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Marawi T, Ainsworth NJ, Zhukovsky P, Rashidi-Ranjbar N, Rajji TK, Tartaglia MC, Voineskos AN, Mulsant BH. Brain-cognition relationships in late-life depression: a systematic review of structural magnetic resonance imaging studies. Transl Psychiatry 2023; 13:284. [PMID: 37598228 PMCID: PMC10439902 DOI: 10.1038/s41398-023-02584-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Most patients with late-life depression (LLD) have cognitive impairment, and at least one-third meet diagnostic criteria for mild cognitive impairment (MCI), a prodrome to Alzheimer's dementia (AD) and other neurodegenerative diseases. However, the mechanisms linking LLD and MCI, and brain alterations underlying impaired cognition in LLD and LLD + MCI remain poorly understood. METHODS To address this knowledge gap, we conducted a systematic review of studies of brain-cognition relationships in LLD or LLD + MCI to identify circuits underlying impaired cognition in LLD or LLD + MCI. We searched MEDLINE, PsycINFO, EMBASE, and Web of Science databases from inception through February 13, 2023. We included studies that assessed cognition in patients with LLD or LLD + MCI and acquired: (1) T1-weighted imaging (T1) measuring gray matter volumes or thickness; or (2) diffusion-weighted imaging (DWI) assessing white matter integrity. Due to the heterogeneity in studies, we only conducted a descriptive synthesis. RESULTS Our search identified 51 articles, resulting in 33 T1 studies, 17 DWI studies, and 1 study analyzing both T1 and DWI. Despite limitations, reviewed studies suggest that lower thickness or volume in the frontal and temporal regions and widespread lower white matter integrity are associated with impaired cognition in LLD. Lower white matter integrity in the posterior cingulate region (precuneus and corpus callosum sub-regions) was more associated with impairment executive function and processing speed than with memory. CONCLUSION Future studies should analyze larger samples of participants with various degrees of cognitive impairment and go beyond univariate statistical models to assess reliable brain-cognition relationships in LLD.
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Affiliation(s)
- Tulip Marawi
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Nicholas J Ainsworth
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Peter Zhukovsky
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Neda Rashidi-Ranjbar
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Tarek K Rajji
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada
| | - Maria Carmela Tartaglia
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Neurology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Aristotle N Voineskos
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Benoit H Mulsant
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Toronto Dementia Research Alliance, University of Toronto, Toronto, ON, Canada.
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2
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Resende EDPF, Hornberger M, Guimarães HC, Gambogi LB, Mariano LI, Teixeira AL, Caramelli P, de Souza LC. Different patterns of gray matter atrophy in behavioral variant frontotemporal dementia with and without episodic memory impairment. Int J Geriatr Psychiatry 2021; 36:1848-1857. [PMID: 33527441 DOI: 10.1002/gps.5503] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/22/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Differentiating patients with behavioral variant frontotemporal dementia (bvFTD) from Alzheimer's disease (AD) is important as these two conditions have distinct treatment and prognosis. Using episodic impairment and medial temporal lobe atrophy as a tool to make this distinction has been debatable in the recent literature, as some patients with bvFTD can also have episodic memory impairment and medial temporal lobe atrophy early in the disease. OBJECTIVES To compare brain atrophy patterns of patients with bvFTD with and without episodic memory impairment to that of patients with AD. METHODS We analyzed 19 patients with bvFTD, 21 with AD and 21 controls, matched by age, sex, and years of education. They underwent brain MRI and the memory test from the Brief Cognitive Battery (BCB) to assess episodic memory. We then categorized the bvFTD group into amnestic (BCB delayed recall score <7) and non-amnestic. RESULTS The amnestic bvFTD group (n = 8) had significant gray matter atrophy in the left parahippocampal gyrus, right cingulate and precuneus regions compared with the nonamnestic group. Compared with AD, amnestic bvFTD had more atrophy in the left fusiform cortex, left insula, left inferior temporal gyrus and right temporal pole, whereas patients with AD had more atrophy in the left hippocampus, left frontal pole and left angular gyrus. CONCLUSIONS There is a group of amnestic bvFTD patients with episodic memory dysfunction and significant atrophy in medial temporal structures, which poses a challenge in considering only these features when differentiating bvFTD from AD clinically.
