1
|
Peterson BS, Li J, Trujillo M, Sawardekar S, Balyozian D, Bansal S, Sun BF, Marcelino C, Nanda A, Xu T, Amen D, Bansal R. A multi-site 99mTc-HMPAO SPECT study of cerebral blood flow in a community sample of patients with major depression. Transl Psychiatry 2024; 14:234. [PMID: 38830866 PMCID: PMC11148018 DOI: 10.1038/s41398-024-02961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 05/09/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024] Open
Abstract
Prior regional Cerebral Blood Flow (rCBF) studies in Major Depressive Disorder (MDD) have been limited by small, highly selective, non-representative samples that have yielded variable and poorly replicated findings. The aim of this study was to compare rCBF measures in a large, more representative community sample of adults with MDD and healthy control participants. This is a cross-sectional, retrospective multi-site cohort study in which clinical data from 338 patients 18-65 years of age with a primary diagnosis of MDD were retrieved from a central database for 8 privately owned, private-pay outpatient psychiatric centers across the United States. Two 99mTc-HMPAO SPECT brain scans, one at rest and one during performance of a continuous performance task, were acquired as a routine component of their initial clinical evaluation. In total, 103 healthy controls, 18-65 years old and recruited from the community were also assessed and scanned. Depressed patients had significantly higher rCBF in frontal, anterior cingulate, and association cortices, and in basal ganglia, thalamus, and cerebellum, after accounting for significantly higher overall CBF. Depression severity associated positively with rCBF in the basal ganglia, hippocampus, cerebellum, and posterior white matter. Elevated rCBF was especially prominent in women and older patients. Elevated rCBF likely represents pathogenic hypermetabolism in MDD, with its magnitude in direct proportion to depression severity. It is brain-wide, with disproportionate increases in cortical and subcortical attentional networks. Hypermetabolism may be a reasonable target for novel therapeutics in MDD.
Collapse
Affiliation(s)
- Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA.
| | - Jennifer Li
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Manuel Trujillo
- Department of Psychiatry at NYU Grossman School of Medicine, New York, NY, USA
- Amen Clinics Inc., Costa Mesa, CA, USA
| | - Siddhant Sawardekar
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - David Balyozian
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Siddharth Bansal
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Bernice F Sun
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Courtney Marcelino
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Anoop Nanda
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Tracy Xu
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Ravi Bansal
- Institute for the Developing Mind, Children's Hospital Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
2
|
Howells D, Rees J, Townsend R, Kirov G. Electroconvulsive Therapy Reverses Cerebral Hypoperfusion in a Patient With Psychotic Depression and Catatonia. J ECT 2022; 38:141-143. [PMID: 35220357 DOI: 10.1097/yct.0000000000000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT A 72-year-old man suffering with severe depression with psychotic symptoms, marked apathy, and psychomotor retardation was treated with electroconvulsive therapy (ECT) after resistance to treatment with psychotropic medications. His age, comorbidities, and dysexecutive syndrome prompted consideration of a diagnosis of frontotemporal dementia (FTD), and a 99mTechnetium-labeled hexamethyl propylene amine oxime single-photon emission computed tomography (SPECT) brain perfusion scan showed bilateral perfusion defects that were most pronounced in the frontal regions of the brain. The scan was judged to be abnormal and in keeping with a neurodegenerative dementia. We reasoned that the fluctuation in symptoms was inconsistent with a diagnosis of FTD and that his severe depression could be improved with ECT even if he had FTD, so we decided to proceed with this treatment. A course of 12 sessions of ECT resulted in remission of his psychiatric symptoms and improvement in cognitive performance. A repeat SPECT scan 5 weeks after the last ECT demonstrated a substantial improvement in cerebral blood flow, favoring the diagnosis of depression, rather than dementia. Similar case reports from the literature suggest that ECT does reverse brain hypoperfusion in severe cases of depression and catatonia. Clinicians should be aware that abnormal SPECT findings are nonspecific and can be caused by various conditions, including psychiatric illness, and are not necessarily diagnostic of a neurodegenerative disease.
