Structural white matter connectometry of reading and dyslexia

The brain's structural connectivity and pre-reading abilities in young children with prenatal alcohol exposure

Children with prenatal alcohol exposure (PAE) may develop a range of neurological and behavioral deficits, including reading and language disorders. Studying the brain's structural connectivity and its relationship to pre-reading/reading skills in young children with PAE can help understand the roots of reading deficits associated with PAE. 363 diffusion MRI scans from 135 children (114 scans from 53 children with PAE) were collected between ages 3-7 years. Children completed NEPSY-II Phonological Processing and Speeded Naming to assess pre-reading skills at each scan. Structural brain network properties were assessed in 16 regions from both hemispheres using graph theory. Linear mixed models were used to account for repeated measures within participants. Children with PAE had significantly lower pre-reading scores than unexposed children, and significantly lower graph theory metrics across bilateral reading networks. Moreover, PAE significantly moderated the associations between Phonological Processing and global efficiency and nodal degree in the bilateral and left hemisphere reading networks, such that children with PAE had stronger associations than unexposed controls. No significant associations were found for Speeded Naming. Our results suggest that brain alterations may underlie early pre-reading difficulties in children with PAE.

Infant neural speech encoding is associated with pre-reading skill development

OBJECTIVE

We longitudinally investigated whether infant P1 and N2 ERPs recorded in newborns and at 28 months could predict pre-reading skills at 28 months and 4-5 years.

METHODS

We recorded ERPs to a pseudoword in newborns and at 28 months in a sample over-represented by infants with familial dyslexia risk. Using multiple linear regression models, we examined P1 and N2 associations with pre-reading skills at 28 months and 4-5 years.

RESULTS

Shorter latencies of the newborn P1 predicted faster serial naming at 28 months. Larger amplitudes and shorter latencies of P1 at 28 months predicted better serial naming abilities and auditory working memory across the pre-reading stage. Right-lateralized P1 and N2 were related to poorer pre-reading skills.

CONCLUSIONS

Infant ERPs, particularly P1, providing information about neural speech encoding abilities, are associated with pre-reading skill development.

SIGNIFICANCE

Infant and early childhood neural speech encoding abilities may work as early predictive markers of reading development and impairment. This study may help to plan early interventions targeting phonological processing to prevent or ameliorate learning deficits.

Visual system structural and functional connections during face viewing in body dysmorphic disorder

Background

Individuals with body dysmorphic disorder (BDD) perceive distortions in their appearance, which could be due to imbalances in global and local visual processing. The vertical occipital fasciculus connects dorsal and ventral visual stream regions, integrating global and local information, yet the role of this structural connection in BDD has not been explored. Here, we investigated the vertical occipital fasciculus's white matter microstructure in those with BDD and healthy controls and tested associations with psychometric measures and effective connectivity while viewing their face during fMRI.

Methods

We analyzed diffusion MRI and fMRI data in 17 unmedicated adults with BDD and 21 healthy controls. For diffusion MRI, bundle-specific analysis was performed, enabling quantitative estimation of neurite density and orientation dispersion of the vertical occipital fasciculus. For task fMRI, participants naturalistically viewed photos of their own face, from which we computed effective connectivity from dorsal to ventral visual regions.

Results

In BDD, neurite density was negatively correlated with appearance dissatisfaction and negatively correlated with effective connectivity. Further, those with weaker effective connectivity while viewing their face had worse BDD symptoms and worse insight. In controls, no significant relationships were found between any of the measures. There were no significant group differences in neurite density or orientation dispersion.

Conclusion

Those with BDD with worse appearance dissatisfaction have a lower fraction of tissue having axons or dendrites along the vertical occipital fasciculus bundle, possibly reflecting impacting the degree of integration of global and local visual information between the dorsal and ventral visual streams. These results provide early insights into how the vertical occipital fasciculus's microstructure relates to the subjective experience of one's appearance, as well as the possibility of distinct functional-structural relationships in BDD.

Clinical characteristics of post-stroke basal ganglia aphasia and the study of language-related white matter tracts based on diffusion spectrum imaging

BACKGROUND

Stroke often damages the basal ganglia, leading to atypical and transient aphasia, indicating that post-stroke basal ganglia aphasia (PSBGA) may be related to different anatomical structural damage and functional remodeling rehabilitation mechanisms. The basal ganglia contain dense white matter tracts (WMTs). Hence, damage to the functional tract may be an essential anatomical structural basis for the development of PSBGA.

