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Zhou X, Yang Y, Zhu F, Chen X, Zhu Y, Gui T, Li Y, Xue Q. Neurometabolic and Brain Functional Alterations Associated with Cognitive Impairment in Patients with Myasthenia Gravis: A Combined 1H-MRS and fMRI Study. Neuroscience 2024; 544:12-27. [PMID: 38423165 DOI: 10.1016/j.neuroscience.2024.02.021] [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] [Received: 08/04/2023] [Revised: 01/04/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
Whether patients with myasthenia gravis (MG) exhibit cognitive impairment is controversial. Also the underlying mechanisms are unknown. We aimed to investigate alterations in cognitive function, neurometabolite levels, and brain function in patients with MG and to explore the associations between abnormal regional brain functional activity, neurometabolite concentrations in the MPFC and left thalamus, and cognitive activity in patients with MG. Neuropsychological tests, proton magnetic resonance spectroscopy, and resting-state functional magnetic resonance imaging were performed on 41 patients with MG and 45 race-, sex-, age-, and education-matched healthy controls (HCs). The results suggest that MG is accompanied by cognitive decline, as indicated by global cognitive function, visual-spatial function, language, memory, abnormalities in regional brain functional activity, and neurometabolite alterations (including GABA, NAA, and Cho) in the medial prefrontal cortex (MPFC) and left thalamus. Cognitive impairment in patients with MG may be related to abnormal regional brain functional activity and changes in neurometabolites, and regional brain functional activity may be modulated by specific neurometabolites.
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Affiliation(s)
- Xiaoling Zhou
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Department of Neurology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, Jiangsu 215000, China
| | - Yang Yang
- Department of Radiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, Jiangsu 214000, China
| | - Feng Zhu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Xiang Chen
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Yunfei Zhu
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Tiantian Gui
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Yonggang Li
- Department of Radiology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
| | - Qun Xue
- Department of Neurology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
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Yang K, Du R, Yang Q, Zhao R, Fan F, Chen S, Luo X, Tan S, Wang Z, Yu T, Tian B, Le TM, Li CSR, Tan Y. Cortical thickness of the inferior parietal lobule as a potential predictor of relapse in men with alcohol dependence. Brain Imaging Behav 2024; 18:331-342. [PMID: 38078981 DOI: 10.1007/s11682-023-00838-7] [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] [Accepted: 12/01/2023] [Indexed: 12/26/2023]
Abstract
Alcohol dependence is a disorder with a high recurrence rate that leads to a considerable public health burden. The risk of relapse appears to be related to a complex interplay of multiple factors. Herein, we aimed to explore the potential neural predictors of relapse in Chinese male patients with alcohol dependence. This study enrolled 58 male patients with alcohol dependence who had undergone acute detoxification. General demographic information and clinical features were collected. Magnetic resonance imaging data were used to measure cortical thickness across 34 regions of the brain. Patients were followed up at six months, and 51 patients completed the follow-up visit. These patients were divided into a relapser and an abstainer group. A binary logistic regression analysis was performed to investigate the potential risk factors of relapse. Compared to abstainers, relapsers showed higher inattention and non-planning impulsivity on the 11th version of the Barratt Impulsive Scale. The cortical thicknesses of the inferior-parietal lobules were significantly higher in abstainers compared with those in relapsers. Furthermore, binary logistic regression analysis showed that the thickness of the inferior parietal lobule predicted relapse, and lower non-planning impulse was a protective factor against relapse. Relapsers show poorer impulse control than abstainers, and structural magnetic resonance imaging revealed a decreased thickness of the inferior parietal lobule in relapsers. Our results indicate the thickness of the inferior parietal lobule as a potential relapse predictor in male patients with alcohol dependence.
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Affiliation(s)
- Kebing Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Ruonan Du
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Qingyan Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Rongjiang Zhao
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Ting Yu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China
| | - Thang M Le
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06519, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, 06519, USA
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, 100096, People's Republic of China.