Collapse
Affiliation(s)
- David Howells
- From the Department of Psychiatry, University Hospital Llandough, Penarth
| | - John Rees
- Department of Radiology, University Hospital of Wales, Heath Park
| | - Rebecca Townsend
- From the Department of Psychiatry, University Hospital Llandough, Penarth
| | - George Kirov
- Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, Cardiff, UK
| |
Collapse
|
3
|
Best SRD, Haustrup N, Pavel DG. Brain SPECT as an Imaging Biomarker for Evaluating Effects of Novel Treatments in Psychiatry-A Case Series. Front Psychiatry 2022; 12:713141. [PMID: 35095582 PMCID: PMC8793864 DOI: 10.3389/fpsyt.2021.713141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 12/13/2021] [Indexed: 01/23/2023] Open
Abstract
The difficulties of evaluating patients with complex neuropsychiatric conditions and prescribing appropriate treatments are well known. Imaging complements clinical assessments and allows a clinician to narrow the differential diagnosis by facilitating accurate and efficient evaluation. This is particularly relevant to neuropsychiatric conditions that are often diagnosed using a trial-and error process of exclusion. Single Photon Emission Computed Tomography (SPECT) is a functional brain imaging procedure that allows practitioners to measure the functional changes of gray matter structures based on regional cerebral blood flow (rCBF). The accurate diagnosis and treatment selection in psychiatry is challenging due to complex cases and frequent comorbidities. However, such complex neuropsychiatric conditions are increasingly benefitting from new treatment approaches, in addition to established medications. Among these are combination transcranial magnetic stimulation with ketamine infusions (CTK), hyperbaric oxygen therapy (HBOT) and perispinal administration of etanercept (PSE). This article provides readers with six case study examples that demonstrate how brain SPECT imaging can be used, both as a diagnostic tool, and as a potential biomarker for monitoring and evaluating novel treatments for patients with complex neuropsychiatric conditions. Six patients were assessed in our clinic and baseline brain SPECT imagesTourettes and a long history of alcohol were visually compared with SPECT images collected after periods of treatment with CTK or HBOT followed by PSE. This retrospective review demonstrates the clinical utility of these novel treatments and describes how SPECT imaging can complement standard diagnostic assessments. A novel display technique for SPECT images is described and we argue that SPECT imaging can be used for monitoring biomarker for clinical change.
Collapse
Affiliation(s)
| | | | - Dan G. Pavel
- PathFinder Brain SPECT, Deerfield, IL, United States
| |
Collapse
|
4
|
Tastevin M, Boyer L, Korchia T, Fond G, Lançon C, Richieri R, Guedj E. Brain SPECT perfusion and PET metabolism as discordant biomarkers in major depressive disorder. EJNMMI Res 2020; 10:121. [PMID: 33030615 PMCID: PMC7544792 DOI: 10.1186/s13550-020-00713-2] [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: 05/07/2020] [Accepted: 09/24/2020] [Indexed: 01/09/2023] Open
Abstract
Background Brain SPECT perfusion and PET metabolism have been, most often interchangeably, proposed to study the underlying pathological process in major depressive disorder (MDD). The objective of this study was to specify similarities and inconsistencies between these two biomarkers according to global characteristics of the disease. We conducted a retrospective study in 16 patients suffering from treatment-resistant MDD who underwent, during the same current episode, a cerebral perfusion SPECT with 99mTc-HMPAO and a metabolic PET with 18F-FDG. Whole-brain voxel-based SPM(T) maps were generated in correlation with the number of depressive episodes and in correlation with the depression duration, separately for the two exams (p-voxel < 0.001 uncorrected, k > 20). Results No significant correlations were found between brain metabolism and either the number of depressive episodes or the duration of the disease, even at an uncorrected p-voxel < 0.005. On the other hand, the increased number of depressive episodes was correlated with decreased perfusion of the right middle frontal cortex, the right anterior cingulum cortex, the right insula, the right medial temporal cortex and the left precuneus. The increased depression duration was correlated with decreased perfusion of the right anterior cingulum cortex. Conclusions This preliminary study demonstrates more significant results with brain perfusion compared with glucose metabolism in treatment-resistant MDD, highlighting the value of brain SPECT despite less favourable instrumentation detection compared to PET.