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Affiliation(s)
- Elisa de Paula França Resende
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Programa de Pós-Graduação em Neurociências da, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Henrique Cerqueira Guimarães
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leandro Boson Gambogi
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luciano Inácio Mariano
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Paulo Caramelli
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Programa de Pós-Graduação em Neurociências da, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Leonardo Cruz de Souza
- Grupo de Neurologia Cognitiva e do Comportamento, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Programa de Pós-Graduação em Neurociências da, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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3
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Rizzi L, Aventurato ÍK, Balthazar MLF. Neuroimaging Research on Dementia in Brazil in the Last Decade: Scientometric Analysis, Challenges, and Peculiarities. Front Neurol 2021; 12:640525. [PMID: 33790850 PMCID: PMC8005640 DOI: 10.3389/fneur.2021.640525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/18/2021] [Indexed: 12/12/2022] Open
Abstract
The last years have evinced a remarkable growth in neuroimaging studies around the world. All these studies have contributed to a better understanding of the cerebral outcomes of dementia, even in the earliest phases. In low- and middle-income countries, studies involving structural and functional neuroimaging are challenging due to low investments and heterogeneous populations. Outstanding the importance of diagnosing mild cognitive impairment and dementia, the purpose of this paper is to offer an overview of neuroimaging dementia research in Brazil. The review includes a brief scientometric analysis of quantitative information about the development of this field over the past 10 years. Besides, discusses some peculiarities and challenges that have limited neuroimaging dementia research in this big and heterogeneous country of Latin America. We systematically reviewed existing neuroimaging literature with Brazilian authors that presented outcomes related to a dementia syndrome, published from 2010 to 2020. Briefly, the main neuroimaging methods used were morphometrics, followed by fMRI, and DTI. The major diseases analyzed were Alzheimer's disease, mild cognitive impairment, and vascular dementia, respectively. Moreover, research activity in Brazil has been restricted almost entirely to a few centers in the Southeast region, and funding could be the main driver for publications. There was relative stability concerning the number of publications per year, the citation impact has historically been below the world average, and the author's gender inequalities are not relevant in this specific field. Neuroimaging research in Brazil is far from being developed and widespread across the country. Fortunately, increasingly collaborations with foreign partnerships contribute to the impact of Brazil's domestic research. Although the challenges, neuroimaging researches performed in the native population regarding regional peculiarities and adversities are of pivotal importance.
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Affiliation(s)
- Liara Rizzi
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
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4
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Brzezińska A, Bourke J, Rivera-Hernández R, Tsolaki M, Woźniak J, Kaźmierski J. Depression in Dementia or Dementia in Depression? Systematic Review of Studies and Hypotheses. Curr Alzheimer Res 2020; 17:16-28. [DOI: 10.2174/1567205017666200217104114] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/09/2020] [Accepted: 01/18/2020] [Indexed: 01/21/2023]
Abstract
The majority of research works to date suggest that Major Depressive Disorder (MDD) is a
risk factor for dementia and may predispose to cognitive decline in both early and late onset variants.
The presence of depression may not, however, reflect the cause, rather, an effect: it may be a response to
cognitive impairment or alters the threshold at which cognitive impairment might manifest or be detected.
An alternative hypothesis is that depression may be part of a prodrome to Alzheimer’s Disease
(AD), suggesting a neurobiological association rather than one of psychological response alone. Genetic
polymorphisms may explain some of the variances in shared phenomenology between the diagnoses, the
instance, when the conditions arise comorbidly, the order in which they are detected that may depend on
individual cognitive and physical reserves, as well as the medical history and individual vulnerability.
This hypothesis is biologically sound but has not been systematically investigated to date. The current
review highlights how genetic variations are involved in the development of both AD and MDD, and the
risk conferred by these variations on the expression of these two disorders comorbidly is an important
consideration for future studies of pathoaetiological mechanisms and in the stratification of study samples
for randomised controlled trials.
