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Kaczmarska M. Valuing embodiment: insights from dance practice among people living with dementia. Front Neurol 2023; 14:1174157. [PMID: 37342779 PMCID: PMC10277497 DOI: 10.3389/fneur.2023.1174157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/08/2023] [Indexed: 06/23/2023] Open
Abstract
There is a growing appreciation for the ability of person-centered arts-based approaches to extend multiple domains of brain health of people living with dementia. Dance is a multi-modal artistic engagement which has positive impacts on cognition, mobility and the emotional and social aspects of brain health. Although research into multiple domains of brain health among older adults and people living with dementia is promising, several gaps remain, specifically in understanding the benefits of co-creative and improvisational dance practices. Collaborative research between dancers, researchers, people living with dementia and care partners is needed to design and evaluate future research on dance and to determine relevance and usability. Furthermore, the respective praxes and experience of researchers, dance artists and people living with dementia contribute distinctly and uniquely to the identification and the assignment of value to dance in the context of the lives of people living with dementia. In this manuscript the author, a community-based dance artist, creative aging advocate and Atlantic Fellow for Equity in Brain Health, discusses current challenges and gaps in the understanding of the value of dance for and with people living with dementia and how transdisciplinary collaboration between neuroscientists, dance artists and people living with dementia can advance collective comprehension and implementation of dance practice.
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Affiliation(s)
- Magda Kaczmarska
- Global Brain Health Institute, San Francisco, CA, United States
- Foundation Dementia Action Alliance Poland, Sopot, Poland
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2
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Subramanian S, Oughli HA, Gebara MA, Palanca BJA, Lenze EJ. Treatment-Resistant Late-Life Depression: A Review of Clinical Features, Neuropsychology, Neurobiology, and Treatment. Psychiatr Clin North Am 2023; 46:371-389. [PMID: 37149351 DOI: 10.1016/j.psc.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Major depression is common in older adults (≥ 60 years of age), termed late-life depression (LLD). Up to 30% of these patients will have treatment-resistant late-life depression (TRLLD), defined as depression that persists despite two adequate antidepressant trials. TRLLD is challenging for clinicians, given several etiological factors (eg, neurocognitive conditions, medical comorbidities, anxiety, and sleep disruption). Proper assessment and management is critical, as individuals with TRLLD often present in medical settings and suffer from cognitive decline and other marks of accelerated aging. This article serves as an evidence-based guide for medical practitioners who encounter TRLLD in their practice.
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Affiliation(s)
- Subha Subramanian
- Department of Neurology, Berenson-Allen Center for Noninvasive Brain Stimulation, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
| | - Hanadi A Oughli
- Department of Psychiatry, Semel Institute for Neuroscience, University of California Los Angeles, Los Angeles, CA, USA
| | - Marie Anne Gebara
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ben Julian A Palanca
- Department of Anesthesiology, Washington University School of Medicine in St. Louis, St Louis, MO, USA; Department of Psychiatry, Washington University School of Medicine in St. Louis, St Louis, MO, USA; Division of Biology and Biomedical Sciences, Washington University School of Medicine in St. Louis; Department of Biomedical Engineering, Washington University in St. Louis, St Louis, MO, USA; Center on Biological Rhythms and Sleep, Washington University School of Medicine in St. Louis, USA; Neuroimaging Labs Research Center, Washington University School of Medicine in St. Louis, St Louis, MO, USA
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St Louis, MO, USA
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Wang ZY, Li MZ, Li WJ, Ouyang JF, Gou XJ, Huang Y. Mechanism of action of Daqinjiao decoction in treating cerebral small vessel disease explored using network pharmacology and molecular docking technology. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2023; 108:154538. [PMID: 36370638 DOI: 10.1016/j.phymed.2022.154538] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 10/14/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral small vessel disease (CSVD) is a clinically commonly-seen slow-progressing cerebral vascular disease. As a classic Chinese formula for the treatment of stroke, Daqinjiao Decoction (DQJD) is now used to treat CSVD with desirable effect. Since the mechanism of action is still unclear, this article will explore the therapeutic effect and mechanism of action of the formula using network pharmacology technology. METHODS The major chemical components and potential target genes of DQJD were screened by bioinformatics. The key targets in CSVD were identified based on network modules. Gene Ontology (GO) functional annotation and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed. Pharmacodynamics of the decoction was evaluated by establishing a rat model with bilateral common carotid artery occlusion in the brain. Molecular docking, Western blot analysis and quantitative real-time polymerase chain reaction (QRT-PCR) were performed to confirm the effectiveness of targets in related pathways. RESULTS Network pharmacology showed that 16 targets and 30 pathways were involved in the DQJD-targeted pathway network. Results revealed that DQJD might play a role by targeting the key targets including Caspse3 and P53 and regulating the P53 signaling pathway. Cognitive function and neuronal cell changes of rats were evaluated using Morris water maze, open field test and HE staining. It was indicated that DQJD could keep the nerve cells intact and neatly arranged. The decoction could improve the memory and learning ability of rats compared with the model group. It decreased the protein and mRNA expression levels of Caspse3 and P53 significantly (p<0.01). CONCLUSION The study shows that baicalein, quercetin and wogonin, the effective components of DQJD, may regulate multiple signaling pathways by targeting the targets like Caspse3 and P53 and treat CSVD by reducing the damage to brain nerve cells.
