Probing prefrontal cortex hemodynamic alterations during facial emotion recognition for major depression disorder through functional near-infrared spectroscopy

Cortical functional mechanisms in emotional cognitive tasks in first-episode, drug-naïve with major depressive disorder: A fNIRS study

BACKGROUND

Previous research has revealed that patients with major depressive disorder (MDD) have negative biases in various aspects of information processing, and these biases are mainly manifested in recognizing facial expressions. However, the link between this emotional cognitive inhibition and neural activation mechanisms in cortical brain regions remains poorly understood. Therefore, this study employed functional near-infrared spectroscopy (fNIRS) to explore the potential impaired regions and neural mechanisms associated with facial emotion cognition in MDD patients.

METHODS

37 MDD patients and 34 healthy controls (HC) were recruited to participate in three sets of cognitive tasks for emotion recognition, and the cortical activation in the brain was synchronously recorded using multi-channel fNIRS.

RESULTS

During tasks requiring the motions identification of sad versus happy emotional states, MDD patients exhibit altered activation in both the left frontopolar cortex (FPC) and the right dorsolateral prefrontal cortex (DLPFC). Notably, the FPC demonstrates a higher level of internal coherence and broader correlation with other cortical areas. Moreover, MDD patients showed lower accuracy in distinguishing emotional cues associated with sadness versus those associated with neutral and happy emotions.

LIMITATIONS

The study had a relatively small sample size, and it specifically examined only three prevalent facial expressions.

CONCLUSION

Facial expression recognition in MDD patients is characterized by negative cognitive interpretation of expressions, which are associated with various cortical altered activations. Neuroimaging further suggests that the cognitive inhibition of emotion signal recognition in everyday interpersonal interactions in MDD patients may primarily be influenced by activation in the left FPC.

NIRS-aided differential diagnosis among patients with major depressive disorder, bipolar disorder, and schizophrenia

BACKGROUND

To establish a clinically applicable neuroimaging-guided diagnostic support system that uses near-infrared spectroscopy (NIRS) for differential diagnosis at the individual level among major depressive disorder (MDD), bipolar disorder (BPD), and schizophrenia (SZ).

METHODS

A total of 192 participants were recruited, including 40 patients with MDD, 38 patients with BPD, 65 patients with SZ, and 49 healthy individuals. We analyzed the spatiotemporal characteristics of hemodynamic responses in the frontotemporal cortex during a verbal fluency test (VFT) measured by NIRS to assess the accuracy of single-subject classification for differential diagnosis among the three psychiatric disorders. The optimal threshold of the frontal centroid value (54 seconds) was utilized on the basis of the findings of the Japanese study.

RESULTS

The application of the optimal threshold of the frontal centroid value (54 seconds) allowed for the accurate differentiation of patients with unipolar MDD (72.5%) from BPD (78.9%) or SZ (84.6%).

CONCLUSION

These results suggest that the NIRS-aided differential diagnosis of major psychiatric disorders can be a promising biomarker in Taiwan. Future multi-site studies are needed to validate our findings.

Decreased hemodynamic response to fearful faces relative to neutral faces in the medial frontal cortex of first-episode drug-naïve major depressive disorder

BACKGROUND

Major depressive disorder (MDD) is a disabling disease with impaired recognition of emotional facial expressions. However, the evidence is heterogeneous, regarding the mechanism of emotional processing in MDD. Focusing on patients with first-episode drug-naïve MDD, we used functional near-infrared spectroscopy (fNIRS) to investigate whether MDD have characteristic patterns in cerebral activation under facial emotion recognition task (FERT).

METHODS

Thirty-five patients with first-episode drug-naïve MDD and 39 healthy controls (HCs) underwent fNIRS measure to evaluate cerebral hemodynamic response in the frontal and temporal cortex during FERT. The 17-item Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale and Inventory of Depressive Symptomatology-Self Report were applied to assess the symptoms of the patients. Cognitive functions were assessed using THINC-integrated tool.

