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Juan Q, Shiwan T, Yurong S, Jiabo S, Yu C, Shui T, Zhijian Y, Qing L. Brain structural and functional abnormalities in affective network are associated with anxious depression. BMC Psychiatry 2024; 24:533. [PMID: 39054442 PMCID: PMC11270941 DOI: 10.1186/s12888-024-05970-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Anxious depression (AD) is a common subtype of major depressive disorder (MDD). Neuroimaging studies of AD have revealed inconsistent and heterogeneous brain alterations with the use of single-model methods. Therefore, it is necessary to explore the pathogenesis of AD using multi-model imaging analyses to obtain more homogeneous and robust results. METHODS One hundred and eighty-two patients with MDD and 64 matched healthy controls (HCs) were recruited. Voxel-based morphometry (VBM) was used to estimate the gray matter volume (GMV) of all subjects. The GMV differences between the AD and non-anxious depression (NAD) participants were used as regions of interest (ROIs) for subsequent resting state functional connectivity (rs-FC) analyses. Correlation analysis was used to evaluate the associations between clinical symptoms and abnormal function in specific brain areas. RESULTS Decreased GMV in the medial frontal gyrus (MFG) and the superior frontal gyrus (SFG) was observed in the AD group compared to the NAD group. Taking the MFG and SFG as ROIs, the rs-FC analysis revealed decreased FC between the left SFG and left temporal pole and between the left SFG and right MFG in the AD group compared to the NAD group. Finally, the FC between the left SFG and left temporal pole was negatively correlated with HAMD-17 scores in the AD group. CONCLUSION By combining the GMV and rs-FC models, this study revealed that structural and functional disruption of the affective network may be an important pathophysiology underlying AD. The structural impairment may serve as the foundation of the functional impairment.
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Affiliation(s)
- Qiao Juan
- Department of Psychology, The Affiliated Xuzhou Eastern Hospital of Xuzhou Medical University, Xuzhou, 221004, China
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Tao Shiwan
- West China Hospital, Mental Health Center, Sichuan University, Chengdu, 610047, China
| | - Sun Yurong
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China
- Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China
| | - Shi Jiabo
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, 210093, China
| | - Chen Yu
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, 210093, China
| | - Tian Shui
- Department of Radiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China
| | - Yao Zhijian
- Department of Psychiatry, the Affiliated Brain Hospital of Nanjing Medical University, Nanjing, 210029, China.
- Nanjing Brain Hospital, Medical School of Nanjing University, Nanjing, 210093, China.
| | - Lu Qing
- School of Biological Sciences & Medical Engineering, Southeast University, Nanjing, 210096, China.
- Child Development and Learning Science, Key Laboratory of Ministry of Education, Nanjing, China.
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Kokubun K, Nemoto K, Yamakawa Y. Smartphone app for lifestyle improvement improves brain health and boosts the vitality and cognitive function of healthy middle-aged adults. Brain Behav 2024; 14:e3500. [PMID: 38685801 PMCID: PMC11058401 DOI: 10.1002/brb3.3500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 03/20/2024] [Accepted: 04/06/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION The number of smartphone apps for brain training is increasing, and the number of people who are working on brain training is also increasing. However, researchers disagree about the effectiveness of brain training. METHODS Therefore, in this study, we conducted an intervention test with the participation of 70 healthy middle-aged men and women and measured the effect of smartphone apps on lifestyle improvement using brain healthcare quotient calculated from brain imaging data. RESULTS As a result, in the intervention group, significant improvements were seen in fractional anisotropy (FA) of the whole brain, corpus callosum, internal capsule, corona radiata, posterior thalamic radiation, external capsule, and superior longitudinal fasciculus. Additionally, in the intervention group, these FA increments correlated with improvements in cognitive function as measured by the trail-making test and vigor as measured by the Profile of Mood States 2nd Edition. CONCLUSION The results of this study suggest that improving lifestyle habits through smartphone apps can improve brain health and cognitive and emotional performance of healthy middle-aged adults. This is consistent with previous research that suggests that FA integrity in the limbic-thalamo-cortical pathway influences cognitive function and emotion regulation.