Collapse
Affiliation(s)
- Maud Tastevin
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France
| | - Laurent Boyer
- CEReSS-Health Service Research and Quality of Life Centre, Aix Marseille University, Marseille, France.,Department of Medical Information and Public Health, APHM, Marseille, France.,Department of Epidemiology and Health Economics, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Theo Korchia
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France
| | - Guillaume Fond
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France.,CEReSS-Health Service Research and Quality of Life Centre, Aix Marseille University, Marseille, France.,Department of Medical Information and Public Health, APHM, Marseille, France
| | - Christophe Lançon
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France.,CEReSS-Health Service Research and Quality of Life Centre, Aix Marseille University, Marseille, France
| | - Raphaëlle Richieri
- Department of Psychiatry, Sainte Marguerite University Hospital, Assistance Publique- Hôpitaux de Marseille, Marseille, France.,CNRS, Centrale Marseille, Institut Fresnel, Aix Marseille University, Marseille, France
| | - Eric Guedj
- Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Aix Marseille University, Marseille, France.
| |
Collapse
|
5
|
Functional neuroimaging in patients presenting with somatoform disorders: A model for investigating persisting symptoms after tick bites and post-treatment Lyme disease syndrome? Med Mal Infect 2019; 49:150-156. [PMID: 30736992 DOI: 10.1016/j.medmal.2019.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/08/2019] [Indexed: 12/13/2022]
Abstract
Approximately 10% of patients presenting with Lyme disease experience fatigue, musculoskeletal pain, concentration disorders, or short-term memory deficits in the six months following treatment. This entity has been defined as post-Lyme disease syndrome or post-treatment Lyme disease syndrome. The pathophysiology of this syndrome is unknown, but neither persistence of the bacterium nor effectiveness of antibiotics are currently reported in the literature. The French High Council for Public Health (French acronym HCSP) has recently defined a new entity called "persistent polymorphic symptoms after a tick bite" allowing for designing studies to better understand these subjective presentations, for which objective biomarkers are currently lacking. This entity encompasses patients experiencing fatigue and generalized pain in the months following a tick bite and can be associated with several subjective symptoms with major impact on the quality of life. In the field of somatoform disorders, this article reviews functional neuroimaging studies in patients presenting with subjective complaints and discusses potential clinical implications for persisting symptoms after tick bites and post-treatment Lyme disease syndrome.
Collapse
|
6
|
Höflich A, Michenthaler P, Kasper S, Lanzenberger R. Circuit Mechanisms of Reward, Anhedonia, and Depression. Int J Neuropsychopharmacol 2018; 22:105-118. [PMID: 30239748 PMCID: PMC6368373 DOI: 10.1093/ijnp/pyy081] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/12/2018] [Indexed: 12/23/2022] Open
Abstract
Pleasure and motivation are important factors for goal-directed behavior and well-being in both animals and humans. Intact hedonic capacity requires an undisturbed interplay between a number of different brain regions and transmitter systems. Concordantly, dysfunction of networks encoding for reward have been shown in depression and other psychiatric disorders. The development of technological possibilities to investigate connectivity on a functional level in humans and to directly influence networks in animals using optogenetics among other techniques has provided new important insights in this field of research.In this review, we aim to provide an overview on the neurobiological substrates of anhedonia on a network level. For this purpose, definition of anhedonia and the involved reward components are described first, then current data on reward networks in healthy individuals and in depressed patients are summarized, and the roles of different neurotransmitter systems involved in reward processing are specified. Based on this information, the impact of different therapeutic approaches on reward processing is described with a particular focus on deep brain stimulation (DBS) as a possibility for a direct modulation of human brain structures in vivo.Overall, results of current studies emphasize the importance of anhedonia in psychiatric disorders and the relevance of targeting this phenotype for a successful psychiatric treatment. However, more data incorporating these results for the refinement of methodological approaches are needed to be able to develop individually tailored therapeutic concepts based on both clinical and neurobiological profiles of patients.
