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
|
He E, Liu M, Gong S, Fu X, Han Y, Deng F. White Matter Alterations in Depressive Disorder. Front Immunol 2022; 13:826812. [PMID: 35634314 PMCID: PMC9133348 DOI: 10.3389/fimmu.2022.826812] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Depressive disorder is the most prevalent affective disorder today. Depressive disorder has been linked to changes in the white matter. White matter changes in depressive disorder could be a result of impaired cerebral blood flow (CBF) and CBF self-regulation, impaired blood-brain barrier function, inflammatory factors, genes and environmental factors. Additionally, white matter changes in patients with depression are associated with clinical variables such as differential diagnosis, severity, treatment effect, and efficacy assessment. This review discusses the characteristics, possible mechanisms, clinical relevance, and potential treatment of white matter alterations caused by depressive disorders.
Collapse
|
3
|
Shi Y, Li J, Tong P, Yang J, Zhang H, Dong L. Regional cerebral blood flow in major depression treated with electroconvulsive therapy: an arterial spin labeling magnetic resonance study. Neurocase 2022; 28:246-250. [PMID: 35225161 DOI: 10.1080/13554794.2022.2044861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Until recently, regional cerebral blood flow (rCBF) in major depressive disorder (MDD) patients treated with electroconvulsive therapy (ECT) using arterial spin labeling (ASL) magnetic resonance imaging (MRI) have seldom been studied. We report here 10 patients with MDD treated by bilateral frontotemporal ECT. rCBF was assessed with ASL MRI pre- and post-ECT, and compared with patients treated by antidepressants. Compared to pre-ECT, rCBF significantly decreased in the bilateral frontal gyrus. Compared to medication, in patients treated with ECT, rCBF showed a significant decrease in the left amygdala, parahippocampal and olfactory gyrus, and right occipital, lingual, calcarine gyrus, and significantly increased in the bilateral frontal gyrus and right frontal gyrus. Compared with antidepressants, ECT altered rCBF, and showed potential to be a superior treatment for major depressive disorder.
Collapse
Affiliation(s)
- Yuanhong Shi
- Department of Clinical Psychology, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Jie Li
- Department of Medical Image Center, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Ping Tong
- Department of Clinical Psychology, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Jing Yang
- Department of Graduate School, Dalian Medical University, Dalian, Liaoning, China
| | - Hongying Zhang
- Department of Medical Image Center, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Liping Dong
- Department of Clinical Psychology, Yangzhou University Affiliated Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| |
Collapse
|
4
|
Dion-Albert L, Bandeira Binder L, Daigle B, Hong-Minh A, Lebel M, Menard C. Sex differences in the blood-brain barrier: Implications for mental health. Front Neuroendocrinol 2022; 65:100989. [PMID: 35271863 DOI: 10.1016/j.yfrne.2022.100989] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/07/2022] [Accepted: 02/19/2022] [Indexed: 12/13/2022]
Abstract
Prevalence of mental disorders, including major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia (SZ) are increasing at alarming rates in our societies. Growing evidence points toward major sex differences in these conditions, and high rates of treatment resistance support the need to consider novel biological mechanisms outside of neuronal function to gain mechanistic insights that could lead to innovative therapies. Blood-brain barrier alterations have been reported in MDD, BD and SZ. Here, we provide an overview of sex-specific immune, endocrine, vascular and transcriptional-mediated changes that could affect neurovascular integrity and possibly contribute to the pathogenesis of mental disorders. We also identify pitfalls in current literature and highlight promising vascular biomarkers. Better understanding of how these adaptations can contribute to mental health status is essential not only in the context of MDD, BD and SZ but also cardiovascular diseases and stroke which are associated with higher prevalence of these conditions.
Collapse
Affiliation(s)
- Laurence Dion-Albert
- Department of Psychiatry and Neuroscience, Faculty of Medicine and CERVO Brain Research Center, Université Laval, Quebec City, Canada
| | - Luisa Bandeira Binder
- Department of Psychiatry and Neuroscience, Faculty of Medicine and CERVO Brain Research Center, Université Laval, Quebec City, Canada
| | - Beatrice Daigle
- Department of Psychiatry and Neuroscience, Faculty of Medicine and CERVO Brain Research Center, Université Laval, Quebec City, Canada
| | - Amandine Hong-Minh
- Smurfit Institute of Genetics, Trinity College Dublin, Lincoln Place Gate, Dublin 2, Ireland
| | - Manon Lebel
- Department of Psychiatry and Neuroscience, Faculty of Medicine and CERVO Brain Research Center, Université Laval, Quebec City, Canada
| | - Caroline Menard
- Department of Psychiatry and Neuroscience, Faculty of Medicine and CERVO Brain Research Center, Université Laval, Quebec City, Canada.
| |
Collapse
|
5
|
Investigating the association between depression and cerebral haemodynamics-A systematic review and meta-analysis. J Affect Disord 2022; 299:144-158. [PMID: 34800572 DOI: 10.1016/j.jad.2021.11.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/25/2021] [Accepted: 11/14/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Vascular mechanisms may play a role in depression. The aim of this review is to summarise the evidence on alterations in cerebral haemodynamics in depression. METHODS MEDLINE (1946- present), Embase (1947-present), Web of Science (1970-present), PsycINFO (1984-present), CINAHL (1976-present) and CENTRAL were searched using a predefined search strategy. A meta-analysis was conducted in four groups: 1) global cerebral blood flow (CBF) in ml/min/100 g, 2) CBF velocity (CBFv) in cm/s (maximum flow of left middle cerebral artery, 3) combined CBF and CBFv, 4) Ratio of uptake of Tc 99 m HMPAO (region of interest compared to whole brain). Data are presented as mean difference or standardised mean difference and 95% confidence interval (95% CI). A narrative synthesis of the remaining studies was performed. RESULTS 87 studies were included. CBF was significantly reduced in depressed patients compared to HC [15 studies, 538 patients, 416 HC, MD: -2.24 (95% CI -4.12, -0.36), p = 0.02, I2 = 64%]. There were no statistically significant differences in other parameters. The narrative synthesis revealed variable changes in CBF in depressed patients, particularly affecting the anterior cingulate and prefrontal cortices. LIMITATIONS There were various sources of heterogeneity including the severity of depression, use of antidepressant medication, imaging modality used and reporting of outcomes. All of these factors made direct comparisons between studies difficult. CONCLUSIONS The reduction in CBF in depressed patients compared to HCs may indicate a role for assessment and CBF altering interventions in high-risk groups. However, results were inconsistent across studies, warranting further work to investigate specific subgroups.
Collapse
|
6
|
Hsu LM, Lane TJ, Wu CW, Lin CY, Yeh CB, Kao HW, Lin CP. Spontaneous thought-related network connectivity predicts sertraline effect on major depressive disorder. Brain Imaging Behav 2021; 15:1705-1717. [PMID: 32710339 DOI: 10.1007/s11682-020-00364-w] [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] [Indexed: 11/25/2022]
Abstract
Sertraline is one of the most commonly prescribed antidepressants. Major depressive disorder (MDD) is characterized by spontaneous thoughts that are laden with negative affect-a "malignant sadness". Prior neuroimaging studies have identified abnormal resting-state functional connectivity (rsFC) in the spontaneous brain networks of MDD patients. But how antidepressant medication acts to relieve the experience of depression as well as adjust its associated spontaneous networks and mood-regulation circuits remains an open question. In this study, we recruited 22 drug-naïve MDD patients along with 35 normal controls and investigated whether the functional integrity of cortical networks associated with spontaneous thoughts is modulated by sertraline treatment. We attempted to predict post-treatment effects based upon what we observed in the pre-treatment rsFC of drug-naïve MDD patients. In the result, we demonstrated that (1) after the sertraline treatment, the medial temporal lobe of default network (DNMTL) and mood regulation pathway-the fronto-parietal control network (FPCN), the thalamus, and the salience network (SN)-were restored to normal connectivity, relative to the pre-treatment condition; however, the altered connections of FPCN-core DN (DNCORE), FPCN-SN, and intra-FPCN among MDD patients remained impaired; (2) thalamo-prefrontal connectivity provides moderate predictive power (r2 = 0.63) for the effectiveness of sertraline treatment. In summary, our findings contribute to a body of evidence that suggests salubrious effects of sertraline treatment primarily involve the FPCN-thalamus-SN pathway. The pre-treatment rsFC in this pathway could serve as a predictor of sertraline treatment outcome.
Collapse
Affiliation(s)
- Li-Ming Hsu
- Department of Radiology and Brain Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Timothy Joseph Lane
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
- Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
- Institute of European and American Studies, Academia Sinica, Taipei, Taiwan
| | - Changwei W Wu
- Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan
- Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei, Taiwan
| | | | - Chi-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Hung-Wen Kao
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu District, Taipei City, 114, Taiwan.
| | - Ching-Po Lin
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
7
|
Hou Z, Li T, He X, Zhang Y, Chen H, Jiang W, Yin Y, Yuan Y. Distinct Features of Cerebral Blood Flow and Spontaneous Neural Activity as Integrated Predictors of Early Response to Antidepressants. Front Psychiatry 2021; 12:788398. [PMID: 35115965 PMCID: PMC8804095 DOI: 10.3389/fpsyt.2021.788398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS The purpose of this study is to explore whether pre-treatment features of brain function can discriminate non-responders to antidepressant medication in the early phase. METHODS Forty-four treatment-responsive depressed (RD) patients, 36 non-responsive depressed (NRD) patients, and 42 healthy controls (HCs) were recruited. Regional cerebral blood flow (CBF) and amplitude of low-frequency fluctuation (ALFF) values were calculated for all subjects. Correlation analyses were used to explore the relationship between symptom improvement and CBF/ALFF. Receiver operating characteristics (ROC) and the 10-fold cross-validation support vector machine (SVM) classifier were applied for the discrimination of treatment response. RESULTS Compared with the HCs, the RD and NRD groups exhibited lower CBF and ALFF in the right posterior lobe of the cerebellum. Compared with the NRD group, the RD group showed distinct CBF patterns in the left frontal striatal regions and right frontal cerebellar regions, as well as distinct ALFF features in the left frontoparietal striatum and right frontotemporal striatal cerebellar regions. The ROC and SVM classifier revealed the optimal power to distinguish the RD and NRD groups based on the combined measures (i.e., CBF and ALFF). CONCLUSION Distinct features of CBF and ALFF in the frontal striatal network may serve as promising neuroimaging predictors for identifying patients with blunted responsiveness, which may facilitate personalized antidepressant treatment.