RESULTS

Hypoactivation in the medial frontal was observed in patients with MDD during recognition of fearful faces relative to neutral faces (F-N faces). Specifically, we found more right lateralized activation in the medial frontal cortex among patients with MDD compared to HCs. Further, the medial frontal activation under the condition of F-N faces was positively correlated to scores of digit symbol substitution test, and negatively relative to severity of depressive symptoms in MDD group.

LIMITATIONS

Our study is cross-sectional designed, and has a relatively small sample size.

CONCLUSIONS

We found abnormal patterns in the medial frontal activation of patients with first-episode drug-naïve MDD in recognition of F-N faces, which correlates with performance in cognitive function and depressive symptoms.

Prefrontal cortex activities during verbal fluency and emotional words tasks in major depressive, adjustment, and bipolar disorders with depressive states

BACKGROUND

It can be difficult to differentiate psychiatric disorders from depressive states, with little knowledge on how to differentiate them. This study aimed to evaluate changes in brain activity during cognitive and emotional tasks in patients with depressive state to help with differential diagnoses.

METHODS

Sixty-two patients with depressive states [17 with adjustment disorder (AD), 27 with major depressive disorder (MDD), and 18 with bipolar disorder (BD)] and 34 healthy controls (HC) were recruited. We used a verbal fluency task (VFT) and emotional word tasks with happy and threat words. Functional near-infrared spectroscopy measured the relative change in oxygenated hemoglobin in the frontotemporal areas.

RESULTS

During the VFT, patients with AD or MDD showed significantly reduced activation in the bilateral frontotemporal region (all p < 0.01), whereas patients with BD demonstrated significantly reduced activation in the right frontotemporal areas compared to HC (p < 0.01). During the emotional words task with happy words, patients with MDD showed significantly increased activity in the frontopolar area compared to HC (p = 0.023). Binary logistic regression analysis showed that MDD or BD was significantly associated with brain activity during the happy word task. In distinguishing MDD or BD from HC, the happy words task performed equally well, with an area under the curve of 0.70.

LIMITATIONS

All study patients were taking psychotropic drugs.

CONCLUSIONS

Brain activation in response to a combination of cognitive or emotional stimuli could assist in distinguishing patients with depressive states from healthy controls.

Hemodynamic analysis of the frontal cortex using multi-task fNIRS in major depressive disorder

BACKGROUND

Appropriate task selection is the key to fNIRS-based major depressive disorder (MDD) diagnosis and treatment; however, there exists no unified rule for task selection, which limits its clinical application.

METHODS

Four tasks were employed to investigate the hemodynamic characteristics of MDD during motor, emotional, cognitive, and combinational tasks. A total of 69 subjects were studied: 50 with MDD and 19 healthy controls. The integral value of oxy-hemoglobin and the asymmetric characteristics of the bilateral frontal lobe were used to demonstrate the hemodynamic changes in MDD during different tasks. A detailed analysis and comparison among different tasks were conducted.

RESULTS

Compared with deoxy-hemoglobin (deoxy-Hb), oxy-Hb was more significant to differentiate between MDD subjects and healthy controls. In subjects with MDD, lower activation of the frontal lobe and smaller integral values of oxy-Hb were observed. In most task paradigms, MDD subjects and healthy controls exhibited diametrically opposite left-right frontal asymmetry. For the integral value of oxy-Hb and the asymmetric characteristics of the bilateral frontal lobe, the differences between MDD subjects and healthy controls under the combinational task were more significant than that under the single tasks.

LIMITATIONS

Brain fatigue patterns over time and their effect on the hemodynamic analysis of MDD should be studied further.

CONCLUSIONS

The difference in hemodynamic characteristics between MDD subjects and healthy controls is closely related to the choice of task, and the combinational task showed better discrimination than the single tasks. It provides guidance for the appropriate task design for MDD in clinics.

