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Tian H, Wang Z, Meng Y, Geng L, Lian H, Shi Z, Zhuang Z, Cai W, He M. Neural mechanisms underlying cognitive impairment in depression and cognitive benefits of exercise intervention. Behav Brain Res 2024; 476:115218. [PMID: 39182624 DOI: 10.1016/j.bbr.2024.115218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 08/22/2024] [Accepted: 08/22/2024] [Indexed: 08/27/2024]
Abstract
Depression is associated with functional brain impairments, although comprehensive studies remain limited. This study reviews neural mechanisms underlying cognitive impairment in depression and identifies associated activation abnormalities in brain regions. The study also explores the underlying neural processes of cognitive benefits of exercise intervention for depression. Executive function impairments, including working memory, inhibitory control and cognitive flexibility are associated with frontal cortex and anterior cingulate areas, especially dorsolateral prefrontal cortex. Depression is associated with certain neural impairments of reward processing, especially orbitofrontal cortex, prefrontal cortex, nucleus accumbens and other striatal regions. Depressed patients exhibit decreased activity in the hippocampus during memory function. Physical exercise has been found to enhance memory function, executive function, and reward processing in depression patients by increasing functional brain regions and the brain-derived neurotrophic factor (BDNF) as a nutritional factor also plays a key role in exercise intervention. The study documents neurophysiological mechanisms behind exercise intervention's improved functions. In summary, the study provides insights into neural mechanisms underlying cognitive impairments in depression and the effectiveness of exercise as a treatment.
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Affiliation(s)
- Huizi Tian
- Department of Psychology, School of Sports Medicine, Wuhan Sports University, China
| | - Zhifang Wang
- School of Psychology, Capital Normal University, China
| | - Yao Meng
- Department of Diving and Hyperbaric Medicine, Naval Special Medical Center, Naval Medical University, China
| | - Lu Geng
- Department of Psychology, School of Sports Medicine, Wuhan Sports University, China
| | - Hao Lian
- Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Zhifei Shi
- Department of Psychology, School of Sports Medicine, Wuhan Sports University, China
| | - Zhidong Zhuang
- Department of Psychology, School of Sports Medicine, Wuhan Sports University, China
| | - Wenpeng Cai
- Faculty of Psychology, Naval Medical University, Shanghai, China.
| | - Mengyang He
- Department of Psychology, School of Sports Medicine, Wuhan Sports University, China.
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Li YT, Zhang C, Han JC, Shang YX, Chen ZH, Cui GB, Wang W. Neuroimaging features of cognitive impairments in schizophrenia and major depressive disorder. Ther Adv Psychopharmacol 2024; 14:20451253241243290. [PMID: 38708374 PMCID: PMC11070126 DOI: 10.1177/20451253241243290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 03/14/2024] [Indexed: 05/07/2024] Open
Abstract
Cognitive dysfunctions are one of the key symptoms of schizophrenia (SZ) and major depressive disorder (MDD), which exist not only during the onset of diseases but also before the onset, even after the remission of psychiatric symptoms. With the development of neuroimaging techniques, these non-invasive approaches provide valuable insights into the underlying pathogenesis of psychiatric disorders and information of cognitive remediation interventions. This review synthesizes existing neuroimaging studies to examine domains of cognitive impairment, particularly processing speed, memory, attention, and executive function in SZ and MDD patients. First, white matter (WM) abnormalities are observed in processing speed deficits in both SZ and MDD, with distinct neuroimaging findings highlighting WM connectivity abnormalities in SZ and WM hyperintensity caused by small vessel disease in MDD. Additionally, the abnormal functions of prefrontal cortex and medial temporal lobe are found in both SZ and MDD patients during various memory tasks, while aberrant amygdala activity potentially contributes to a preference to negative memories in MDD. Furthermore, impaired large-scale networks including frontoparietal network, dorsal attention network, and ventral attention network are related to attention deficits, both in SZ and MDD patients. Finally, abnormal activity and volume of the dorsolateral prefrontal cortex (DLPFC) and abnormal functional connections between the DLPFC and the cerebellum are associated with executive dysfunction in both SZ and MDD. Despite these insights, longitudinal neuroimaging studies are lacking, impeding a comprehensive understanding of cognitive changes and the development of early intervention strategies for SZ and MDD. Addressing this gap is critical for advancing our knowledge and improving patient prognosis.
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Affiliation(s)
- Yu-Ting Li
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Chi Zhang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
- Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Jia-Cheng Han
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Yu-Xuan Shang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Zhu-Hong Chen
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Guang-Bin Cui
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi’an 710038, Shaanxi, China
| | - Wen Wang
- Department of Radiology, Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Xi’an 710038, Shaanxi, China
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Liu C, Li L, Zhu D, Lin S, Ren L, Zhen W, Tan W, Wang L, Tian L, Wang Q, Mao P, Pan W, Li B, Ma X. Individualized prediction of cognitive test scores from functional brain connectome in patients with first-episode late-life depression. J Affect Disord 2024; 352:32-42. [PMID: 38360359 DOI: 10.1016/j.jad.2024.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/17/2024] [Accepted: 02/08/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND In the realm of cognitive screening, the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) are widely utilized for detecting cognitive deficits in patients with late-life depression (LLD), However, the interindividual variability in neuroimaging biomarkers contributing to individual-specific symptom severity remains poorly understood. In this study, we used a connectome-based predictive model (CPM) approach on resting-state functional magnetic resonance imaging data from patients with LLD to establish individualized prediction models for the MoCA and the MMSE scores. METHODS We recruited 135 individuals diagnosed with first-episode LLD for this research. Participants underwent the MMSE and MoCA tests, along with resting-state functional magnetic resonance imaging scans. Functional connectivity matrices derived from these scans were utilized in CPM models to predict MMSE or MoCA scores. Predictive precision was assessed by correlating predicted and observed scores, with the significance of prediction performance evaluated through a permutation test. RESULTS The negative model of the CPM procedure demonstrated a significant capacity to predict MoCA scores (r = -0.309, p = 0.002). Similarly, the CPM procedure could predict MMSE scores (r = -0.236, p = 0.016). The predictive models for cognitive test scores in LLD primarily involved the visual network, somatomotor network, dorsal attention network, and ventral attention network. CONCLUSIONS Brain functional connectivity emerges as a promising predictor of personalized cognitive test scores in LLD, suggesting that functional connectomes are potential neurobiological markers for cognitive performance in patients with LLD.
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Affiliation(s)
- Chaomeng Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dandi Zhu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Shuo Lin
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Ren
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Wenfeng Zhen
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Weihao Tan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lina Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Lu Tian
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Qian Wang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Peixian Mao
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Weigang Pan
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
| | - Bing Li
- Hebei Provincial Mental Health Center, Baoding, China; Hebei Key Laboratory of Major Mental and Behavioral Disorders, Baoding, China; The Sixth Clinical Medical College of Hebei University, Baoding, China.
| | - Xin Ma
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
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Dai P, Zhou Y, Shi Y, Lu D, Chen Z, Zou B, Liu K, Liao S. Classification of MDD using a Transformer classifier with large-scale multisite resting-state fMRI data. Hum Brain Mapp 2024; 45:e26542. [PMID: 38088473 PMCID: PMC10789197 DOI: 10.1002/hbm.26542] [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: 05/22/2023] [Revised: 10/27/2023] [Accepted: 11/09/2023] [Indexed: 01/16/2024] Open
Abstract
Major depressive disorder (MDD) is one of the most common psychiatric disorders worldwide with high recurrence rate. Identifying MDD patients, particularly those with recurrent episodes with resting-state fMRI, may reveal the relationship between MDD and brain function. We proposed a Transformer-Encoder model, which utilized functional connectivity extracted from large-scale multisite rs-fMRI datasets to classify MDD and HC. The model discarded the Transformer's Decoder part, reducing the model's complexity and decreasing the number of parameters to adapt to the limited sample size and it does not require a complex feature selection process and achieves end-to-end classification. Additionally, our model is suitable for classifying data combined from multiple brain atlases and has an optional unsupervised pre-training module to acquire optimal initial parameters and speed up the training process. The model's performance was tested on a large-scale multisite dataset and identified brain regions affected by MDD using the Grad-CAM method. After conducting five-fold cross-validation, our model achieved an average classification accuracy of 68.61% on a dataset consisting of 1611 samples. For the selected recurrent MDD dataset, the model reached an average classification accuracy of 78.11%. Abnormalities were detected in the frontal gyri and cerebral cortex of MDD patients in both datasets. Furthermore, the identified brain regions in the recurrent MDD dataset generally exhibited a higher contribution to the model's performance.
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Affiliation(s)
- Peishan Dai
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Ying Zhou
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Yun Shi
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Da Lu
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Zailiang Chen
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Beiji Zou
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
| | - Kun Liu
- Brain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaChina
| | - Shenghui Liao
- School of Computer Science and EngineeringCentral South UniversityChangshaChina
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Almdahl IS, Martinussen LJ, Ousdal OT, Kraus M, Sowa P, Agartz I, Korsnes MS. Task-based functional connectivity reveals aberrance with the salience network during emotional interference in late-life depression. Aging Ment Health 2023; 27:2043-2051. [PMID: 36914245 DOI: 10.1080/13607863.2023.2179972] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 02/05/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVES Late-life depression (LLD) is a common and debilitating disorder. Previously, resting-state studies have revealed abnormal functional connectivity (FC) of brain networks in LLD. Since LLD is associated with emotional-cognitive control deficits, the aim of this study was to compare FC of large-scale brain networks in older adults with and without a history of LLD during a cognitive control task with emotional stimuli. METHODS Cross-sectional case-control study. Twenty participants diagnosed with LLD and 37 never-depressed adults 60-88 years of age underwent functional magnetic resonance imaging during an emotional Stroop task. Network-region-to-region FC was assessed with seed regions in the default mode, the frontoparietal, the dorsal attention, and the salience networks. RESULTS FC between salience and sensorimotor network regions and between salience and dorsal attention network regions were reduced in LLD patients compared to controls during the processing of incongruent emotional stimuli. The normally positive FC between these networks were negative in LLD patients and inversely correlated with vascular risk and white matter hyperintensities. CONCLUSIONS Emotional-cognitive control in LLD is associated with aberrant functional coupling between salience and other networks. This expands on the network-based LLD model and proposes the salience network as a target for future interventions.