Collapse
Affiliation(s)
- Anna Höflich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Paul Michenthaler
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria
| | - Rupert Lanzenberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria,Correspondence: Rupert Lanzenberger, MD, PD, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria ()
| |
Collapse
|
7
|
Richieri R, Verger A, Boyer L, Boucekine M, David A, Lançon C, Cermolacce M, Guedj E. Predictive value of dorso-lateral prefrontal connectivity for rTMS response in treatment-resistant depression: A brain perfusion SPECT study. Brain Stimul 2018; 11:1093-1097. [PMID: 29802071 DOI: 10.1016/j.brs.2018.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 03/19/2018] [Accepted: 05/14/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Previous clinical trials have suggested that repetitive transcranial magnetic stimulation (rTMS) has a significant antidepressant effect in patients with treatment resistant depression (TRD). However, results remain heterogeneous with many patients without effective response. OBJECTIVE The aim of this SPECT study was to determine before treatment the predictive value of the connectivity of the stimulated area on further rTMS response in patients with TRD. METHODS Fifty-eight TRD patients performed a brain perfusion SPECT before high frequency rTMS of the left dorsolateral prefrontal cortex (DLPFC). A voxel based-analysis was achieved to compare connectivity of the left DLPFC in responders and non-responders using inter-regional correlations (p < 0.005, corrected for cluster volume). A multiple logistic regression model was thereafter used with the goal of establishing a predictive score. RESULTS Before rTMS, responders exhibited increased SPECT connectivity between the left DLPFC and the right cerebellum in comparison to non-responders, independently of age, gender, severity of depression, and severity of treatment resistance. The area under the curve for the combination of these two SPECT clusters to predict rTMS response was 0.756 (p < 0.005). CONCLUSIONS SPECT connectivity of the left DLPFC predicts rTMS response before treatment.
Collapse
Affiliation(s)
- Raphaëlle Richieri
- Department of Psychiatry, La Conception University Hospital, 13005 Marseille, France; Aix-Marseille Univ, EA 3279 - Self-perceived Health Assessment Research Unit, 13005 Marseille, France; Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
| | - Antoine Verger
- Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone, APHM, 13005 Marseille, France; Department of Nuclear Medicine & Nancyclotep Imaging Platform, 54000 Nancy, France; IADI, INSERM U947, 54000 Nancy, France
| | - Laurent Boyer
- Aix-Marseille Univ, EA 3279 - Self-perceived Health Assessment Research Unit, 13005 Marseille, France; Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Mohamed Boucekine
- Aix-Marseille Univ, EA 3279 - Self-perceived Health Assessment Research Unit, 13005 Marseille, France
| | - Anthony David
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Christophe Lançon
- Department of Psychiatry, La Conception University Hospital, 13005 Marseille, France; Aix-Marseille Univ, EA 3279 - Self-perceived Health Assessment Research Unit, 13005 Marseille, France
| | - Michel Cermolacce
- Department of Psychiatry, La Conception University Hospital, 13005 Marseille, France
| | - Eric Guedj
- Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone, APHM, 13005 Marseille, France; Aix-Marseille University, INT, CNRS UMR 7289, 13005 Marseille, France; Aix-Marseille University, CERIMED, 13005 Marseille, France
| |
Collapse
|
8
|
Longer depressive episode duration negatively influences HF-rTMS treatment response: a cerebellar metabolic deficiency? Brain Imaging Behav 2018; 11:8-16. [PMID: 26780241 DOI: 10.1007/s11682-016-9510-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Repetitive transcranial magnetic stimulation (rTMS) is an evidence based neurostimulation modality used to treat patients with Major Depressive Disorder (MDD). In spite that the duration of current a depressive episode has been put forward as a negative predictor for clinical outcome, little is known about the underlying neurobiological mechanisms of this phenomenon. To address this important issue, in a sample of 43 melancholic stage III treatment resistant antidepressant-free refractory MDD patients, we reanalysed regional cerebral glucose metabolism (CMRglc) before high frequency (HF)-rTMS treatment, applied to the left dorsolateral prefrontal cortex (DLPFC). Besides that a lower baseline cerebellar metabolic activity indicated negative clinical response, a longer duration of the depressive episode was a negative indicator for recovery and negatively influenced cerebellar CMRglc. This exploratory 18FDG PET study is the first to demonstrate that the clinical response of HF-rTMS treatment in TRD patients may depend on the metabolic state of the cerebellum. Our observations could imply that for left DLPFC HF-rTMS non-responders other brain localisations for stimulation, more specifically the cerebellum, may be warranted.
