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Reyes A, Hermann BP, Prabhakaran D, Ferguson L, Almane DN, Shih JJ, Iragui‐Madoz VJ, Struck A, Punia V, Jones JE, Busch RM, McDonald CR. Validity of the MoCA as a cognitive screening tool in epilepsy: Are there implications for global care and research? Epilepsia Open 2024; 9:1526-1537. [PMID: 38874380 PMCID: PMC11296095 DOI: 10.1002/epi4.12991] [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: 03/25/2024] [Revised: 05/06/2024] [Accepted: 05/28/2024] [Indexed: 06/15/2024] Open
Abstract
OBJECTIVE This study evaluated the diagnostic performance of a widely available cognitive screener, the Montreal cognitive assessment (MoCA), to detect cognitive impairment in older patients (age ≥ 55) with epilepsy residing in the US, using the International Classification of Cognitive Disorders in Epilepsy (IC-CoDE) as the gold standard. METHODS Fifty older adults with focal epilepsy completed the MoCA and neuropsychological measures of memory, language, executive function, and processing speed/attention. The IC-CoDE taxonomy divided participants into IC-CoDE Impaired and Intact groups. Sensitivity and specificity across several MoCA cutoffs were examined. Spearman correlations examined relationships between the MoCA total score and clinical and demographic variables and MoCA domain scores and individual neuropsychological tests. RESULTS IC-CoDE impaired patients demonstrated significantly lower scores on the MoCA total, visuospatial/executive, naming, language, delayed recall, and orientation domain scores (Cohen's d range: 0.336-2.77). The recommended MoCA cutoff score < 26 had an overall accuracy of 72%, 88.2% sensitivity, and 63.6% specificity. A MoCA cutoff score < 24 yielded optimal sensitivity (70.6%) and specificity (78.8%), with overall accuracy of 76%. Higher MoCA total scores were associated with greater years of education (p = 0.016) and fewer antiseizure medications (p = 0.049). The MoCA memory domain was associated with several standardized measures of memory, MoCA language domain with category fluency, and MoCA abstraction domain with letter fluency. SIGNIFICANCE This study provides initial validation of the MoCA as a useful screening tool for older adults with epilepsy that can be used to identify patients who may benefit from comprehensive neuropsychological testing. Further, we demonstrate that a lower cutoff (i.e., <24) better captures cognitive impairment in older adults with epilepsy than the generally recommended cutoff and provides evidence for construct overlap between MoCA domains and standard neuropsychological tests. Critically, similar efforts in other regions of the world are needed. PLAIN LANGUAGE SUMMARY The Montreal cognitive assessment (MoCA) can be a helpful tool to screen for cognitive impairment in older adults with epilepsy. We recommend that adults 55 or older with epilepsy who score less than 24 on the MoCA are referred to a neuropsychologist for a comprehensive evaluation to assess any changes in cognitive abilities and mood.
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Affiliation(s)
- Anny Reyes
- Department of Radiation Medicine & Applied SciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Bruce P. Hermann
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Divya Prabhakaran
- Department of Radiation Medicine & Applied SciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Lisa Ferguson
- Epilepsy CenterNeurological Institute, Cleveland ClinicClevelandOhioUSA
| | - Dace N. Almane
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Jerry J. Shih
- Department of NeuroscienceUniversity of CaliforniaSan DiegoCaliforniaUSA
| | | | - Aaron Struck
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Vineet Punia
- Epilepsy CenterNeurological Institute, Cleveland ClinicClevelandOhioUSA
- Department of NeurologyCleveland ClinicClevelandOhioUSA
| | - Jana E. Jones
- Department of NeurologyUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Robyn M. Busch
- Epilepsy CenterNeurological Institute, Cleveland ClinicClevelandOhioUSA
- Department of NeurologyCleveland ClinicClevelandOhioUSA
| | - Carrie R. McDonald
- Department of Radiation Medicine & Applied SciencesUniversity of CaliforniaSan DiegoCaliforniaUSA
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
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Jeżowska-Jurczyk K, Jurczyk P, Budrewicz S, Pokryszko-Dragan A. Evaluation of Event-Related Potentials in Assessing Cognitive Functions of Adult Patients with Epilepsy of Unknown Etiology. J Clin Med 2023; 12:jcm12072500. [PMID: 37048584 PMCID: PMC10094758 DOI: 10.3390/jcm12072500] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/21/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Background: Cognitive impairment (CI) is an important consequence of epilepsy. The aim of the study was to assess cognitive performance in patients with epilepsy, using neuropsychological tests (NT) and event-related potentials (ERPs), with regard to demographic and clinical data. Methods: The study comprised 50 patients with epilepsy of unknown etiology and 46 healthy controls. Based on the NT results, the patients were divided into subgroups with/without CI. Parameters of P300 potential were compared between the patients and controls. P300 parameters and NT results were referred to demographics and clinical characteristics of epilepsy. Results: Based on the NT, 66% of patients were assigned as cognitively impaired. Median P300 latency was significantly (p < 0.0002) prolonged in the study group. Subgroups of patients with and without CI significantly (p < 0.034) differed in education level and vocational activity, duration of epilepsy, age at its onset and frequency of polytherapy. P300 parameters showed significant (p < 0.03) relationships with duration of epilepsy, type and frequency of seizures and polytherapy. Conclusions: Cognitive impairment and ERPs abnormalities occur in a majority of patients with epilepsy of unknown etiology. Characteristics of epilepsy and socioeconomic status are related to cognitive performance. ERPs may complement neuropsychological methods in the assessment of cognition in patients with epilepsy.