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Affiliation(s)
- Ina S Almdahl
- Department of Old Age Psychiatry, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Liva J Martinussen
- Department of Old Age Psychiatry, Oslo University Hospital, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | - Olga Therese Ousdal
- The Department of Biomedicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | | | - Piotr Sowa
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
- K.G. Jebsen Centre for Neurodevelopmental Disorders, University of Oslo, Oslo, Norway
| | - Maria S Korsnes
- Department of Old Age Psychiatry, Oslo University Hospital, Oslo, Norway
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
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Nagayama T, Yamaguchi S, Nakayama T, Yang S, Inagaki S, Nagayama M. Effects of white matter hyperintensities on isolated executive function assessed by the Trail Making Test. F1000Res 2023; 12:1021. [PMID: 38434635 PMCID: PMC10905008 DOI: 10.12688/f1000research.139557.1] [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] [Accepted: 08/08/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND White matter hyperintensities (WMHs) on MRI are associated with cognitive dysfunction, particularly slow processing speed and executive dysfunction. However, it is not clear whether WMHs burden affects isolated executive function independent of aging when WMHs are assessed separately in periventricular hyperintensity (PVH) and deep and subcortical white matter hyperintensity (DSWMH). PURPOSE To assess the relationship between the degree of WMHs and the performance on the Trail Making Test (TMT), which can evaluate isolated ability of set-shifting and working memory. METHODS 74 participants who visited our memory clinic and underwent the TMT subtests (TMT-A and TMT-B) and the Mini-Mental State Examination (MMSE). All subjects performed the TMT within the time limits and their MMSE scores were 24 or higher, and they were diagnosed as having normal cognition or mild cognitive impairment. The extent of PVH and DSWMH was graded from 0 to 3 using the Fazekas scale. We obtained testing time to complete the TMT-A and TMT-B, and calculated TMT-B minus TMT-A. We performed correlation analyses between the degree of WMHs and the time measures of the TMT subtests with adjustment of age. RESULTS Average scores of the MMSE were not different among the groups either by PVH grade or by DSWMH grade. In contrast, average time required for the TMT-A, TMT-B, and TMT-B minus TMT-A increased along with exacerbation of PVH and DSWMH grade. After the adjustment of age we found significant association between only DSWMH grade and the time difference of TMT-B minus TMT-A. CONCLUSIONS Exacerbation of PVH and DSWMH differentially affected isolated executive functions assessed by the TMT subtests independent of age and general cognitive function.
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Affiliation(s)
- Tomiko Nagayama
- Neurology, International University of Health and Welfare,Atami Hospital, Atami, Shizuoka, 413-0012, Japan
| | - Shuhei Yamaguchi
- Shimane Prefecture Bureau of Hospital Administration, Shimane Prefectural Center Hospital, Izumo, Shimane, 693-8555, Japan
| | - Takuya Nakayama
- Rehabilitation, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, 413-0012, Japan
| | - Sunghoon Yang
- Neurology, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, 413-0012, Japan
| | - Seiichi Inagaki
- Graduate School of Public Health, International University of Health and Welfare, Narita, Tiba, 286-8686, Japan
| | - Masao Nagayama
- Neurology, International University of Health and Welfare, Atami Hospital, Atami, Shizuoka, 413-0012, Japan
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Anziano M, Mouthon M, Thoeny H, Sperber C, Spierer L. Mental flexibility depends on a largely distributed white matter network: Causal evidence from connectome-based lesion-symptom mapping. Cortex 2023; 165:38-56. [PMID: 37253289 DOI: 10.1016/j.cortex.2023.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/20/2022] [Accepted: 04/06/2023] [Indexed: 06/01/2023]
Abstract
Mental flexibility (MF) refers to the capacity to dynamically switch from one task to another. Current neurocognitive models suggest that since this function requires interactions between multiple remote brain areas, the integrity of the anatomic tracts connecting these brain areas is necessary to maintain performance. We tested this hypothesis by assessing with a connectome-based lesion-symptom mapping approach the effects of white matter lesions on the brain's structural connectome and their association with performance on the trail making test, a neuropsychological test of MF, in a sample of 167 first unilateral stroke patients. We found associations between MF deficits and damage of i) left lateralized fronto-temporo-parietal connections and interhemispheric connections between left temporo-parietal and right parietal areas; ii) left cortico-basal connections; and iii) left cortico-pontine connections. We further identified a relationship between MF and white matter disconnections within cortical areas composing the cognitive control, default mode and attention functional networks. These results for a central role of white matter integrity in MF extend current literature by providing causal evidence for a functional interdependence among the regional cortical and subcortical structures composing the MF network. Our results further emphasize the necessity to consider connectomics in lesion-symptom mapping analyses to establish comprehensive neurocognitive models of high-order cognitive functions.
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Affiliation(s)
- Marco Anziano
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland.
| | - Michael Mouthon
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| | - Harriet Thoeny
- Department of Diagnostic and Interventional Radiology, Cantonal Hospital of Fribourg, University of Fribourg, Fribourg, Switzerland
| | - Christoph Sperber
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Lucas Spierer
- Laboratory for Neurorehabilitation Science, Medicine Section, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Jellinger KA. The heterogeneity of late-life depression and its pathobiology: a brain network dysfunction disorder. J Neural Transm (Vienna) 2023:10.1007/s00702-023-02648-z. [PMID: 37145167 PMCID: PMC10162005 DOI: 10.1007/s00702-023-02648-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/28/2023] [Indexed: 05/06/2023]
Abstract
Depression is frequent in older individuals and is often associated with cognitive impairment and increasing risk of subsequent dementia. Late-life depression (LLD) has a negative impact on quality of life, yet the underlying pathobiology is still poorly understood. It is characterized by considerable heterogeneity in clinical manifestation, genetics, brain morphology, and function. Although its diagnosis is based on standard criteria, due to overlap with other age-related pathologies, the relationship between depression and dementia and the relevant structural and functional cerebral lesions are still controversial. LLD has been related to a variety of pathogenic mechanisms associated with the underlying age-related neurodegenerative and cerebrovascular processes. In addition to biochemical abnormalities, involving serotonergic and GABAergic systems, widespread disturbances of cortico-limbic, cortico-subcortical, and other essential brain networks, with disruption in the topological organization of mood- and cognition-related or other global connections are involved. Most recent lesion mapping has identified an altered network architecture with "depressive circuits" and "resilience tracts", thus confirming that depression is a brain network dysfunction disorder. Further pathogenic mechanisms including neuroinflammation, neuroimmune dysregulation, oxidative stress, neurotrophic and other pathogenic factors, such as β-amyloid (and tau) deposition are in discussion. Antidepressant therapies induce various changes in brain structure and function. Better insights into the complex pathobiology of LLD and new biomarkers will allow earlier and better diagnosis of this frequent and disabling psychopathological disorder, and further elucidation of its complex pathobiological basis is warranted in order to provide better prevention and treatment of depression in older individuals.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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9
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Pace B, Holtzer R, Wagshul ME. Gray matter volume and within-task verbal fluency performance among older adults. Brain Cogn 2023; 166:105960. [PMID: 36868129 PMCID: PMC10257804 DOI: 10.1016/j.bandc.2023.105960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 03/05/2023]
Abstract
The current study examined the relationship between gray matter volume (GMV) and rate of word generation over the course of three consecutive 20-sec intervals in 60-sec letter and category verbal fluency (VF) tasks. Attenuated rate of within-person word generation in VF provides incremental information beyond total scores and predicts increased risk of incident Mild Cognitive Impairment (MCI). No studies to date, however, have determined the structural neural substrates underlying word generation rate in VF. Participants were 70 community-residing adults ≥ 65 years, who completed the letter and category VF tasks and a 3 T structural MRI scan. Linear mixed effects models (LMEMs) were used to determine the moderating effect of GMV on word generation rate. Whole brain voxel-wise LMEMs, adjusted for age, gender, education, Wide-Range Achievement Test - reading subtest score (WRAT3), and global health score, were run using permutation methods to correct for multiple comparisons. Lower GMV, primarily in frontal regions (superior frontal, rostral middle frontal, frontal pole, medial orbitofrontal, and pars orbitalis), were related to attenuated word generation rate, especially for letter VF. We propose that lower frontal GMV underlies inefficient executive word search processes reflected by attenuated word generation slope in letter VF amongst older adults.
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Affiliation(s)
- Brigitte Pace
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, The Bronx, NY 10461, United States.
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, The Bronx, NY 10461, United States; Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, NY 10416, United States.
| | - Mark E Wagshul
- Department of Radiology, Gruss Magnetic Resonance Research Center, Albert Einstein College of Medicine, 1250 Morris Park Ave, The Bronx, NY 10461, United States; Physiology and Biophysics, Albert Einstein College of Medicine, 1300 Morris Park Ave, The Bronx, NY 10416, United States.