METHODS

We first analyzed the clinical characteristics of PSBGA in 28 patients and 15 healthy controls (HCs) using the Western Aphasia Battery and neuropsychological test batteries. Moreover, we investigated white matter injury during the acute stage using diffusion magnetic resonance imaging scans for differential tractography. Finally, we used multiple regression models in correlation tractography to analyze the relationship between various language functions and quantitative anisotropy (QA) of WMTs.

RESULTS

Compared with HCs, patients with PSBGA showed lower scores for fluency, comprehension (auditory word recognition and sequential commands), naming (object naming and word fluency), reading comprehension of sentences, Mini-Mental State Examination, and Montreal Cognitive Assessment, along with increased scores in Hamilton Anxiety Scale-17 and Hamilton Depression Scale-17 within 7 days after stroke onset (P < 0.05). Differential tractography revealed that patients with PSBGA had damaged fibers, including in the body fibers of the corpus callosum, left cingulum bundles, left parietal aslant tracts, bilateral superior longitudinal fasciculus II, bilateral thalamic radiation tracts, left fornix, corpus callosum tapetum, and forceps major, compared with HCs (FDR < 0.02). Correlation tractography highlighted that better comprehension was correlated with a higher QA of the left inferior fronto-occipital fasciculus (IFOF), corpus callosum forceps minor, and left extreme capsule (FDR < 0.0083). Naming was positively associated with the QA of the left IFOF, forceps minor, left arcuate fasciculus, and uncinate fasciculus (UF) (FDR < 0.0083). Word fluency of naming was also positively associated with the QA of the forceps minor, left IFOF, and thalamic radiation tracts (FDR < 0.0083). Furthermore, reading was positively correlated with the QA of the forceps minor, left IFOF, and UF (FDR < 0.0083).

CONCLUSION

PSBGA is primarily characterized by significantly impaired word fluency of naming and preserved repetition abilities, as well as emotional and cognitive dysfunction. Damaged limbic pathways, dorsally located tracts in the left hemisphere, and left basal ganglia pathways are involved in PSBGA pathogenesis. The results of connectometry analysis further refine the current functional localization model of higher-order neural networks associated with language functions.

The role of language-related functional brain regions and white matter tracts in network plasticity of post-stroke aphasia

The neural mechanisms underlying language recovery after a stroke remain controversial. This review aimed to summarize the plasticity and reorganization mechanisms of the language network through neuroimaging studies. Initially, we discussed the involvement of right language homologues, perilesional tissue, and domain-general networks. Subsequently, we summarized the white matter functional mapping and remodeling mechanisms associated with language subskills. Finally, we explored how non-invasive brain stimulation (NIBS) promoted language recovery by inducing neural network plasticity. It was observed that the recruitment of right hemisphere language area homologues played a pivotal role in the early stages of frontal post-stroke aphasia (PSA), particularly in patients with larger lesions. Perilesional plasticity correlated with improved speech performance and prognosis. The domain-general networks could respond to increased "effort" in a task-dependent manner from the top-down when the downstream language network was impaired. Fluency, repetition, comprehension, naming, and reading skills exhibited overlapping and unique dual-pathway functional mapping models. In the acute phase, the structural remodeling of white matter tracts became challenging, with recovery predominantly dependent on cortical activation. Similar to the pattern of cortical activation, during the subacute and chronic phases, improvements in language functions depended, respectively, on the remodeling of right white matter tracts and the restoration of left-lateralized language structural network patterns. Moreover, the midline superior frontal gyrus/dorsal anterior cingulate cortex emerged as a promising target for NIBS. These findings offered theoretical insights for the early personalized treatment of aphasia after stroke.