Collapse
|
9
|
Richieri R, Jouvenoz D, Verger A, Fiat P, Boyer L, Lançon C, Guedj E. Changes in dorsolateral prefrontal connectivity after rTMS in treatment-resistant depression: a brain perfusion SPECT study. Eur J Nucl Med Mol Imaging 2017; 44:1051-1055. [PMID: 28154905 DOI: 10.1007/s00259-017-3640-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 01/25/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive and safe alternative to electroconvulsive therapy for treatment-resistant depression (TRD). After rTMS, changes in brain SPECT perfusion have been remotely identified within medial temporal limbic areas, while no local effects have been found within the left dorsolateral prefrontal cortex (DLPFC)-i.e. under the coil. Functional changes in connectivity may underlie these remote effects. Interestingly, functional connectivity has been recently investigated using perfusion SPECT, and abnormalities identified in TRD patients. The aim of the present study is to evaluate perfusion and connectivity SPECT changes in TRD patients after rTMS of the left DLPFC. We hypothesize that changes in DLPFC networks may explain remote hypoperfusions found after rTMS. METHODS Fifty-eight TRD patients underwent a brain SPECT before and after high-frequency rTMS of the left DLPFC. Whole-brain voxel-based changes in perfusion were evaluated with SPM8, and inter-regional correlation analysis performed to study left DLPFC functional connectivity (p < 0.005, corrected for cluster volume). RESULTS After rTMS, patients were significantly improved on Beck Depression Inventory score (p < 0.0001). Considering a 50% reduction threshold, 27 patients were identified as responders (47%). After rTMS, perfusion changes were not found locally within the left DLPFC, but remotely within the bilateral temporal lobes, including limbic areas. Inter-regional correlation SPECT analysis brings out a decrease of connectivity between the left DLPFC and both the cingulate/medial frontal cortex and bilateral medial temporal limbic areas, in relation with the clinical response. CONCLUSIONS rTMS of DLPFC in TRD patients leads to remote temporal hypoperfusions in relation with changes in functional connectivity between the DLPFC and the default mode network, especially including medial temporal limbic areas.
Collapse
Affiliation(s)
- Raphaëlle Richieri
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France.,EA 3279 - Self-perceived Health Assessment Research Unit, Aix-Marseille Univ, 13005, Marseille, France
| | - Damien Jouvenoz
- Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone, APHM, 264 rue Saint Pierre, 13005, Marseille, France
| | - Antoine Verger
- Department of Nuclear Medicine & Nancyclotep Imaging Platform, 54000, Nancy, France.,IADI, INSERM U947, 54000, Nancy, France
| | - Patrick Fiat
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France.,EA 3279 - Self-perceived Health Assessment Research Unit, Aix-Marseille Univ, 13005, Marseille, France
| | - Laurent Boyer
- EA 3279 - Self-perceived Health Assessment Research Unit, Aix-Marseille Univ, 13005, Marseille, France.,Department of Public Health, Assistance Publique - Hôpitaux de Marseille, Marseille, France
| | - Christophe Lançon
- Department of Psychiatry, La Conception University Hospital, 13005, Marseille, France.,EA 3279 - Self-perceived Health Assessment Research Unit, Aix-Marseille Univ, 13005, Marseille, France
| | - Eric Guedj
- Service Central de Biophysique et Médecine Nucléaire, Hôpital de la Timone, APHM, 264 rue Saint Pierre, 13005, Marseille, France. .,Aix-Marseille Univ, INT, CNRS UMR 7289, 13005, Marseille, France. .,Aix-Marseille Univ, CERIMED, 13005, Marseille, France.