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10
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Automatic diagnosis of late-life depression by 3D convolutional neural networks and cross-sample Entropy analysis from resting-state fMRI. Brain Imaging Behav 2023; 17:125-135. [PMID: 36418676 PMCID: PMC9922223 DOI: 10.1007/s11682-022-00748-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/26/2022] [Accepted: 11/12/2022] [Indexed: 11/25/2022]
Abstract
Resting-state fMRI has been widely used in investigating the pathophysiology of late-life depression (LLD). Unlike the conventional linear approach, cross-sample entropy (CSE) analysis shows the nonlinear property in fMRI signals between brain regions. Moreover, recent advances in deep learning, such as convolutional neural networks (CNNs), provide a timely application for understanding LLD. Accurate and prompt diagnosis is essential in LLD; hence, this study aimed to combine CNN and CSE analysis to discriminate LLD patients and non-depressed comparison older adults based on brain resting-state fMRI signals. Seventy-seven older adults, including 49 patients and 28 comparison older adults, were included for fMRI scans. Three-dimensional CSEs with volumes corresponding to 90 seed regions of interest of each participant were developed and fed into models for disease classification and depression severity prediction. We obtained a diagnostic accuracy > 85% in the superior frontal gyrus (left dorsolateral and right orbital parts), left insula, and right middle occipital gyrus. With a mean root-mean-square error (RMSE) of 2.41, three separate models were required to predict depressive symptoms in the severe, moderate, and mild depression groups. The CSE volumes in the left inferior parietal lobule, left parahippocampal gyrus, and left postcentral gyrus performed best in each respective model. Combined complexity analysis and deep learning algorithms can classify patients with LLD from comparison older adults and predict symptom severity based on fMRI data. Such application can be utilized in precision medicine for disease detection and symptom monitoring in LLD.
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Dai J, Liu XF, Wang QL, Peng YJ, Zhang QZY, Jiang FX, Yan J. A new method for establishing operative channels in unilateral biportal endoscopic surgery: Technical notes and preliminary results. J Back Musculoskelet Rehabil 2022; 36:367-375. [PMID: 36278335 DOI: 10.3233/bmr-220005] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND The unilateral biportal endoscopic (UBE) technique has been widely used in spine surgery. At present, a traditional rigid working channel is available for the UBE system. A metal semicircular canal is located in the working channel. However, due to the metal material of the working channel, arthroscopy and instruments are constrained from moving in UBE surgery. Additionally, an assistant is needed during the procedure to hold the traditional working channel. OBJECTIVE For simplicity of operation and convenient movement of the arthroscopy and instrument, we describe a new method for establishing operative channels in UBE surgery. METHODS We retrospectively reviewed 50 patients who underwent unilateral biportal endoscopic discectomy (UBED) from February 2020 to August 2020 via our new method. The Oswestry Disability Index (ODI) and visual analogue scale (VAS) score were measured preoperatively and 1 month, 3 months, 6 months and 12 months postoperatively. Statistical comparisons were made using analysis of covariance and paired t tests. RESULTS The VAS scores for back pain at the five time points were 5.20 ± 2.57, 1.96 ± 0.95, 1.50 ± 0.84, 1.64 ± 1.08 and 1.18 ± 0.39. The leg pain VAS scores were 7.02 ± 2.25, 2.02 ± 1.27, 1.48 ± 0.89, 1.32 ± 0.79 and 0.88 ± 0.52. The ODI values were 51.08 ± 19.97, 19.62 ± 15.51, 8.26 ± 7.40, and 7.54 ± 6.42 to 3.24 ± 1.10. The postoperative ODIs and VAS scores of low back pain and leg pain were significantly lower than those before surgery, and differences were statistically significant (all p< 0.05). The pressure of the closed outflow was significantly higher than that of the open outflow (37.35 ± 13.11 mm Hg vs. 24.55 ± 12.64 mm Hg p= 0.003). After we tightened the infusion strap to open the outflow, the pressure decreased significantly (26.4 ± 14.08 mm Hg vs. 37.35 ± 13.11 mm Hg p= 0.015). There were 2 cases of complications, including 1 case of postoperative recurrence and 1 case of dural tears. CONCLUSION This study demonstrates the technical feasibility, safety, and efficacy of modified channel establishment in UBE surgery.
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Schlemm E, Jensen M, Kuceyeski A, Jamison K, Ingwersen T, Mayer C, Königsberg A, Boutitie F, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Puig J, Simonsen CZ, Thijs V, Wouters A, Gerloff C, Thomalla G, Cheng B. Early effect of thrombolysis on structural brain network organisation after anterior‐circulation stroke in the randomized
WAKE‐UP
trial. Hum Brain Mapp 2022; 43:5053-5065. [PMID: 36102287 PMCID: PMC9582379 DOI: 10.1002/hbm.26073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/11/2022] [Accepted: 08/22/2022] [Indexed: 11/08/2022] Open
Abstract
The symptoms of acute ischemic stroke can be attributed to disruption of the brain network architecture. Systemic thrombolysis is an effective treatment that preserves structural connectivity in the first days after the event. Its effect on the evolution of global network organisation is, however, not well understood. We present a secondary analysis of 269 patients from the randomized WAKE‐UP trial, comparing 127 imaging‐selected patients treated with alteplase with 142 controls who received placebo. We used indirect network mapping to quantify the impact of ischemic lesions on structural brain network organisation in terms of both global parameters of segregation and integration, and local disruption of individual connections. Network damage was estimated before randomization and again 22 to 36 h after administration of either alteplase or placebo. Evolution of structural network organisation was characterised by a loss in integration and gain in segregation, and this trajectory was attenuated by the administration of alteplase. Preserved brain network organization was associated with excellent functional outcome. Furthermore, the protective effect of alteplase was spatio‐topologically nonuniform, concentrating on a subnetwork of high centrality supported in the salvageable white matter surrounding the ischemic cores. This interplay between the location of the lesion, the pathophysiology of the ischemic penumbra, and the spatial embedding of the brain network explains the observed potential of thrombolysis to attenuate topological network damage early after stroke. Our findings might, in the future, lead to new brain network‐informed imaging biomarkers and improved prognostication in ischemic stroke.
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Affiliation(s)
- Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Märit Jensen
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Amy Kuceyeski
- Department of Radiology Weill Cornell Medicine New York New York USA
| | - Keith Jamison
- Department of Radiology Weill Cornell Medicine New York New York USA
| | - Thies Ingwersen
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Carola Mayer
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Florent Boutitie
- Department of Radiology Weill Cornell Medicine New York New York USA
- Hospices Civils de Lyon, Service de Biostatistique Lyon France
- Université Lyon 1 Villeurbanne France
- CNRS, UMR 5558 Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique‐Santé Villeurbanne France
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Klinik für Neurologie Medical Park Berlin Humboldtmühle Berlin Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Klinik und Hochschulambulanz für Neurologie Charité‐Universitätsmedizin Berlin Berlin Germany
- German Centre for Neurodegenerative Diseases (DZNE) Berlin Germany
- German Centre for Cardiovascular Research (DZHK) Berlin Germany
- ExcellenceCluster NeuroCure Berlin Germany
| | - Jochen B. Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB) Charité ‐ Universitätsmedizin Berlin Berlin Germany
| | - Robin Lemmens
- Department of Neurology University Hospitals Leuven Leuven Belgium
- Department of Neurosciences Division of Experimental Neurology KU Leuven—University of Leuven Leuven Belgium
- VIB, Centre for Brain & Disease Research Laboratory of Neurobiology Leuven Belgium
| | - Keith W. Muir
- Institute of Neuroscience & Psychology University of Glasgow Glasgow UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1 CREATIS CNRS UMR 5220‐INSERM U1206, INSA‐Lyon Lyon France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI) Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona Spain
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI) Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI) Girona Spain
| | | | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health University of Melbourne Heidelberg Victoria Australia
- Department of Neurology Austin Health Heidelberg Victoria Australia
| | - Anke Wouters
- Department of Neurology University Hospitals Leuven Leuven Belgium
- Department of Neurosciences Division of Experimental Neurology KU Leuven—University of Leuven Leuven Belgium
- VIB, Centre for Brain & Disease Research Laboratory of Neurobiology Leuven Belgium
- Department of Neurology Amsterdam UMC University of Amsterdam Amsterdam Netherlands
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf‐ und Neurozentrum University Medical Centre Hamburg‐Eppendorf Hamburg Germany
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Minor M, Jaywant A, Toglia J, Campo M, O'Dell MW. Discharge Rehabilitation Measures Predict Activity Limitations in Patients With Stroke 6 Months After Inpatient Rehabilitation. Am J Phys Med Rehabil 2022; 101:761-767. [PMID: 34686630 DOI: 10.1097/phm.0000000000001908] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to identify rehabilitation measures at discharge from acute inpatient stroke rehabilitation that predict activity limitations at 6 mos postdischarge. DESIGN This is a retrospective analysis of a prospective, longitudinal, observational cohort study. It was conducted in an acute inpatient rehabilitation unit at an urban, academic medical center. Activity limitations in patients ( N = 141) with stroke of mild-moderate severity were assessed with the activity measure for post-acute care at inpatient stroke rehabilitation discharge and 6-mo follow-up. Rehabilitation measures at discharge were investigated as predictors for activity limitations at 6 mos. RESULTS Measures of balance (Berg Balance Scale), functional limitations in motor-based activities (functional independence measure-motor subscore), and motor impairment (motricity index), in addition to discharge activities measure for post-acute care scores, strongly predicted activity limitations in basic mobility and daily activities at 6 mos (51% and 41% variance explained, respectively). Functional limitations in cognition (functional independence measure-cognitive subscore) and executive function impairment (Trail Making Test-part B), in addition to the discharge activities measure for post-acute care score, modestly predicted limitations in cognitively based daily activities at 6 mos (12% of variance). CONCLUSIONS Standardized rehabilitation measures at inpatient stroke rehabilitation discharge can predict future activity limitations, which may improve prediction of outcome post-stroke and aid in postdischarge treatment planning.