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Yang K, Du R, Yang Q, Zhao R, Fan F, Chen S, Luo X, Tan S, Wang Z, Yu T, Tian B, Le TM, Li CSR, Tan Y. Cortical thickness of the inferior parietal lobule as a potential predictor of relapse in men with alcohol dependence. RESEARCH SQUARE 2023:rs.3.rs-2628081. [PMID: 36945425 PMCID: PMC10029073 DOI: 10.21203/rs.3.rs-2628081/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Background Alcohol dependence (AD) is a disorder with a high recurrence rate that leads to a considerable public health burden. The risk of relapse appears to be related to a complex interplay of multiple factors. Herein, we aimed to explore the potential neural predictors of relapse in Chinese male patients with AD. Methods This study enrolled 58 male patients with AD who had undergone acute detoxification. General demographic information and clinical features were collected. Magnetic resonance imaging (MRI) data were used to measure cortical thickness across 34 regions of the brain. Patients were followed up at 6 months, and 51 patients completed the follow-up visit. These patients were divided into a relapser and an abstainer group. A binary logistic regression analysis was performed to investigate the potential risk factors of relapse. Results Compared to abstainers, relapsers showed higher inattention and non-planning impulsivity on the 11th version of the Barratt Impulsive Scale. The cortical thicknesses of the inferior-parietal lobule were significantly greater in abstainers compared with those in relapsers. Furthermore, binary logistic regression analysis showed that the thickness of the inferior parietal lobule predicted relapse. Conclusions Relapsers show poorer impulse control than abstainers, and MRI imaging shows a decreased thickness of the inferior parietal lobule in relapsers. Our results indicate the thickness of the inferior parietal lobule as a potential relapse predictor in male patients with AD.
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Affiliation(s)
- Kebing Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Ruonan Du
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Qingyan Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Rongjiang Zhao
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Song Chen
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | | | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Ting Yu
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
| | | | | | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital
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Song T, Song X, Zhu C, Patrick R, Skurla M, Santangelo I, Green M, Harper D, Ren B, Forester BP, Öngür D, Du F. Mitochondrial dysfunction, oxidative stress, neuroinflammation, and metabolic alterations in the progression of Alzheimer's disease: A meta-analysis of in vivo magnetic resonance spectroscopy studies. Ageing Res Rev 2021; 72:101503. [PMID: 34751136 PMCID: PMC8662951 DOI: 10.1016/j.arr.2021.101503] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022]
Abstract
Accumulating evidence demonstrates that metabolic changes in the brain associated with neuroinflammation, oxidative stress, and mitochondrial dysfunction play an important role in the pathophysiology of mild cognitive impairment (MCI) and Alzheimer's disease (AD). However, the neural signatures associated with these metabolic alterations and underlying molecular mechanisms are still elusive. Accordingly, we reviewed the literature on in vivo human brain 1H and 31P-MRS studies and use meta-analyses to identify patterns of brain metabolic alterations in MCI and AD. 40 and 39 studies on MCI and AD, respectively, were classified according to brain regions. Our results indicate decreased N-acetyl aspartate and creatine but increased myo-inositol levels in both MCI and AD, decreased glutathione level in MCI as well as disrupted energy metabolism in AD. In addition, the hippocampus shows the strongest alterations in most of these metabolites. This meta-analysis also illustrates progressive metabolite alterations from MCI to AD. Taken together, it suggests that 1) neuroinflammation and oxidative stress may occur in the early stages of AD, and likely precede neuron loss in its progression; 2) the hippocampus is a sensitive region of interest for early diagnosis and monitoring the response of interventions; 3) targeting bioenergetics associated with neuroinflammation/oxidative stress is a promising approach for treating AD.
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Affiliation(s)
- Tao Song
- Psychotic Disorders Division, McLean Hospital, 02478, USA; McLean Imaging Center, McLean Hospital, 02478, USA; Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Xiaopeng Song
- Psychotic Disorders Division, McLean Hospital, 02478, USA; McLean Imaging Center, McLean Hospital, 02478, USA; Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Chenyawen Zhu
- Psychotic Disorders Division, McLean Hospital, 02478, USA; McLean Imaging Center, McLean Hospital, 02478, USA
| | - Regan Patrick
- Division of Geriatric Psychiatry, McLean Hospital, 02478, USA; Department of Neuropsychology, McLean Hospital, 02478, USA; Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Miranda Skurla
- Division of Geriatric Psychiatry, McLean Hospital, 02478, USA
| | | | - Morgan Green
- Division of Geriatric Psychiatry, McLean Hospital, 02478, USA
| | - David Harper
- Division of Geriatric Psychiatry, McLean Hospital, 02478, USA; Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Boyu Ren
- Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, 02478, USA; Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, 02478, USA; Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Fei Du
- Psychotic Disorders Division, McLean Hospital, 02478, USA; McLean Imaging Center, McLean Hospital, 02478, USA; Harvard Medical School, Boston, Massachusetts 02115, USA.