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Affiliation(s)
- Zhuo-Yuan Wang
- Central Laboratory, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai, Shanghai University of Traditional Chinese Medicine, Shanghai 201999, China
| | - Ming-Zhe Li
- Shanghai Research Institute of Acupuncture and Meridian, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200030, China
| | - Wen-Jie Li
- Experimental Research center, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Research of Chinese Medicine on Prevention and Treatment for Major Diseases, Beijing 100700, China
| | - Jing-Feng Ouyang
- Experimental Research center, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Research of Chinese Medicine on Prevention and Treatment for Major Diseases, Beijing 100700, China
| | - Xiao-Jun Gou
- Central Laboratory, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai, Shanghai University of Traditional Chinese Medicine, Shanghai 201999, China.
| | - Ying Huang
- Experimental Research center, China Academy of Chinese Medical Sciences, Beijing Key Laboratory of Research of Chinese Medicine on Prevention and Treatment for Major Diseases, Beijing 100700, China.
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Mio M, Grigorian A, Zou Y, Dimick MK, Selkirk B, Kertes P, McCrindle BW, Swardfager W, Hahn MK, Black SE, MacIntosh BJ, Goldstein BI. Neurovascular correlates of retinal microvascular caliber in adolescent bipolar disorder. J Affect Disord 2023; 320:81-90. [PMID: 36162693 DOI: 10.1016/j.jad.2022.09.082] [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] [Received: 12/14/2021] [Revised: 08/26/2022] [Accepted: 09/20/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The connection between vascular and brain metrics is well-studied in older adults, but neglected in youth and in psychiatric populations at increased cardiovascular risk. We therefore examined the association of retinal vascular caliber with cerebral blood flow (CBF) in adolescents with and without bipolar disorder (BD). METHODS Ninety-four adolescents (n = 48 BD, n = 46 controls) completed retinal fundus imaging, yielding estimates of arteriolar and venular diameter. Arterial spin labelling MRI was performed to measure CBF. We tested for associations between retinal vascular caliber and CBF in regions of interest; anterior cingulate cortex (ACC), middle frontal gyrus, and hippocampus in BD and controls separately. Complementary voxel-wise analyses were also performed. RESULTS In the BD group, higher arteriovenous ratio (AVR) was associated with greater ACC CBF (β = 0.34, puncorrected = 0.02), after controlling for age, sex, and BMI, however this finding did not survive correction for multiple comparisons. The control group did not show any associations (β = 0.13, puncorrected = 0.40). Voxel-wise analyses within the BD group detected a significant positive association between AVR and regional CBF in two distinct clusters: i) left hippocampus (p < 0.0001); ii) right middle temporal gyrus (p = 0.04). LIMITATIONS Limited sample size; young, medically healthy sample limits signal detection; cross-sectional design. CONCLUSION This study reveals that higher AVR is associated with higher regional CBF in adolescents with BD. Present findings advance understanding of potential neurofunctional mechanisms linking retinal vascular caliber with psychiatric diagnoses. This proof-of-concept study was designed to generate initial insights to guide future studies focusing on the vascular-brain connection in youth and in psychiatry.