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Affiliation(s)
- Maria Minor
- From the MD Program (MM), Department of Rehabilitation Medicine (AJ, JT, MWO), and Department of Psychiatry (AJ), Weill Cornell Medicine, New York, New York; School of Health and Natural Sciences, Mercy College, Dobbs Ferry, New York (JT, MC); and New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York (AJ, JT, MWO)
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14
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Zhou H, Zhong X, Chen B, Wang Q, Zhang M, Mai N, Wu Z, Huang X, Chen X, Peng Q, Ning Y. Elevated homocysteine levels, white matter abnormalities and cognitive impairment in patients with late-life depression. Front Aging Neurosci 2022; 14:931560. [PMID: 35923546 PMCID: PMC9340773 DOI: 10.3389/fnagi.2022.931560] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cognitive impairment in late−life depression (LLD) is considered to be caused by neurodegenerative changes. Elevated homocysteine (Hcy) levels may be linked to cognitive abnormalities associated with LLD. The important role of white matter (WM) damage in cognitive impairment and pathogenesis in patients with LLD has been widely reported. However, no research has explored the interrelationships of these features in patients with LLD. Objective The goal of the study was to examine the interrelationship between Hcy levels, cognition, and variations in WM microstructure detected by diffusion tensor imaging (DTI) in patients with LLD. Methods We recruited 89 healthy controls (HCs) and 113 patients with LLD; then, we measured the plasma Hcy levels of participants in both groups. All individuals performed a battery of neuropsychological tests to measure cognitive ability. Seventy-four patients with LLD and 68 HCs experienced a DTI magnetic resonance imaging (MRI) scan. Results Patients with LLD showed significantly lower fractional anisotropy (FA) values in the bilateral inferior longitudinal fasciculus than those of healthy participants. Only in LLD patients was Hcy concentration inversely associated to FA values in the forceps minor. Finally, multiple regression analyses showed that an interaction between Hcy levels and FA values in the right cingulum of the cingulate cortex and right inferior longitudinal fasciculus were independent contributors to the executive function of patients with LLD. Conclusion Our results highlight the complex interplay between elevated homocysteine levels and WM abnormalities in the pathophysiology of LLD-related cognitive impairment, consistent with the neurodegeneration hypothesis.
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Affiliation(s)
- Huarong Zhou
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaomei Zhong
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ben Chen
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qiang Wang
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Zhang
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Naikeng Mai
- Department of Neurology, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhangying Wu
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xingxiao Huang
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xinru Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Qi Peng
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yuping Ning
- Center for Geriatric Neuroscience, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
- *Correspondence: Yuping Ning,
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15
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Jellinger KA. The enigma of vascular depression in old age: a critical update. J Neural Transm (Vienna) 2022; 129:961-976. [PMID: 35705878 DOI: 10.1007/s00702-022-02521-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/22/2022] [Indexed: 12/14/2022]
Abstract
Depression is common in older individuals and is associated with high disability and increased mortality, yet the factors predicting late-life depression (LLD) are poorly understood. The relationship between of depressive disorder, age- and disease-related processes have generated pathogenic hypotheses and provided new treatment options. LLD syndrome is often related to a variety of vascular mechanisms, in particular hypertension, cerebral small vessel disease, white matter lesions, subcortical vascular impairment, and other processes (e.g., inflammation, neuroimmune regulatory dysmechanisms, neurodegenerative changes, amyloid accumulation) that may represent etiological factors by affecting frontolimbic and other neuronal networks predisposing to depression. The "vascular depression" hypothesis suggests that cerebrovascular disease (CVD) and vascular risk factors may predispose, induce or perpetuate geriatric depressive disorders. It is based on the presence of various cerebrovascular risk factors in many patients with LLD, its co-morbidity with cerebrovascular lesions, and the frequent development of depression after stroke. Other findings related to vascular depression are atrophy of the medial temporal cortex or generalized cortical atrophy that are usually associated with cognitive impairment. Other pathogenetic hypotheses of LLD, such as metabolic or inflammatory ones, are briefly discussed. Treatment planning should consider there may be a modest response to antidepressants, but several evidence-based and novel treatment options for LLD exist, such as electroconvulsive therapy, transcranial magnetic stimulation, neurobiology-based psychotherapy, as well as antihypertension and antiinflammatory drugs. However, their effectiveness needs further investigation, and new methodologies for prevention and treatment of depression in older individuals should be developed.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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16
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He E, Liu M, Gong S, Fu X, Han Y, Deng F. White Matter Alterations in Depressive Disorder. Front Immunol 2022; 13:826812. [PMID: 35634314 PMCID: PMC9133348 DOI: 10.3389/fimmu.2022.826812] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Depressive disorder is the most prevalent affective disorder today. Depressive disorder has been linked to changes in the white matter. White matter changes in depressive disorder could be a result of impaired cerebral blood flow (CBF) and CBF self-regulation, impaired blood-brain barrier function, inflammatory factors, genes and environmental factors. Additionally, white matter changes in patients with depression are associated with clinical variables such as differential diagnosis, severity, treatment effect, and efficacy assessment. This review discusses the characteristics, possible mechanisms, clinical relevance, and potential treatment of white matter alterations caused by depressive disorders.
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17
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Jaywant A, Dunlop K, Victoria LW, Oberlin L, Lynch CJ, Respino M, Kuceyeski A, Scult M, Hoptman MJ, Liston C, O’Dell MW, Alexopoulos GS, Perlis RH, Gunning FM. Estimated Regional White Matter Hyperintensity Burden, Resting State Functional Connectivity, and Cognitive Functions in Older Adults. Am J Geriatr Psychiatry 2022; 30:269-280. [PMID: 34412936 PMCID: PMC8799753 DOI: 10.1016/j.jagp.2021.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/24/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE White matter hyperintensities (WMH) are linked to deficits in cognitive functioning, including cognitive control and memory; however, the structural, and functional mechanisms are largely unknown. We investigated the relationship between estimated regional disruptions to white matter fiber tracts from WMH, resting state functional connectivity (RSFC), and cognitive functions in older adults. DESIGN Cross-sectional study. SETTING Community. PARTICIPANTS Fifty-eight cognitively-healthy older adults. MEASUREMENTS Tasks of cognitive control and memory, structural MRI, and resting state fMRI. We estimated the disruption to white matter fiber tracts from WMH and its impact on gray matter regions in the cortical and subcortical frontoparietal network, default mode network, and ventral attention network by overlaying each subject's WMH mask on a normative tractogram dataset. We calculated RSFC between nodes in those same networks. We evaluated the interaction of regional WMH burden and RSFC in predicting cognitive control and memory. RESULTS The interaction of estimated regional WMH burden and RSFC in cortico-striatal regions of the default mode network and frontoparietal network was associated with delayed recall. Models predicting working memory, cognitive inhibition, and set-shifting were not significant. CONCLUSION Findings highlight the role of network-level structural and functional alterations in resting state networks that are related to WMH and impact memory in older adults.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine,Department of Rehabilitation Medicine, Weill Cornell Medicine
| | - Katharine Dunlop
- Department of Psychiatry, Weill Cornell Medicine,Feil Family Brain and Mind Research Institute, Weill Cornell Medicine
| | - Lindsay W. Victoria
- Department of Psychiatry, Weill Cornell Medicine,Weill Cornell Institute of Geriatric Psychiatry
| | - Lauren Oberlin
- Department of Psychiatry, Weill Cornell Medicine,Weill Cornell Institute of Geriatric Psychiatry
| | - Charles J. Lynch
- Department of Psychiatry, Weill Cornell Medicine,Feil Family Brain and Mind Research Institute, Weill Cornell Medicine
| | - Matteo Respino
- Department of Psychiatry, Weill Cornell Medicine,Weill Cornell Institute of Geriatric Psychiatry
| | | | | | - Matthew J. Hoptman
- Nathan Kline Institute for Psychiatric Research,Department of Psychiatry, New York University School of Medicine
| | - Conor Liston
- Department of Psychiatry, Weill Cornell Medicine,Feil Family Brain and Mind Research Institute, Weill Cornell Medicine
| | | | - George S. Alexopoulos
- Department of Psychiatry, Weill Cornell Medicine,Weill Cornell Institute of Geriatric Psychiatry
| | - Roy H. Perlis
- Harvard Medical School/Massachusetts General Hospital
| | - Faith M. Gunning
- Department of Psychiatry, Weill Cornell Medicine,Weill Cornell Institute of Geriatric Psychiatry
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18
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Pizem D, Novakova L, Gajdos M, Rektorova I. Is the vertex a good control stimulation site? Theta burst stimulation in healthy controls. J Neural Transm (Vienna) 2022; 129:319-329. [DOI: 10.1007/s00702-022-02466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/16/2022] [Indexed: 01/02/2023]
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19
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Influences of dopaminergic system dysfunction on late-life depression. Mol Psychiatry 2022; 27:180-191. [PMID: 34404915 PMCID: PMC8850529 DOI: 10.1038/s41380-021-01265-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/04/2021] [Indexed: 12/15/2022]
Abstract
Deficits in cognition, reward processing, and motor function are clinical features relevant to both aging and depression. Individuals with late-life depression often show impairment across these domains, all of which are moderated by the functioning of dopaminergic circuits. As dopaminergic function declines with normal aging and increased inflammatory burden, the role of dopamine may be particularly salient for late-life depression. We review the literature examining the role of dopamine in the pathogenesis of depression, as well as how dopamine function changes with aging and is influenced by inflammation. Applying a Research Domain Criteria (RDoC) Initiative perspective, we then review work examining how dopaminergic signaling affects these domains, specifically focusing on Cognitive, Positive Valence, and Sensorimotor Systems. We propose a unified model incorporating the effects of aging and low-grade inflammation on dopaminergic functioning, with a resulting negative effect on cognition, reward processing, and motor function. Interplay between these systems may influence development of a depressive phenotype, with an initial deficit in one domain reinforcing decline in others. This model extends RDoC concepts into late-life depression while also providing opportunities for novel and personalized interventions.