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Wang M, Cheng X, Shi Q, Xu B, Hou X, Zhao H, Gui Q, Wu G, Dong X, Xu Q, Shen M, Cheng Q, Xue S, Feng H, Ding Z. Brain diffusion tensor imaging reveals altered connections and networks in epilepsy patients. Front Hum Neurosci 2023; 17:1142408. [PMID: 37033907 PMCID: PMC10073437 DOI: 10.3389/fnhum.2023.1142408] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Accumulating evidence shows that epilepsy is a disease caused by brain network dysfunction. This study explored changes in brain network structure in epilepsy patients based on graph analysis of diffusion tensor imaging data. Methods The brain structure networks of 42 healthy control individuals and 26 epilepsy patients were constructed. Using graph theory analysis, global and local network topology parameters of the brain structure network were calculated, and changes in global and local characteristics of the brain network in epilepsy patients were quantitatively analyzed. Results Compared with the healthy control group, the epilepsy patient group showed lower global efficiency, local efficiency, clustering coefficient, and a longer shortest path length. Both healthy control individuals and epilepsy patients showed small-world attributes, with no significant difference between groups. The epilepsy patient group showed lower nodal local efficiency and nodal clustering coefficient in the right olfactory cortex and right rectus and lower nodal degree centrality in the right olfactory cortex and the left paracentral lobular compared with the healthy control group. In addition, the epilepsy patient group showed a smaller fiber number of edges in specific regions of the frontal lobe, temporal lobe, and default mode network, indicating reduced connection strength. Discussion Epilepsy patients exhibited lower global and local brain network properties as well as reduced white matter fiber connectivity in key brain regions. These findings further support the idea that epilepsy is a brain network disorder.
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Affiliation(s)
- Meixia Wang
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaoyu Cheng
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Qianru Shi
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Bo Xu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaoxia Hou
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Huimin Zhao
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qian Gui
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Guanhui Wu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Xiaofeng Dong
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qinrong Xu
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Mingqiang Shen
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Qingzhang Cheng
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
| | - Shouru Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hongxuan Feng
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- *Correspondence: Hongxuan Feng,
| | - Zhiliang Ding
- Department of Neurology, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, China
- Zhiliang Ding,
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Lim SC, Oh J, Hong BY, Lim SH. Changes in the Brain in Temporal Lobe Epilepsy with Unilateral Hippocampal Sclerosis: An Initial Case Series. Healthcare (Basel) 2022; 10:healthcare10091648. [PMID: 36141260 PMCID: PMC9498839 DOI: 10.3390/healthcare10091648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022] Open
Abstract
Temporal lobe epilepsy (TLE) is a network disorder of the brain. Network disorders predominately involve dysregulation of hippocampal function caused by neuronal hyperexcitability. However, the relationship between the macro- and microscopic changes in specific brain regions is uncertain. In this study, the pattern of brain atrophy in patients with TLE and hippocampal sclerosis (HS) was investigated using volumetry, and microscopic changes in specific lesions were observed to examine the anatomical correspondence with specific target lesions using diffusion tensor imaging (DTI) with statistical parametric mapping (SPM). This retrospective cross-sectional study enrolled 17 patients with TLE and HS. We manually measured the volumes of the hippocampus (HC), amygdala (AMG), entorhinal cortex, fornix, and thalamus (TH) bilaterally. The mean diffusivity and fractional anisotropy of each patient were then quantified and analyzed by a voxel-based statistical correlation method using SPM8. In right TLE with HS, there was no evidence of any abnormal diffusion properties associated with the volume reduction in specific brain regions. In left TLE with HS, there were significant changes in the volumes of the AMG, HC, and TH. Despite the small sample size, these differences in conditions were considered meaningful. Chronic left TLE with HS might cause structural changes in the AMG, HC, and TH, unlike right TLE with HS.