Collapse
Affiliation(s)
- Zhenghua Hou
- Department of Psychosomatics and Psychiatry, Institute of Psychosomatics, School of Medicine, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Tong Li
- Department of Psychiatry, The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, United States.,Department of Information Engineering, Harbin Institute of Technology, Harbin, China
| | - Xiaofu He
- Department of Psychiatry, The New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, United States
| | - Yuqun Zhang
- Department of Psychosomatics and Psychiatry, Institute of Psychosomatics, School of Medicine, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Huanxin Chen
- Key Laboratory of Cognition and Personality, Ministry of Education, School of Psychology, Southwest University, Chongqing, China
| | - Wenhao Jiang
- Department of Psychosomatics and Psychiatry, Institute of Psychosomatics, School of Medicine, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Yingying Yin
- Department of Psychosomatics and Psychiatry, Institute of Psychosomatics, School of Medicine, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, Institute of Psychosomatics, School of Medicine, Affiliated Zhongda Hospital, Southeast University, Nanjing, China
| |
Collapse
|
8
|
Kihira S, Koo C, Nael K, Belani P. Regional Parieto-occipital Hypoperfusion on Arterial Spin Labeling Associates with Major Depressive Disorder. Open Neuroimag J 2020. [DOI: 10.2174/1874440002013010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Reduced cerebral blood flow in parieto-occipital regions has been reported in neurodegenerative disorders using ASL. We aimed to investigate neuropsychiatric and neurodegenerative comorbidities that may associate with parieto-occipital region hypoperfusion.
Methods:
This was a retrospective single-center study. Between March 2017 to May 2018, adult patients who underwent brain MRI with the inclusion of ASL perfusion and who had bilateral reductions of CBF in the parieto-occipital regions were included. ASL was performed using a pseudo-continuous arterial spin labeling (pCASL) technique on 1.5T MR system. Age and gender-matched patients with no perfusion defect were concurrently collected. Comorbidity data was collected from EMR, including major depressive disorder, Alzheimer’s disease, Parkinson’s disease, Schizophrenia, anxiety disorder, hypertension, diabetes mellitus type II, coronary artery disease, and chronic kidney disease. A Pearson’s Chi-Square test was performed to assess for comorbidities associated with hypoperfusion of the parieto-occipital lobes.
Results:
Our patient cohort consisted of 93 patients with bilateral hypoperfusion in the parieto-occipital lobes and 93 age and gender-matched patients without corresponding perfusion defects based on ASL-CBF. Among the comorbidities assessed, there was a statistically significant association between hypoperfusion of the parieto-occipital lobes and major depressive disorder (p=0.004) and Parkinson’s disease (p=0.044). There was no statistically significant association for Alzheimer’s disease, generalized anxiety disorder, diabetes mellitus type II, hypertension, coronary artery disease, or chronic kidney disease.
Conclusion:
Major depressive disorder may be linked to regional parieto-occipital hypoperfusion on ASL.
Collapse
|
9
|
Zhang W, Shen H, Yao X, Liu F, Wang S, Yang Y, Zhang N, Wang C. Clinical and Diffusion Tensor Imaging to Evaluate Falls, Balance and Gait Dysfunction in Leukoaraiosis: an Observational, Prospective Cohort Study. J Geriatr Psychiatry Neurol 2020; 33:223-230. [PMID: 31500496 DOI: 10.1177/0891988719874132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the correlation between leukoaraiosis (LA) and falls, to determine the risk factors for falls in patients with LA, and to detect specific white matter tracts are associated with the falls by using the diffusion tensor magnetic resonance imaging (DTI) screen. METHODS For the elderly patients with LA, we collected demographic information and scores for the Tinetti Balance and Gait Scale, Berg Balance Scale, Timed up-and-go test, and Cognitive, Emotional, Sleep-related Scale. All the patients underwent DTI scanning and were followed up for 1 year. RESULTS Ninety-four individuals were prospectively enrolled. After multivariable analyses, age, history of falls in the past year, antidepressants usage, and LA-Fazekas grade were reported to be risk factors for falls. In patients with severe LA, the fall incidence was higher than in those with mild LA. Tract-Based Spatial Statistics showed that fractional anisotropy values of the corpus callosum, cingulate gyrus, anterior limb of internal capsule, cerebral peduncle, anterior corona, and fronto-occipital fasciculus were significantly reduced in the patients who fell. The body of the corpus callosum and anterior corona radiate were significantly related to balance and gait function. CONCLUSIONS Our findings indicated that age, history of falls in the past year, antidepressants usage, and LA-Fazekas grade were risk factors for falls in elderly patients with LA. Leukoaraiosis was relevant for falls, but LA severity had a threshold effect with falls. The loss of integrity of some white matter tracts might influence balance and gait function. The DTI had preeminent clinical application prospects for identifying fall risk in patients with LA.
Collapse
Affiliation(s)
- Weiyi Zhang
- Department of neurology, Fuxing Hospital, the Eighth Clinical Medical College, Capital Medical University, Beijing, China
| | - Huicong Shen
- Department of Radiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Xiaomei Yao
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Fei Liu
- Department of Neuropsychiatry & Behavior Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Shuo Wang
- Department of Neuropsychiatry & Behavior Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Yang Yang
- Department of Neuropsychiatry & Behavior Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Disease, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Psychology, Capital Medical University, Beijing, China.,Branch Institute of Sleep and Consciousness, Beijing Institutes of Brain Diseases, Beijing, China
| | - Ning Zhang
- Department of Neuropsychiatry & Behavior Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Disease, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Psychology, Capital Medical University, Beijing, China.,Branch Institute of Sleep and Consciousness, Beijing Institutes of Brain Diseases, Beijing, China
| | - Chunxue Wang
- Department of Neuropsychiatry & Behavior Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Disease, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.,Department of Psychology, Capital Medical University, Beijing, China.,Branch Institute of Sleep and Consciousness, Beijing Institutes of Brain Diseases, Beijing, China
| |
Collapse
|
10
|
Investigating resting brain perfusion abnormalities and disease target-engagement by intranasal oxytocin in women with bulimia nervosa and binge-eating disorder and healthy controls. Transl Psychiatry 2020; 10:180. [PMID: 32513936 PMCID: PMC7280271 DOI: 10.1038/s41398-020-00871-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/19/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022] Open
Abstract
Advances in the treatment of bulimia nervosa and binge-eating disorder (BN/BED) have been marred by our limited understanding of the underpinning neurobiology. Here we measured regional cerebral blood flow (rCBF) to map resting perfusion abnormalities in women with BN/BED compared with healthy controls and investigate whether intranasal oxytocin (OT), proposed as a potential treatment, can restore perfusion in disorder-related brain circuits. Twenty-four women with BN/BED and 23 healthy women participated in a randomized, double-blind, crossover, placebo-controlled study. We used arterial spin labelling MRI to measure rCBF and the effects of an acute dose of intranasal OT (40 IU) or placebo over 18-26 min post dosing, as we have previously shown robust OT-induced changes in resting rCBF in men in a similar time-window (15-36 min post dosing). We tested for effects of treatment, diagnosis and their interaction on extracted rCBF values in anatomical regions-of-interest previously implicated in BN/BED by other neuroimaging modalities, and conducted exploratory whole-brain analyses to investigate previously unidentified brain regions. We demonstrated that women with BN/BED presented increased resting rCBF in the medial prefrontal and orbitofrontal cortices, anterior cingulate gyrus, posterior insula and middle/inferior temporal gyri bilaterally. Hyperperfusion in these areas specifically correlated with eating symptoms severity in patients. Our data did not support a normalizing effect of intranasal OT on perfusion abnormalities in these patients, at least for the specific dose (40 IU) and post-dosing interval (18-26 min) examined. Our findings enhance our understanding of resting brain abnormalities in BN/BED and identify resting rCBF as a non-invasive potential biomarker for disease-related changes and treatment monitoring. They also highlight the need for a comprehensive investigation of intranasal OT pharmacodynamics in women before we can fully ascertain its therapeutic value in disorders affecting predominantly this gender, such as BN/BED.