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Late-life depression accentuates cognitive weaknesses in older adults with small vessel disease. Neuropsychopharmacology 2022; 47:580-587. [PMID: 33564103 PMCID: PMC8674355 DOI: 10.1038/s41386-021-00973-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/03/2021] [Accepted: 01/12/2021] [Indexed: 02/08/2023]
Abstract
Neuroimaging features of small vessel disease (SVD) are highly prevalent in older adulthood and associated with significant variability in clinical symptoms, yet the factors predicting these symptom disparities are poorly understood. We employed a novel metric of SVD, peak width of skeletonized mean diffusivity (PSMD), to elucidate the relationship of late-life depression (LLD) to the cognitive presentation of vascular pathology. A total of 109 older adults without a diagnosis of a neurocognitive disorder were enrolled in the study; 44 with major depressive disorder and 65 age-matched controls. Subjects completed neuropsychological testing and magnetic resonance imaging including FLAIR and diffusion tensor imaging sequences, from which white matter hyperintensity volume and diffusion metrics (fractional anisotropy, mean diffusivity, PSMD) were quantified. In hierarchical models, the relationship between vascular burden and cognitive performance varied as a function of diagnostic status, such that the negative association between PSMD and processing speed was significantly stronger in participants with LLD compared to controls. Greater PSMD also predicted poorer performance on delayed memory and executive function tasks specifically among those with LLD, while there were no associations between PSMD and task performance among controls. PSMD outperformed conventional SVD and diffusion markers in predicting cognitive performance and dysexecutive behaviors in participants with LLD. These data suggest that LLD may confer a vulnerability to the cognitive manifestations of white matter abnormalities in older adulthood. PSMD, a novel biomarker of diffuse microstructural changes in SVD, may be a more sensitive marker of subtle cognitive deficits stemming from vascular pathology in LLD.
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21
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Jellinger KA. Pathomechanisms of Vascular Depression in Older Adults. Int J Mol Sci 2021; 23:ijms23010308. [PMID: 35008732 PMCID: PMC8745290 DOI: 10.3390/ijms23010308] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Depression in older individuals is a common complex mood disorder with high comorbidity of both psychiatric and physical diseases, associated with high disability, cognitive decline, and increased mortality The factors predicting the risk of late-life depression (LLD) are incompletely understood. The reciprocal relationship of depressive disorder and age- and disease-related processes has generated pathogenic hypotheses and provided various treatment options. The heterogeneity of depression complicates research into the underlying pathogenic cascade, and factors involved in LLD considerably differ from those involved in early life depression. Evidence suggests that a variety of vascular mechanisms, in particular cerebral small vessel disease, generalized microvascular, and endothelial dysfunction, as well as metabolic risk factors, including diabetes, and inflammation that may induce subcortical white and gray matter lesions by compromising fronto-limbic and other important neuronal networks, may contribute to the development of LLD. The "vascular depression" hypothesis postulates that cerebrovascular disease or vascular risk factors can predispose, precipitate, and perpetuate geriatric depression syndromes, based on their comorbidity with cerebrovascular lesions and the frequent development of depression after stroke. Vascular burden is associated with cognitive deficits and a specific form of LLD, vascular depression, which is marked by decreased white matter integrity, executive dysfunction, functional disability, and poorer response to antidepressive therapy than major depressive disorder without vascular risk factors. Other pathogenic factors of LLD, such as neurodegeneration or neuroimmune regulatory dysmechanisms, are briefly discussed. Treatment planning should consider a modest response of LLD to antidepressants, while vascular and metabolic factors may provide promising targets for its successful prevention and treatment. However, their effectiveness needs further investigation, and intervention studies are needed to assess which interventions are appropriate and effective in clinical practice.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150 Vienna, Austria
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22
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Short- and Long-Term Safety and Efficacy of Self-Expandable Leo Stents Used Alone or with Coiling for Ruptured and Unruptured Intracranial Aneurysms: A Retrospective Observational Study. J Clin Med 2021; 10:jcm10194541. [PMID: 34640559 PMCID: PMC8509248 DOI: 10.3390/jcm10194541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
To assess the efficacy and safety of the Leo stent used alone or with coiling to treat complex intracranial aneurysms (IAs) not eligible for simple or balloon-assisted coiling, this single-center retrospective study included consecutive adults with ruptured or unruptured IAs treated in 2011-2018 by stenting with or without coiling. The indication for stenting was IA complexity precluding simple or balloon-assisted coiling. Extensive data on the patients, IAs, antiplatelet treatments, procedures, and outcomes over the first 36 months were collected. Risk factors for early complications (univariate analysis) and delayed ischemia (multivariate analysis) were sought. We include 64 patients with 66 IAs. The procedural success rate was 65/66 (98.5%). Obliteration was Raymond Roy class I or II for 85% of IAs. Six patients died including four of the 12 patients presenting with subarachnoid hemorrhage, which was the only significant risk factor for early major complications. At 1 month, 45/64 (69%) had no disabilities. No rebleeding was reported. Ischemia was detected by routine MRI in 20 (35%) of the 57 patients with long-term data and was asymptomatic in 14. The stent-within-a-stent configuration was the only independent risk factor for ischemia. The Leo stent used alone or with coils to manage challenging IAs was associated with a high procedural success rate and complete or nearly complete IA obliteration of 85% of IAs. The high frequency of ischemia is ascribable to our use of routine serial MRI. In patients with bleeding, the Leo stent was associated with an excess risk of early, major, intracranial complications, as compared to patients without bleeding. Long-term follow-up was marked by the occurrence of ischemic events in the vascular territory of the stent, mostly silent.
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Dotson VM, Gradone AM, Bogoian HR, Minto LR, Taiwo Z, Salling ZN. Be Fit, Be Sharp, Be Well: The Case for Exercise as a Treatment for Cognitive Impairment in Late-life Depression. J Int Neuropsychol Soc 2021; 27:776-789. [PMID: 34154693 PMCID: PMC10436256 DOI: 10.1017/s1355617721000710] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To lay out the argument that exercise impacts neurobiological targets common to both mood and cognitive functioning, and thus more research should be conducted on its use as an alternative or adjunctive treatment for cognitive impairment in late-life depression (LLD). METHOD This narrative review summarizes the literature on cognitive impairment in LLD, describes the structural and functional brain changes and neurochemical changes that are linked to both cognitive impairment and mood disruption, and explains how exercise targets these same neurobiological changes and can thus provide an alternative or adjunctive treatment for cognitive impairment in LLD. RESULTS Cognitive impairment is common in LLD and predicts recurrence of depression, poor response to antidepressant treatment, and overall disability. Traditional depression treatment with medication, psychotherapy, or both, is not effective in fully reversing cognitive impairment for most depressed older adults. Physical exercise is an ideal treatment candidate based on evidence that it 1) is an effective treatment for depression, 2) enhances cognitive functioning in normal aging and in other patient populations, and 3) targets many of the neurobiological mechanisms that underlie mood and cognitive functioning. Results of the limited existing clinical trials of exercise for cognitive impairment in depression are mixed but overall support this contention. CONCLUSIONS Although limited, existing evidence suggests exercise may be a viable alternative or adjunctive treatment to address cognitive impairment in LLD, and thus more research in this area is warranted. Moving forward, additional research is needed in large, diverse samples to translate the growing research findings into clinical practice.
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Affiliation(s)
- Vonetta M. Dotson
- Department of Psychology, Georgia State University
- Gerontology Institute, Georgia State University
| | | | | | - Lex R. Minto
- Department of Psychology, Georgia State University
| | - Zinat Taiwo
- Department of Psychology, Georgia State University
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24
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Hayley S, Hakim AM, Albert PR. Depression, dementia and immune dysregulation. Brain 2021; 144:746-760. [PMID: 33279966 DOI: 10.1093/brain/awaa405] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/26/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022] Open
Abstract
Major depression is a prevalent illness that increases the risk of several neurological conditions. These include stroke, cardiovascular disease, and dementia including Alzheimer's disease. In this review we ask whether certain types of depression and associated loneliness may be a harbinger of cognitive decline and possibly even dementia. We propose that chronic stress and inflammation combine to compromise vascular and brain function. The resulting increases in proinflammatory cytokines and microglial activation drive brain pathology leading to depression and mild cognitive impairment, which may progress to dementia. We present evidence that by treating the inflammatory changes, depression can be reversed in many cases. Importantly, there is evidence that anti-inflammatory and antidepressant treatments may reduce or prevent dementia in people with depression. Thus, we propose a model in which chronic stress and inflammation combine to increase brain permeability and cytokine production. This leads to microglial activation, white matter damage, neuronal and glial cell loss. This is first manifest as depression and mild cognitive impairment, but can eventually evolve into dementia. Further research may identify clinical subgroups with inflammatory depression at risk for dementia. It would then be possible to address in clinical trials whether effective treatment of the depression can delay the onset of dementia.
