levels were impaired in patients with MDD compared with HCs (p = 0.018 for left prefrontal cortex; p = 0.021 for right ventromedial prefrontal cortex; p = 0.002 for left frontopolar cortex). Among the three groups including HCs, MDD without suicidality, and MDD with suicidality, prefrontal oxygenation was most decreased in MDD patients with suicidality. A significantly impaired prefrontal oxygenation in the right ventrolateral prefrontal cortex (VLPFC) was detected after adjusting for covariates in MDD patients with suicidality, compared to those without suicidality. CONCLUSION Impaired prefrontal oxygenation during cognitive execution may serve as a diagnostic biomarker for suicidality in young adult patients with MDD.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Hanyang University Hospital, Seoul, South Korea
| | | | - Bumseok Jeong
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Mi Jin Park
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hyun Soo Kim
- Department of Psychiatry, Dong-A University Hospital, Busan, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea.,Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.,Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea
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Ozawa S. Application of Near-Infrared Spectroscopy for Evidence-Based Psychotherapy. Front Psychol 2021; 12:527335. [PMID: 34366946 PMCID: PMC8342759 DOI: 10.3389/fpsyg.2021.527335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 06/23/2021] [Indexed: 11/13/2022] Open
Abstract
This perspective article discusses the importance of evidence-based psychotherapy and highlights the usefulness of near-infrared spectroscopy (NIRS) in assessing the effects of psychotherapeutic interventions as a future direction of clinical psychology. NIRS is a safe and non-invasive neuroimaging technique that can be implemented in a clinical setting to measure brain activity via a simple procedure. This article discusses the possible benefits and challenges of applying NIRS for this purpose, and the available methodology based on previous studies that used NIRS to evaluate psychotherapeutic effects. Furthermore, this perspective article suggests alternative methodologies that may be useful, namely, the single- and multi-session evaluations using immediate pre- and post-intervention measurements. These methods can be used to evaluate state changes in brain activity, which can be derived from a single session of psychotherapeutic interventions. This article provides a conceptual schema important in actualizing NIRS application for evidence-base psychotherapy.
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Affiliation(s)
- Sachiyo Ozawa
- UTokyo Center for Integrative Science of Human Behavior (CiSHuB), Center for Evolutionary Cognitive Sciences, Graduate School of Arts and Sciences, The University of Tokyo, Tokyo, Japan
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Ramos-Henderson M, Ledezma-Dámes A, López N, Machado Goyano Mac Kay AP. Executive functions and functional impairment in Latin seniors suffering from depression. NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2021; 28:543-558. [PMID: 32715938 DOI: 10.1080/13825585.2020.1796915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
UNLABELLED Functional impairment (FI) relates to the condition of executive functions (EFs). While EFs become affected by age and educational level (EL). Seniors suffering from depression (SSDs) on the other hand show EF-related deficiencies; however, there is hardly any literature available regarding their relationship with FI in Latin SSDs, who usually have low ELs. OBJECTIVE To verify the relationship between EFs and FI in SSDs of Latin origins, by controlling the effects associated with age and educational level. METHODOLOGY Cross-sectional study, of cases and controls, conducted on a nonprobability sample, made up of 102 self-sufficient SSDs and 142 control subjects over age 50, monolinguals of Latin origin (Chileans), all assessed by means of a battery of assessments such as: Geriatric Depression Scale, Addenbrook's Cognitive Assessment III, Trail making Tests A and B, STROOP word-color test, and semantic and phonological verbal fluency tests. A domain of composite EFs was established with standardized Chilean population scores, where age and educational levels were controlled. A simple linear regression analysis was conducted to determine the relationship between EFs and FI in SSDs. RESULTS Upon controlling age and educational levels, EFs explained an FI variance of 3.9% in SSDs; depression explained an EF variance of 3.2%, and 3.7% of FI. CONCLUSION The results of the present study highlight the importance of a timely intervention when it comes to geriatric depression, considering the negative effect it has over the executive functions and the functionality of seniors.