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Affiliation(s)
- Sung Chul Lim
- Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Juhee Oh
- Department of Neurology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Bo Young Hong
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Seong Hoon Lim
- Department of Rehabilitation Medicine, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-31-249-8952; Fax: +82-31-251-4481
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Novak A, Vizjak K, Gacnik A, Rakusa M. Cognitive impairment in people with epilepsy: Montreal Cognitive Assessment (MoCA) as a screening tool. Acta Neurol Belg 2022; 123:451-456. [PMID: 35925540 DOI: 10.1007/s13760-022-02046-4] [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: 05/01/2022] [Accepted: 07/19/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Although cognitive impairment is common in people with epilepsy, it is often neglected in outpatient clinics. MoCA is a simple and reliable test, which was validated for the cognitive screening of Alzheimer's and vascular dementia. The aim of our study was to evaluate MoCA as a tool for a cognitive screening of people with epilepsy. METHODS Our study included 50 people with epilepsy and 46 healthy individuals. All participants took the Slovenian version of the MoCA. Mean age, education and MoCA scores were compared between the two groups. RESULTS There was no significant difference between people with epilepsy and the controls in age (47.6, SD 18.1 vs 50.9, SD 14.0 years) or education (12.8, SD 2.8 vs 13.4, SD 2.8 years). People with epilepsy had significantly lower total MoCA scores than did the controls (23.3, SD 4.5 vs 27.5, SD 1.9 points; p < 0.001). CONCLUSIONS People with epilepsy achieved a lower score in several cognitive domains compared to the control group. MoCA can be used as an appropriate screening tool for cognitive impairment in people with epilepsy in the outpatient clinic. For a more accurate evaluation, neuropsychological assessments should be used.
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Affiliation(s)
- Ajda Novak
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Karmen Vizjak
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Albin Gacnik
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia
| | - Martin Rakusa
- Divison of Neurology, University Medical Centre Maribor, Maribor, Slovenia.
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Li X, Jiang Y, Li W, Qin Y, Li Z, Chen Y, Tong X, Xiao F, Zuo X, Gong Q, Zhou D, Yao D, An D, Luo C. Disrupted functional connectivity in white matter resting-state networks in unilateral temporal lobe epilepsy. Brain Imaging Behav 2021; 16:324-335. [PMID: 34478055 DOI: 10.1007/s11682-021-00506-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 02/08/2023]
Abstract
Unilateral temporal lobe epilepsy (TLE) is the most common type of focal epilepsy characterized by foci in the unilateral temporal lobe grey matters of regions such as the hippocampus. However, it remains unclear how the functional features of white matter are altered in TLE. In the current study, resting-state functional magnetic resonance imaging (fMRI) was performed on 71 left TLE (LTLE) patients, 79 right TLE (RTLE) patients and 47 healthy controls (HC). Clustering analysis was used to identify fourteen white matter networks (WMN). The functional connectivity (FC) was calculated among WMNs and between WMNs and grey matter. Furthermore, the FC laterality of hemispheric WMNs was assessed. First, both patient groups showed decreased FCs among WMNs. Specifically, cerebellar white matter illustrated decreased FCs with the cerebral superficial WMNs, implying a dysfunctional interaction between the cerebellum and the cerebral cortex in TLE. Second, the FCs between WMNs and the ipsilateral hippocampus (grey matter foci) were also reduced in patient groups, which may suggest insufficient functional integration in unilateral TLE. Interestingly, RTLE showed more severe abnormalities of white matter FCs, including links to the bilateral hippocampi and temporal white matter, than LTLE. Taken together, these findings provide functional evidence of white matter abnormalities, extending the understanding of the pathological mechanism of white matter impairments in unilateral TLE.
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Affiliation(s)
- Xuan Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu, 610054, People's Republic of China
| | - Yuchao Jiang
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu, 610054, People's Republic of China
| | - Wei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610054, People's Republic of China
| | - Yingjie Qin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610054, People's Republic of China
| | - Zhiliang Li
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu, 610054, People's Republic of China
| | - Yan Chen
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu, 610054, People's Republic of China
| | - Xin Tong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610054, People's Republic of China
| | - Fenglai Xiao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610054, People's Republic of China
| | - Xiaojun Zuo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu, 610054, People's Republic of China
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610054, People's Republic of China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610054, People's Republic of China
| | - Dezhong Yao
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu, 610054, People's Republic of China
| | - Dongmei An
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610054, People's Republic of China
| | - Cheng Luo
- The Clinical Hospital of Chengdu Brain Science Institute, MOE Key Lab for Neuroinformation, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Second North Jianshe Road, Chengdu, 610054, People's Republic of China.