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Affiliation(s)
- Megan Mio
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada.
| | - Anahit Grigorian
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada
| | - Yi Zou
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada
| | - Beth Selkirk
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada
| | - Peter Kertes
- John and Liz Tory Eye Centre, Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, Canada; University of Toronto, Ophthalmology and Vision Sciences, Toronto, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Canada; Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Walter Swardfager
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Department, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sandra E Black
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Bradley J MacIntosh
- Hurvitz Brain Sciences Research Program, Sunnybrook Health Sciences Centre, Toronto, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
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5
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Kim WSH, Dimick MK, Omrin D, Mitchell RHB, Riegert D, Levitt A, Schaffer A, Belo S, Iazzetta J, Detzler G, Choi M, Choi S, Herrmann N, McIntyre RS, MacIntosh BJ, Orser BA, Goldstein BI. Proof-of-concept randomized controlled trial of single-session nitrous oxide treatment for refractory bipolar depression: Focus on cerebrovascular target engagement. Bipolar Disord 2022; 25:221-232. [PMID: 36579458 DOI: 10.1111/bdi.13288] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND There remain few efficacious treatments for bipolar depression, which dominates the course of bipolar disorder (BD). Despite multiple studies reporting associations between depression and cerebral blood flow (CBF), little is known regarding CBF as a treatment target, or predictor and/or indicator of treatment response, in BD. Nitrous oxide, an anesthetic gas with vasoactive and putative antidepressant properties, has a long history as a neuroimaging probe. We undertook an experimental medicine paradigm, coupling in-scanner single-session nitrous oxide treatment of bipolar depression with repeated measures of CBF. METHODS In this double-blind randomized controlled trial, 25 adults with BD I/II and current treatment-refractory depression received either: (1) nitrous oxide (20 min at 25% concentration) plus intravenous saline (n = 12), or (2) medical air plus intravenous midazolam (2 mg total; n = 13). Study outcomes included changes in depression severity (Montgomery-Asberg Depression Rating Scale scores, primary) and changes in CBF (via arterial spin labeling magnetic resonance imaging). RESULTS There were no significant between-group differences in 24-h post-treatment MADRS change or treatment response. However, the nitrous oxide group had significantly greater same-day reductions in depression severity. Lower baseline regional CBF predicted greater 24-h post-treatment MADRS reductions with nitrous oxide but not midazolam. In region-of-interest and voxel-wise analyses, there was a pattern of regional CBF reductions following treatment with midazolam versus nitrous oxide. CONCLUSIONS Present findings, while tentative and based on secondary endpoints, suggest differential associations of nitrous oxide versus midazolam with bipolar depression severity and cerebral hemodynamics. Larger studies integrating neuroimaging targets and repeated nitrous oxide treatment sessions are warranted.
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Affiliation(s)
- William S H Kim
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mikaela K Dimick
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Danielle Omrin
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Rachel H B Mitchell
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Riegert
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anthony Levitt
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ayal Schaffer
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Susan Belo
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Iazzetta
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Mabel Choi
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Choi
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Herrmann
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Roger S McIntyre
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Ontario, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Beverley A Orser
- Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Benjamin I Goldstein
- Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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6
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Hakim A. Perspectives on the complex links between depression and dementia. Front Aging Neurosci 2022; 14:821866. [PMID: 36092800 PMCID: PMC9449721 DOI: 10.3389/fnagi.2022.821866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 08/05/2022] [Indexed: 12/04/2022] Open
Abstract
This review highlights that depression is a growing health problem for the individual, and because of its high frequency in most societies, a growing burden on health care budgets. The focus of the review is the physiological links between depression and dementia, specifically Alzheimer’s disease. It suggests that depression is a significant risk factor for cognitive decline and explores the pathways that may lead depressed individuals to suffer this outcome. This review shows that depression and a number of its precursors activate pro-inflammatory mediators. These lead to cerebral small vessel disease with the consequent reduction in cerebral blood flow, which is known to precede cognitive decline. Thus, the impact of depression on the physiological events that lead to dementia is identical to the impact of other dementia risk factors recently reviewed. Depression is distinct, however, in being a relatively treatable condition, but the impact of treating depression on later cognitive decline is not always positive, leading to the hypothesis that only the antidepressants that attenuate inflammation alleviate subsequent cognitive decline.