Empathy development from adolescence to adulthood and its consistency across targets

This research was conducted with two main goals-to contribute to knowledge on the development of empathy from early adolescence to adulthood, including its contribution to decoding emotion expression, and to improve the understanding of the nature of empathy by simultaneously assessing empathy toward two different targets-humans and animals. It unfolded into two cross-sectional studies: One (S1) obtaining measures of empathy toward humans and animals as targets across five age groups (from pre-adolescents to adults); and another (S2) where a subset of the adolescents who participated in S1 were assessed in emotion expression decoding and subjective and physiological responses to emotional video clips. The results of S1 showed that empathy toward animals and most dimensions of empathy toward humans increase toward adulthood, with important gender differences in empathy to animals and humans, and empathy levels in girls starting off in the age trajectory at higher levels, A moderate correlation between empathy toward human and toward animal targets was also found. S2 showed that the expression of positive emotion is better recognized than that of negative emotion, surprise, or neutral expression, and that the measure of human-directed empathy predicts successful decoding of negative emotion, whereas skin conductance responses (SCRs) and subjective valence ratings predicted successful identification of positive emotion. Gender differences emerged but not across all age groups nor all subscales. Results yield keys to the developmental "pace" and trajectory of the various dimensions of empathy and to how empathy relates to emotion decoding.

Hybrid motion artifact detection and correction approach for functional near-infrared spectroscopy measurements

SIGNIFICANCE

Functional near-infrared spectroscopy (fNIRS) is a promising optical neuroimaging technique, measuring the hemodynamic signals from the cortex. However, improving signal quality and reducing artifacts arising from oscillation and baseline shift (BS) are still challenging up to now for fNIRS applications.

AIM

Considering the advantages and weaknesses of the different algorithms to reduce the artifact effect in fNIRS signals, we propose a hybrid artifact detection and correction approach.

APPROACH

First, distinct artifact detection was realized through an fNIRS detection strategy. Then the artifacts were divided into three categories: BS, slight oscillation, and severe oscillation. A comprehensive correction was applied through three main steps: severe artifact correction by cubic spline interpolation, BS removal by spline interpolation, and slight oscillation reduction by dual-threshold wavelet-based method.

RESULTS

Using fNIRS data acquired during whole night sleep monitoring, we compared the performance of our approach with existing algorithms in signal-to-noise ratio (SNR) and Pearson's correlation coefficient (R). We found that the proposed method showed improvements in performance in SNR and R with strong stability.

CONCLUSIONS

These results suggest that the new hybrid artifact detection and correction method enhances the viability of fNIRS as a functional neuroimaging modality.

A scoping review of near infrared spectroscopy studies employing a verbal fluency task in bipolar disorder

BACKGROUND

Deficits in cognitive functioning, including attention, memory, and executive functions, along with impairments in language production, are present in patients with bipolar disorder (BD) patients during mood phases, but also during euthymia.Verbal fluency tasks (VFTs), being able to evaluate integrity of a wide range of cognitive domains and represent, can be used to screen for these disturbances. Neuroimaging studies, including Near-InfraRed Spectroscopy (NIRS), have repeatedly showed widespread alterations in the prefrontal and temporal cortex during the performance of VFTs in BD patients. This review aims to summarize the results of NIRS studies that evaluated hemodynamic responses associated with the VFTs in prefrontal and temporal regions in BD patients.

METHODS

We performed a scoping review of studies evaluating VFT-induced activation in prefrontal and temporal regions in BD patients, and the relationship between NIRS data and various clinical variables.

RESULTS

15 studies met the inclusion criteria. In BD patients, compared to healthy controls, NIRS studies showed hypoactivation of the dorsolateral prefrontal cortex, ventrolateral prefrontal cortex and anterior temporal regions. Moreover, clinical variables, such as depressive and social adaptation scores, were negatively correlated with hemodynamic responses in prefrontal and temporal regions, while a positive correlation were reported for measures of manic symptoms and impulsivity.

LIMITATIONS

The heterogeneity of the studies in terms of methodology, study design and clinical characteristics of the samples limited the comparability of the findings.

