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He G, Huang X, Sun H, Xing Y, Gu S, Ren J, Liu W, Lu M. Gray matter volume alterations in de novo Parkinson's disease: A mediational role in the interplay between sleep quality and anxiety. CNS Neurosci Ther 2024; 30:e14867. [PMID: 39031989 PMCID: PMC11259571 DOI: 10.1111/cns.14867] [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: 05/05/2024] [Revised: 06/24/2024] [Accepted: 07/07/2024] [Indexed: 07/22/2024] Open
Abstract
OBJECTIVE Parkinson's disease (PD) is increasingly recognized for its non-motor symptoms, among which emotional disturbances and sleep disorders frequently co-occur. The commonality of neuroanatomical underpinnings for these symptoms is not fully understood. This study is intended to investigate the differences in gray matter volume (GMV) between PD patients with anxiety (A-PD) and those without anxiety (NA-PD). Additionally, it seeks to uncover the interplay between GMV variations and the manifestations of anxiety and sleep quality. METHODS A total of 37 A-PD patients, 43 NA-PD patients, and 36 healthy controls (HCs) were recruited, all of whom underwent voxel-based morphometry (VBM) analysis. Group differences in GMV were assessed using analysis of covariance (ANCOVA). Partial correlation between GMV, anxiety symptom, and sleep quality were analyzed. Mediation analysis explored the mediating role of the volume of GMV-distinct brain regions on the relationship between sleep quality and anxiety within the PD patient cohort. RESULTS A-PD patients showed significantly lower GMV in the fusiform gyrus (FG) and right inferior temporal gyrus (ITG) compared to HCs and NA-PD patients. GMV in these regions correlated negatively with Hamilton Anxiety Rating Scale (HAMA) scores (right ITG: r = -0.690, p < 0.001; left FG: r = -0.509, p < 0.001; right FG: r = -0.576, p < 0.001) and positively with sleep quality in PD patients (right ITG: r = 0.592, p < 0.001; left FG: r = 0.356, p = 0.001; right FG: r = 0.470, p < 0.001). Mediation analysis revealed that GMV in the FG and right ITG mediated the relationship between sleep quality and anxiety symptoms, with substantial effect sizes accounted for by the right ITG (25.74%) and FG (left: 11.90%, right: 15.59%). CONCLUSION This study has shed further light on the relationship between sleep disturbances and anxiety symptoms in PD patients. Given the pivotal roles of the FG and the ITG in facial recognition and the recognition of emotion-related facial expressions, our findings indicate that compromised sleep quality, under the pathological conditions of PD, may exacerbate the reduction in GMV within these regions, impairing the recognition of emotional facial expressions and thereby intensifying anxiety symptoms.
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Affiliation(s)
- Guixiang He
- Department of NeurologyAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
- The Yancheng School of Clinical Medicine of Nanjing Medical UniversityYancheng Third People's HospitalYanchengChina
- Jiangsu Key Laboratory of Neurodegeneration, Department of PharmacologyNanjing Medical UniversityNanjingChina
| | - Xiaofang Huang
- Department of NeurologyAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
| | - Haihua Sun
- The Yancheng School of Clinical Medicine of Nanjing Medical UniversityYancheng Third People's HospitalYanchengChina
| | - Yi Xing
- Department of NeurologyAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
| | - Siyu Gu
- The Yancheng School of Clinical Medicine of Nanjing Medical UniversityYancheng Third People's HospitalYanchengChina
| | - Jingru Ren
- Department of NeurologyAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
| | - Weiguo Liu
- Department of NeurologyAffiliated Nanjing Brain Hospital, Nanjing Medical UniversityNanjingChina
| | - Ming Lu
- Jiangsu Key Laboratory of Neurodegeneration, Department of PharmacologyNanjing Medical UniversityNanjingChina
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Edmiston EK, Chase HW, Jones N, Nhan TJ, Phillips ML, Fournier JC. Differential role of fusiform gyrus coupling in depressive and anxiety symptoms during emotion perception. Soc Cogn Affect Neurosci 2024; 19:nsae009. [PMID: 38334745 PMCID: PMC10908550 DOI: 10.1093/scan/nsae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 12/06/2023] [Accepted: 02/01/2024] [Indexed: 02/10/2024] Open
Abstract
Anxiety and depression co-occur; the neural substrates of shared and unique components of these symptoms are not understood. Given emotional alterations in internalizing disorders, we hypothesized that function of regions associated with emotion processing/regulation, including the anterior cingulate cortex (ACC), amygdala and fusiform gyrus (FG), would differentiate these symptoms. Forty-three adults with depression completed an emotional functional magnetic resonance imaging task and the Hamilton Depression and Anxiety Scales. We transformed these scales to examine two orthogonal components, one representing internalizing symptom severity and the other the type of internalizing symptoms (anxiety vs depression). We extracted blood oxygen level dependent signal from FG subregions, ACC, and amygdala and performed generalized psychophysiological interaction analyses to assess relationships between symptoms and brain function. Type of internalizing symptoms was associated with FG3-FG1 coupling (F = 8.14, P = 0.007). More coupling was associated with a higher concentration of depression, demonstrating that intra-fusiform coupling is differentially associated with internalizing symptom type (anxiety vs depression). We found an interaction between task condition and internalizing symptoms and dorsal (F = 4.51, P = 0.014) and rostral ACC activity (F = 4.27, P = 0.012). Post hoc comparisons revealed that less activity was associated with greater symptom severity during emotional regulation. Functional coupling differences during emotional processing are associated with depressive relative to anxiety symptoms and internalizing symptom severity. These findings could inform future treatments for depression.