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Affiliation(s)
- Miguel Ramos-Henderson
- Centro De Investigación E Innovación En Gerontología Aplicada (CIGAP), Facultad De Salud, Universidad Santo Tomás , Antofagasta, Chile
- Escuela De Psicología, Facultad De Ciencias Sociales Y De La Comunicación, Universidad Santo Tomás , Antofagasta, Chile
| | - Andrés Ledezma-Dámes
- Centro De Investigación E Innovación En Gerontología Aplicada (CIGAP), Facultad De Salud, Universidad Santo Tomás , Antofagasta, Chile
| | - Norman López
- Departamento De Ciencias Sociales, Universidad De La Costa , Barranquilla, Colombia
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Chang SL, Wang JY. Age differences in the longitudinal associations of leisure-time physical activity and depressive symptoms with cognitive decline in older Taiwanese. Aging Ment Health 2021; 25:679-685. [PMID: 31829035 DOI: 10.1080/13607863.2019.1701626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The associations of physical activity and depressive symptoms with cognitive decline are likely age dependent. The study was therefore aimed to investigate the age differences in the associations of leisure-time physical activity (LTPA) and depressive symptoms with cognitive decline in older Taiwanese.Method: A total of 3545 participants, age ≥50, from 2003 (baseline) and 2007 (end-point) survey datasets were analyzed. Cognitive decline was defined as a decrease of two or more points on the Short Portable Mental Status Questionnaire. The long-term LTPA and depressive symptoms were the change of status between the two time-points. Multivariable logistic regression was conducted to evaluate the longitudinal associations, stratified by age.Results: Significant associations between all levels of long-term LTPA status and cognitive decline were observed for the older group (age ≥70), but not any for the younger group (age 50-69). Significant associations between long-term depressive symptoms status and cognitive decline were also found in all levels for the older group, but only in one level for the younger group. The two odds ratios of cognitive decline between the age groups were further found to be significantly different for those with active LTPA in both time-points (p=.005) and for those with depressive symptoms decreased (p=.014).Conclusion: The findings suggest that there are age differences in the longitudinal associations of LTPA and depressive symptoms with cognitive decline in older Taiwanese. Understanding the pattern of age differences could be helpful in preventing cognitive decline of the elderly.
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Affiliation(s)
- Shujen Lee Chang
- Department of Psychology, College of Medical and Health Science, Asia University, Wufeng, Taichung, Taiwan
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Wufeng, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
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Bair A, Marksteiner J, Falch R, Ettinger U, Reyes Del Paso GA, Duschek S. Features of autonomic cardiovascular control during cognition in major depressive disorder. Psychophysiology 2020; 58:e13628. [PMID: 32621782 DOI: 10.1111/psyp.13628] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 11/27/2022]
Abstract
Previous research has suggested reduced parasympathetic cardiac regulation during cognitive activity in major depressive disorder (MDD). However, little is known about possible abnormalities in sympathetic control and cardiovascular reactivity. This study aimed to provide a comprehensive analysis of autonomic cardiovascular control in the context of executive functions in MDD. Thirty six MDD patients and 39 healthy controls participated. Parameters of sympathetic (pre-ejection period, PEP) and parasympathetic control (high and low frequency heart rate variability, HF HRV, LF HRV; and baroreflex sensitivity, BRS) as well as RR interval were obtained at rest and during performance of executive function tasks (number-letter task, n-back task, continuous performance test, and Stroop task). Patients, as compared to controls, exhibited lower HF HRV and LF HRV during task execution and smaller shortenings in PEP and RR interval between baseline and tasks. They displayed longer reaction times during all conditions of the tasks and more omission errors and false alarms on the continuous performance test. In the total sample, on-task HF HRV, LF HRV and BRS, and reactivity in HF HRV, LF HRV, and PEP, were positively associated with task performance. As performance reduction arose independent of executive function load of the tasks, the behavioral results reflect impairments in attention and processing speed rather than executive dysfunctions in MDD. Abnormalities in cardiovascular control during cognition in MDD appear to involve both divisions of the autonomic nervous system. Low tonic parasympathetic control and blunted sympathetic reactivity imply reduced physiological adjustment resources and, by extension, provide suboptimal conditions for cognitive performance.