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Zhou M, Jiang W, Zhong D, Zheng J. Resting-state brain entropy in right temporal lobe epilepsy and its relationship with alertness. Brain Behav 2019; 9:e01446. [PMID: 31605452 PMCID: PMC6851803 DOI: 10.1002/brb3.1446] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To date, no functional MRI (fMRI) studies have focused on brain entropy in right temporal lobe epilepsy (rTLE) patients. Here, we characterized brain entropy (BEN) alterations in patients with rTLE using resting-state functional MRI(rs-fMRI) and explored the relationship between BEN and alertness. METHOD Thirty-one rTLE patients and 33 controls underwent MRI scanning to investigate differences in BEN and resting-state functional connectivity (rs-FC) in regions of interest (ROIs) between patients and controls. Correlation analyses were performed to examine relationships between the BEN of each ROI and alertness reaction times (RTs) in rTLE patients. RESULTS Compared with controls, the BEN of rTLE patients was significantly increased in the right middle temporal gyrus, inferior temporal gyrus, and other regions of the left hemisphere and significantly decreased in the right middle frontal gyrus and left supplementary motor area (p < .05). The rs-FCs between the ROIs (at p < .01, with the left superior parietal lobule and right precentral gyrus defined as ROI1 and ROI2, respectively) and the whole brain showed an increasing trend in rTLE patients. In addition, the BEN of ROI2 was associated with the intrinsic alertness and phasic alertness RTs of patients with rTLE. CONCLUSIONS Our findings suggest that BEN is altered in patients with rTLE and that decreased BEN in the right precentral gyrus is positively related to intrinsic and phasic alertness; the abnormal FC in the brain regions with altered entropy suggests a reconstruction of brain functional connectivity. These findings suggest that BEN mapping may provide a useful tool for probing brain mechanisms related to TLE.
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Affiliation(s)
- Muhua Zhou
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wenyu Jiang
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Dan Zhong
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jinou Zheng
- Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Chen VCH, Liu YC, Chao SH, McIntyre RS, Cha DS, Lee Y, Weng JC. Brain structural networks and connectomes: the brain-obesity interface and its impact on mental health. Neuropsychiatr Dis Treat 2018; 14:3199-3208. [PMID: 30538478 PMCID: PMC6263220 DOI: 10.2147/ndt.s180569] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Obesity is a complex and multifactorial disease identified as a global epidemic. Convergent evidence indicates that obesity differentially influences patients with neuropsychiatric disorders providing a basis for hypothesizing that obesity alters brain structure and function associated with the brain's propensity toward disturbances in mood and cognition. Herein, we characterize alterations in brain structures and networks among obese subjects (ie, body mass index [BMI] ≥30 kg/m2) when compared with non-obese controls. PATIENTS AND METHODS We obtained noninvasive diffusion tensor imaging and generalized q-sampling imaging scans of 20 obese subjects (BMI=37.9±5.2 SD) and 30 non-obese controls (BMI=22.6±3.4 SD). Graph theoretical analysis and network-based statistical analysis were performed to assess structural and functional differences between groups. We additionally assessed for correlations between diffusion indices, BMI, and anxiety and depressive symptom severity (ie, Hospital Anxiety and Depression Scale total score). RESULTS The diffusion indices of the posterior limb of the internal capsule, corona radiata, and superior longitudinal fasciculus were significantly lower among obese subjects when compared with controls. Moreover, obese subjects were more likely to report anxiety and depressive symptoms. There were fewer structural network connections observed in obese subjects compared with non-obese controls. Topological measures of clustering coefficient (C), local efficiency (Elocal), global efficiency (Eglobal), and transitivity were significantly lower among obese subjects. Similarly, three sub-networks were identified to have decreased structural connectivity among frontal-temporal regions in obese subjects compared with non-obese controls. CONCLUSION We extend knowledge further by delineating structural interconnectivity alterations within and across brain regions that are adversely affected in individuals who are obese.
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Affiliation(s)
- Vincent Chin-Hung Chen
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan,
| | - Yi-Chun Liu
- Department of Medical Imaging and Radiological Sciences, Chung Shan Medical University, Taichung, Taiwan
| | - Seh-Huang Chao
- Center of Metabolic and Bariatric Surgery, Jen-Ai Hospital, Taichung, Taiwan
| | - Roger S McIntyre
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Danielle S Cha
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, ON, Canada.,School of Medicine, University of Queensland, Queensland, Brisbane, Australia
| | - Yena Lee
- Mood Disorder Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Jun-Cheng Weng
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan, .,Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan,
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