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Morley KC, Perry CJ, Watt J, Hurzeler T, Leggio L, Lawrence AJ, Haber P. New approved and emerging pharmacological approaches to alcohol use disorder: a review of clinical studies. Expert Opin Pharmacother 2021; 22:1291-1303. [PMID: 33615945 DOI: 10.1080/14656566.2021.1892641] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
introduction: The number of medications approved for AUD is small and they generally have limited efficacy. We need new pharmacotherapies for the management of AUD.Areas covered: In this review, the authors aim to synthesise literature for new approved and emerging pharmacotherapies for AUD. Recently approved medications include nalmefene, which was approved in Europe and Australia for the purposes of controlled drinking. Baclofen has also been approved in France but not in other countries. Off label medications including topiramate and gabapentin have received significant attention with multiple RCTs and meta-analyses and have widespread use in several countries including the USA. Several novel medications have emerged over the last decade but further work is required to determine their efficacy and safety for the widespread management of AUD.Expert opinion: Despite significant advances in our understanding of the neurobiological basis of factors that contribute to the development and maintenance of AUD, there have been few new AUD medications approved for almost 20 years. There are many challenges to the development and introduction of new pharmacotherapies for AUD. Strategies for improving the translational pipeline include drug repurposing and utilisation of human acute laboratory models.
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Affiliation(s)
- Kirsten C Morley
- Central Clinical School, Sydney School of Medicine, Faculty of Medicine & Health, University of Sydney, NSW, Australia.,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Christina J Perry
- University of Melbourne, Mental Health Theme, Florey Institute of Neuroscience and Mental Health, Parkville, Australia
| | - Joshua Watt
- Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Tristan Hurzeler
- Central Clinical School, Sydney School of Medicine, Faculty of Medicine & Health, University of Sydney, NSW, Australia
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Baltimore and Bethesda, USA.,Department of Neuroscience, Georgetown University Medical Center, Washington, USA.,Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, USA
| | - Andrew J Lawrence
- University of Melbourne, Mental Health Theme, Florey Institute of Neuroscience and Mental Health, Parkville, Australia.,Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, USA
| | - Paul Haber
- Central Clinical School, Sydney School of Medicine, Faculty of Medicine & Health, University of Sydney, NSW, Australia.,Edith Collins Centre (Alcohol, Drugs and Toxicology), Sydney Local Health District, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, USA
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Britton MK, Porges EC, Bryant V, Cohen RA. Neuroimaging and Cognitive Evidence for Combined HIV-Alcohol Effects on the Central Nervous System: A Review. Alcohol Clin Exp Res 2020; 45:290-306. [PMID: 33296091 DOI: 10.1111/acer.14530] [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] [Received: 04/27/2020] [Accepted: 11/29/2020] [Indexed: 12/27/2022]
Abstract
Alcohol use disorder (AUD) among people living with HIV (PLWH) is a significant public health concern. Despite the advent of effective antiretroviral therapy, up to 50% of PLWH still experience worsened neurocognition, which comorbid AUD exacerbates. We report converging lines of neuroimaging and neuropsychological evidence linking comorbid HIV/AUD to dysfunction in brain regions linked to executive function, learning and memory, processing speed, and motor control, and consequently to impairment in daily life. The brain shrinkage, functional network alterations, and brain metabolite disruption seen in individuals with HIV/AUD have been attributed to several interacting pathways: viral proteins and EtOH are directly neurotoxic and exacerbate each other's neurotoxic effects; EtOH reduces antiretroviral adherence and increases viral replication; AUD and HIV both increase gut microbial translocation, promoting systemic inflammation and HIV transport into the brain by immune cells; and HIV may compound alcohol's damaging effects on the liver, further increasing inflammation. We additionally review the neurocognitive effects of aging, Hepatitis C coinfection, obesity, and cardiovascular disease, tobacco use, and nutritional deficiencies, all of which have been shown to compound cognitive changes in HIV, AUD, and in their comorbidity. Finally, we examine emerging questions in HIV/AUD research, including genetic and cognitive protective factors, the role of binge drinking in HIV/AUD-linked cognitive decline, and whether neurocognitive and brain functions normalize after drinking cessation.
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Affiliation(s)
- Mark K Britton
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Eric C Porges
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
| | - Vaughn Bryant
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA.,Department of Epidemiology, (VB), University of Florida, Gainesville, Florida, USA
| | - Ronald A Cohen
- From the, Department of Clinical and Health Psychology, (MKB, ECP, VB, RAC), Center for Cognitive Aging and Memory, Cognitive Aging and Memory Clinical Translational Research Program, University of Florida, Gainesville, Florida, USA
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