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Affiliation(s)
- Antoine Hakim
- Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada
- Division of Neurology, University of Ottawa, Ottawa, ON, Canada
- *Correspondence: Antoine Hakim,
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7
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Jellinger KA. The enigma of vascular depression in old age: a critical update. J Neural Transm (Vienna) 2022; 129:961-976. [PMID: 35705878 DOI: 10.1007/s00702-022-02521-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 05/22/2022] [Indexed: 12/14/2022]
Abstract
Depression is common in older individuals and is associated with high disability and increased mortality, yet the factors predicting late-life depression (LLD) are poorly understood. The relationship between of depressive disorder, age- and disease-related processes have generated pathogenic hypotheses and provided new treatment options. LLD syndrome is often related to a variety of vascular mechanisms, in particular hypertension, cerebral small vessel disease, white matter lesions, subcortical vascular impairment, and other processes (e.g., inflammation, neuroimmune regulatory dysmechanisms, neurodegenerative changes, amyloid accumulation) that may represent etiological factors by affecting frontolimbic and other neuronal networks predisposing to depression. The "vascular depression" hypothesis suggests that cerebrovascular disease (CVD) and vascular risk factors may predispose, induce or perpetuate geriatric depressive disorders. It is based on the presence of various cerebrovascular risk factors in many patients with LLD, its co-morbidity with cerebrovascular lesions, and the frequent development of depression after stroke. Other findings related to vascular depression are atrophy of the medial temporal cortex or generalized cortical atrophy that are usually associated with cognitive impairment. Other pathogenetic hypotheses of LLD, such as metabolic or inflammatory ones, are briefly discussed. Treatment planning should consider there may be a modest response to antidepressants, but several evidence-based and novel treatment options for LLD exist, such as electroconvulsive therapy, transcranial magnetic stimulation, neurobiology-based psychotherapy, as well as antihypertension and antiinflammatory drugs. However, their effectiveness needs further investigation, and new methodologies for prevention and treatment of depression in older individuals should be developed.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150, Vienna, Austria.
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8
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Transcranial Photobiomodulation Therapy for Sexual Dysfunction Associated with Depression or Induced by Antidepressant Medications. PHOTONICS 2022. [DOI: 10.3390/photonics9050330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sexual dysfunction (SD) is frequently encountered in patients suffering from depression. There is a bidirectional relationship between various types of SD and depression, so the presence or treatment of one condition may exacerbate or improve the other condition. The most frequent sexual problem in untreated depressed patients is declining sexual desire, while in treated depressed patients it is difficulties with erection/ejaculation and with orgasm. Numerous classes of neuropsychiatric medications, commonly used in depressed patients—such as antidepressant, antipsychotic, alpha sympathetic, and opioid drugs—may cause SD. Photobiomodulation (PBM) therapy, also called low-level light/laser therapy, is a novel neuromodulation technique for neuropsychiatric conditions, such as depression. Transcranial PBM (tPBM) targets the cellular metabolism—through the mitochondrial respiratory enzyme, cytochrome c oxidase—and has numerous cellular and physiological beneficial effects on the central nervous system. This paper represents a comprehensive review of the application of tPBM to SD, coexisting with depression or induced by antidepressant medications.
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9
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Liu M, He E, Fu X, Gong S, Han Y, Deng F. Cerebral blood flow self-regulation in depression. J Affect Disord 2022; 302:324-331. [PMID: 35032508 DOI: 10.1016/j.jad.2022.01.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Depression is a common neuropsychiatric disease with a high prevalence rate. Sleep problems, memory decline, dizziness and headaches are the most common neurological symptoms in depressed patients. Abnormality of cerebral blood flow (CBF) has been observed in depressive patients, but those patients did not have intracranial structural damage. Both of those phenomena might be related to cerebral blood flow self-regulation (CBFSR: cerebral blood flow self-regulation). CBFSR can maintain CBF relatively stable in response to changes in neurological and metabolic factors. Therefore, this review aimed to discuss CBFSR in depression. METHODS We searched for keywords such as "depression", "cerebral blood flow", "cerebral autoregulation", "cerebrovascular reactivity" and the words related to depression. We analyzed whether there is a change in the CBFSR in depression, further explored whether there is a relationship between the pathogenesis of depression and the CBFSR, and discussed the possible mechanism of impaired CBFSR in patients with depression. RESULTS Discovered by the literature review, CBFSR is significantly impaired in depressed patients. The level of circulating markers of endothelial dysfunction, nitric oxide, inflammatory cytokines, glucocorticoid and monoamine neurotransmitters is mostly abnormal in depression, which affected the CBFSR to varying degrees. LIMITATIONS Limitations include the small number of direct studies about depression and CBFSR mechanisms. CONCLUSION CBFSR is impaired in depression. The underlying mechanisms include endothelial dysfunction, overactivation of microglia and changes of cytokines, hyperactivation of the HPA axis, increased oxidative stress, monoamine neurotransmitter disorders, etc. These deepened our understanding of the clinical symptoms of depressed patients.