CONCLUSIONS

Given its non-invasiveness, good time-resolution and no need of posturalconstraint, NIRS technique could represent a useful tool for the evaluation of prefrontal and temporal haemodynamic correlates of cognitive performances in BD patients.

Depression and Cognitive Impairment: Current Understanding of Its Neurobiology and Diagnosis

BACKGROUND

Eye movement is critical for obtaining precise visual information and providing sensorimotor processes and advanced cognitive functions to the brain behavioral indicator.

METHODS

In this article, we present a narrative review of the eye-movement paradigms (such as fixation, smooth pursuit eye movements, and memory-guided saccade tasks) in major depression.

RESULTS

Characteristics of eye movement are considered to reflect several aspects of cognitive deficits regarded as an aid to diagnosis. Findings regarding depressive disorders showed differences from the healthy population in paradigms, the characteristics of eye movement may reflect cognitive deficits in depression. Neuroimaging studies have demonstrated the effectiveness of different eye movement paradigms for MDD screening.

CONCLUSION

Depression can be distinguished from other mental illnesses based on eye movements. Eye movement reflects cognitive deficits that can help diagnose depression, and it can make the entire diagnostic process more accurate.

Fronto-limbic neuroimaging biomarkers for diagnosis and prediction of treatment responses in major depressive disorder

The neuroimaging is an important tool for understanding the biomarkers and predicting treatment responses in major depressive disorder (MDD). The potential biomarkers and prediction of treatment response in MDD will be addressed in the review article. The brain regions of cognitive control and emotion regulation, such as the frontal and limbic regions, might represent the potential targets for MDD biomarkers. The potential targets of frontal lobes might include anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC). For the limbic system, hippocampus and amygdala might be the potentially promising targets for MDD. The potential targets of fronto-limbic regions have been found in the studies of several major neuroimaging modalities, such as the magnetic resonance imaging, near-infrared spectroscopy, electroencephalography, positron emission tomography, and single-photon emission computed tomography. Additional regions, such as brainstem and midbrain, might also play a part in the MDD biomarkers. For the prediction of treatment response, the gray matter volumes, white matter tracts, functional representations and receptor bindings of ACC, DLPFC, OFC, amygdala, and hippocampus might play a role in the prediction of antidepressant responses in MDD. For the response prediction of psychotherapies, the fronto-limbic, reward regions, and insula will be the potential targets. For the repetitive transcranial magnetic stimulation, the DLPFC, ACC, limbic, and visuospatial regions might represent the predictive targets for treatment. The neuroimaging targets of MDD might be focused in the fronto-limbic regions. However, the neuroimaging targets for the prediction of treatment responses might be inconclusive and beyond the fronto-limbic regions.

A systematic review of studies that used NIRS to measure neural activation during emotion processing in healthy individuals

Functional neuroimaging provides an avenue for earlier diagnosis and tailored treatment of psychological disorders characterised by emotional impairment. Near-infrared spectroscopy (NIRS) offers ecological advantages compared to other neuroimaging techniques and suitability of measuring regions involved in emotion functions. A systematic review was conducted to evaluate the capacity of NIRS to detect activation during emotion processing and to provide recommendations for future research. Following a comprehensive literature search, we reviewed 85 journal articles, which compared activation during emotional experience, regulation or perception with either a neutral condition or baseline period among healthy participants. The quantitative synthesis of outcomes was limited to thematical analysis, owing to the lack of standardisation between studies. Although most studies found increased prefrontal activity during emotional experience and regulation, the findings were more inconsistent for emotion perception. Some researchers reported increased activity during the task, some reported decreases, some no significant changes, and some reported mixed findings depending on the valence and region. We propose that variations in the cognitive task and stimuli, recruited sample, and measurement and analysis of data are the primary causes of inconsistency. Recommendations to improve consistency in future research by carefully considering the choice of population, cognitive task and analysis approach are provided.