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Affiliation(s)
- Agnieszka Brzezińska
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Julius Bourke
- Centre for Psychiatry, Wolfson Institute for Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University London, London E14NS, United Kingdom
| | - Rayito Rivera-Hernández
- Department of Psychiatry, Psychology, Legal Medicine and History of Medicine, University of Salamanca, Salamanca, Spain
| | - Magda Tsolaki
- 3rd Department of Neurology, Aristotle University of Thessaloniki, Thessaloniki, Greece, “George Papanicolaou” Hospital, Thessaloniki, Greece
| | - Joanna Woźniak
- Central Clinical Hospital of Medical University of Lodz, Lodz, Poland
| | - Jakub Kaźmierski
- Department of Old Age Psychiatry and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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5
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Differential Effect of Demographics, Processing Speed, and Depression on Cognitive Function in 755 Non-demented Community-dwelling Elderly Individuals. Cogn Behav Neurol 2019; 32:236-246. [DOI: 10.1097/wnn.0000000000000211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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6
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Lai CH. Major Depressive Disorder in Neuroimaging: What is Beyond Fronto-limbic Model? CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2019. [DOI: 10.2174/1573400515666181213155225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The major depressive disorder (MDD) is a chronic illness with major manifestations
in cognitive, social and occupational functions. The pathophysiological model is an intrigue
issue for scientists to understand the origin of MDD.
Objective:
In the beginning, the cortico-limbic-striato-pallidal-thalamic model has been proposed to
link the clinical symptoms with the abnormalities in brain structure and function. However, the
model is still evolving due to recent advances in the neuroimaging techniques, especially for functional
magnetic resonance imaging (fMRI). The recent findings in the fMRI studies in MDD showed
the importance of fronto-limbic model for the modulations between cognitive function and primitive
and negative emotions.
Method:
This review will focus on the literature of fMRI studies in MDD with findings not in the
fronto-limbic structures.
Results:
Additional regions beyond the fronto-limbic model have been observed in some literature of
MDD. Some regions in the parietal, temporal and occipital lobes have been shown with the alterations
in gray matter, white matter and brain function. The importance of sensory detection, visuospatial function,
language reception, motor response and emotional memories in these regions might provide the
clues to understand the cognitive misinterpretations related to altered reception of outside information,
behavioral responses related to biased cognition and emotional memories and clinical symptoms related
to the significant alterations of interactions between different brain regions.
Conclusion:
Future studies to establish a more comprehensive model for MDD will be warranted,
especially for the model beyond the fronto-limbic structures.
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Affiliation(s)
- Chien-Han Lai
- Institute of Biophotonics, National Yang-Ming University, Taipei City, Taiwan
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7
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Santos MAO, Bezerra LS, Carvalho ARMR, Brainer-Lima AM. Global hippocampal atrophy in major depressive disorder: a meta-analysis of magnetic resonance imaging studies. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:369-378. [PMID: 30234890 DOI: 10.1590/2237-6089-2017-0130] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/06/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Major depressive disorder (MDD), an incapacitating mental disorder, is characterized by episodes of at least 2 weeks of apparent changes in mood, cognition, and neurovegetative functions. Many neuroimaging studies using magnetic resonance imaging (MRI) have examined morphometric changes in patients with MDD, but the results are not conclusive. This study aims to review the literature and perform a meta-analysis on hippocampal volume (HcV) in patients with MDD. METHODS Studies on HcV in patients with MDD diagnosis were identified from major databases (MEDLINE, EMBASE, The Cochrane Library, Scopus, PsycINFO, and SciELO) using the search terms depression, major depressive disorder, MDD, unipolar, magnetic resonance imaging, MRI, and hippocampus. RESULTS A meta-analysis of 29 studies fulfilling specific criteria was performed. The sample included 1327 patients and 1004 healthy participants. The studies were highly heterogeneous with respect to age, sex, age of onset, and average illness duration. However, the pooled effect size of depression was significant in both hippocampi. MDD was associated with right (-0.43; 95% confidence interval [95%CI] -0.66 to -0.21) and left (-0.40; 95%CI -0.66 to -0.15) hippocampal atrophy. CONCLUSIONS MDD seems to be associated with global HcV atrophy. Larger longitudinal follow-up studies designed to analyze the influence of sociodemographic variables on this relationship are required to yield better evidence about this topic.