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Affiliation(s)
- Angela Bair
- Institute of Psychology, UMIT - University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Josef Marksteiner
- Department of Psychiatry, County Hospital of Hall in Tirol, Hall in Tirol, Austria
| | - Reingard Falch
- Department of Psychiatry, County Hospital of Hall in Tirol, Hall in Tirol, Austria
| | | | | | - Stefan Duschek
- Institute of Psychology, UMIT - University of Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Ho CSH, Lim LJH, Lim AQ, Chan NHC, Tan RS, Lee SH, Ho RCM. Diagnostic and Predictive Applications of Functional Near-Infrared Spectroscopy for Major Depressive Disorder: A Systematic Review. Front Psychiatry 2020; 11:378. [PMID: 32477179 PMCID: PMC7232562 DOI: 10.3389/fpsyt.2020.00378] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/15/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Major depressive disorder (MDD) is a global psychiatric disorder with no established biomarker. There is growing evidence that functional near-infrared spectroscopy (fNIRS) has the ability to aid in the diagnosis and prediction of the treatment response of MDD. The aim of this review was to systematically review, and gather the evidence from existing studies that used fNIRS signals in the diagnosis of MDD, correlations with depression symptomatology, and the monitoring of treatment response. METHODS PubMed, EMBASE, ScienceDirect, and Cochrane Library databases were searched for published English articles from 1980 to June 2019 that focused on the application of fNIRS for (i) differentiating depressed versus nondepressed individuals, (ii) correlating with depression symptomatology, and in turn (iii) monitoring treatment responses in depression. Studies were included if they utilized fNIRS to evaluate cerebral hemodynamic variations in patients with MDD of any age group. The quality of the evidence was assessed using the Newcastle-Ottawa quality assessment scale. RESULTS A total of 64 studies were included in this review, with 12 studies being longitudinal, while the rest were cross-sectional. More than two-thirds of the studies (n = 49) had acceptable quality. fNIRS consistently demonstrated attenuated cerebral hemodynamic changes in depressed compared to healthy individuals. fNIRS signals have also shown promise in correlating with individual symptoms of depression and monitoring various treatment responses. CONCLUSIONS This review provides comprehensive updated evidence of the diagnostic and predictive applications of fNIRS in patients with MDD. Future studies involving larger sample sizes, standardized methodology, examination of more brain regions in an integrative approach, and longitudinal follow-ups are needed.
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Affiliation(s)
- Cyrus S H Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lucas J H Lim
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - A Q Lim
- Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Nicole H C Chan
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - R S Tan
- Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - S H Lee
- Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore, Singapore
| | - Roger C M Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Institute of Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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Cerebral blood flow responses during prosaccade and antisaccade preparation in major depression. Eur Arch Psychiatry Clin Neurosci 2019; 269:813-822. [PMID: 30421150 DOI: 10.1007/s00406-018-0956-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/03/2018] [Indexed: 12/17/2022]
Abstract
While impairments in executive functions have been well established in major depressive disorder (MDD), specific deficits in proactive control have scarcely been studied so far. Proactive control refers to cognitive processes during anticipation of a behaviorally relevant event that facilitate readiness to react. In this study, cerebral blood flow responses were investigated in MDD patients during a precued antisaccade task requiring preparatory attention and proactive inhibition. Using functional transcranial Doppler sonography, blood flow velocities in the middle cerebral arteries of both hemispheres were recorded in 40 MDD patients and 40 healthy controls. In the task, a target appeared left or right of the fixation point 5 s after a cuing stimulus; subjects had to move their gaze to the target (prosaccade) or its mirror image position (antisaccade). Video-based eye-tracking was applied for ocular recording. A right dominant blood flow increase arose during prosaccade and antisaccade preparation, which was smaller in MDD patients than controls. Patients exhibited a higher error rate than controls for antisaccades but not prosaccades. The smaller blood flow response may reflect blunted anticipatory activation of the dorsolateral prefrontal and inferior parietal cortices in MDD. The patients' increased antisaccade error rate suggests deficient inhibitory control. The findings support the notion of impairments in proactive control in MDD, which are clinically relevant as they may contribute to the deficits in cognition and behavioral regulation that characterize the disorder.