Collapse
|
11
|
Zhang N, Qin J, Yan J, Zhu Y, Xu Y, Zhu X, Ju S, Li Y. Increased ASL-CBF in the right amygdala predicts the first onset of depression in healthy young first-degree relatives of patients with major depression. J Cereb Blood Flow Metab 2020; 40:54-66. [PMID: 31272311 PMCID: PMC6928554 DOI: 10.1177/0271678x19861909] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Healthy first-degree relatives of patients with major depression are at an elevated risk of developing depression, and regional cerebral blood flow (CBF) alterations are observed in patients with depression. Therefore, in a 33-month follow-up study, we used arterial spin labeling-magnetic resonance imaging (ASL-MRI) to investigate quantitative CBF before and after the diagnosis of depression in healthy young adults with and without first-degree relatives with major depression (FH + and FH-, respectively). In cross-sectional and longitudinal CBF comparisons, CBF in the right amygdala was increased or decreased. Additionally, a significant correlation was observed between the altered CBF in the right amygdala and the scores on the 17-item Hamilton Depression Rating Scale (HDRS) in the FH + group. Furthermore, logistic regression and receiver operating characteristic curve analyses showed that increased CBF in the right amygdala at baseline predicted the subsequent onset of depression in the FH + group. Our results suggest that among healthy young adults with a familial risk of depression, those who exhibit increased CBF in the amygdala are susceptible to developing this disease.
Collapse
Affiliation(s)
- Ningning Zhang
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jiasheng Qin
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jinchuan Yan
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yan Zhu
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Yuhao Xu
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Xiaolan Zhu
- Department of Central Laboratory, The Fourth Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Shenghong Ju
- Department of Radiology, Zhongda Affiliated Hospital of Southeast University, Nanjing, China
| | - Yuefeng Li
- Department of Radiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China.,Department of Radiology, Zhongda Affiliated Hospital of Southeast University, Nanjing, China
| |
Collapse
|
12
|
Luckett P, Paul RH, Navid J, Cooley SA, Wisch JK, Boerwinkle AH, Tomov D, Ances BM. Deep Learning Analysis of Cerebral Blood Flow to Identify Cognitive Impairment and Frailty in Persons Living With HIV. J Acquir Immune Defic Syndr 2019; 82:496-502. [PMID: 31714429 PMCID: PMC6857844 DOI: 10.1097/qai.0000000000002181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Deep learning algorithms of cerebral blood flow were used to classify cognitive impairment and frailty in people living with HIV (PLWH). Feature extraction techniques identified brain regions that were the strongest predictors. SETTING Virologically suppressed (<50 copies/mL) PLWH (n = 125) on combination antiretroviral therapy were enrolled. Participants averaged 51.4 (11.4) years of age and 13.7 (2.8) years of education. Participants were administered a neuropsychological battery, assessed for frailty, and completed structural neuroimaging. METHODS Deep neural network (DNN) models were trained to classify PLWH as cognitively unimpaired or impaired based on neuropsychological tests (Hopkins Verbal Learning Test-Revised and Brief Visuospatial Memory Test-Revised, Trail making, Letter-Number Sequencing, Verbal Fluency, and Color Word Interference), as well as frail, prefrail, or nonfrail based on the Fried phenotype criteria (at least 3 of the following 5: weight loss, physical inactivity, exhaustion, grip strength, walking time). RESULTS DNNs classified individuals with cognitive impairment in the learning, memory, and executive domains with 82%-86% accuracy (0.81-0.87 AUC). Our model classified nonfrail, prefrail, and frail PLWH with 75% accuracy. The strongest predictors of cognitive impairment were cortical (parietal, occipital, and temporal) and subcortical (amygdala, caudate, and hippocampus) regions, whereas the strongest predictors of frailty were subcortical (amygdala, caudate, hippocampus, thalamus, pallidum, and cerebellum). CONCLUSIONS DNN models achieved high accuracy in classifying cognitive impairment and frailty status in PLWH. Feature selection algorithms identified predictive regions in each domain and identified overlapping regions between cognitive impairment and frailty. Our results suggest frailty in HIV is primarily subcortical, whereas cognitive impairment in HIV involves subcortical and cortical brain regions.
Collapse
Affiliation(s)
- Patrick Luckett
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Robert H Paul
- Department of Psychological Sciences, University of Missouri Saint Louis, St. Louis, MI
| | - Jaimie Navid
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Sarah A Cooley
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Julie K Wisch
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Anna H Boerwinkle
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Dimitre Tomov
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| | - Beau M Ances
- Department of Neurology, Washington University School of Medicine, St. Louis, MI
| |
Collapse
|
13
|
Lai CH. Fear Network Model in Panic Disorder: The Past and the Future. Psychiatry Investig 2019; 16:16-26. [PMID: 30176707 PMCID: PMC6354036 DOI: 10.30773/pi.2018.05.04.2] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/04/2018] [Indexed: 01/04/2023] Open
Abstract
The core concept for pathophysiology in panic disorder (PD) is the fear network model (FNM). The alterations in FNM might be linked with disturbances in the autonomic nervous system (ANS), which is a common phenomenon in PD. The traditional FNM included the frontal and limbic regions, which were dysregulated in the feedback mechanism for cognitive control of frontal lobe over the primitive response of limbic system. The exaggerated responses of limbic system are also associated with dysregulation in the neurotransmitter system. The neuroimaging studies also corresponded to FNM concept. However, more extended areas of FNM have been discovered in recent imaging studies, such as sensory regions of occipital, parietal cortex and temporal cortex and insula. The insula might integrate the filtered sensory information via thalamus from the visuospatial and other sensory modalities related to occipital, parietal and temporal lobes. In this review article, the traditional and advanced FNM would be discussed. I would also focus on the current evidences of insula, temporal, parietal and occipital lobes in the pathophysiology. In addition, the white matter and functional connectome studies would be reviewed to support the concept of advanced FNM. An emerging dysregulation model of fronto-limbic-insula and temporooccipito-parietal areas might be revealed according to the combined results of recent neuroimaging studies. The future delineation of advanced FNM model can be beneficial from more extensive and advanced studies focusing on the additional sensory regions of occipital, parietal and temporal cortex to confirm the role of advanced FNM in the pathophysiology of PD.
Collapse
Affiliation(s)
- Chien-Han Lai
- Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan.,PhD Psychiatry & Neuroscience Clinic, Taoyuan, Taiwan.,Department of Psychiatry, Yeezen General Hospital, Taoyuan, Taiwan
| |
Collapse
|
14
|
Luo MY, Guo ZN, Qu Y, Zhang P, Wang Z, Jin H, Ma HY, Lv S, Sun X, Yang Y. Compromised Dynamic Cerebral Autoregulation in Patients With Depression. Front Psychiatry 2019; 10:373. [PMID: 31258489 PMCID: PMC6587060 DOI: 10.3389/fpsyt.2019.00373] [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: 10/14/2018] [Accepted: 05/13/2019] [Indexed: 01/18/2023] Open
Abstract
Background: Patients with depression tend to have various comorbid neurological symptoms, but the mechanisms remain unclear. The purpose of this study was to analyze the characteristics of dynamic cerebral autoregulation in depressed patients. Methods: Patients (aged ≥ 18 years) who were diagnosed with depression [17-item Hamilton Depression Rating Scale (HAMD) > 17] or suspected of depression (HAMD > 7) were enrolled in this study. Medically healthy volunteers were recruited as controls. The subjects also received the 7-item HAMD. We simultaneously recorded noninvasive continuous arterial blood pressure and bilateral middle cerebral artery blood flow velocity from each subject. Cerebral autoregulation was assessed by analyzing the phase difference using transfer function analysis. Results: This study enrolled 54 patients with suspected depression, 45 patients with depression, and 48 healthy volunteers. The mean phase difference values were significantly lower in the patients with depression (F = 9.071, P < 0.001). In the multiple regression analysis, depression was negatively correlated with the phase difference values. Conclusions: Dynamic cerebral autoregulation was compromised in patients with depression and negatively correlated with the depression score. Improving dynamic cerebral autoregulation may be a potential therapeutic method for treating the neurological symptoms of depression.
Collapse
Affiliation(s)
- Ming-Ya Luo
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Zhen-Ni Guo
- Clinical Trial and Research Center for Stroke, Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Yang Qu
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Peng Zhang
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Zan Wang
- Clinical Trial and Research Center for Stroke, Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Hang Jin
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Hong-Yin Ma
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Shan Lv
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Xin Sun
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| | - Yi Yang
- Department of Neurology, First Hospital of Jilin University, Chang Chun, China
| |
Collapse
|
15
|
Wei W, Karim HT, Lin C, Mizuno A, Andreescu C, Karp JF, Reynolds CF, Aizenstein HJ. Trajectories in Cerebral Blood Flow Following Antidepressant Treatment in Late-Life Depression: Support for the Vascular Depression Hypothesis. J Clin Psychiatry 2018; 79:18m12106. [PMID: 30358242 PMCID: PMC6419103 DOI: 10.4088/jcp.18m12106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/28/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Studies have identified longitudinally that there exists an association between depression, cerebral blood flow (CBF), and white matter hyperintensities that are thought to be due to vascular pathologies in the brain. However, the changes in CBF, a measure that reflects cerebrovascular integrity, following pharmacotherapy are not well understood. In this study, we investigated the dynamic CBF changes over the course of antidepressant treatment and the association of these changes with depressive symptoms. METHODS We used pseudocontinuous arterial spin labeling to investigate CBF changes in a sample of older patients (≥ 50 years of age; N = 46; 29 female) with a DSM-IV diagnosis of major depressive disorder. Participants had 5 magnetic resonance imaging scans (at baseline, the day after receiving a placebo, the day after receiving a first dose of venlafaxine, a week after starting venlafaxine treatment, and at the end of trial [12 weeks]). Montgomery-Asberg Depression Rating Scale (MADRS) was used to evaluate depression severity and treatment outcome. We investigated the association between changes in depression severity with changes in voxel-wise CBF while adjusting for potential confounding factors. RESULTS Increased CBF in the middle and posterior cingulate between baseline and end of treatment was significantly associated with percent decrease in MADRS score, independent of sex and Mini-Mental State Examination score (5,000 permutations, cluster forming threshold P < .005, family-wise error P < .05). No significant effects were detected between baseline and other scans (ie, placebo, acute [single dose], or subacute [after a week]). CONCLUSIONS Regional CBF increases were associated with decreases in depressive symptoms. This observation is consistent with the vascular depression hypothesis in late-life depression. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT00892047 and NCT01124188.