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Affiliation(s)
- Elliot Kale Edmiston
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
| | - Henry W Chase
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Neil Jones
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Tiffany J Nhan
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA 01605, United States
| | - Mary L Phillips
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, United States
| | - Jay C Fournier
- Department of Psychiatry and Behavioral Health, The Ohio State University College of Medicine, Columbus, OH 43210, United States
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Zugman A, Jett L, Antonacci C, Winkler AM, Pine DS. A systematic review and meta-analysis of resting-state fMRI in anxiety disorders: Need for data sharing to move the field forward. J Anxiety Disord 2023; 99:102773. [PMID: 37741177 PMCID: PMC10753861 DOI: 10.1016/j.janxdis.2023.102773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/25/2023]
Abstract
Anxiety disorders are among the most prevalent psychiatric disorders. Neuroimaging findings remain uncertain, and resting state functional magnetic resonance (rs-fMRI) connectivity is of particular interest since it is a scalable functional imaging modality. Given heterogeneous past findings for rs-fMRI in anxious individuals, we characterize patterns across anxiety disorders by conducting a systematic review and meta-analysis. Studies were included if they contained at the time of scanning both a healthy group and a patient group. Due to insufficient study numbers, the quantitative meta-analysis only included seed-based studies. We performed an activation likelihood estimation (ALE) analysis that compared patients and healthy volunteers. All analyses were corrected for family-wise error with a cluster-level threshold of p < .05. Patients exhibited hypo-connectivity between the amygdala and the medial frontal gyrus, anterior cingulate cortex, and cingulate gyrus. This finding, however, was not robust to potential file-drawer effects. Though limited by strict inclusion criteria, our results highlight the heterogeneous nature of reported findings. This underscores the need for data sharing when attempting to detect reliable patterns of disruption in brain activity across anxiety disorders.
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Affiliation(s)
- André Zugman
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States.
| | - Laura Jett
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States; Child Emotion Lab, University of Wisconsin, Madison, Madison, WI, United States.
| | - Chase Antonacci
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States; Department of Psychology, Stanford University, Stanford, CA, United States.
| | - Anderson M Winkler
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States; Division of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Brownsville, Texas, United States.
| | - Daniel S Pine
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, United States.
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Meng L, Zhang Y, Lin H, Mu J, Liao H, Wang R, Jiao S, Ma Z, Miao Z, Jiang W, Wang X. Abnormal hubs in global network as potential neuroimaging marker in generalized anxiety disorder at rest. Front Psychol 2022; 13:1075636. [PMID: 36591087 PMCID: PMC9801974 DOI: 10.3389/fpsyg.2022.1075636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Background Mounting studies have reported altered neuroimaging features in generalized anxiety disorder (GAD). However, little is known about changes in degree centrality (DC) as an effective diagnostic method for GAD. Therefore, we aimed to explore the abnormality of DCs and whether these features can be used in the diagnosis of GAD. Methods Forty-one GAD patients and 45 healthy controls participated in the study. Imaging data were analyzed using DC and receiver operating characteristic (ROC) methods. Results Compared with the control group, increased DC values in bilateral cerebellum and left middle temporal gyrus (MTG), and decreased DC values in the left medial frontal orbital gyrus (MFOG), fusiform gyrus (FG), and bilateral posterior cingulate cortex (PCC). The ROC results showed that the DC value of the left MTG could serve as a potential neuroimaging marker with high sensitivity and specificity for distinguishing patients from healthy controls. Conclusion Our findings demonstrate that abnormal DCs in the left MTG can be observed in GAD, highlighting the importance of GAD pathophysiology.