Choir singing is associated with enhanced structural connectivity across the adult lifespan

The global ageing of populations calls for effective, ecologically valid methods to support brain health across adult life. Previous evidence suggests that music can promote white matter (WM) microstructure and grey matter (GM) volume while supporting auditory and cognitive functioning and emotional well-being as well as counteracting age-related cognitive decline. Adding a social component to music training, choir singing is a popular leisure activity among older adults, but a systematic account of its potential to support healthy brain structure, especially with regard to ageing, is currently missing. The present study used quantitative anisotropy (QA)-based diffusion MRI connectometry and voxel-based morphometry to explore the relationship of lifetime choir singing experience and brain structure at the whole-brain level. Cross-sectional multiple regression analyses were carried out in a large, balanced sample (N = 95; age range 21-88) of healthy adults with varying levels of choir singing experience across the whole age range and within subgroups defined by age (young, middle-aged, and older adults). Independent of age, choir singing experience was associated with extensive increases in WM QA in commissural, association, and projection tracts across the brain. Corroborating previous work, these overlapped with language and limbic networks. Enhanced corpus callosum microstructure was associated with choir singing experience across all subgroups. In addition, choir singing experience was selectively associated with enhanced QA in the fornix in older participants. No associations between GM volume and choir singing were found. The present study offers the first systematic account of amateur-level choir singing on brain structure. While no evidence for counteracting GM atrophy was found, the present evidence of enhanced structural connectivity coheres well with age-typical structural changes. Corroborating previous behavioural studies, the present results suggest that regular choir singing holds great promise for supporting brain health across the adult life span.

Dmd mdx mice have defective oligodendrogenesis, delayed myelin compaction and persistent hypomyelination

Duchenne muscular dystrophy (DMD) is caused by mutations in the DMD gene, resulting in the loss of dystrophin, a large cytosolic protein that links the cytoskeleton to extracellular matrix receptors in skeletal muscle. Aside from progressive muscle damage, many patients with DMD also have neurological deficits of unknown etiology. To investigate potential mechanisms for DMD neurological deficits, we assessed postnatal oligodendrogenesis and myelination in the Dmdmdx mouse model. In the ventricular-subventricular zone (V-SVZ) stem cell niche, we found that oligodendrocyte progenitor cell (OPC) production was deficient, with reduced OPC densities and proliferation, despite a normal stem cell niche organization. In the Dmdmdx corpus callosum, a large white matter tract adjacent to the V-SVZ, we also observed reduced OPC proliferation and fewer oligodendrocytes. Transmission electron microscopy further revealed significantly thinner myelin, an increased number of abnormal myelin structures and delayed myelin compaction, with hypomyelination persisting into adulthood. Our findings reveal alterations in oligodendrocyte development and myelination that support the hypothesis that changes in diffusion tensor imaging seen in patients with DMD reflect developmental changes in myelin architecture.

Investigating Dyslexia through Diffusion Tensor Imaging across Ages: A Systematic Review

Dyslexia is a neurodevelopmental disorder that presents a deficit in accuracy and/or fluency while reading or spelling that is not expected given the level of cognitive functioning. Research indicates brain structural changes mainly in the left hemisphere, comprising arcuate fasciculus (AF) and corona radiata (CR). The purpose of this systematic review is to better understand the possible methods for analyzing Diffusion Tensor Imaging (DTI) data while accounting for the characteristics of dyslexia in the last decade of the literature. Among 124 articles screened from PubMed and Scopus, 49 met inclusion criteria, focusing on dyslexia without neurological or psychiatric comorbidities. Article selection involved paired evaluation, with a third reviewer resolving discrepancies. The selected articles were analyzed using two topics: (1) a demographic and cognitive assessment of the sample and (2) DTI acquisition and analysis. Predominantly, studies centered on English-speaking children with reading difficulties, with preserved non-verbal intelligence, attention, and memory, and deficits in reading tests, rapid automatic naming, and phonological awareness. Structural differences were found mainly in the left AF in all ages and in the bilateral superior longitudinal fasciculus for readers-children and adults. A better understanding of structural brain changes of dyslexia and neuroadaptations can be a guide for future interventions.