Collapse
Affiliation(s)
- Wenjing Wei
- The Third Xiangya Hospital of Central South University, Changsha, Hunan, China,University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| | - Helmet T. Karim
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Chemin Lin
- Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Akiko Mizuno
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jordan F. Karp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Charles F. Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| |
Collapse
|
16
|
Bouhrara M, Lee DY, Rejimon AC, Bergeron CM, Spencer RG. Spatially adaptive unsupervised multispectral nonlocal filtering for improved cerebral blood flow mapping using arterial spin labeling magnetic resonance imaging. J Neurosci Methods 2018; 309:121-131. [PMID: 30130609 DOI: 10.1016/j.jneumeth.2018.08.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cerebral blood flow (CBF) is an emerging biomarker for normal aging and neurodegenerative diseases. Arterial spin labeling (ASL) perfusion MRI permits noninvasive quantification of CBF. However, high-quality mapping of CBF from ASL imaging is challenging, largely due to noise. NEW METHOD We demonstrate the ability of the recently introduced nonlocal estimation of multispectral magnitudes (NESMA) filter to greatly improve determination of CBF estimates from ASL imaging data. We evaluated the results of NESMA-ASL for CBF mapping from data obtained on human brain (n = 10) across a wide age range (21-74 years) using a standard clinical protocol. Results were compared to those obtained from unfiltered images or filtered images using conventional and advanced filters. Quantitative analyses for different spatial image resolutions and signal-to-noise ratios, SNRs, were also conducted. RESULTS Our results demonstrate the potential of NESMA-ASL to permit high-quality high-resolution CBF mapping. NESMA-ASL substantially reduces random variation in derived CBF estimates while preserving edges and small structures, with minimal bias and dispersion in derived CBF estimates. COMPARISON WITH EXISTING METHODS NESMA-ASL outperforms all evaluated filters in terms of noise reduction and detail preservation. Further, unlike other filters, NESMA-ASL is straightforward to implement requiring only one user-defined parameter, which is relatively insensitive to SNR or local image structure. CONCLUSIONS In-vivo estimation of CBF in the human brain from ASL imaging data was markedly improved through use of the NESMA-ASL filter. The use of NESMA-ASL may contribute significantly to the goal of high-quality high-resolution CBF mapping within a clinically feasible acquisition time.
Collapse
Affiliation(s)
- Mustapha Bouhrara
- Laboratory of Clinical Investigation, National Institute on Aging, NIH, Baltimore, Maryland, USA.
| | - Diana Y Lee
- Laboratory of Clinical Investigation, National Institute on Aging, NIH, Baltimore, Maryland, USA
| | - Abinand C Rejimon
- Laboratory of Clinical Investigation, National Institute on Aging, NIH, Baltimore, Maryland, USA
| | - Christopher M Bergeron
- Laboratory of Clinical Investigation, National Institute on Aging, NIH, Baltimore, Maryland, USA
| | - Richard G Spencer
- Laboratory of Clinical Investigation, National Institute on Aging, NIH, Baltimore, Maryland, USA
| |
Collapse
|
17
|
Daou MAZ, Boyd BD, Donahue MJ, Albert K, Taylor WD. Anterior-posterior gradient differences in lobar and cingulate cortex cerebral blood flow in late-life depression. J Psychiatr Res 2018; 97:1-7. [PMID: 29156413 PMCID: PMC5742550 DOI: 10.1016/j.jpsychires.2017.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/10/2017] [Accepted: 11/10/2017] [Indexed: 02/08/2023]
Abstract
Vascular pathology is common in late-life depression, contributing to changes in cerebral function. We examined whether late-life depression was associated with differences in cerebral blood flow (CBF) and whether such differences were related to vascular risk and cerebrovascular pathology, specifically white matter hyperintensity (WMH) volumes. Twenty-three depressed elders and 20 age- and sex-matched elders with no psychiatric history completed cranial 3T MRI. MRI procedures included a pseudo-continuous Arterial Spin Labeling (pcASL) acquisition obtained while on room air and during a hypercapnia challenge allowing for calculation of cerebrovascular reactivity (CVR). Brain segmentation identified frontal, temporal, parietal and cingulate sub-regions in which CBF and CVR were calculated. The depressed group exhibited an anterior-posterior gradient in CBF, with lower CBF throughout the frontal lobe but higher CBF in the parietal lobe, temporal lobe, thalamus and hippocampus. A similar anterior to posterior gradient was observed in the cingulate cortex, with anterior regions exhibiting lower CBF and posterior regions exhibiting higher CBF. We did not observe any group differences in CVR measures. We did not observe significant relationships between CBF and CVR with vascular risk or WMH volumes, aside from an isolated finding associating higher WMH volumes with lower CBF in the rostral anterior cingulate cortex. Decreased anterior CBF in depressed elders might reflect decreased metabolic activity in these regions, while increased posterior CBF may represent either compensatory processes or different activity of posterior intrinsic functional networks. Future work should examine how these findings are related to compensatory changes with aging.
Collapse
Affiliation(s)
- Margarita Abi Zeid Daou
- The Center for Cognitive Medicine, Department of Psychiatry and
Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212,
USA
| | - Brian D. Boyd
- The Center for Cognitive Medicine, Department of Psychiatry and
Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212,
USA
| | - Manus J. Donahue
- The Department of Radiology and Radiological Science, Vanderbilt
University Medical Center, Nashville, TN, 37212, USA
| | - Kimberly Albert
- The Center for Cognitive Medicine, Department of Psychiatry and
Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212,
USA
| | - Warren D. Taylor
- The Center for Cognitive Medicine, Department of Psychiatry and
Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212,
USA,Geriatric Research, Education and Clinical Center, Department of
Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN,
37212, USA
| |
Collapse
|
18
|
Effects of a brief cognitive behavioural therapy group intervention on baseline brain perfusion in adolescents with major depressive disorder. Neuroreport 2018; 28:348-353. [PMID: 28328739 DOI: 10.1097/wnr.0000000000000770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
A number of neuroimaging studies have identified altered regional cerebral blood flow (rCBF) related to major depressive disorder (MDD) in adult samples, particularly in the lateral prefrontal, cingular and temporal regions. In contrast, neuroimaging investigations in adolescents with MDD are rare, although investigating young patients during a significant period of brain maturation might offer valuable insights into the neural mechanisms of MDD. We acquired perfusion images obtained with continuous arterial spin labelling in 21 medication-naive adolescents with MDD before and after a five-session cognitive behavioural group therapy (group CBT). A control group included medication-naive patients under treatment as usual while waiting for the psychotherapy. We found relatively increased rCBF in the right dorsolateral prefrontal cortex (DLPFC; BA 46), the right caudate nucleus and the left inferior parietal lobe (BA 40) after CBT compared with before CBT. Relatively increased rCBF in the right DLPFC postgroup CBT was confirmed by time (post vs. pre)×group (intervention/waiting list) interaction analyses. In the waiting group, relatively increased rCBF was found in the thalamus and the anterior cingulate cortex (BA 24). The relatively small number of patients included in this pilot study has to be considered. Our findings indicate that noninvasive resting perfusion scanning is suitable to identify CBT-related changes in adolescents with MDD. rCBF increase in the DLPFC following a significant reduction in MDD symptoms in adolescents might represent the core neural correlate of changes in 'top-down' cognitive processing, a possible correlate of improved self-regulation and cognitive control.
Collapse
|
19
|
Liao W, Wang Z, Zhang X, Shu H, Wang Z, Liu D, Zhang Z. Cerebral blood flow changes in remitted early- and late-onset depression patients. Oncotarget 2017; 8:76214-76222. [PMID: 29100305 PMCID: PMC5652699 DOI: 10.18632/oncotarget.19185] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 06/17/2017] [Indexed: 01/08/2023] Open
Abstract
Abnormal cerebral blood flow (CBF) is reportedly associated with major depressive disorder (MDD). We have investigated CBF changes in early-onset depression (EOD) and late-onset depression (LOD), and their impact on cognitive function. Thirty-two remitted EOD patients, 32 remitted LOD patients, and 43 age-matched healthy controls were recruited, and the pulsed arterial spin labeling data were scanned under 3.0T MRI and processed through voxel-by-voxel statistical analysis. Compared to healthy controls, LOD patients had decreased normalized CBF in the bilateral precuneus, cuneus, right fronto-cingulate-striatal areas, and right temporal, occipital and parietal lobes, but increased normalized CBF in the left frontal and temporal cortices and the cingulate gyrus. EOD patients had decreased normalized CBF in the left cerebellum and right calcarine/lingual/fusiform gyrus, and increased normalized CBF in right angular gyrus. LOD patients displayed hemispheric asymmetry in CBF, and had more regions with abnormal CBF than EOD patients. A significant correlation between abnormal CBF and impaired cognitive function was detected in LOD patients, but not EOD patients. These results demonstrate greater CBF abnormalities in LOD patients than EOD patients, and suggest these CBF changes may be associated with progressive degradation of cognitive function in LOD patients.