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Affiliation(s)
- Marcelo Antônio Oliveira Santos
- Grupo de Pesquisa em Epidemiologia e Cardiologia, Universidade Federal de Pernambuco, Recife, PE, Brazil.,Centro Universitário Maurício de Nassau, Recife, PE, Brazil
| | - Lucas Soares Bezerra
- Grupo de Pesquisa em Epidemiologia e Cardiologia, Universidade Federal de Pernambuco, Recife, PE, Brazil.,Centro Universitário Maurício de Nassau, Recife, PE, Brazil
| | | | - Alessandra Mertens Brainer-Lima
- Centro Universitário Maurício de Nassau, Recife, PE, Brazil.,Pronto-Socorro Cardiológico Universitário de Pernambuco (PROCAPE), Universidade de Pernambuco (UPE), Recife, PE, Brazil
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8
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A specific pattern of gray matter atrophy in Alzheimer's disease with depression. J Neurol 2017; 264:2101-2109. [PMID: 28856425 DOI: 10.1007/s00415-017-8603-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 01/16/2023]
Abstract
Considering the high incidence of depressive symptoms in Alzheimer's disease (AD), we conducted a large-sample study to investigate the pattern of gray matter (GM) abnormalities that differentiates depressive from non-depressive AD patients. We included 201 AD patients who underwent MRI assessment and categorized them into depressive and non-depressive subgroups based on the Geriatric Depression Scale (GDS; cut-off score: ≤9). We performed whole-brain voxel-based morphometry analysis in 173 patients after MRI quality control and used between-group comparisons and regression analysis models to analyze the volumetric data controlling for nuisance variables. Depressive AD patients had extensive GM volume loss mainly in the paracentral region, specifically in post- and pre-central gyrus, supplementary motor areas and thalamus compared to non-depressive patients. Similar findings were obtained for the group of 173 patients using regression analysis and GDS score as predictor variable. We provided the first clear demonstration of a unique pattern of GM atrophy that characterizes AD patients with depression which is consistent with regions implicated in the phenomenon of psychomotor retardation that characterizes depression.
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9
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Dinomais M, Celle S, Duval GT, Roche F, Henni S, Bartha R, Beauchet O, Annweiler C. Anatomic Correlation of the Mini-Mental State Examination: A Voxel-Based Morphometric Study in Older Adults. PLoS One 2016; 11:e0162889. [PMID: 27741236 PMCID: PMC5065203 DOI: 10.1371/journal.pone.0162889] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 08/30/2016] [Indexed: 01/14/2023] Open
Abstract
The clinical utility of the Mini-Mental State Examination (MMSE) and its shorter version (SMMSE) is still debated. There is a need to better understand the neuroanatomical correlates of these cognitive tests. The objective of this cross-sectional study was to determine whether lower MMSE and SMMSE scores correlated with focal brain volume reduction in older adults. Participants from the GAIT study (n = 207; mean, 70.9±5.9 years; 57% female; mean MMSE 26.2±3.9; mean SMMSE 5.1±1.1) were evaluated using the MMSE and SMMSE and received a 1.5-Tesla MRI scan of the brain. Cortical gray and white matter subvolumes were automatically segmented using Statistical Parametric Mapping. Age, gender, education level, and total intracranial volume were included as potential confounders. We found correlations between the MMSE score and specific cortical regions of the limbic system including the hippocampus, amygdala, cingulate gyrus, and parahippocampal gyrus, independently of the diagnostic category (i.e., mild cognitive impairment or Alzheimer disease or controls). Regarding correlations with the SMMSE score, only one cluster in the left hippocampus was identified, which overlapped with the cluster that was positively correlated with the MMSE score. There were no correlations with the volume of white matter. In conclusion, worse MMSE and SMMSE scores were associated with gray matter atrophy mainly in the limbic system. This finding highlights that atrophy of specific brain regions are related to performance on the MMSE and the SMMSE tests, and provides new insights into the cognitive function probed by these tests.