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Affiliation(s)
- Shawn Hayley
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Antoine M Hakim
- Ottawa Hospital Research Institute (Neuroscience), uOttawa Brain and Mind Research Institute, Ottawa, ON, Canada
| | - Paul R Albert
- Ottawa Hospital Research Institute (Neuroscience), uOttawa Brain and Mind Research Institute, Ottawa, ON, Canada
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25
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Educational level as a protective factor against the influence of depressive symptoms on cognition in older adults: implications for functional independence during a 10-year follow-up. Int Psychogeriatr 2021; 33:813-825. [PMID: 33762060 DOI: 10.1017/s1041610221000272] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To examine whether the educational level moderates the relationship between baseline depressive symptoms and cognitive functioning at 5- and 10-year follow-ups in older adults, considering the association between cognitive functioning and difficulty with activities of daily living (ADL). DESIGN Using a prospective design, a path analysis was performed. SETTING In-home, face-to-face interviews and self-administered questionnaires, within the National Social Life, Health, and Aging Project. PARTICIPANTS In total, 1,461 participants (mean age = 66.62) were followed up from Wave 1 (baseline) to Wave 2 (at 5 years) and Wave 3 (at 10 years). MEASUREMENTS Depressive symptoms were assessed at baseline. Cognitive functioning and difficulty with ADL were assessed at baseline and at 5 and 10 years. RESULTS Educational level moderates the relationship between depressive symptoms and cognitive functioning at 5 years (β = 0.07, SE = 0.03, p = 0.04, Cohen's f2 = 0.02), being depressive symptoms related to poor cognitive functioning only at low educational levels. Cognitive functioning predicts difficulty with ADL at 5 and 10 years (β = -0.08, SE = 0.03, p = 0.008, Cohen's f2 = 0.01; β = -0.09, SE = 0.03, p = 0.006, Cohen's f2 = 0.02). The proposed model yielded excellent fit (CFI = 1.00, RMSEA = 0.0001, 90% CI 0.0001-0.03, SRMR = 0.004, and χ2(8) = 7.16, p = 0.52). CONCLUSIONS Cognitive reserve may act as a protective factor against the effect of depressive symptoms on cognition in older adults, which, in turn, is relevant to their functional independence.
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26
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Gunning FM, Oberlin LE, Schier M, Victoria LW. Brain-based mechanisms of late-life depression: Implications for novel interventions. Semin Cell Dev Biol 2021; 116:169-179. [PMID: 33992530 PMCID: PMC8548387 DOI: 10.1016/j.semcdb.2021.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
Late-life depression (LLD) is a particularly debilitating illness. Older adults suffering from depression commonly experience poor outcomes in response to antidepressant treatments, medical comorbidities, and declines in daily functioning. This review aims to further our understanding of the brain network dysfunctions underlying LLD that contribute to disrupted cognitive and affective processes and corresponding clinical manifestations. We provide an overview of a network model of LLD that integrates the salience network, the default mode network (DMN) and the executive control network (ECN). We discuss the brain-based structural and functional mechanisms of LLD with an emphasis on their link to clinical subtypes that often fail to respond to available treatments. Understanding the brain networks that underlie these disrupted processes can inform the development of targeted interventions for LLD. We propose behavioral, cognitive, or computational approaches to identifying novel, personalized interventions that may more effectively target the key cognitive and affective symptoms of LLD.
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Affiliation(s)
- Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Lauren E Oberlin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Maddy Schier
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA
| | - Lindsay W Victoria
- Department of Psychiatry, Weill Cornell Medicine, New York, NY 10065, USA.
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27
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What does hand motor function tell us about our aging brain in association with WMH? Aging Clin Exp Res 2021; 33:1577-1584. [PMID: 32860625 PMCID: PMC8203504 DOI: 10.1007/s40520-020-01683-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Abstract
Background White matter hyperintensities (WMH) are a common cerebral finding in older people. WMH are usually asymptomatic, but excessive WMH are associated with cognitive decline and dementia. WMH are also among the neurological findings most consistently associated with declining motor performance in healthy ageing. Aims To determine if WMH load is associated with simple and complex motor movements in dominant and non-dominant hands in cognitively intact older subjects. Methods Hand motor performance was assessed with the Purdue Pegboard and Finger-tapping tests on 44 healthy right-handed participants, mean age 70.9 years (range 59–84 years). Participants also underwent magnetic resonance (MR) imaging, which were used to quantify WMH volume. The effect of WMH on the motor parameters was assessed via mediation analyses. Results WMH load increased significantly with age, while the motor scores decreased significantly with age. WMH load mediated only the relationship between age and left-hand pegboard scores. Discussion WMH mediated only the more complex Purdue Pegboard task for the non-dominant hand. This is likely because complex movements in the non-dominant hand recruit a larger cerebral network, which is more vulnerable to WMH. Conclusions Complex hand movements in the non-dominant hand are mediated by WMH. Subtle loss of motor movements of non-dominant hand might predict future excessive white matter atrophy.
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28
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Schlemm E, Ingwersen T, Königsberg A, Boutitie F, Ebinger M, Endres M, Fiebach JB, Fiehler J, Galinovic I, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Puig J, Simonsen CZ, Thijs V, Wouters A, Gerloff C, Thomalla G, Cheng B. Preserved structural connectivity mediates the clinical effect of thrombolysis in patients with anterior-circulation stroke. Nat Commun 2021; 12:2590. [PMID: 33972513 PMCID: PMC8110812 DOI: 10.1038/s41467-021-22786-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/29/2021] [Indexed: 12/12/2022] Open
Abstract
Thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke aims to restore compromised blood flow and prevent further neuronal damage. Despite the proven clinical efficacy of this treatment, little is known about the short-term effects of systemic thrombolysis on structural brain connectivity. In this secondary analysis of the WAKE-UP trial, we used MRI-derived measures of infarct size and estimated structural network disruption to establish that thrombolysis is associated not only with less infarct growth, but also with reduced loss of large-scale connectivity between grey-matter areas after stroke. In a causal mediation analysis, infarct growth mediated a non-significant 8.3% (CI95% [-8.0, 32.6]%) of the clinical effect of thrombolysis on functional outcome. The proportion mediated jointly through infarct growth and change of structural connectivity, especially in the border zone around the infarct core, however, was as high as 33.4% (CI95% [8.8, 77.4]%). Preservation of structural connectivity is thus an important determinant of treatment success and favourable functional outcome in addition to lesion volume. It might, in the future, serve as an imaging endpoint in clinical trials or as a target for therapeutic interventions.
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Affiliation(s)
- Eckhard Schlemm
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Thies Ingwersen
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Königsberg
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florent Boutitie
- Hospices Civils de Lyon, Service de Biostatistique, Lyon, France
- Université Lyon 1, Villeurbanne, France
- CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique-Santé, Villeurbanne, France
| | - Martin Ebinger
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Matthias Endres
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- ExcellenceCluster NeuroCure, Berlin, Germany
| | - Jochen B Fiebach
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ivana Galinovic
- Centrum für Schlaganfallforschung Berlin (CSB), Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Robin Lemmens
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven, Belgium
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Leuven, Belgium
| | - Keith W Muir
- Institute of Neuroscience & Psychology, University of Glasgow, Glasgow, UK
| | - Norbert Nighoghossian
- Department of Stroke Medicine, Université Claude Bernard Lyon 1, CREATIS CNRS UMR 5220-INSERM U1206, INSA-Lyon; Hospices Civils de Lyon, Lyon, France
| | - Salvador Pedraza
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, Salt, Girona, Spain
| | - Josep Puig
- Department of Radiology, Institut de Diagnostic per la Image (IDI), Hospital Dr Josep Trueta, Institut d'Investigació Biomèdica de Girona (IDIBGI), Parc Hospitalari Martí i Julià de Salt - Edifici M2, Salt, Girona, Spain
| | - Claus Z Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Vincent Thijs
- Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
- Austin Health, Department of Neurology, Heidelberg, VIC, Australia
| | - Anke Wouters
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- KU Leuven - University of Leuven, Department of Neurosciences, Experimental Neurology, Leuven, Belgium
- VIB, Center for Brain & Disease Research, Laboratory of Neurobiology, Campus Gasthuisberg, Leuven, Belgium
| | - Christian Gerloff
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Götz Thomalla
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bastian Cheng
- Klinik und Poliklinik für Neurologie, Kopf- und Neurozentrum, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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29
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Gunning FM, Anguera JA, Victoria LW, Areán PA. A digital intervention targeting cognitive control network dysfunction in middle age and older adults with major depression. Transl Psychiatry 2021; 11:269. [PMID: 33947831 PMCID: PMC8096948 DOI: 10.1038/s41398-021-01386-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/08/2021] [Accepted: 04/20/2021] [Indexed: 02/03/2023] Open
Abstract
Nonpharmacological interventions targeting putative network mechanisms of major depressive disorder (MDD) may represent novel treatments. This mechanistic study investigates how a video game-like intervention, designed to improve cognitive control network (CCN) functioning by targeting multitasking, influences the CCN of middle-aged and older adults with MDD. The sample consisted of 34 adults aged 45-75 with SCID-defined diagnosis of MDD, Hamilton depression rating scale scores ≥20, and a deficit in cognitive control. Participants were instructed to play at home for 20-25 min per day, at least 5 times per week, for 4 weeks. Evidence of target engagement was defined a priori as >2/3 of participants showing CCN improvement. CCN engagement was defined as a change in a Z score of ≥0.5 on functional magnetic resonance imaging (fMRI) in activation and functional connectivity of the CCN during task-based and resting-state fMRI, respectively. 74% of participants showed a change in activation of the CCN, and 72% showed an increase in resting-state functional connectivity. Sixty-eight percent demonstrated improved cognitive control function, measured as either improvement on sustained attention or working memory performance or reduced self-reported symptoms of apathy on the frontal systems behavioral scale (FrsBe). Participants also reported a significant reduction in mood symptoms measured by PHQ-9. A remotely deployed neuroscience-informed video game-like intervention improves both CCN functions and mood in middle-aged and older adults with MDD. This easily-disseminated intervention may rescue CCN dysfunction present in a substantial subset of middle-aged and older adults with MDD.