White matter microstructural plasticity associated with educational intervention in reading disability

Children's reading progress typically slows during extended breaks in formal education, such as summer vacations. This stagnation can be especially concerning for children with reading difficulties or disabilities, such as dyslexia, because of the potential to exacerbate the skills gap between them and their peers. Reading interventions can prevent skill loss and even lead to appreciable gains in reading ability during the summer. Longitudinal studies relating intervention response to brain changes can reveal educationally relevant insights into rapid learning-driven brain plasticity. The current work focused on reading outcomes and white matter connections, which enable communication among the brain regions required for proficient reading. We collected reading scores and diffusion-weighted images at the beginning and end of summer for 41 children with reading difficulties who had completed either 1st or 2nd grade. Children were randomly assigned to either receive an intensive reading intervention (n = 26; Seeing Stars from Lindamood-Bell which emphasizes orthographic fluency) or be deferred to a wait-list group (n = 15), enabling us to analyze how white matter properties varied across a wide spectrum of skill development and regression trajectories. On average, the intervention group had larger gains in reading compared to the non-intervention group, who declined in reading scores. Improvements on a proximal measure of orthographic processing (but not other more distal reading measures) were associated with decreases in mean diffusivity within core reading brain circuitry (left arcuate fasciculus and left inferior longitudinal fasciculus) and increases in fractional anisotropy in the left corticospinal tract. Our findings suggest that responses to intensive reading instruction are related predominantly to white matter plasticity in tracts most associated with reading.

Impact of corpus callosum integrity on functional interhemispheric connectivity and cognition in healthy subjects

To examine the corpus callosum's (CC) integrity in terms of fractional anisotropy (FA) and how it affects resting-state hemispheric connectivity (rs-IHC) and cognitive function in healthy individuals. Sixty-eight healthy individuals were recruited for the study. The global FA (gFA) and FA values of each CC tract (forceps minor, body, tapetum, and forceps major) were evaluated using diffusion-weighted imaging (DWI) sequences. The homotopic functional connectivity technique was used to quantify the effects of FA in the CC tracts on bilateral functional connectivity, including the confounding effect of gFA. Brain regions with higher or lower rs-IHC were identified using the threshold-free cluster enhancement family-wise error-corrected p-value of 0.05. The null hypothesis was rejected if the p-value was ≤ 0.05 for the nonparametric partial correlation technique. Several clusters of increased rs-IHC were identified in relation to the FA of individual CC tracts, each with a unique topographic distribution and extension. Only forceps minor FA values correlated with cognitive scores. The integrity of CC influences rs-IHC differently in healthy subjects. Specifically, forceps minor anisotropy impacts rs-IHC and cognition more than other CC tracts do.

Bridging Reduced Grip Strength and Altered Executive Function: Specific Brain White Matter Structural Changes in Patients with Alzheimer's Disease

Objective

To investigate the correlation between specific fiber tracts and grip strength and cognitive function in patients with Alzheimer's disease (AD) by fixel-based analysis (FBA).

Methods

AD patients were divided into AD with low grip strength (AD-LGS, n=29) and AD without low grip strength (AD-nLGS, n=25), along with 31 normal controls (NC). General data, neuropsychological tests, grip strength and cranial magnetic resonance imaging (MRI) scans were collected. FBA evaluated white matter (WM) fiber metrics, including fiber density (FD), fiber cross-sectional (FC), and fiber density and cross-sectional area (FDC). The mean fiber indicators of the fiber tracts of interest (TOI) were extracted in cerebral region of significant statistical differences in FBA to further compare the differences between groups and analyze the correlation between fiber properties and neuropsychological test scores.

Results

Compared to AD-nLGS group, AD-LGS group showed significant reductions in FDC in several cerebral regions. In AD patients, FDC values of bilateral uncinate fasciculus and left superior longitudinal fasciculus were positively correlated with Clock Drawing Test scores, while FDC of splenium of corpus callosum, bilateral anterior cingulate tracts, forceps major, and bilateral inferior longitudinal fasciculus were positively correlated with the Executive Factor Score of Memory and Executive Screening scale scores.

Conclusion

Reduced grip strength in AD patients is associated with extensive impairment of WM structural integrity. Changes in FDC of specific WM fiber tracts related to executive function play a significant mediating role in the reduction of grip strength in AD patients.