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Affiliation(s)
- Keisuke Kokubun
- Open Innovation InstituteKyoto UniversityKyotoJapan
- Graduate School of ManagementKyoto UniversityKyotoJapan
| | - Kiyotaka Nemoto
- Department of Psychiatry, Institute of MedicineUniversity of TsukubaTsukubaJapan
| | - Yoshinori Yamakawa
- Open Innovation InstituteKyoto UniversityKyotoJapan
- Graduate School of ManagementKyoto UniversityKyotoJapan
- Institute of Innovative Research, Tokyo Institute of TechnologyMeguroTokyoJapan
- ImPACT Program of Council for Science, Technology and Innovation (Cabinet Office, Government of Japan)ChiyodaTokyoJapan
- Office for Academic and Industrial InnovationKobe UniversityKobeJapan
- Brain ImpactKyotoJapan
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Wang X, Lin J, Lu H, Xiong Y, Duan C, Zhang D, Huang J, Deng L, Li C, Li R, Zhang D, Bian X, Zhou J, Pan L, Lou X. Alteration of White Matter Connectivity for MR-Guided Focused Ultrasound in the Treatment of Essential Tremor. J Magn Reson Imaging 2024; 59:1358-1370. [PMID: 37491872 DOI: 10.1002/jmri.28896] [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: 02/03/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has been implemented as a therapeutic alternative for the treatment of drug-refractory essential tremor (ET). However, its impact on the brain structural network is still unclear. PURPOSE To investigate both global and local alterations of the white matter (WM) connectivity network in ET after MRgFUS thalamotomy. STUDY TYPE Retrospective. SUBJECTS Twenty-seven ET patients (61 ± 11 years, 19 males) with MRgFUS thalamotomy and 28 healthy controls (HC) (61 ± 11 years, 20 males) were recruited for comparison. FIELD STRENGTH/SEQUENCE A 3 T/single shell diffusion tensor imaging by using spin-echo-based echo-planar imaging, three-dimensional T1 weighted imaging by using gradient-echo-based sequence. ASSESSMENT Patients were undergoing MRgFUS thalamotomy and their clinical data were collected from pre-operation to 6-month post-operation. Network topological metrics, including rich-club organization, small-world, and efficiency properties were calculated. Correlation between the topological metrics and tremor scores in ET groups was also calculated to assess the role of neural remodeling in the brain. STATISTICAL TESTS Two-sample independent t-tests, chi-squared test, ANOVA, Bonferroni test, and Spearman's correlation. Statistical significance was set at P < 0.05. RESULTS For ET patients, the strength of rich-club connection and clustering coefficient significantly increased vs. characteristic path length decreased at 6-month post-operation compared with pre-operation. The distribution pattern of rich-club regions was different in ET groups. Specifically, the order of the rich-club regions was changed according to the network degree value after MRgFUS thalamotomy. Moreover, the altered nodal efficiency in the right temporal pole of the superior temporal gyrus (R = 0.434-0.596) and right putamen (R = 0.413-0.436) was positively correlated with different tremor improvement. DATA CONCLUSION These findings might improve understanding of treatment-induced modulation from a network perspective and may work as an objective marker in the assessment of ET tremor control with MRgFUS thalamotomy. LEVEL OF EVIDENCE 3 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Xiaoyu Wang
- School of Medicine, Nankai University, Tianjin, China
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jiaji Lin
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Haoxuan Lu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Yongqin Xiong
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Caohui Duan
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Dong Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jiayu Huang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Linlin Deng
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Chenxi Li
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Runze Li
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Dekang Zhang
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xiangbing Bian
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Jiayou Zhou
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Longsheng Pan
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- School of Medicine, Nankai University, Tianjin, China
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
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Wei J, Wang M, Dou Y, Wang Y, Du Y, Zhao L, Ni R, Yang X, Ma X. Dysconnectivity of the brain functional network and abnormally expressed peripheral transcriptional profiles in patients with anxious depression. J Psychiatr Res 2024; 171:316-324. [PMID: 38340698 DOI: 10.1016/j.jpsychires.2024.01.021] [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: 12/18/2023] [Accepted: 01/15/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Major depressive disorder (MDD) is a heterogeneous mental disorder, and accompanying anxiety symptoms, known as anxious depression (AD), are the most common subtype. However, the pathophysiology of AD may be distinct in depressed patients without anxiety (NAD) and remains unknown. This study aimed to investigate the relationship between functional connectivity and peripheral transcriptional profiles in patients with AD and NAD. METHODS Functional imaging data were collected to identify differences in functional networks among patients with AD (n = 66), patients with NAD (n = 115), and healthy controls (HC, n = 200). The peripheral transcriptional data were clustered as co-expression modules, and their associations with AD, AND, and HC were analyzed. The gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment analyses of the genes in the significant module were performed. Correlation analysis was performed to identify functional network-associated gene co-expression modules. RESULTS A network was identified which consisted of 23 nodes and 28 edges that were significantly different among three sample groups. The regions of the network were located in temporal and occipital lobe. Two gene co-expression modules were shown to be associated with NAD, and one of which was correlated with the disrupted network in the AD group. The biological function of this module was enriched in immune regulation pathways. CONCLUSION The results suggested that immune-related mechanisms were associated with functional networks in AD.
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Affiliation(s)
- Jinxue Wei
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Min Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Yikai Dou
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Wang
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Yue Du
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Liansheng Zhao
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Rongjun Ni
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Xiao Yang
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaohong Ma
- Mental Health Center and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China.