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Affiliation(s)
- Faith M. Gunning
- grid.5386.8000000041936877XDepartment of Psychiatry, Weill Cornell Medicine, New York, NY USA
| | - Joaquin A. Anguera
- grid.266102.10000 0001 2297 6811Departments of Neurology and Psychiatry, University of California San Francisco, San Francisco, CA USA
| | - Lindsay W. Victoria
- grid.5386.8000000041936877XDepartment of Psychiatry, Weill Cornell Medicine, New York, NY USA
| | - Patricia A. Areán
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA USA
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30
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Abnormalities of cortical structures in patients with postpartum depression: A surface-based morphometry study. Behav Brain Res 2021; 410:113340. [PMID: 33945830 DOI: 10.1016/j.bbr.2021.113340] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Postpartum depression (PPD) is a serious postpartum mental health problem worldwide. However, the cortical structural alterations in patients with PPD remain unclear. This study investigated the cortical structural alterations of PPD patients through multidimensional structural patterns and their potential correlations with clinical severity. METHODS High-resolution 3D T1 structural images were acquired from 21 drug-naive patients with PPD and 18 healthy postpartum women matched for age, educational level, and body mass index. The severity of PPD was assessed by using the Hamilton Depression Scale (HAMD) and Edinburgh Postnatal Depression Scale (EPDS) scores. Cortical morphological parameters including cortical thickness, surface area, and mean curvature were calculated using the surface-based morphometric (SBM) method. General linear model (GLM) analyses were performed to evaluate the relationship of cortical morphological parameters with clinical scales. RESULTS In the present study, PPD patients showed a thinner cortical thickness in the right inferior parietal lobule compared with the healthy controls. Increased surface area was observed in the left superior frontal gyrus, caudal middle frontal gyrus, middle temporal gyrus, insula, and right supramarginal cortex in PPD patients. Likewise, PPD patients exhibited a higher mean curvature in the left superior and right inferior parietal lobule. Furthermore, increased cortical surface area in the left insula had a positive correlation with EPDS scores, and higher mean curvature in the left superior parietal lobule was negatively correlated with EPDS scores. LIMITATIONS First, SBM cannot reflect the changes of subcortical structures that are considered to play a role in the development of PPD. Second, the sample size of this study is small. These positive results should be interpreted with caution. Third, this cross-sectional study does not involve a comparison of structural MRI before and after pregnancy. CONCLUSIONS The complex cortical structural alterations of patients with PPD mainly involved the prefrontal and parietal regions. The morphometric alterations in these specific regions may provide promising markers for assessing the severity of PPD.
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31
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Dhamala E, Jamison KW, Jaywant A, Dennis S, Kuceyeski A. Distinct functional and structural connections predict crystallised and fluid cognition in healthy adults. Hum Brain Mapp 2021; 42:3102-3118. [PMID: 33830577 PMCID: PMC8193532 DOI: 10.1002/hbm.25420] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022] Open
Abstract
White matter pathways between neurons facilitate neuronal coactivation patterns in the brain. Insight into how these structural and functional connections underlie complex cognitive functions provides an important foundation with which to delineate disease‐related changes in cognitive functioning. Here, we integrate neuroimaging, connectomics, and machine learning approaches to explore how functional and structural brain connectivity relate to cognition. Specifically, we evaluate the extent to which functional and structural connectivity predict individual crystallised and fluid cognitive abilities in 415 unrelated healthy young adults (202 females) from the Human Connectome Project. We report three main findings. First, we demonstrate functional connectivity is more predictive of cognitive scores than structural connectivity, and, furthermore, integrating the two modalities does not increase explained variance. Second, we show the quality of cognitive prediction from connectome measures is influenced by the choice of grey matter parcellation, and, possibly, how that parcellation is derived. Third, we find that distinct functional and structural connections predict crystallised and fluid abilities. Taken together, our results suggest that functional and structural connectivity have unique relationships with crystallised and fluid cognition and, furthermore, studying both modalities provides a more comprehensive insight into the neural correlates of cognition.
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Affiliation(s)
- Elvisha Dhamala
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Keith W Jamison
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Sarah Dennis
- Sarah Lawrence College, Bronxville, New York, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
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32
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Kim YK, Han KM. Neural substrates for late-life depression: A selective review of structural neuroimaging studies. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110010. [PMID: 32544600 DOI: 10.1016/j.pnpbp.2020.110010] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 12/15/2022]
Abstract
Recent neuroimaging studies have characterized the pathophysiology of late-life depression (LLD) as a dysfunction of the brain networks involved in the regulation of emotion, motivational behavior, cognitive control, executive function, and self-referential thinking. In this article, we reviewed LLD-associated structural neuroimaging markers such as white matter hyperintensity (WMH), white matter integrity measured by diffusion tensor imaging, cortical and subcortical volumes, and cortical thickness, which may provide a structural basis for brain network dysfunction in LLD. LLD was associated with greater severity or volumes of deep, periventricular, or overall WMH and with decreased white matter integrity in the brain regions belonging to the fronto-striatal-limbic circuits and reduced white matter tract integrity which connects these circuits, such as the cingulum, corpus callosum, or uncinate fasciculus. Decreased volumes or cortical thickness in the prefrontal cortex, orbitofrontal cortex, anterior and posterior cingulate cortex, several temporal and parietal regions, hippocampus, amygdala, striatum, thalamus, and the insula were associated with LLD. These structural neuroimaging findings were also associated with cognitive dysfunction, which is a prominent clinical feature in LLD. Several structural neuroimaging markers including the WMH burden, white matter integrity, and cortical and subcortical volumes predicted antidepressant response in LLD. These structural neuroimaging findings support the hypothesis that disruption of the brain networks involved in emotion regulation and cognitive processing by impaired structural connectivity is strongly associated with the pathophysiology of LLD.
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Affiliation(s)
- Yong-Ku Kim
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Kyu-Man Han
- Department of Psychiatry, College of Medicine, Korea University, Seoul, Republic of Korea.
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33
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Liu J, Liu B, Wang M, Ju Y, Dong Q, Lu X, Sun J, Zhang L, Guo H, Zhao F, Li W, Zhang L, Li Z, Zhang Y, Liao M, Li L. Evidence for Progressive Cognitive Deficits in Patients With Major Depressive Disorder. Front Psychiatry 2021; 12:627695. [PMID: 33664684 PMCID: PMC7921310 DOI: 10.3389/fpsyt.2021.627695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/25/2021] [Indexed: 01/24/2023] Open
Abstract
Background: Cognitive deficits have shown progressive feature in major depressive disorder (MDD). However, it remains unknown which component of cognitive function is progressively impaired across episodes of MDD. Here we aim to identify the progressively impaired cognitive components in patients with MDD. Methods: A comprehensive neurocognitive test battery was used to assess the cognitive components (executive function, attention, processing speed, memory, working memory, inhibition, shifting, and verbal fluency) in 35 patients with first-episode MDD (FED), 60 patients with recurrent MDD (RD) and 111 matched healthy controls (HCs). After 6 months of treatment with antidepressant, 20 FED and 36 RD patients achieved clinical remission and completed their second-time neurocognitive tests. Statistical analyses were conducted to identify the impaired cognitive components in the FED and RD groups before and after treatment, and to assess the relationship between the cognitive components and the number of episodes and total illness duration in the MDD patient group. Results: At baseline, both the FED and RD groups showed impairments in all of the cognitive components; the FED and RD groups showed no significant difference in all of the components except for shifting. After remission, only shifting in the RD group showed no significant improvement and remained in an impaired status. Furthermore, shifting was the only component negatively correlated with the number of episodes as well as the total illness duration. Conclusions: Shifting may serve as the progressive cognitive deficit across episodes of MDD. Clinical Trials Registration: Registry name: HPA function and MRI study of trauma-related depression; Registration number: ChiCTR1800014591; URL: http://www.chictr.org.cn/edit.aspx?pid=24669&htm=4.
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Affiliation(s)
- Jin Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Bangshan Liu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Mi Wang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Yumeng Ju
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Qiangli Dong
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Xiaowen Lu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Jinrong Sun
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Liang Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Hua Guo
- Zhumadian Psychiatric Hospital, Zhumadian, China
| | - Futao Zhao
- Zhumadian Psychiatric Hospital, Zhumadian, China
| | - Weihui Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Li Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Zexuan Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Yan Zhang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Mei Liao
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
| | - Lingjiang Li
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Psychiatry and Mental Health, China National Clinical Research Center on Mental Disorders (Xiangya), China National Technology Institute on Mental Disorders, Hunan Technology Institute of Psychiatry, Mental Health Institute of Central South University, Changsha, China
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Pang L, Cui M, Dai W, Kong J, Chen H, Wu S. Can Intraoperative Low-Dose R, S-Ketamine Prevent Depressive Symptoms After Surgery? The First Meta-Analysis of Clinical Trials. Front Pharmacol 2020; 11:586104. [PMID: 33192527 PMCID: PMC7604489 DOI: 10.3389/fphar.2020.586104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/18/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Postoperative depression is a common complication after surgery that profoundly affects recovery and prognosis. New research indicates that (R,S)-ketamine is a potent antidepressant that exerts a rapid and sustained antidepressive effect. However, there is no consensus on whether intraoperative low-dose (R,S)-ketamine prevents postoperative depression. Objectives: This study aimed to investigate the safety, feasibility, and short-term complications of intraoperative low-dose (R,S)-ketamine in preventing postoperative depressive symptoms. Methods: The Web of Science, Cochrane, PubMed, and CNKI databases were systematically searched (last search February 28, 2020) to identify studies involving ketamine. Sensitivity and metaregression analyses were performed to identify potential confounders. The meta-analysis was performed using Review Manager 5.3. Results: A total of 13 studies (seven in Chinese and six in English) representing 1,148 cases of patients who were treated with (R,S)-ketamine and 874 cases of patients who received other treatments were included in the meta-analysis. Anesthesia duration and blood loss did not significantly differ between the two groups, demonstrating that (R,S)-ketamine was safe (odds ratio,OR: 0.27; 95% CI: -1.14 to 1.68; P = 0.71) for prophylactic treatment of postoperative depression. Blood loss (OR: -1.83; 95% CI: -8.34 to 4.68; P = 0.58), the number of postoperative depressive patients (95% CI: 0.8-1.07; P = 0.08; (R,S)-ketamine: control = 12.9%:15.8%), and postoperative complications (OR: 0.83, 95% CI: 0.44-1.58; P = 0.57; (R,S)-ketamine: control = 19.3%:19.3%) were all similar across groups. Intra-operative low-dose (R,S)-ketamine reduced extubation time (OR: -2.84; 95% CI: -5.48 to -0.21; P = 0.03). Conclusions: The prophylactic anti-depressant effect of (R,S)-ketamine did not significantly differ between the (R,S)-ketamine and control groups in patients undergoing general or spinal anesthesia. However, (R,S)-ketamine use led to a higher incidence of adverse reactions in patients under 40 years of age who underwent a Cesarean section under spinal anesthesia.