Collapse
Affiliation(s)
- Wenxiang Liao
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China
| | - Ze Wang
- Center for Cognition and Brain Disorders, Hangzhou Normal University, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 311121, China
| | - Xiangrong Zhang
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China.,Department of Geriatric Psychiatry, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Hao Shu
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China
| | - Zan Wang
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China
| | - Duan Liu
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China
| | - Zhijun Zhang
- Neurologic Department of Affiliated ZhongDa Hospital, Neuropsychiatric Institute and Medical School of Southeast University, Nanjing, Jiangsu 210009, China
| |
Collapse
|
20
|
Hall B, Mak E, Cervenka S, Aigbirhio FI, Rowe JB, O’Brien JT. In vivo tau PET imaging in dementia: Pathophysiology, radiotracer quantification, and a systematic review of clinical findings. Ageing Res Rev 2017; 36:50-63. [PMID: 28315409 DOI: 10.1016/j.arr.2017.03.002] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/15/2017] [Accepted: 03/06/2017] [Indexed: 12/14/2022]
Abstract
In addition to the deposition of β-amyloid plaques, neurofibrillary tangles composed of aggregated hyperphosphorylated tau are one of the pathological hallmarks of Alzheimer's disease and other neurodegenerative disorders. Until now, our understanding about the natural history and topography of tau deposition has only been based on post-mortem and cerebrospinal fluid studies, and evidence continues to implicate tau as a central driver of downstream neurodegenerative processes and cognitive decline. Recently, it has become possible to assess the regional distribution and severity of tau burden in vivo with the development of novel radiotracers for positron emission tomography (PET) imaging. In this article, we provide a comprehensive discussion of tau pathophysiology, its quantification with novel PET radiotracers, as well as a systematic review of tau PET imaging in normal aging and various dementia conditions: mild cognitive impairment, Alzheimer's disease, frontotemporal dementia, progressive supranuclear palsy, and Lewy body dementia. We discuss the main findings in relation to group differences, clinical-cognitive correlations of tau PET, and multi-modal relationships among tau PET and other pathological markers. Collectively, the small but growing literature of tau PET has yielded consistent anatomical patterns of tau accumulation that recapitulate post-mortem distribution of neurofibrillary tangles which correlate with cognitive functions and other markers of pathology. In general, AD is characterised by increased tracer retention in the inferior temporal lobe, extending into the frontal and parietal regions in more severe cases. It is also noted that the spatial topography of tau accumulation is markedly distinct to that of amyloid burden in aging and AD. Tau PET imaging has also revealed characteristic spatial patterns among various non-AD tauopathies, supporting its potential role for differential diagnosis. Finally, we propose novel directions for future tau research, including (a) longitudinal imaging in preclinical dementia, (b) multi-modal mapping of tau pathology onto other pathological processes such as neuroinflammation, and (c) the need for more validation studies against post-mortem samples of the same subjects.
Collapse
|
21
|
Rakesh G, Szabo ST, Alexopoulos GS, Zannas AS. Strategies for dementia prevention: latest evidence and implications. Ther Adv Chronic Dis 2017; 8:121-136. [PMID: 28815009 DOI: 10.1177/2040622317712442] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/24/2017] [Indexed: 01/21/2023] Open
Abstract
Dementia is a common and debilitating syndrome with enormous impact on individuals and societies. Preventing disease onset or progression would translate to public health and societal benefits. In this review, we discuss the latest evidence on interventions that may show promise for the prevention of cognitive decline. We appraise existing evidence primarily drawn from randomized controlled trials, systematic reviews, and meta-analyses, but also highlight observational studies in humans and relevant work in model organisms. Overall, there is currently limited evidence to support a cause-effect relationship between any preventive strategy and the development or progression of dementia. However, studies to date suggest that a multifactorial intervention comprising regular exercise and healthy diet, along with the amelioration of vascular risk factors, psychosocial stress, and major depressive episodes may be most promising for the prevention of cognitive decline. We discuss the challenges, future directions, and implications of this line of research.
Collapse
Affiliation(s)
- Gopalkumar Rakesh
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - Steven T Szabo
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - George S Alexopoulos
- Department of Psychiatry, Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, White Plains, NY, USA
| | - Anthony S Zannas
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, Germany
| |
Collapse
|
22
|
Haller S, Zaharchuk G, Thomas DL, Lovblad KO, Barkhof F, Golay X. Arterial Spin Labeling Perfusion of the Brain: Emerging Clinical Applications. Radiology 2017; 281:337-356. [PMID: 27755938 DOI: 10.1148/radiol.2016150789] [Citation(s) in RCA: 329] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Arterial spin labeling (ASL) is a magnetic resonance (MR) imaging technique used to assess cerebral blood flow noninvasively by magnetically labeling inflowing blood. In this article, the main labeling techniques, notably pulsed and pseudocontinuous ASL, as well as emerging clinical applications will be reviewed. In dementia, the pattern of hypoperfusion on ASL images closely matches the established patterns of hypometabolism on fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) images due to the close coupling of perfusion and metabolism in the brain. This suggests that ASL might be considered as an alternative for FDG, reserving PET to be used for the molecular disease-specific amyloid and tau tracers. In stroke, ASL can be used to assess perfusion alterations both in the acute and the chronic phase. In arteriovenous malformations and dural arteriovenous fistulas, ASL is very sensitive to detect even small degrees of shunting. In epilepsy, ASL can be used to assess the epileptogenic focus, both in peri- and interictal period. In neoplasms, ASL is of particular interest in cases in which gadolinium-based perfusion is contraindicated (eg, allergy, renal impairment) and holds promise in differentiating tumor progression from benign causes of enhancement. Finally, various neurologic and psychiatric diseases including mild traumatic brain injury or posttraumatic stress disorder display alterations on ASL images in the absence of visualized structural changes. In the final part, current limitations and future developments of ASL techniques to improve clinical applicability, such as multiple inversion time ASL sequences to assess alterations of transit time, reproducibility and quantification of cerebral blood flow, and to measure cerebrovascular reserve, will be reviewed. © RSNA, 2016 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Sven Haller
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Greg Zaharchuk
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - David L Thomas
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Karl-Olof Lovblad
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Frederik Barkhof
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| | - Xavier Golay
- From Affidea Centre Diagnostique Radiologique de Carouge, Clos de la Fonderie 1, 1227 Carouge, Switzerland (S.H.); Dept of Surgical Sciences, Div of Radiology, Uppsala Univ, Sweden (S.H.); Dept of Neuroradiology, Univ Hosp Freiburg, Germany (S.H.); Faculty of Medicine Univ of Geneva, Switzerland (S.H.); Dept of Radiology, Stanford Univ, Stanford, Calif (G.Z.); Univ College London, Inst of Neurology, London, England (D.L.T., X.G.); Dept of Diagnostic and Interventional Neuroradiology, Geneva Univ Hosps,Switzerland (K.O.L.); Dept of Radiology & Nuclear Medicine and PET Research, VU Univ Medical Ctr, Amsterdam, the Netherlands (F.B.); and Insts of Neurology and Healthcare Engineering, Univ College London, England (F.B.)
| |
Collapse
|
23
|
Frontocingulate cerebral blood flow and cerebrovascular reactivity associated with antidepressant response in late-life depression. J Affect Disord 2017; 215:103-110. [PMID: 28324779 PMCID: PMC5472992 DOI: 10.1016/j.jad.2017.03.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/08/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Vascular pathology is common in late-life depression (LLD) and may contribute to alterations in cerebral blood flow (CBF) and cerebrovascular reactivity (CVR). In turn, such hemodynamic deficits may adversely affect brain function and clinical course. The goal of this study was to examine whether altered cerebral hemodynamics in depressed elders predicted antidepressant response. METHODS 21 depressed elders completed cranial 3T MRI, including a pseudo-continuous Arterial Spin Labeling (pcASL) acquisition on both room air and during a hypercapnia challenge. Participants then completed 12 weeks of open-label sertraline. Statistical analyses examined the relationship between regional normalized CBF and CVR values and change in Montgomery-Asberg Depression Rating Scale (MADRS) and tested for differences based on remission status. RESULTS 10 participants remitted and 11 did not. After controlling for age and baseline MADRS, greater change in MADRS with treatment was associated with lower pre-treatment normalized CBF in the caudal anterior cingulate cortex (cACC) and lateral orbitofrontal cortex (OFC), as well as lower CVR with hypercapnia in the caudal medial frontal gyrus (cMFG). After controlling for age and baseline MADRS score, remitters exhibited lower CBF in the cACC and lower CVR in the cMFG. LIMITATIONS Our sample was small, did not include a placebo arm, and we examined only specific regions of interest. CONCLUSIONS Our findings suggest that increased perfusion of the OFC and the ACC is associated with a poor antidepressant response. They do not support that vascular pathology as measured by CBF and CVR negatively affects acute treatment outcomes.