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Affiliation(s)
- Mickael Dinomais
- Université d’Angers, Laboratoire Angevin de Recherche en Ingénierie des Systèmes (LARIS)–EA7315 F-49000 France, LUNAM, Université d’Angers, Département de Médecine Physique et de Réadaptation, CHU Angers, F-49933, France
| | - Sebastien Celle
- Service de Physiologie Clinique et de l’Exercice, CHU, Saint-Etienne, France, EA 4607 "SNA EPIS" Faculté de Médecine J Lisfranc UJM, PRES Université de Lyon, F-42023, France
| | - Guillaume T. Duval
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, Angers University Hospital, UPRES EA 4638, University of Angers, UNAM, Angers, France
| | - Frederic Roche
- Service de Physiologie Clinique et de l’Exercice, CHU, Saint-Etienne, France, EA 4607 "SNA EPIS" Faculté de Médecine J Lisfranc UJM, PRES Université de Lyon, F-42023, France
| | - Samir Henni
- Department of Sports Medicine and Vascular Investigations, University Hospital, Angers, France
| | - Robert Bartha
- Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Ontario, Canada
| | - Olivier Beauchet
- Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis—Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Cedric Annweiler
- Department of Neuroscience, Division of Geriatric Medicine and Memory Clinic, Angers University Hospital, UPRES EA 4638, University of Angers, UNAM, Angers, France
- Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, the University of Western Ontario, London, Ontario, Canada
- * E-mail:
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Atkinson L, Sankar A, Adams TM, Fu CHY. Recent Advances in Neuroimaging of Mood Disorders: Structural and Functional Neural Correlates of Depression, Changes with Therapy, and Potential for Clinical Biomarkers. ACTA ACUST UNITED AC 2014. [DOI: 10.1007/s40501-014-0022-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Frontal-insula gray matter deficits in first-episode medication-naïve patients with major depressive disorder. J Affect Disord 2014; 160:74-9. [PMID: 24445133 DOI: 10.1016/j.jad.2013.12.036] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/17/2013] [Accepted: 12/17/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study is designed to investigate the gray matter volume (GMV) deficits in patients with first-episode medication-naïve major depressive disorder (MDD). METHODS We enrolled 38 patients with first-episode medication-naïve MDD and 27 controls in this project. Voxel-based morphometry was used to compare GMV differences between two groups. Besides, the relationship between GMV of patients and the severity of clinical symptoms was estimated to confirm the role of GMV deficits in clinical symptoms. The correlation between total GMV and illness duration was also performed to elucidate the impacts of untreated duration on the GMV. RESULTS We found that first-episode medication-naïve MDD patients had significant GMV deficits in bilateral superior frontal gyri, left middle frontal gyrus, left medial frontal gyrus and left insula. The GMV of patient group was negatively correlated with the severity of clinical symptoms and the illness duration. CONCLUSION A pattern of GMV deficits in fronto-insula might represent the biomarker for first-episode medication-naïve MDD.
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12
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Ribeiz SRI, Duran F, Oliveira MC, Bezerra D, Castro CC, Steffens DC, Busatto Filho G, Bottino CMC. Structural brain changes as biomarkers and outcome predictors in patients with late-life depression: a cross-sectional and prospective study. PLoS One 2013; 8:e80049. [PMID: 24244606 PMCID: PMC3828217 DOI: 10.1371/journal.pone.0080049] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/30/2013] [Indexed: 11/25/2022] Open
Abstract
The relationship between structural changes in grey matter and treatment response in patients with late-life depression remains an intriguing area of research. This magnetic resonance imaging (MRI) study compares the baseline grey matter volume of elderly people with and without major depression (according to the DSM-IV-TR criteria) and assesses its association with antidepressant treatment response. Brain MRI scans were processed using statistical parametric mapping and voxel-based morphometry. The sample consisted of 30 patients with depression and 22 healthy controls. We found a significant volumetric reduction in the orbitofrontal cortex bilaterally in patients in comparison with controls. According to their remission status after antidepressant treatment, patients were classified as remitted or not remitted. Compared with controls, remitted patients showed a volumetric reduction in the orbitofrontal cortex bilaterally and in another cluster in the right middle temporal pole. Non-remitted patients showed an even greater volumetric reduction in the orbitofrontal cortex bilaterally compared with controls. To investigate predictive factors of remission after antidepressant treatment, we used a logistic regression. Both baseline Mini Mental State Examination score and baseline left superior lateral orbitofrontal cortex volume (standardized to the total grey matter volume) were associated with remission status. Our findings support the use of regional brain atrophy as a potential biomarker for depression. In addition, baseline cognitive impairment and regional grey matter abnormalities predict antidepressant response in patients with late-life depression.