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Affiliation(s)
- Liwei Pang
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Meiying Cui
- Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Wanling Dai
- Innovation Institute of China Medical University, Shenyang, China
| | - Jing Kong
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hongzhi Chen
- Department of Anesthesiology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Shuodong Wu
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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35
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Wang Z, Hu JB, Ji GJ, Xu DR, Wang DD, Xi CX, Hu CC, Lu J, Du YL, Lu QQ, Huang TT, Lai JB, Chen JK, Zhou WH, Wei N, Xu Y, Wang K, Hu SH. Executive function and its relation to anatomical connectome in homosexual and heterosexual men. Quant Imaging Med Surg 2020; 10:1973-1983. [PMID: 33014729 DOI: 10.21037/qims-19-821b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Sexual orientation has been suggested to affect executive function, of which the neurobiological basis is still largely unknown. In this study, we explored the interrelationship between neuropsychological characteristics in homosexual and heterosexual men and their anatomical connectome by graph theoretical analysis. Methods Fifty-three homosexual and 47 heterosexual males underwent diffusion tensor magnetic resonance imaging (MRI) and neuropsychological assessments. Whole-brain anatomical networks were constructed using white matter tractography, performed on the diffusion tensor imaging data. Neuropsychological tests included the Wisconsin Card Sorting Test (WCST), the Continuous Performance Test (CPT) and the Trail-Making Test (TMT). Results The cognitive performance of homosexual men was significantly poorer than their heterosexual counterparts in terms of WCST total correct responses. Anatomical connectome analysis revealed a lower (P=0.001) anatomical connectivity between left PoCG and left SMG (P=0.003) in homosexual men as compared to heterosexual men. Linear regression analyses showed that the WCST total correct responses score was significantly linked with sexual orientation (P=0.001). The anatomical connectivity strength between left PoCG and left SMG was also shown to be significantly correlated with sexual orientation (P=0.039) and education (P=0.047). Conclusions Our study demonstrated the differences in the performance of WCST and anatomical connectome of large-scale brain networks between homosexual and heterosexual men, extending our understanding of the brain's circuitry and the characteristics of executive function in men of different sexual orientation.
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Affiliation(s)
- Zheng Wang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Jian Bo Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Gong Jun Ji
- Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China
| | - Dong Rong Xu
- Epidemiology Division & MRI Unit, Department of Psychiatry, Columbia University & New York State Psychiatric Institute, New York, NY, USA
| | - Dan Dan Wang
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Cai Xi Xi
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Chan Chan Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Jing Lu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Yan Li Du
- Zhejiang University School of Medicine, Hangzhou, China
| | - Qiao Qiao Lu
- Zhejiang University School of Medicine, Hangzhou, China
| | | | - Jian Bo Lai
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Jing Kai Chen
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Wei Hua Zhou
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Ning Wei
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Yi Xu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
| | - Kai Wang
- Laboratory of Cognitive Neuropsychology, Department of Medical Psychology, Anhui Medical University, Hefei, China
| | - Shao Hua Hu
- Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,The Key Laboratory of Mental Disorder's Management of Zhejiang Province, Hangzhou, China
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Solomonov N, Victoria LW, Dunlop K, Respino M, Hoptman MJ, Zilcha-Mano S, Oberlin L, Liston C, Areán PA, Gunning FM, Alexopoulos GS. Resting State Functional Connectivity and Outcomes of Psychotherapies for Late-Life Depression. Am J Geriatr Psychiatry 2020; 28:859-868. [PMID: 32376080 PMCID: PMC7369214 DOI: 10.1016/j.jagp.2020.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Problem solving therapy (PST) and "Engage," a reward-exposure" based therapy, are important treatment options for late-life depression, given modest efficacy of antidepressants in this disorder. Abnormal function of the reward and default mode networks has been observed during depressive episodes. This study examined whether resting state functional connectivity (rsFC) of reward and DMN circuitries is associated with treatment outcomes. METHODS Thirty-two older adults with major depression (mean age = 72.7) were randomized to 9-weeks of either PST or "Engage." We assessed rsFC at baseline and week 6. We placed seeds in three a priori regions of interest: subgenual anterior cingulate cortex (sgACC), dorsal anterior cingulate cortex (dACC), and nucleus accumbens (NAcc). Outcome measures included the Hamilton Depression Rating Scale (HAMD) and the Behavioral Activation for Depression Scale (BADS). RESULTS In both PST and "Engage," higher rsFC between the sgACC and middle temporal gyrus at baseline was associated with greater improvement in depression severity (HAMD). Preliminary findings suggested that in "Engage" treated participants, lower rsFC between the dACC and dorsomedial prefrontal cortex at baseline was associated with HAMD improvement. Finally, in Engage only, increased rsFC from baseline to week 6 between NAcc and Superior Parietal Cortex was associated with increased BADS scores. CONCLUSION The results suggest that patients who present with higher rsFC between the sgACC and a structure within the DMN may benefit from behavioral psychotherapies for late life depression. "Engage" may lead to increased rsFC within the reward system reflecting a reconditioning of the reward systems by reward exposure.
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Affiliation(s)
- Nili Solomonov
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (NS, LWV, LO, FMG, and GSA), White Plains, NY.
| | - Lindsay W Victoria
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (NS, LWV, LO, FMG, and GSA), White Plains, NY
| | - Katharine Dunlop
- Feil Family Brain Mind Research Institute, Weill Cornell Medicine (KD and CL), New York, NY
| | | | - Matthew J Hoptman
- The Nathan S. Kline Institute for Psychiatric Research (MJH), Orangeburg, NY; New York University School of Medicine (MJH), New York, NY
| | - Sigal Zilcha-Mano
- Columbia University (SZM), New York, NY; Haifa University (SZM), Haifa, Israel
| | - Lauren Oberlin
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (NS, LWV, LO, FMG, and GSA), White Plains, NY
| | - Conor Liston
- Feil Family Brain Mind Research Institute, Weill Cornell Medicine (KD and CL), New York, NY
| | - Patricia A Areán
- Department of Psychiatry and Behavioral Sciences (PAA), University of Washington School of Medicine, Seattle, WA
| | - Faith M Gunning
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (NS, LWV, LO, FMG, and GSA), White Plains, NY
| | - George S Alexopoulos
- Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine (NS, LWV, LO, FMG, and GSA), White Plains, NY
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Brain function differences in drug-naïve first-episode auditory verbal hallucination-schizophrenia patients with versus without insight. Chin Med J (Engl) 2019; 132:2199-2205. [PMID: 31478928 PMCID: PMC6797149 DOI: 10.1097/cm9.0000000000000419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background: Few studies have reported brain function differences in drug-naïve first-episode schizophrenia patients who had auditory verbal hallucinations (AVH) with insight vs. those without insight. This study aimed to investigate brain function differences between drug-naïve first-episode AVH-schizophrenia patients with and without insight. Methods: Forty first-episode drug-naïve AVH-schizophrenia patients with or without insight and 40 healthy controls between December 2016 and December 2018 were recruited in this study. The auditory hallucinations rating scale (AHRS) was used to assess AVH severity, while the insight and treatment attitudes questionnaire was used to distinguish insight. The global functional connectivity density (gFCD) between different groups was compared using a voxel-wise one-way analysis of covariance. The relationship between gFCD and AHRS total scores were analyzed using voxel-wise multiple regression. Results: Finally, 13 first-episode drug-naïve AVH-schizophrenia patients with insight, 15 AVH-schizophrenia patients without insight, and 20 healthy controls were included for analysis. Except for global assessment of functioning scores, there were no significant differences in sociodemographic information between the AVH-schizophrenia and healthy groups (P > 0.05). Compared to the healthy controls, AVH-schizophrenia patients with insight demonstrated a decreased gFCD in the supra-marginal gyrus within the primary auditory cortex, while those without insight demonstrated an increased gFCD in the inferior frontal gyrus and superior temporal gyrus and decreased gFCD in the supplemental motor area. Compared to the AVH-schizophrenia patients with insight, those without insight demonstrated an increased gFCD in the supra-marginal gyrus and posterior superior temporal lobule and a decreased gFCD in the frontal lobe. No significant correlation between gFCD and AVH severity (AHRS total score: r = 0.23, P = 0.590; and frequency: r = 0.42, P = 0.820) was found in both AVH-schizophrenia groups. Conclusions: The gFCD-aberrant brain regions in the AVH-schizophrenia patients without insight were wider compared to those with insight, although the AHRS scores were not significantly different. The AVH-schizophrenia patients without insight had wide functional impairment in the frontal lobule, which may underlie the lack of insight and the abnormal hyperactivity in the inferior frontal gurus and temporal lobe related to the AVH symptoms.
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