Collapse
|
24
|
Pauls MMH, Clarke N, Trippier S, Betteridge S, Howe FA, Khan U, Kruuse C, Madigan JB, Moynihan B, Pereira AC, Rolfe D, Rostrup E, Haig CE, Barrick TR, Isaacs JD, Hainsworth AH. Perfusion by Arterial Spin labelling following Single dose Tadalafil In Small vessel disease (PASTIS): study protocol for a randomised controlled trial. Trials 2017; 18:229. [PMID: 28532471 PMCID: PMC5440904 DOI: 10.1186/s13063-017-1973-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 05/04/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cerebral small vessel disease is a common cause of vascular cognitive impairment in older people, with no licensed treatment. Cerebral blood flow is reduced in small vessel disease. Tadalafil is a widely prescribed phosphodiesterase-5 inhibitor that increases blood flow in other vascular territories. The aim of this trial is to test the hypothesis that tadalafil increases cerebral blood flow in older people with small vessel disease. METHODS/DESIGN Perfusion by Arterial Spin labelling following Single dose Tadalafil In Small vessel disease (PASTIS) is a phase II randomised double-blind crossover trial. In two visits, 7-30 days apart, participants undergo arterial spin labelling to measure cerebral blood flow and a battery of cognitive tests, pre- and post-dosing with oral tadalafil (20 mg) or placebo. SAMPLE SIZE 54 participants are required to detect a 15% increase in cerebral blood flow in subcortical white matter (p < 0.05, 90% power). Primary outcomes are cerebral blood flow in subcortical white matter and deep grey nuclei. Secondary outcomes are cortical grey matter cerebral blood flow and performance on cognitive tests (reaction time, information processing speed, digit span forwards and backwards, semantic fluency). DISCUSSION Recruitment started on 4th September 2015 and 36 participants have completed to date (19th April 2017). No serious adverse events have occurred. All participants have been recruited from one centre, St George's University Hospitals NHS Foundation Trust. TRIAL REGISTRATION European Union Clinical Trials Register: EudraCT number 2015-001235-20 . Registered on 13 May 2015.
Collapse
Affiliation(s)
- Mathilde M. H. Pauls
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
- Cell Biology and Genetics Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
- Department of Neurology, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Natasha Clarke
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
- Stroke Clinical Research Network, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Sarah Trippier
- Stroke Clinical Research Network, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Shai Betteridge
- Department of Neuropsychology, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Franklyn A. Howe
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Usman Khan
- Department of Neurology, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Christina Kruuse
- Department of Neurology, Herlev Hospital, Herlev Ringvej 75, 2730 Herlev, Denmark
| | - Jeremy B. Madigan
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
- Department of Neuroradiology, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | | | - Anthony C. Pereira
- Department of Neurology, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Debbie Rolfe
- Joint Research and Enterprise Office, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Egill Rostrup
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Nordre Ringvej 57, DK-2600 Glostrup, Denmark
| | - Caroline E. Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, G12 8QQ UK
| | - Thomas R. Barrick
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| | - Jeremy D. Isaacs
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
- Cell Biology and Genetics Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
- Department of Neurology, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
| | - Atticus H. Hainsworth
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
- Cell Biology and Genetics Research Centre, Molecular and Clinical Sciences Research Institute, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
- Department of Neurology, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, London, SW17 0QT UK
- Cerebrovascular Disease, St George’s University of London, Cranmer Terrace, London, SW17 0RE UK
| |
Collapse
|
25
|
A Comparison of Neuroimaging Abnormalities in Multiple Sclerosis, Major Depression and Chronic Fatigue Syndrome (Myalgic Encephalomyelitis): is There a Common Cause? Mol Neurobiol 2017; 55:3592-3609. [PMID: 28516431 PMCID: PMC5842501 DOI: 10.1007/s12035-017-0598-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/03/2017] [Indexed: 01/23/2023]
Abstract
There is copious evidence of abnormalities in resting-state functional network connectivity states, grey and white matter pathology and impaired cerebral perfusion in patients afforded a diagnosis of multiple sclerosis, major depression or chronic fatigue syndrome (CFS) (myalgic encephalomyelitis). Systemic inflammation may well be a major element explaining such findings. Inter-patient and inter-illness variations in neuroimaging findings may arise at least in part from regional genetic, epigenetic and environmental variations in the functions of microglia and astrocytes. Regional differences in neuronal resistance to oxidative and inflammatory insults and in the performance of antioxidant defences in the central nervous system may also play a role. Importantly, replicated experimental findings suggest that the use of high-resolution SPECT imaging may have the capacity to differentiate patients afforded a diagnosis of CFS from those with a diagnosis of depression. Further research involving this form of neuroimaging appears warranted in an attempt to overcome the problem of aetiologically heterogeneous cohorts which probably explain conflicting findings produced by investigative teams active in this field. However, the ionising radiation and relative lack of sensitivity involved probably preclude its use as a routine diagnostic tool.
Collapse
|
26
|
Tong E, Sugrue L, Wintermark M. Understanding the Neurophysiology and Quantification of Brain Perfusion. Top Magn Reson Imaging 2017; 26:57-65. [PMID: 28277465 DOI: 10.1097/rmr.0000000000000128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Newer neuroimaging technology has moved beyond pure anatomical imaging and ventured into functional and physiological imaging. Perfusion magnetic resonance imaging (PWI), which depicts hemodynamic conditions of the brain at the microvascular level, has an increasingly important role in clinical central nervous system applications. This review provides an overview of the established role of PWI in brain tumor and cerebrovascular imaging, as well as some emerging applications in neuroimaging. PWI allows better characterization of brain tumors, grading, and monitoring. In acute stroke imaging, PWI is utilized to distinguish penumbra from infarcted tissue. PWI is a promising tool in the assessment of neurodegenerative and neuropsychiatric diseases, although its clinical role is not yet defined.
Collapse
Affiliation(s)
- Elizabeth Tong
- *Department of Radiology & Biomedical Imaging, University of California, San Francisco †Department of Neuroradiology, Stanford University Medical Center, Palo Alto, CA
| | | | | |
Collapse
|
27
|
Aizenstein HJ, Baskys A, Boldrini M, Butters MA, Diniz BS, Jaiswal MK, Jellinger KA, Kruglov LS, Meshandin IA, Mijajlovic MD, Niklewski G, Pospos S, Raju K, Richter K, Steffens DC, Taylor WD, Tene O. Vascular depression consensus report - a critical update. BMC Med 2016; 14:161. [PMID: 27806704 PMCID: PMC5093970 DOI: 10.1186/s12916-016-0720-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 10/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Vascular depression is regarded as a subtype of late-life depression characterized by a distinct clinical presentation and an association with cerebrovascular damage. Although the term is commonly used in research settings, widely accepted diagnostic criteria are lacking and vascular depression is absent from formal psychiatric manuals such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition - a fact that limits its use in clinical settings. Magnetic resonance imaging (MRI) techniques, showing a variety of cerebrovascular lesions, including extensive white matter hyperintensities, subcortical microvascular lesions, lacunes, and microinfarcts, in patients with late life depression, led to the introduction of the term "MRI-defined vascular depression". DISCUSSION This diagnosis, based on clinical and MRI findings, suggests that vascular lesions lead to depression by disruption of frontal-subcortical-limbic networks involved in mood regulation. However, despite multiple MRI approaches to shed light on the spatiotemporal structural changes associated with late life depression, the causal relationship between brain changes, related lesions, and late life depression remains controversial. While postmortem studies of elderly persons who died from suicide revealed lacunes, small vessel, and Alzheimer-related pathologies, recent autopsy data challenged the role of these lesions in the pathogenesis of vascular depression. Current data propose that the vascular depression connotation should be reserved for depressed older patients with vascular pathology and evident cerebral involvement. Based on current knowledge, the correlations between intra vitam neuroimaging findings and their postmortem validity as well as the role of peripheral markers of vascular disease in late life depression are discussed. CONCLUSION The multifold pathogenesis of vascular depression as a possible subtype of late life depression needs further elucidation. There is a need for correlative clinical, intra vitam structural and functional MRI as well as postmortem MRI and neuropathological studies in order to confirm the relationship between clinical symptomatology and changes in specific brain regions related to depression. To elucidate the causal relationship between regional vascular brain changes and vascular depression, animal models could be helpful. Current treatment options include a combination of vasoactive drugs and antidepressants, but the outcomes are still unsatisfying.
Collapse
Affiliation(s)
- Howard J Aizenstein
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrius Baskys
- Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA
| | - Maura Boldrini
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, New York, NY, USA
| | - Meryl A Butters
- Department of Psychiatry, University of Pittsburgh Medical School, Pittsburgh, PA, USA
| | - Breno S Diniz
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Manoj Kumar Jaiswal
- Department of Psychiatry, Columbia University, New York, NY, USA.,Division of Molecular Imaging and Neuropathology, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, Vienna, A-1150, Austria.