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Affiliation(s)
- Salma R. I. Ribeiz
- Old Age Research Group (PROTER), Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
- * E-mail:
| | - Fabio Duran
- Laboratory of Psychiatric Neuroimaging (LIM 21), Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Melaine C. Oliveira
- Institute of Mathematic and Statistics (IME), University of São Paulo, São Paulo, Brazil
| | - Diana Bezerra
- Old Age Research Group (PROTER), Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
| | - Claudio Campi Castro
- Department of Diagnostic Imaging, Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - David C. Steffens
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Connecticut, United States of America
| | - Geraldo Busatto Filho
- Laboratory of Psychiatric Neuroimaging (LIM 21), Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Cássio M. C. Bottino
- Old Age Research Group (PROTER), Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil
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13
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Sexton CE, Mackay CE, Ebmeier KP. A systematic review and meta-analysis of magnetic resonance imaging studies in late-life depression. Am J Geriatr Psychiatry 2013; 21:184-95. [PMID: 23343492 DOI: 10.1016/j.jagp.2012.10.019] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 08/30/2011] [Accepted: 09/30/2011] [Indexed: 11/26/2022]
Abstract
Gray matter abnormalities within frontal-subcortical and limbic networks are hypothesized to play a key role in the pathophysiology of late-life depression. In this work, gray matter abnormalities in late-life depression are examined in a systematic review and meta-analysis of magnetic resonance imaging studies. In the systematic review, 27 articles were identified that compared participants with late-life depression with comparison group participants, and 17 studies were suitable for inclusion in meta-analyses of volumes of the whole brain, orbitofrontal cortex, caudate, hippocampus, putamen, and thalamus. Volume reductions were detected in 7 of 15 comparisons of the hippocampus and a meta-analysis revealed a significant, but small, effect size. Although examined by fewer studies, meta-analyses also revealed significant volume reductions in the orbitofrontal cortex, putamen, and thalamus. A more systematic and comprehensive analysis of the global distribution of gray matter abnormalities, and an examination of subcortical abnormalities were identified as key areas for future research.
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Affiliation(s)
- Claire E Sexton
- University Department of Psychiatry, University of Oxford, United Kingdom
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Bezerra DM, Pereira FRS, Cendes F, Jackowski MP, Nakano EY, Moscoso MAA, Ribeiz SRI, Avila R, Castro CCD, Bottino CMC. DTI voxelwise analysis did not differentiate older depressed patients from older subjects without depression. J Psychiatr Res 2012; 46:1643-9. [PMID: 23040088 DOI: 10.1016/j.jpsychires.2012.09.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/19/2012] [Accepted: 09/01/2012] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Neuroimaging has been widely used in studies to investigate depression in the elderly because it is a noninvasive technique, and it allows the detection of structural and functional brain alterations. Fractional anisotropy (FA) and mean diffusivity (MD) are neuroimaging indexes of the microstructural integrity of white matter, which are measured using diffusion tensor imaging (DTI). The aim of this study was to investigate differences in FA or MD in the entire brain without a previously determined region of interest (ROI) between depressed and non-depressed elderly patients. METHOD Brain magnetic resonance imaging scans were obtained from 47 depressed elderly patients, diagnosed according to DSM-IV criteria, and 36 healthy elderly patients as controls. Voxelwise statistical analysis of FA data was performed using tract-based spatial statistics (TBSS). RESULTS After controlling for age, no significant differences among FA and MD parameters were observed in the depressed elderly patients. No significant correlations were found between cognitive performance and FA or MD parameters. CONCLUSION There were no significant differences among FA or MD values between mildly or moderately depressed and non-depressed elderly patients when the brain was analyzed without a previously determined ROI.
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Affiliation(s)
- Diana Moitinho Bezerra
- Old Age Research Group - PROTER, Institute and Department of Psychiatry, University of São Paulo, São Paulo, Brazil.