Hemodynamics of the left cerebral hemisphere during silent reading:analysis using near-infrared spectroscopy

The purpose of this study was to investigate the hemodynamic activity in the left cerebral hemisphere during silent reading in college students with typical development using near-infrared spectroscopy (NIRS). Sixty college students with typical development participated in this study. In the silent reading task, participants were asked to read a text from Andersen's fairy tale. Then, the change in oxygenated hemoglobin (oxy-Hb) concentration during silent reading of the text was calculated. The number of letters read during the silent reading task was also measured to calculate the silent reading speed. The average trend graph of 60 college students revealed increased oxy-Hb concentration in both the left inferior frontal gyrus (Broca's area) and the left inferior occipitotemporal gyrus during silent reading. A negative correlation was found between the change in oxy-Hb concentration in Broca's area and silent reading speed. A positive correlation was found between oxy-Hb concentration change in the left inferior occipitotemporal gyrus and silent reading speed. The increase in oxy-Hb concentration in Broca's area observed during silent reading may reflect effortful reading in students with reading difficulty. The increase in oxy-Hb concentration in the left inferior occipitotemporal gyrus observed during silent reading may reflect proficiency in reading. Our findings suggest the usefulness of NIRS in assessing reading function and its potential use in the diagnosis of developmental dyslexia. J. Med. Invest. 71 : 267-272, August, 2024.

Disentangling influences of dyslexia, development, and reading experience on effective brain connectivity in children

Altered brain connectivity between regions of the reading network has been associated with reading difficulties. However, it remains unclear whether connectivity differences between children with dyslexia (DYS) and those with typical reading skills (TR) are specific to reading impairments or to reading experience. In this functional MRI study, 132 children (M = 10.06 y, SD = 1.46) performed a phonological lexical decision task. We aimed to disentangle (1) disorder-specific from (2) experience-related differences in effective connectivity and to (3) characterize the development of DYS and TR. We applied dynamic causal modeling to age-matched (n_dys = 25, n_TR = 35) and reading-level-matched (n_dys = 25, n_TR = 22) groups. Developmental effects were assessed in beginning and advanced readers (TR: n_beg = 48, n_adv = 35, DYS: n_beg = 24, n_adv = 25). We show that altered feedback connectivity between the inferior parietal lobule and the visual word form area (VWFA) during print processing can be specifically attributed to reading impairments, because these alterations were found in DYS compared to both the age-matched and reading-level-matched TR. In contrast, feedforward connectivity from the VWFA to parietal and frontal regions characterized experience in TR and increased with age and reading skill. These directed connectivity findings pinpoint disorder-specific and experience-dependent alterations in the brain's reading network.

Fiber-specific structural properties relate to reading skills in children and adolescents

Recent studies suggest that the cross-sectional relationship between reading skills and white matter microstructure, as indexed by fractional anisotropy, is not as robust as previously thought. Fixel-based analyses yield fiber-specific micro- and macrostructural measures, overcoming several shortcomings of the traditional diffusion tensor model. We ran a whole-brain analysis investigating whether the product of fiber density and cross-section (FDC) related to single-word reading skills in a large, open, quality-controlled dataset of 983 children and adolescents ages 6-18. We also compared FDC between participants with (n = 102) and without (n = 570) reading disabilities. We found that FDC positively related to reading skills throughout the brain, especially in left temporoparietal and cerebellar white matter, but did not differ between reading proficiency groups. Exploratory analyses revealed that among metrics from other diffusion models - diffusion tensor imaging, diffusion kurtosis imaging, and neurite orientation dispersion and density imaging - only the orientation dispersion and neurite density indexes from NODDI were associated (inversely) with reading skills. The present findings further support the importance of left-hemisphere dorsal temporoparietal white matter tracts in reading. Additionally, these results suggest that future DWI studies of reading and dyslexia should be designed to benefit from advanced diffusion models, include cerebellar coverage, and consider continuous analyses that account for individual differences in reading skill.