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Hoffmann A, Montoro CI, Reyes del Paso GA, Duschek S. Cerebral blood flow modulations during proactive control in major depressive disorder. Int J Psychophysiol 2018; 133:175-181. [DOI: 10.1016/j.ijpsycho.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/13/2018] [Accepted: 07/05/2018] [Indexed: 02/06/2023]
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Hoffmann A, Montoro CI, Reyes Del Paso GA, Duschek S. Cerebral blood flow modulations during cognitive control in major depressive disorder. J Affect Disord 2018; 237:118-125. [PMID: 29803902 DOI: 10.1016/j.jad.2018.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/23/2018] [Accepted: 05/13/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND This study investigated cerebral blood flow modulations during proactive and reactive cognitive control in major depressive disorder (MDD). Proactive control refers to preparatory processes during anticipation of a behaviorally relevant event; reactive control is activated after such an event to ensure goal attainment. METHODS Using functional transcranial Doppler sonography, blood flow velocities in the middle cerebral arteries of both hemispheres were recorded in 40 MDD patients and 40 healthy controls during a precued Stroop task. The font color of color words, which appeared 5 s after an acoustic warning signal, had to be indicated while ignoring word meaning. RESULTS Patients, as compared to controls, exhibited smaller bilateral blood flow increases during task preparation and larger increases after color word presentation. Response time was longer in patients irrespective of the match or mismatch between font color and word meaning. The blood flow increase after word presentation correlated positively with response time. LIMITATIONS Potential effects of psychotropic medication on cognition and cerebral blood flow could not be controlled. CONCLUSIONS The study revealed evidence of reduced cortical activity during proactive and elevated activity that occurs during reactive control in MDD. Deficient implementation of proactive control in MDD may lead to increased reliance on reactive control. The association between the blood flow increase after color word presentation and poorer performance indicates that deficient response preparation cannot be compensated for by reactive strategies. The findings are clinically relevant, as they may contribute to our understanding of the mechanisms relevant to cognitive impairments in MDD.
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Affiliation(s)
- Alexandra Hoffmann
- UMIT - Institute of Psychology, University for Health Sciences Medical Informatics and Technology, Eduard-Wallnöfer Zentrum 1, Hall in Tirol 6060, Austria.
| | | | | | - Stefan Duschek
- UMIT - Institute of Psychology, University for Health Sciences Medical Informatics and Technology, Eduard-Wallnöfer Zentrum 1, Hall in Tirol 6060, Austria
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Lee S, Kang BM, Kim JH, Min J, Kim HS, Ryu H, Park H, Bae S, Oh D, Choi M, Suh M. Real-time in vivo two-photon imaging study reveals decreased cerebro-vascular volume and increased blood-brain barrier permeability in chronically stressed mice. Sci Rep 2018; 8:13064. [PMID: 30166586 PMCID: PMC6117335 DOI: 10.1038/s41598-018-30875-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/07/2018] [Indexed: 01/15/2023] Open
Abstract
Chronic stress disrupts brain homeostasis and adversely affects the cerebro-vascular system. Even though the effects of chronic stress on brain system have been extensively studied, there are few in vivo dynamic studies on the effects of chronic stress on the cerebro-vascular system. In this study, the effects of chronic stress on cerebral vasculature and BBB permeability were studied using in vivo two-photon (2p) microscopic imaging with an injection of fluorescence-conjugated dextran. Our real-time 2p imaging results showed that chronic stress reduced the vessel diameter and reconstructed vascular volume, regardless of vessel type and branching order. BBB permeability was investigated with two different size of tracers. Stressed animals exhibited a greater BBB permeability to 40-kDa dextran, but not to 70-kDa dextran, which is suggestive of weakened vascular integrity following stress. Molecular analysis revealed significantly higher VEGFa mRNA expression and a reduction in claudin-5. In summary, chronic stress decreases the size of cerebral vessels and increases BBB permeability. These results may suggest that the sustained decrease in cerebro-vascular volume due to chronic stress leads to a hypoxic condition that causes molecular changes such as VEGF and claudin-5, which eventually impairs the function of BBB.