| | - Lev S Kruglov
- Department of Geriatric Psychiatry of the St. Petersburg Psychoneurological Research Institute named after V. M. Bekhterev, Medical Faculty of St. Petersburg University, St. Petersburg, Russia
| | - Ivan A Meshandin
- Clinical Department, Scientific and Practical Center of Psychoneurology named after V. M. Soloviev, St. Petersburg, Russia
| | - Milija D Mijajlovic
- Neurology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, Belgrade, Serbia
| | - Guenter Niklewski
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany
| | - Sarah Pospos
- Memory Disorders Clinic, Riverside Psychiatric Medical Group, Riverside, CA, USA
| | - Keerthy Raju
- Consultant in Old Age Psychiatry, Cheshire and Wirral Partnership NHS Foundation Trust, Chester, UK
| | - Kneginja Richter
- University Clinic for Psychiatry and Psychotherapy, Paracelsus Private Medical University, Nuremberg, Germany.,Faculty for Social Sciences, Technical University of Nuremberg Georg Simon Ohm, Nuremberg, Germany
| | - David C Steffens
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | - Warren D Taylor
- Department of Psychiatry, The Center for Cognitive Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Veterans Affairs Medical Center, The Geriatric Research, Education, and Clinical Center (GRECC), Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Oren Tene
- Departments of Neurology and Psychiatry, Tel Aviv Medical Center, Tel Aviv, Israel.,Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| |
Collapse
|
28
|
Vasic N, Wolf ND, Grön G, Sosic-Vasic Z, Connemann BJ, Sambataro F, von Strombeck A, Lang D, Otte S, Dudek M, Wolf RC. Baseline brain perfusion and brain structure in patients with major depression: a multimodal magnetic resonance imaging study. J Psychiatry Neurosci 2015; 40:412-21. [PMID: 26125119 PMCID: PMC4622640 DOI: 10.1503/jpn.140246] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Abnormal regional cerebral blood flow (rCBF) and grey matter volume have been frequently reported in patients with major depressive disorder (MDD). However, it is unclear to what extent structural and functional change co-occurs in patients with MDD and whether markers of neural activity, such as rCBF, can be predicted by structural change. METHODS Using MRI, we investigated resting-state rCBF and brain structure in patients with MDD and healthy controls between July 2008 and January 2013. We acquired perfusion images obtained with continuous arterial spin labelling, used voxel-based morphometry to assess grey matter volume and integrated biological parametric mapping analyses to investigate the impact of brain atrophy on rCBF. RESULTS We included 43 patients and 29 controls in our study. Frontotemporal grey matter volume was reduced in patients compared with controls. In patients, rCBF was reduced in the anterior cingulate and bilateral parahippocampal areas and increased in frontoparietal and striatal regions. These abnormalities were confirmed by analyses with brain volume as a covariate. In patients with MDD there were significant negative correlations between the extent of depressive symptoms and bilateral parahippocampal rCBF. We found a positive correlation between depressive symptoms and rCBF for right middle frontal cortical blood flow. LIMITATIONS Medication use in patients has to be considered as a limitation of our study. CONCLUSION Our data suggest that while changes of cerebral blood flow and brain volume co-occur in patients with MDD, structural change is not sufficient to explain altered neural activity in patients at rest. Abnormal brain structure and function in patients with MDD appear to reflect distinct levels of neuropathology.
Collapse
Affiliation(s)
- Nenad Vasic
- Correspondence to: N. Vasic, Department of Forensic Psychiatry and Psychotherapy, University of Ulm, District Hospital Guenzburg, Ludwig-Heilmeyer-Str. 2, 89312 Guenzburg, Germany;
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Patel MJ, Andreescu C, Price JC, Edelman KL, Reynolds CF, Aizenstein HJ. Machine learning approaches for integrating clinical and imaging features in late-life depression classification and response prediction. Int J Geriatr Psychiatry 2015; 30:1056-67. [PMID: 25689482 PMCID: PMC4683603 DOI: 10.1002/gps.4262] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/19/2014] [Accepted: 01/05/2015] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Currently, depression diagnosis relies primarily on behavioral symptoms and signs, and treatment is guided by trial and error instead of evaluating associated underlying brain characteristics. Unlike past studies, we attempted to estimate accurate prediction models for late-life depression diagnosis and treatment response using multiple machine learning methods with inputs of multi-modal imaging and non-imaging whole brain and network-based features. METHODS Late-life depression patients (medicated post-recruitment) (n = 33) and older non-depressed individuals (n = 35) were recruited. Their demographics and cognitive ability scores were recorded, and brain characteristics were acquired using multi-modal magnetic resonance imaging pretreatment. Linear and nonlinear learning methods were tested for estimating accurate prediction models. RESULTS A learning method called alternating decision trees estimated the most accurate prediction models for late-life depression diagnosis (87.27% accuracy) and treatment response (89.47% accuracy). The diagnosis model included measures of age, Mini-mental state examination score, and structural imaging (e.g. whole brain atrophy and global white mater hyperintensity burden). The treatment response model included measures of structural and functional connectivity. CONCLUSIONS Combinations of multi-modal imaging and/or non-imaging measures may help better predict late-life depression diagnosis and treatment response. As a preliminary observation, we speculate that the results may also suggest that different underlying brain characteristics defined by multi-modal imaging measures-rather than region-based differences-are associated with depression versus depression recovery because to our knowledge this is the first depression study to accurately predict both using the same approach. These findings may help better understand late-life depression and identify preliminary steps toward personalized late-life depression treatment.
Collapse
Affiliation(s)
- Meenal J Patel
- Department of Bioengineering, University of Pittsburgh, PA, USA
| | - Carmen Andreescu
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| | - Julie C Price
- Department of Radiology, University of Pittsburgh Medical Center, PA, USA
| | - Kathryn L Edelman
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
- Department of Neurology, University of Pittsburgh, PA, USA
- Department of Neuroscience, University of Pittsburgh, PA, USA
| | - Howard J Aizenstein
- Department of Bioengineering, University of Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh School of Medicine, PA, USA
| |
Collapse
|
30
|
A neuroradiologist's guide to arterial spin labeling MRI in clinical practice. Neuroradiology 2015; 57:1181-202. [PMID: 26351201 PMCID: PMC4648972 DOI: 10.1007/s00234-015-1571-z] [Citation(s) in RCA: 173] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/05/2015] [Indexed: 01/01/2023]
Abstract
Arterial spin labeling (ASL) is a non-invasive MRI technique to measure cerebral blood flow (CBF). This review provides a practical guide and overview of the clinical applications of ASL of the brain, as well its potential pitfalls. The technical and physiological background is also addressed. At present, main areas of interest are cerebrovascular disease, dementia and neuro-oncology. In cerebrovascular disease, ASL is of particular interest owing to its quantitative nature and its capability to determine cerebral arterial territories. In acute stroke, the source of the collateral blood supply in the penumbra may be visualised. In chronic cerebrovascular disease, the extent and severity of compromised cerebral perfusion can be visualised, which may be used to guide therapeutic or preventative intervention. ASL has potential for the detection and follow-up of arteriovenous malformations. In the workup of dementia patients, ASL is proposed as a diagnostic alternative to PET. It can easily be added to the routinely performed structural MRI examination. In patients with established Alzheimer’s disease and frontotemporal dementia, hypoperfusion patterns are seen that are similar to hypometabolism patterns seen with PET. Studies on ASL in brain tumour imaging indicate a high correlation between areas of increased CBF as measured with ASL and increased cerebral blood volume as measured with dynamic susceptibility contrast-enhanced perfusion imaging. Major advantages of ASL for brain tumour imaging are the fact that CBF measurements are not influenced by breakdown of the blood–brain barrier, as well as its quantitative nature, facilitating multicentre and longitudinal studies.
Collapse
|
31
|
Wang Y, Zhang H, Tang S, Liu X, O'Neil A, Turner A, Chai F, Chen F, Berk M. Assessing regional cerebral blood flow in depression using 320-slice computed tomography. PLoS One 2014; 9:e107735. [PMID: 25251476 PMCID: PMC4175469 DOI: 10.1371/journal.pone.0107735] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 08/15/2014] [Indexed: 12/17/2022] Open
Abstract
While there is evidence that the development and course of major depressive disorder (MDD) symptomatology is associated with vascular disease, and that there are changes in energy utilization in the disorder, the extent to which cerebral blood flow is changed in this condition is not clear. This study utilized a novel imaging technique previously used in coronary and stroke patients, 320-slice Computed-Tomography (CT), to assess regional cerebral blood flow (rCBF) in those with MDD and examine the pattern of regional cerebral perfusion. Thirty nine participants with depressive symptoms (Hamilton Depression Rating Scale 24 (HAMD24) score > 20, and Self-Rating Depression Scale (SDS) score > 53) and 41 healthy volunteers were studied. For all subjects, 3 ml of venous blood was collected to assess hematological parameters. Transcranial Doppler (TCD) ultrasound was utilized to measure parameters of cerebral artery rCBFV and analyse the Pulsatility Index (PI). 16 subjects (8 = MDD; 8 = healthy) also had rCBF measured in different cerebral artery regions using 320-slice CT. Differences among groups were analyzed using ANOVA and Pearson's tests were employed in our statistical analyses. Compared with the control group, whole blood viscosity (including high\middle\low shear rate)and hematocrit (HCT) were significantly increased in the MDD group. PI values in different cerebral artery regions and parameters of rCBFV in the cerebral arteries were decreased in depressive participants, and there was a positive relationship between rCBFV and the corresponding vascular rCBF in both gray and white matter. rCBF of the left gray matter was lower than that of the right in MDD. Major depression is characterized by a wide range of CBF impairments and prominent changes in gray matter blood flow. 320-slice CT appears to be a valid and promising tool for measuring rCBF, and could thus be employed in psychiatric settings for biomarker and treatment response purposes.