Extraction of discriminative features from EEG signals of dyslexic children; before and after the treatment

Dyslexia is a neurological disorder manifested as difficulty reading and writing. It can occur despite adequate instruction, intelligence, and intact sensory abilities. Different electroencephalogram (EEG) patterns have been demonstrated between dyslexic and healthy subjects in previous studies. This study focuses on the difference between patients before and after treatment. The main goal is to identify the subset of features that adequately discriminate subjects before and after a specific treatment plan. The treatment consists of Transcranial Direct Current Stimulation (tDCS) and occupational therapy using the BrainWare SAFARI software. The EEG signals of sixteen dyslexic children were recorded during the eyes-closed resting state before and after treatment. The preprocessing step was followed by the extraction of a wide range of features to investigate the differences related to the treatment. An optimal subset of features extracted from recorded EEG signals was determined using Principal Component Analysis (PCA) in conjunction with the Sequential Floating Forward Selection (SFFS) algorithm. The results showed that treatment leads to significant changes in EEG features like spectral and phase-related EEG features, in various regions. It has been demonstrated that the extracted subset of discriminative features can be useful for classification applications in treatment assessment. The most discriminative subset of features could classify the data with an accuracy of 92% with SVM classifier. The above result confirms the efficacy of the treatment plans in improving dyslexic children's cognitive skills.

The relationship between reading abilities and the left occipitotemporal sulcus: A dual perspective study

Reading activates a region within the left lateral occipitotemporal sulcus (OTS) known as the 'visual word form area' (VWFA). While several studies have investigated the impact of reading on brain structure through neuroplastic mechanisms, it has been recently suggested that individual differences in the pattern of the posterior OTS may predict reading skills in adults. In the present study, we first examined whether the structure and morphology and the anatomical connectivity of the left OTS are associated to reading ability. Second, we explored whether reading skills are predicted by the pattern of the left OTS. We found that reading skills were positively associated with increased connectivity between the left OTS and a network of reading-related regions in the left hemisphere. On the other hand, we did not observe an association between the pattern of the left OTS and reading skills. Finally, we found evidence that the morphology and the connectivity of the left OTS are correlated to its sulcal pattern.

Stroke disconnectome decodes reading networks

Cognitive functional neuroimaging has been around for over 30 years and has shed light on the brain areas relevant for reading. However, new methodological developments enable mapping the interaction between functional imaging and the underlying white matter networks. In this study, we used such a novel method, called the disconnectome, to decode the reading circuitry in the brain. We used the resulting disconnection patterns to predict a typical lesion that would lead to reading deficits after brain damage. Our results suggest that white matter connections critical for reading include fronto-parietal U-shaped fibres and the vertical occipital fasciculus (VOF). The lesion most predictive of a reading deficit would impinge on the left temporal, occipital, and inferior parietal gyri. This novel framework can systematically be applied to bridge the gap between the neuropathology of language and cognitive neuroscience.

Diffusion spectrum imaging of patients with middle cerebral artery stenosis

OBJECTIVE

We aimed to detect microstructural changes in the brains of patients with unilateral middle cerebral artery (MCA) stenosis and to assess the integrity of the fiber structure and the small-world networks using diffusion spectrum imaging (DSI).

METHODS

A total of 21 healthy controls and 48 patients with unilateral MCA stenosis underwent 3.0 T MRI examination using DSI technique. Differential tractography, diffusion connectometry, and structural networks were performed by using DSI software. The correlation between the stenosis and quantitative anisotropy (QA) were analyzed using multiple regression models in the correlation tractography.

RESULTS

Differential tractography analysis showed that the left or right MCA stenosis group had decreased fiber connectivity in the brain network compared with the control group. The correlation tractography analysis of the patients with MCA stenosis showed that QA was negatively correlated with stenosis in the bilateral arcuate fasciculus, bilateral corticostriatal and corticothalamic pathway, bilateral corticopontine and corticospinal tract, right superior longitudinal fasciculus, right cingulum, corpus callosum, and left frontal aslant tract. Statistically significant differences were shown between the MCA stenosis groups and control group in graph density, global efficiency, network path length, and rich club coefficient.

CONCLUSION

DSI revealed that stroke-free patients with unilateral MCA stenosis have a disrupted structural network and damaged white matter fibers. Furthermore, the fiber connection disruption is more severe in the ipsilateral hemisphere and less prominent in the contralateral hemisphere in patients with unilateral MCA stenosis. Therefore, microstructural impairment has happened to patients with unilateral MCA stenosis even at a subclinical stage.