Diagnostic and Predictive Applications of Functional Near-Infrared Spectroscopy for Major Depressive Disorder: A Systematic Review

INTRODUCTION

Major depressive disorder (MDD) is a global psychiatric disorder with no established biomarker. There is growing evidence that functional near-infrared spectroscopy (fNIRS) has the ability to aid in the diagnosis and prediction of the treatment response of MDD. The aim of this review was to systematically review, and gather the evidence from existing studies that used fNIRS signals in the diagnosis of MDD, correlations with depression symptomatology, and the monitoring of treatment response.

METHODS

PubMed, EMBASE, ScienceDirect, and Cochrane Library databases were searched for published English articles from 1980 to June 2019 that focused on the application of fNIRS for (i) differentiating depressed versus nondepressed individuals, (ii) correlating with depression symptomatology, and in turn (iii) monitoring treatment responses in depression. Studies were included if they utilized fNIRS to evaluate cerebral hemodynamic variations in patients with MDD of any age group. The quality of the evidence was assessed using the Newcastle-Ottawa quality assessment scale.

RESULTS

A total of 64 studies were included in this review, with 12 studies being longitudinal, while the rest were cross-sectional. More than two-thirds of the studies (n = 49) had acceptable quality. fNIRS consistently demonstrated attenuated cerebral hemodynamic changes in depressed compared to healthy individuals. fNIRS signals have also shown promise in correlating with individual symptoms of depression and monitoring various treatment responses.

CONCLUSIONS

This review provides comprehensive updated evidence of the diagnostic and predictive applications of fNIRS in patients with MDD. Future studies involving larger sample sizes, standardized methodology, examination of more brain regions in an integrative approach, and longitudinal follow-ups are needed.

Promising Neuroimaging Biomarkers in Depression

The neuroimaging has been applied in the study of pathophysiology in major depressive disorder (MDD). In this review article, several kinds of methodologies of neuroimaging would be discussed to summarize the promising biomarkers in MDD. For the magnetic resonance imaging (MRI) and magnetoencephalography field, the literature review showed the potentially promising roles of frontal lobes, such as anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC). In addition, the limbic regions, such as hippocampus and amygdala, might be the potentially promising biomarkers for MDD. The structures and functions of ACC, DLPFC, OFC, amygdala and hippocampus might be confirmed as the biomarkers for the prediction of antidepressant treatment responses and for the pathophysiology of MDD. The functions of cognitive control and emotion regulation of these regions might be crucial for the establishment of biomarkers. The near-infrared spectroscopy studies demonstrated that blood flow in the frontal lobe, such as the DLPFC and OFC, might be the biomarkers for the field of near-infrared spectroscopy. The electroencephalography also supported the promising role of frontal regions, such as the ACC, DLPFC and OFC in the biomarker exploration, especially for the sleep electroencephalogram to detect biomarkers in MDD. The positron emission tomography (PET) and single-photon emission computed tomography (SPECT) in MDD demonstrated the promising biomarkers for the frontal and limbic regions, such as ACC, DLPFC and amygdala. However, additional findings in brainstem and midbrain were also found in PET and SPECT. The promising neuroimaging biomarkers of MDD seemed focused in the fronto-limbic regions.

What Role Does the Prefrontal Cortex Play in the Processing of Negative and Positive Stimuli in Adolescent Depression?

This perspective describes the contribution of the prefrontal cortex to the symptoms of depression in adolescents and specifically the processing of positive and negative information. We also discuss how the prefrontal cortex (PFC) activity and connectivity during tasks and at rest might be a biomarker for risk for depression onset in adolescents. We include some of our recent work examining not only the anticipation and consummation of positive and negative stimuli, but also effort to gain positive and avoid negative stimuli in adolescents with depression. We find, using region of interest analyses, that the PFC is blunted in those with depression compared to controls across the different phases but in a larger sample the PFC is blunted in the anticipatory phase of the study only. Taken together, in adolescents with depression there is evidence for dysfunctional PFC activity across different studies and tasks. However, the data are limited with small sample sizes and inconsistent findings. Larger longitudinal studies with more detailed assessments of symptoms across the spectrum are needed to further evaluate the role of the PFC in adolescent depression.