Collapse
Affiliation(s)
- Yiming Wang
- Department of Psychiatry, Hospital Affiliated to Guiyang Medical University, Guiyang, Guizhou, China
- * E-mail: (YW); (XL)
| | - Hongming Zhang
- Department of Cardiology, The General Hospital of Jinan Military Region, Jinan, China
| | - Songlin Tang
- Department of Psychiatry, Hospital Affiliated to Guiyang Medical University, Guiyang, Guizhou, China
- Department of Neurology, First People's Hospital of Shaoyang, Shaoyang, Hunan, China
| | - Xingde Liu
- Department of Cardiology, Hospital Affiliated to Guiyang Medical University, Guiyang City, Guizhou, China
- * E-mail: (YW); (XL)
| | - Adrienne O'Neil
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alyna Turner
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Fangxian Chai
- Department of Psychiatry, Hospital Affiliated to Guiyang Medical University, Guiyang, Guizhou, China
| | - Fanying Chen
- Mental Health Education And Counseling Center, Guiyang Medical University, Guiyang City, Guizhou, China
| | - Michael Berk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Psychiatry, The University of Melbourne, Parkville, Victoria, Australia
- Department of Psychiatry, Orygen Youth Health Research Centre, The University of Melbourne, Parkville, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
32
|
Lai CH, Wu YT, Yu PL, Yuan W. Improvements in white matter micro-structural integrity of right uncinate fasciculus and left fronto-occipital fasciculus of remitted first-episode medication-naïve panic disorder patients. J Affect Disord 2013; 150:330-6. [PMID: 23680435 DOI: 10.1016/j.jad.2013.04.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/10/2013] [Accepted: 04/10/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We designed this study to investigate neural correlates of white matter micro-structural integrity of remitted patients with first-episode, medication-naïve and very late-onset panic disorder. METHOD Twenty-one remitted patients with panic disorder completed treatment course with treatment of escitalopram (dose range around 10-15 mg/d). Twenty-one healthy controls were also enrolled into this study. Patients and controls all received 3-Tesla magnetic resonance imaging diffusion tensor imaging scanning at baseline and 6th week. We utilized FDT (FMRIB's Diffusion Toolbox v2.0) function of FSL (FMRIB Software Library) to calculate fractional anisotropy (FA). We compared FA values of patients and controls at baseline and 6th week to estimate the changes of FA of remitted patient group and inter-scan bias of controls. FA outputs of remitted patients and controls were compared by independent t test. RESULTS We found increased FA in some regions of right uncinate fasciculus and left fronoto-occipital fasciculus after remission in patient group (corrected p<0.05). Reduced FA of other regions of right uncinate fasciculus was still observed in remitted patients when they were compared to the control group. CONCLUSION Subtle changes of white matter micro-structural integrity after remission might represent neural correlates of treatment effects for first-episode, medication-naïve and very late-onset panic disorder.
Collapse
Affiliation(s)
- Chien-Han Lai
- Department of Psychiatry, Cheng Hsin General Hospital, No. 45, Cheng Hsin St., Pai-Tou Destrict, Taipei City, Taiwan, ROC.
| | | | | | | |
Collapse
|
33
|
Blood pressure regulation IX: cerebral autoregulation under blood pressure challenges. Eur J Appl Physiol 2013. [PMID: 23737006 DOI: 10.1007/s00421‐013‐2667‐y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cerebral autoregulation (CA) is integral to the delicate process of maintaining stable cerebral perfusion and brain tissue oxygenation against changes in arterial blood pressure. The last four decades has seen dramatic advances in understanding CA physiology, and the role that CA might play in the causation and progression of disease processes that affect the cerebral circulation such as stroke. However, the translation of these basic scientific advances into clinical practice has been limited by the maintenance of old constructs and because there are persistent gaps in our understanding of how this vital vascular mechanism should be quantified. In this review, we re-evaluate relevant studies that challenge established paradigms about how the cerebral perfusion pressure and blood flow are related. In the context of blood pressure being a major haemodynamic challenge to the cerebral circulation, we conclude that: (1) the physiological properties of CA remain inconclusive, (2) many extant methods for CA characterisation are based on simplistic assumptions that can give rise to misleading interpretations, and (3) robust evaluation of CA requires thorough consideration not only of active vasomotor function, but also the unique properties of the intracranial environment.
Collapse
|
34
|
Tzeng YC, Ainslie PN. Blood pressure regulation IX: cerebral autoregulation under blood pressure challenges. Eur J Appl Physiol 2013; 114:545-59. [PMID: 23737006 PMCID: PMC3929776 DOI: 10.1007/s00421-013-2667-y] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/21/2013] [Indexed: 12/11/2022]
Abstract
Cerebral autoregulation (CA) is integral to the delicate process of maintaining stable cerebral perfusion and brain tissue oxygenation against changes in arterial blood pressure. The last four decades has seen dramatic advances in understanding CA physiology, and the role that CA might play in the causation and progression of disease processes that affect the cerebral circulation such as stroke. However, the translation of these basic scientific advances into clinical practice has been limited by the maintenance of old constructs and because there are persistent gaps in our understanding of how this vital vascular mechanism should be quantified. In this review, we re-evaluate relevant studies that challenge established paradigms about how the cerebral perfusion pressure and blood flow are related. In the context of blood pressure being a major haemodynamic challenge to the cerebral circulation, we conclude that: (1) the physiological properties of CA remain inconclusive, (2) many extant methods for CA characterisation are based on simplistic assumptions that can give rise to misleading interpretations, and (3) robust evaluation of CA requires thorough consideration not only of active vasomotor function, but also the unique properties of the intracranial environment.
Collapse
Affiliation(s)
- Yu-Chieh Tzeng
- Cardiovascular Systems Laboratory, Centre for Translational Physiology, University of Otago, 23A Mein Street, PO Box 7343, Wellington South, New Zealand,
| | | |
Collapse
|
35
|
Tryambake D, He J, Firbank MJ, O'Brien JT, Blamire AM, Ford GA. Intensive blood pressure lowering increases cerebral blood flow in older subjects with hypertension. Hypertension 2013; 61:1309-15. [PMID: 23529166 DOI: 10.1161/hypertensionaha.112.200972] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hypertension is associated with reduced cerebral blood flow (CBF). Intensive (<130/80 mm Hg) blood pressure (BP) lowering in older people might give greater reduction in cardiovascular risk, but there are concerns that this might produce hypoperfusion which may precipitate falls and possibly stroke. We determined the effect of intensive compared with usual BP lowering on CBF in hypertensive older subjects. Individuals aged >70 years with a history of systolic hypertension on 1 or no BP lowering drugs were recruited from primary care (n=37; age, 75±4 years; systolic BP, >150 mm Hg) and randomized to receive intensive (target BP, <130/80 mm Hg) or usual (target BP, <140/85 mm Hg) BP lowering for 12 weeks, with reviews every 2 weeks. CBF, determined using 3T arterial spin labeling MRI, and 24-hour ambulatory BP were performed at baseline and after 12 weeks of treatment. Baseline BP (ambulatory or in clinic) and baseline gray matter CBF were not significantly different between the groups. After treatment, BP was reduced significantly in both groups but fell more in the intensive group (26/17 versus 15/5 mm Hg; P<0.01). Over the same period, gray matter CBF increased significantly in the intensive group (7±11 mL/min per 100 g; P=0.013) but was unchanged in the usual BP target group (-3±9 mL/min per 100 g; P=0.23); P<0.01 for comparison. Intensive BP lowering in older people with hypertension increases CBF, compared with BP lowering to usual target. These findings suggest hypertension in older people shifts the autoregulatory CBF curve rightward and downward and is reversible with BP lowering.
Collapse
Affiliation(s)
- Dinesh Tryambake
- Institute for Ageing and Health, Newcastle University, Stroke Research Group, Level 6, Leazes Wing, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK
| | | | | | | | | | | |
Collapse
|
36
|
Jellinger KA. Organic bases of late-life depression: a critical update. J Neural Transm (Vienna) 2013; 120:1109-25. [PMID: 23355089 DOI: 10.1007/s00702-012-0945-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 11/30/2012] [Indexed: 02/07/2023]
Abstract
Late-life depression (LLD) is frequently associated with cognitive impairment and increases the risk of subsequent dementia. Cerebrovascular disease, deep white matter lesions, Alzheimer disease (AD) and dementia with Lewy bodies (DLB) have all been hypothesized to contribute to this increased risk, and a host of studies have looked at the interplay between cerebrovascular disease and LLD. This has resulted in new concepts of LLD, such as "vascular depression", but despite multiple magnetic resonance imaging (MRI) studies in this field, the relationship between structural changes in human brain and LLD is still controversial. While pathological findings of suicide in some elderly persons revealed multiple lacunes, small vessel cerebrovascular disease, AD-related lesions or multiple neurodegenerative pathologies, recent autopsy data challenged the role of subcortical lacunes and white matter lesions as major morphological substrates of depressive symptoms as well as poorer executive function and memory. Several neuropathological studies, including a personal clinico-pathological study in a small cohort of elderly persons with LLD and age-matched controls confirmed that lacunes, periventricular and deep white matter demyelination as well as AD-related lesions are usually unrelated to the occurrence of LLD. In the same line, neuropathological data show that early-onset depression is not associated with an acceleration of age-related neurodegenerative changes. Very recent data on the critical role of glia-modulating neuronal dysfunction and degeneration in depression are discussed.
Collapse
Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Kenyongasse 18, 1070 Vienna, Austria.
| |
Collapse
|
37
|
Abstract
PURPOSE OF REVIEW This article reviews literature published over the period January 2011-June 2012 on biomarkers in major depression. RECENT FINDINGS Although a large body of research accumulated over the past decades points to distinct biological mechanisms being involved in the pathophysiology of major depressive disorder (MDD), its precise pathobiology is not yet fully understood. In the last 2 years, substantial new research has been generated in an attempt to identify and characterize novel candidate biomarkers for MDD. This review provides an update on biomarker research in MDD and summarizes the most recent results from neuroimaging, genetic, epigenetic, and neurochemical studies in MDD. SUMMARY Promising new findings report high diagnostic accuracy for metabonomic and epigenetic approaches as well as combinatorial functional neuroimaging approaches, which are currently representing the forefront of MDD biomarker development.
Collapse
|