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Affiliation(s)
- Lili Meng
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China,Department of Sleep, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Yuandong Zhang
- Clinical College, Wuhan University of Science and Technology, Wuhan, China
| | - Hang Lin
- Clinical College, Wuhan University of Science and Technology, Wuhan, China
| | - Jingping Mu
- Department of Mental Health, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Heng Liao
- Department of Mental Health, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Runlan Wang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China,Department of Sleep, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Shufen Jiao
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China,Department of Sleep, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Zilong Ma
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China,Department of Sleep, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Zhuangzhuang Miao
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Jiang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Wei Jiang,
| | - Xi Wang
- Department of Mental Health, Taihe Hospital, Hubei University of Medicine, Shiyan, China,Xi Wang,
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Ji S, Zhang Y, Chen N, Liu X, Li Y, Shao X, Yang Z, Yao Z, Hu B. Shared increased entropy of brain signals across patients with different mental illnesses: A coordinate-based activation likelihood estimation meta-analysis. Brain Imaging Behav 2022; 16:336-343. [PMID: 34997426 DOI: 10.1007/s11682-021-00507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 11/25/2022]
Abstract
Entropy is a measurement of brain signal complexity. Studies have found increased/decreased entropy of brain signals in psychiatric patients. There is no consistent conclusion regarding the relationship between the entropy of brain signals and mental illness. Therefore, this meta-analysis aimed to identify consistent abnormalities in the brain signal entropy in patients with different mental illnesses. We conducted a systematic search to collect resting-state functional magnetic resonance imaging (rs-fMRI) studies in patients with psychiatric disorders. This work identified 9 eligible rs-fMRI studies, which included a total of 14 experiments, 67 activation foci, and 1383 subjects. We tested the convergence across their findings by using the activation likelihood estimation method. P-value maps were corrected by using cluster-level family-wise error p < 0.05 and permuting 2000 times. Results showed that patients with different psychiatric disorders shared commonly increased entropy of brain signals in the left inferior and middle frontal gyri, and the right fusiform gyrus, cuneus, precuneus. No shared alterations were found in the subcortical regions and cerebellum in the patient group. Our findings suggested that the increased entropy of brain signals in the cortex, not subcortical regions and cerebellum, might have associations with the pathophysiology across mental illnesses. This meta-analysis study provided the first comprehensive understanding of the abnormality in brain signal complexity across patients with different psychiatric disorders.
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Affiliation(s)
- Shanling Ji
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Gansu Province, 730000, Lanzhou, China
| | - Yinghui Zhang
- Mental Health Center Hospital of Guangyuan, Guangyuan, China
| | - Nan Chen
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Gansu Province, 730000, Lanzhou, China
| | - Xia Liu
- School of Computer Science, Qinghai Normal University, Xining, China
| | - Yongchao Li
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Gansu Province, 730000, Lanzhou, China
| | - Xuexiao Shao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Gansu Province, 730000, Lanzhou, China
| | - Zhengwu Yang
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Gansu Province, 730000, Lanzhou, China
| | - Zhijun Yao
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Gansu Province, 730000, Lanzhou, China.
| | - Bin Hu
- Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, Gansu Province, 730000, Lanzhou, China.
- CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.
- Joint Research Center for Cognitive Neurosensor Technology of Lanzhou University & Institute of Semiconductors, Chinese Academy of Sciences, Lanzhou, China.
- Engineering Research Center of Open Source Software and Real-Time System, (Lanzhou University), Ministry of Education, Lanzhou, Gansu Province, 730000, China.
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de Lacy N, Kutz JN, Calhoun VD. Sex-related differences in brain dynamism at rest as neural correlates of positive and negative valence system constructs. Cogn Neurosci 2021; 12:131-154. [PMID: 32715898 PMCID: PMC7881523 DOI: 10.1080/17588928.2020.1793752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/22/2020] [Indexed: 10/23/2022]
Abstract
Clinical anxiety and depression are the most prevalent mental illnesses, likely representing maladaptive expressions of negative valence systems concerned with conditioned responses to fear, threat, loss, and frustrative nonreward. These conditions exhibit similar, striking sex/gender-related differences in onset, incidence, and severity for which the neural correlates are not yet established. In alarge sample of neurotypical young adults, we demonstrate that intrinsic brain dynamism metrics derived from sex-sensitive models of whole-brain network function are significantly associated with valence system traits. Surprisingly, we found that greater brain dynamism is strongly positively correlated to anxiety and depression traits in males, but almost wholly decoupled from traits for important cognitive control and reappraisal strategies associated with positive valence. Conversely, intrinsic brain dynamism is strongly positively coupled to drive, novelty-seeking and self-control in females with only rare or non-significant directional negative correlation with anxiety and depression traits. Our results suggest that the dynamic neural correlates of traits for valence, anxiety and depression are significantly different in males/men and females/women. These findings may relate to the known sex/gender-related differences in cognitive reappraisal of emotional experiences and clinical presentations of anxiety and depression, with potential relevance to gold standard therapies based on enhancing cognitive control strategies.