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15
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Sexton CE, McDermott L, Kalu UG, Herrmann LL, Bradley KM, Allan CL, Le Masurier M, Mackay CE, Ebmeier KP. Exploring the pattern and neural correlates of neuropsychological impairment in late-life depression. Psychol Med 2012; 42:1195-1202. [PMID: 22030013 DOI: 10.1017/s0033291711002352] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neuropsychological impairment is a key feature of late-life depression, with deficits observed across multiple domains. However, it is unclear whether deficits in multiple domains represent relatively independent processes with specific neural correlates or whether they can be explained by cognitive deficits in executive function or processing speed. METHOD We examined group differences across five domains (episodic memory; executive function; language skills; processing speed; visuospatial skills) in a sample of 36 depressed participants and 25 control participants, all aged ≥ 60 years. The influence of executive function and processing speed deficits on other neuropsychological domains was also investigated. Magnetic resonance imaging correlates of executive function, processing speed and episodic memory were explored in the late-life depression group. RESULTS Relative to controls, the late-life depression group performed significantly worse in the domains of executive function, processing speed, episodic memory and language skills. Impairments in executive function or processing speed were sufficient to explain differences in episodic memory and language skills. Executive function was correlated with anisotropy of the anterior thalamic radiation and uncinate fasciculus; processing speed was correlated with anisotropy of genu of the corpus callosum. Episodic memory was correlated with anisotropy of the anterior thalamic radiation, the genu and body of the corpus callosum and the fornix. CONCLUSIONS Executive function and processing speed appear to represent important cognitive deficits in late-life depression, which contribute to deficits in other domains, and are related to reductions in anisotropy in frontal tracts.
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Affiliation(s)
- C E Sexton
- Department of Psychiatry, University of Oxford, Oxford, UK
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16
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Regional cortical thickness and subcortical volume changes are associated with cognitive impairments in the drug-naive patients with late-onset depression. Neuropsychopharmacology 2012; 37:838-49. [PMID: 22048467 PMCID: PMC3260976 DOI: 10.1038/npp.2011.264] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Previous studies have shown an association between late-onset depression (LOD) and cognitive impairment in older adults. However, the neural correlates of this relationship are not yet clear. The aim of this study was to investigate the differences in both cortical thickness and subcortical volumes between drug-naive LOD patients and healthy controls and explore the relationship between LOD and cognitive impairments. A total of 48 elderly, drug-naive patients with LOD and 47 group-matched healthy control subjects underwent 3T MRI scanning, and the cortical thickness was compared between the groups in multiple locations, across the continuous cortical surface. The subcortical volumes were also compared on a structure-by-structure basis. Subjects with LOD exhibited significantly decreased cortical thickness in the rostral anterior cingulate cortex, the medial orbitofrontal cortex, dorsolateral prefrontal cortex, the superior and middle temporal cortex, and the posterior cingulate cortex when compared with healthy subjects (all p<0.05, false discovery rate corrected). Reduced volumes of the right hippocampus was also observed in LOD patients when compared with healthy controls (p<0.001). There were significant correlations between memory functions and cortical thickness of medial temporal, isthmus cingulate, and precuneus (p<0.001). This study was the first study to explore the relationships between the cortical thickness/subcortical volumes and cognitive impairments of drug-naive patients with LOD. These structural changes might explain the neurobiological mechanism of LOD as a risk factor of dementia.
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17
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Abstract
Stress in mammals triggers a neuroendocrine response mediated by the hypothalamic-pituitary-adrenal axis and the autonomic nervous system. Increased activity of these two systems induces behavioural, cardiovascular, endocrine and metabolic cascades that enable the individual to fight or flee and cope with the stress. Our understanding of stress and stress-response mechanisms is generally robust. Here, however, we review three themes that remain controversial and perhaps deserve further scrutiny and investigation before they achieve canonical status. The themes are, first, hypocortisolaemia in post-traumatic stress disorder (PTSD). A reduction rather than a stress-induced increase in adrenal glucocorticoid levels, as seen in major depressive disorder (MDD), is puzzling and furthermore is not a consistent feature of PTSD. Overall, studies on PTSD show that glucocorticoid levels may be normal or higher or lower than normal. The second theme concerns the reduction in volume of the hippocampus in MDD attributed to the neurotoxicity of hypercortisolaemia. Again, as for hypocortisolaemia in PTSD, reduced hippocampal volume in MDD has been found in some but not all studies. Third, the discovery of a causal association between Helicobacter pylori and peptic ulcers apparently brought to an end the long-held view that peptic ulceration was caused predominantly by stress. However, recent studies suggest that stress can cause peptic ulceration in the absence of H. pylori. Predictably, the aetiological pendulum of gastric and duodenal ulceration has swung from 'all stress' to 'all bacteria' followed by a sober realisation that both factors may play a role. This raises the question as to whether stress and H. pylori interact, and if so how? All three controversies are of clinical significance, pose fundamental questions about stress mechanisms and offer important areas for future research.
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Affiliation(s)
- G Fink
- Mental Health Research Institute, Parkville, Melbourne, Victoria, Australia.
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