Comparison of Functional and Structural Neural Network Features in Older Adults With Depression With vs Without Apathy and Association With Response to Escitalopram: Secondary Analysis of a Nonrandomized Clinical Trial

IMPORTANCE

Apathy is prevalent among individuals with late-life depression and is associated with poor response to pharmacotherapy, including chronicity and disability. Elucidating brain networks associated with apathy and poor treatment outcomes can inform intervention development.

OBJECTIVES

To assess the brain network features of apathy among individuals with late-life depression and identify brain network abnormalities associated with poor antidepressant response.

DESIGN, SETTING, AND PARTICIPANTS

This secondary analysis of a single-group, open-label nonrandomized clinical trial of escitalopram conducted at an outpatient geriatric psychiatry clinic enrolled 40 adults aged 59 to 85 years with major depressive disorder from July 1, 2012, to July 31, 2019.

INTERVENTIONS

After a 2-week washout period, participants received escitalopram titrated to a target of 20 mg/d for 12 weeks.

MAIN OUTCOMES AND MEASURES

Baseline and posttreatment magnetic resonance imaging (MRI), clinical, and cognitive assessments were conducted. Functional MRI was used to map group differences in resting state functional connectivity (rsFC) of the salience network, and diffusion MRI connectometry was performed to evaluate pathway-level disruptions in structural connectivity. The Apathy Evaluation Scale was used to quantify apathy, and the Hamilton Depression Rating Scale (HAM-D) was used to quantify the primary outcome of depression severity.

RESULTS

Forty participants (26 women [65%]; mean [SD] age, 70.0 [6.6] years [range, 59-85 years]) with depression were included; 20 participants (50%) also had apathy. Relative to nonapathetic participants with depression, those with depression and apathy had lower rsFC of salience network seeds with the dorsolateral prefrontal cortex (DLPFC), premotor cortex, midcingulate cortex, and paracentral lobule and greater rsFC with the lateral temporal cortex and temporal pole (z score >2.7; Bonferroni-corrected threshold of P < .0125). Compared with participants without apathy, those with apathy had lower structural connectivity in the splenium, cingulum, and fronto-occipital fasciculus (t score >2.5; false discovery rate-corrected P = .02). Twenty-seven participants completed escitalopram treatment; 16 (59%) achieved remission (HAM-D score <10). Lower insula-DLPFC/midcingulate cortex rsFC was associated with less symptomatic improvement (HAM-D % change) (β [df] = 0.588 [26]; P = .001) and a higher likelihood of nonremission (odds ratio, 1.041 [95% CI, 1.003-1.081]; P = .04) after treatment and, in regression models, was a mediator of the association between baseline apathy and persistence of depression. Lower dorsal anterior cingulate-DLPFC/paracentral rsFC was associated with residual cognitive difficulties on measures of attention (β [df] = 0.445 [26]; P = .04) and executive function (β [df] = 0.384 [26]; P = .04).

CONCLUSIONS AND RELEVANCE

This study suggests that disturbances in connectivity between the salience network and other large-scale networks that support goal-directed behavior may give rise to apathy and may be associated with poor response of late-life depression to antidepressant pharmacotherapy. These network disturbances may serve as targets for novel interventions.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01728194.

Structural white matter characteristics for working memory and switching/inhibition in children with reading difficulties: The role of the left superior longitudinal fasciculus

Reading difficulties (RDs) are characterized by slow and inaccurate reading as well as additional challenges in cognitive control (i.e., executive functions, especially in working memory, inhibition, and visual attention). Despite evidence demonstrating differences in these readers' language and visual processing abilities, white matter differences associated with executive functions (EFs) difficulties in children with RDs are scarce. Structural correlates for reading and EFs in 8- to 12-year-old children with RDs versus typical readers (TRs) were examined using diffusion tensor imaging (DTI) data. Results suggest that children with RDs showed significantly lower reading and EF abilities versus TRs. Lower fractional anisotropy (FA) in left temporo-parietal tracts was found in children with RDs, who also showed positive correlations between reading and working memory and switching/inhibition scores and FA in the left superior longitudinal fasciculus (SLF). FA in the left SLF predicted working memory performance mediated by reading ability in children with RDs but not TRs. Our findings support alterations in white matter tracts related to working memory, switching/inhibition, and overall EF challenges in children with RDs and the linkage between working memory difficulties and FA alterations in the left SLF in children with RDs via reading.