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Affiliation(s)
- Nina de Lacy
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific St, Seattle, WA 98195
| | - J. Nathan Kutz
- Department of Applied Mathematics, University of Washington, Lewis Hall 201, Seattle WA 98195
| | - Vince D. Calhoun
- Tri-institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia State University, Georgia Institute of Technology, Emory University, Atlanta, GA, 30303, USA
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Ghaddar B, Veeren B, Rondeau P, Bringart M, Lefebvre d'Hellencourt C, Meilhac O, Bascands JL, Diotel N. Impaired brain homeostasis and neurogenesis in diet-induced overweight zebrafish: a preventive role from A. borbonica extract. Sci Rep 2020; 10:14496. [PMID: 32879342 PMCID: PMC7468118 DOI: 10.1038/s41598-020-71402-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
Overweight and obesity are worldwide health concerns leading to many physiological disorders. Recent data highlighted their deleterious effects on brain homeostasis and plasticity, but the mechanisms underlying such disruptions are still not well understood. In this study, we developed and characterized a fast and reliable diet-induced overweight (DIO) model in zebrafish, for (1) studying the effects of overfeeding on brain homeostasis and for (2) testing different preventive and/or therapeutic strategies. By overfeeding zebrafish for 4 weeks, we report the disruption of many metabolic parameters reproducing human overweight features including increased body weight, body mass index, fasting blood glucose levels and liver steatosis. Furthermore, DIO fish displayed blood–brain barrier leakage, cerebral oxidative stress, neuroinflammation and decreased neurogenesis. Finally, we investigated the preventive beneficial effects of A. borbonica, an endogenous plant from Reunion Island. Overnight treatment with A. borbonica aqueous extract during the 4 weeks of overfeeding limited some detrimental central effects of DIO. In conclusion, we established a relevant DIO model in zebrafish demonstrating that overfeeding impairs peripheral and central homeostasis. This work also highlights the preventive protective effects of A. borbonica aqueous extracts in DIO, and opens a way to easily screen drugs aiming at limiting overweight and associated neurological disorders.
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Affiliation(s)
- Batoul Ghaddar
- INSERM, UMR 1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France
| | - Bryan Veeren
- INSERM, UMR 1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France
| | - Philippe Rondeau
- INSERM, UMR 1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France
| | - Matthieu Bringart
- INSERM, UMR 1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France
| | - Christian Lefebvre d'Hellencourt
- INSERM, UMR 1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France
| | - Olivier Meilhac
- INSERM, UMR 1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France.,CHU de La Réunion, Saint-Denis, France
| | - Jean-Loup Bascands
- INSERM, UMR 1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France
| | - Nicolas Diotel
- INSERM, UMR 1188, Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion, Saint-Denis de La Réunion, France.
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Progressive brain structural alterations assessed via causal analysis in patients with generalized anxiety disorder. Neuropsychopharmacology 2020; 45:1689-1697. [PMID: 32396920 PMCID: PMC7419314 DOI: 10.1038/s41386-020-0704-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 12/17/2022]
Abstract
Accumulating neuroimaging studies implicate widespread brain structural alterations in patients with generalized anxiety disorder (GAD), but little is known regarding the temporal information of these changes and their causal relationships. In this study, a morphometric analysis was performed on T1-weighted structural images, and the progressive changes in the gray matter volume (GMV) in GAD were simulated by dividing the patients into different groups from low illness duration to high illness duration. The duration was defined as the interval between the onset of GAD and the time for magnetic resonance imaging collection. Then, a causal structural covariance network analysis was conducted to describe the causal relationships of the brain structural alterations in GAD. With increased illness duration, the GMV reduction in GAD originated from the subgenual anterior cingulate cortex (sgACC) and propagated to the bilateral ventromedial prefrontal cortex, right dorsomedial prefrontal cortex, left inferior temporal gyrus, and right insula. Intriguingly, the sgACC and the right insula had positive causal effects on each other. Moreover, both sgACC and right insula exhibited positive causal effects on the parietal cortex and negative effects on the posterior cingulate cortex, dorsolateral prefrontal cortex, visual cortex, and temporal lobe. The opposite causal effects were noted on the somatosensory and the ventrolateral prefrontal cortices. In conclusion, patients with GAD show gradual GMV reduction with increasing ilness duration. Furthermore, the causal effects of the sgACC and the right insula GMV reduction with shifts of duration may provide an important new avenue for understanding the pathological anomalies in GAD.
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