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Hirschfeld LR, Deardorff R, Chumin EJ, Wu YC, McDonald BC, Cao S, Risacher SL, Yi D, Byun MS, Lee JY, Kim YK, Kang KM, Sohn CH, Nho K, Saykin AJ, Lee DY. White matter integrity is associated with cognition and amyloid burden in older adult Koreans along the Alzheimer's disease continuum. Alzheimers Res Ther 2023; 15:218. [PMID: 38102714 PMCID: PMC10725037 DOI: 10.1186/s13195-023-01369-5] [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: 04/19/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND White matter (WM) microstructural changes in the hippocampal cingulum bundle (CBH) in Alzheimer's disease (AD) have been described in cohorts of largely European ancestry but are lacking in other populations. METHODS We assessed the relationship between CBH WM integrity and cognition or amyloid burden in 505 Korean older adults aged ≥ 55 years, including 276 cognitively normal older adults (CN), 142 with mild cognitive impairment (MCI), and 87 AD patients, recruited as part of the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's disease (KBASE) at Seoul National University. RESULTS Compared to CN, AD and MCI subjects showed significantly higher RD, MD, and AxD values (all p-values < 0.001) and significantly lower FA values (left p ≤ 0.002, right p ≤ 0.015) after Bonferroni adjustment for multiple comparisons. Most tests of cognition and mood (p < 0.001) as well as higher medial temporal amyloid burden (p < 0.001) were associated with poorer WM integrity in the CBH after Bonferroni adjustment. CONCLUSION These findings are consistent with patterns of WM microstructural damage previously reported in non-Hispanic White (NHW) MCI/AD cohorts, reinforcing existing evidence from predominantly NHW cohort studies.
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Affiliation(s)
- Lauren R Hirschfeld
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
| | - Rachael Deardorff
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Evgeny J Chumin
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, 47405, USA
| | - Yu-Chien Wu
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Brenna C McDonald
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Sha Cao
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Shannon L Risacher
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, 03080, South Korea
| | - Min Soo Byun
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, 03080, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, 03080, South Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, 03080, South Korea
- Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, 07061, South Korea
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, South Korea
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, 03080, South Korea
| | - Kwangsik Nho
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Indiana University School of Informatics and Computing, Indianapolis, IN, 46202, USA
| | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202, USA
| | - Dong Young Lee
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, 03080, South Korea
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, 03080, South Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, 03080, South Korea
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Hirschfeld LR, Deardorff R, Chumin EJ, Wu YC, McDonald BC, Cao S, Risacher SL, Yi D, Byun MS, Lee JY, Kim YK, Kang KM, Sohn CH, Nho K, Saykin AJ, Lee DY. White matter integrity is associated with cognition and amyloid burden in older adult Koreans along the Alzheimer's disease continuum. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.04.05.23288147. [PMID: 37066317 PMCID: PMC10104207 DOI: 10.1101/2023.04.05.23288147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND White matter (WM) microstructural changes in the hippocampal cingulum bundle (CBH) in Alzheimer's disease (AD) have been described in cohorts of largely European ancestry but are lacking in other populations. METHODS We assessed the relationship between CBH WM integrity and cognition or amyloid burden in 505 Korean older adults aged ≥55 years, including 276 cognitively normal older adults (CN), 142 mild cognitive impairment (MCI), and 87 AD, recruited as part of the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's disease (KBASE) at Seoul National University. RESULTS Compared to CN, AD and MCI subjects showed decreased WM integrity in the bilateral CBH. Cognition, mood, and higher amyloid burden were also associated with poorer WM integrity in the CBH. CONCLUSION These findings are consistent with patterns of WM microstructural damage previously reported in non-Hispanic White (NHW) MCI/AD cohorts, reinforcing existing evidence from predominantly NHW cohort studies.
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Affiliation(s)
- Lauren Rose Hirschfeld
- Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, IN USA, 46202
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA, 46202
| | - Rachael Deardorff
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA, 46202
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN USA, 46202
| | - Evgeny J Chumin
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA, 46202
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN USA, 47405
| | - Yu-Chien Wu
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA, 46202
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN USA, 46202
| | - Brenna C McDonald
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA, 46202
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN USA, 46202
| | - Sha Cao
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA, 46202
- Department of Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, IN USA, 46202
| | - Shannon L Risacher
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA, 46202
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN USA, 46202
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Korea, 03080
| | - Min Soo Byun
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea, 03080
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea, 03080
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea, 03080
- Department of Neuropsychiatry, SMG-SNU Boramae Medical Center, Seoul, Korea, 07061
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Korea, 07061
| | - Koung Mi Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Korea, 03080
| | - Chul-Ho Sohn
- Department of Radiology, Seoul National University Hospital, Seoul, Korea, 03080
| | - Kwangsik Nho
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA, 46202
- Indiana University School of Informatics and Computing, Indianapolis, IN USA, 46202
| | - Andrew J Saykin
- Indiana Alzheimer's Disease Research Center, Indiana University School of Medicine, Indianapolis, IN USA, 46202
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN USA, 46202
| | - Dong Young Lee
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Korea, 03080
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea, 03080
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea, 03080
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