| |
Collapse
|
10
|
Daulatzai MA. Cerebral hypoperfusion and glucose hypometabolism: Key pathophysiological modulators promote neurodegeneration, cognitive impairment, and Alzheimer's disease. J Neurosci Res 2016; 95:943-972. [PMID: 27350397 DOI: 10.1002/jnr.23777] [Citation(s) in RCA: 263] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/06/2016] [Accepted: 05/07/2016] [Indexed: 02/06/2023]
Abstract
Aging, hypertension, diabetes, hypoxia/obstructive sleep apnea (OSA), obesity, vitamin B12/folate deficiency, depression, and traumatic brain injury synergistically promote diverse pathological mechanisms including cerebral hypoperfusion and glucose hypometabolism. These risk factors trigger neuroinflammation and oxidative-nitrosative stress that in turn decrease nitric oxide and enhance endothelin, Amyloid-β deposition, cerebral amyloid angiopathy, and blood-brain barrier disruption. Proinflammatory cytokines, endothelin-1, and oxidative-nitrosative stress trigger several pathological feedforward and feedback loops. These upstream factors persist in the brain for decades, upregulating amyloid and tau, before the cognitive decline. These cascades lead to neuronal Ca2+ increase, neurodegeneration, cognitive/memory decline, and Alzheimer's disease (AD). However, strategies are available to attenuate cerebral hypoperfusion and glucose hypometabolism and ameliorate cognitive decline. AD is the leading cause of dementia among the elderly. There is significant evidence that pathways involving inflammation and oxidative-nitrosative stress (ONS) play a key pathophysiological role in promoting cognitive dysfunction. Aging and several comorbid conditions mentioned above promote diverse pathologies. These include inflammation, ONS, hypoperfusion, and hypometabolism in the brain. In AD, chronic cerebral hypoperfusion and glucose hypometabolism precede decades before the cognitive decline. These comorbid disease conditions may share and synergistically activate these pathophysiological pathways. Inflammation upregulates cerebrovascular pathology through proinflammatory cytokines, endothelin-1, and nitric oxide (NO). Inflammation-triggered ONS promotes long-term damage involving fatty acids, proteins, DNA, and mitochondria; these amplify and perpetuate several feedforward and feedback pathological loops. The latter includes dysfunctional energy metabolism (compromised mitochondrial ATP production), amyloid-β generation, endothelial dysfunction, and blood-brain-barrier disruption. These lead to decreased cerebral blood flow and chronic cerebral hypoperfusion- that would modulate metabolic dysfunction and neurodegeneration. In essence, hypoperfusion deprives the brain from its two paramount trophic substances, viz., oxygen and nutrients. Consequently, the brain suffers from synaptic dysfunction and neuronal degeneration/loss, leading to both gray and white matter atrophy, cognitive dysfunction, and AD. This Review underscores the importance of treating the above-mentioned comorbid disease conditions to attenuate inflammation and ONS and ameliorate decreased cerebral blood flow and hypometabolism. Additionally, several strategies are described here to control chronic hypoperfusion of the brain and enhance cognition. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Mak Adam Daulatzai
- Sleep Disorders Group, EEE Dept/MSE, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
11
|
Amen DG, Willeumier K, Omalu B, Newberg A, Raghavendra C, Raji CA. Perfusion Neuroimaging Abnormalities Alone Distinguish National Football League Players from a Healthy Population. J Alzheimers Dis 2016; 53:237-41. [PMID: 27128374 PMCID: PMC4942725 DOI: 10.3233/jad-160207] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND National Football League (NFL) players are exposed to multiple head collisions during their careers. Increasing awareness of the adverse long-term effects of repetitive head trauma has raised substantial concern among players, medical professionals, and the general public. OBJECTIVE To determine whether low perfusion in specific brain regions on neuroimaging can accurately separate professional football players from healthy controls. METHOD A cohort of retired and current NFL players (n = 161) were recruited in a longitudinal study starting in 2009 with ongoing interval follow up. A healthy control group (n = 124) was separately recruited for comparison. Assessments included medical examinations, neuropsychological tests, and perfusion neuroimaging with single photon emission computed tomography (SPECT). Perfusion estimates of each scan were quantified using a standard atlas. We hypothesized that hypoperfusion particularly in the orbital frontal, anterior cingulate, anterior temporal, hippocampal, amygdala, insular, caudate, superior/mid occipital, and cerebellar sub-regions alone would reliably separate controls from NFL players. Cerebral perfusion differences were calculated using a one-way ANOVA and diagnostic separation was determined with discriminant and automatic linear regression predictive models. RESULTS NFL players showed lower cerebral perfusion on average (p < 0.01) in 36 brain regions. The discriminant analysis subsequently distinguished NFL players from controls with 90% sensitivity, 86% specificity, and 94% accuracy (95% CI 95-99). Automatic linear modeling achieved similar results. Inclusion of age and clinical co-morbidities did not improve diagnostic classification. CONCLUSION Specific brain regions commonly damaged in traumatic brain injury show abnormally low perfusion on SPECT in professional NFL players. These same regions alone can distinguish this group from healthy subjects with high diagnostic accuracy. This study carries implications for the neurological safety of NFL players.
Collapse
Affiliation(s)
| | | | - Bennet Omalu
- Department of Pathology, University of California, Davis, CA, USA
| | - Andrew Newberg
- Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Cauligi Raghavendra
- Department of Computer Science, University of Southern California, Los Angeles, CA, USA
| | - Cyrus A. Raji
- Department of Radiology, University of California Los Angeles Medical Center, Los Angeles, CA, USA
| |
Collapse
|