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Affiliation(s)
- Sohee Lee
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea
| | - Bok-Man Kang
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Jae Hwan Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea.,Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Jiwoong Min
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Hyung Seok Kim
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Hyunwoo Ryu
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Hyejin Park
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea.,Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea.,Department of Biological Science, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Sungjun Bae
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Daehwan Oh
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Myunghwan Choi
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea.,Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea.,Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Minah Suh
- Center for Neuroscience Imaging Research, Institute for Basic Science (IBS), Suwon, 16419, Republic of Korea. .,Department of Biomedical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea. .,Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea. .,Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea.
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25
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Daulatzai MA. Cerebral hypoperfusion and glucose hypometabolism: Key pathophysiological modulators promote neurodegeneration, cognitive impairment, and Alzheimer's disease. J Neurosci Res 2016; 95:943-972. [PMID: 27350397 DOI: 10.1002/jnr.23777] [Citation(s) in RCA: 274] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 02/06/2023]
Abstract
Aging, hypertension, diabetes, hypoxia/obstructive sleep apnea (OSA), obesity, vitamin B12/folate deficiency, depression, and traumatic brain injury synergistically promote diverse pathological mechanisms including cerebral hypoperfusion and glucose hypometabolism. These risk factors trigger neuroinflammation and oxidative-nitrosative stress that in turn decrease nitric oxide and enhance endothelin, Amyloid-β deposition, cerebral amyloid angiopathy, and blood-brain barrier disruption. Proinflammatory cytokines, endothelin-1, and oxidative-nitrosative stress trigger several pathological feedforward and feedback loops. These upstream factors persist in the brain for decades, upregulating amyloid and tau, before the cognitive decline. These cascades lead to neuronal Ca2+ increase, neurodegeneration, cognitive/memory decline, and Alzheimer's disease (AD). However, strategies are available to attenuate cerebral hypoperfusion and glucose hypometabolism and ameliorate cognitive decline. AD is the leading cause of dementia among the elderly. There is significant evidence that pathways involving inflammation and oxidative-nitrosative stress (ONS) play a key pathophysiological role in promoting cognitive dysfunction. Aging and several comorbid conditions mentioned above promote diverse pathologies. These include inflammation, ONS, hypoperfusion, and hypometabolism in the brain. In AD, chronic cerebral hypoperfusion and glucose hypometabolism precede decades before the cognitive decline. These comorbid disease conditions may share and synergistically activate these pathophysiological pathways. Inflammation upregulates cerebrovascular pathology through proinflammatory cytokines, endothelin-1, and nitric oxide (NO). Inflammation-triggered ONS promotes long-term damage involving fatty acids, proteins, DNA, and mitochondria; these amplify and perpetuate several feedforward and feedback pathological loops. The latter includes dysfunctional energy metabolism (compromised mitochondrial ATP production), amyloid-β generation, endothelial dysfunction, and blood-brain-barrier disruption. These lead to decreased cerebral blood flow and chronic cerebral hypoperfusion- that would modulate metabolic dysfunction and neurodegeneration. In essence, hypoperfusion deprives the brain from its two paramount trophic substances, viz., oxygen and nutrients. Consequently, the brain suffers from synaptic dysfunction and neuronal degeneration/loss, leading to both gray and white matter atrophy, cognitive dysfunction, and AD. This Review underscores the importance of treating the above-mentioned comorbid disease conditions to attenuate inflammation and ONS and ameliorate decreased cerebral blood flow and hypometabolism. Additionally, several strategies are described here to control chronic hypoperfusion of the brain and enhance cognition. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE Dept/MSE, The University of Melbourne, Parkville, Victoria, Australia
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Rosenbaum D, Hagen K, Deppermann S, Kroczek AM, Haeussinger FB, Heinzel S, Berg D, Fallgatter AJ, Metzger FG, Ehlis AC. State-dependent altered connectivity in late-life depression: a functional near-infrared spectroscopy study. Neurobiol Aging 2016; 39:57-68. [DOI: 10.1016/j.neurobiolaging.2015.11.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 11/04/2015] [Accepted: 11/27/2015] [Indexed: 01/08/2023]
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