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Affiliation(s)
- Min Liu
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Enling He
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Xiyao Fu
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Sizhu Gong
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Yue Han
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China
| | - Fang Deng
- Department of Neurology, The First Hospital of Jilin University, No.1, Xinmin Street, Changchun, China.
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10
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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.
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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.
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11
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Jellinger KA. Pathomechanisms of Vascular Depression in Older Adults. Int J Mol Sci 2021; 23:ijms23010308. [PMID: 35008732 PMCID: PMC8745290 DOI: 10.3390/ijms23010308] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Depression in older individuals is a common complex mood disorder with high comorbidity of both psychiatric and physical diseases, associated with high disability, cognitive decline, and increased mortality The factors predicting the risk of late-life depression (LLD) are incompletely understood. The reciprocal relationship of depressive disorder and age- and disease-related processes has generated pathogenic hypotheses and provided various treatment options. The heterogeneity of depression complicates research into the underlying pathogenic cascade, and factors involved in LLD considerably differ from those involved in early life depression. Evidence suggests that a variety of vascular mechanisms, in particular cerebral small vessel disease, generalized microvascular, and endothelial dysfunction, as well as metabolic risk factors, including diabetes, and inflammation that may induce subcortical white and gray matter lesions by compromising fronto-limbic and other important neuronal networks, may contribute to the development of LLD. The "vascular depression" hypothesis postulates that cerebrovascular disease or vascular risk factors can predispose, precipitate, and perpetuate geriatric depression syndromes, based on their comorbidity with cerebrovascular lesions and the frequent development of depression after stroke. Vascular burden is associated with cognitive deficits and a specific form of LLD, vascular depression, which is marked by decreased white matter integrity, executive dysfunction, functional disability, and poorer response to antidepressive therapy than major depressive disorder without vascular risk factors. Other pathogenic factors of LLD, such as neurodegeneration or neuroimmune regulatory dysmechanisms, are briefly discussed. Treatment planning should consider a modest response of LLD to antidepressants, while vascular and metabolic factors may provide promising targets for its successful prevention and treatment. However, their effectiveness needs further investigation, and intervention studies are needed to assess which interventions are appropriate and effective in clinical practice.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, 1150 Vienna, Austria
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12
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Baek JH, Shin DW, Fava M, Mischoulon D, Kim H, Park MJ, Kim EJ, Han KD, Jeon HJ. Increased metabolic variability is associated with newly diagnosed depression: A nationwide cohort study. J Affect Disord 2021; 294:786-793. [PMID: 34375203 DOI: 10.1016/j.jad.2021.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The effect of dynamic changes in metabolic parameters over time on the development of depression has yet to be examined. In this study, we aimed to determine the association between the variability of metabolic parameters and the development of depression using nationally representative data. METHODS We used health examination data provided by the South Korean National Health Insurance System (NHIS) and included those who underwent the examination ≥ 3 times within five years of enrollment, without a previous history of depression (n = 9,058,424). The variability of each metabolic parameter including weight circumference, blood pressure, fasting blood glucose, high-density lipoprotein cholesterol, and triglyceride levels was estimated using variability independent of mean (VIM) indices. High variability was defined as the highest quartile (Q4) of variability. RESULTS Each metabolic parameter with high variability was associated with a higher risk of newly diagnosed depression compared to those with low variability, after adjusting for age, sex, smoking, alcohol drinking, regular exercise, income status, baseline diabetes, hypertension, and dyslipidemia. As the number of highly variable metabolic parameters increased, the risk for newly diagnosed depression increased even after adjusting for the aforementioned covariates (hazard ratio (HR) = 1.4, 95% confidence interval (CI): 1.3 - 1.4 in those with five highly variable parameters compared to those with no highly variable parameter). LIMITATIONS relatively short observation period; no systematic measure of depression severity. CONCLUSIONS Our results suggest that the variability of metabolic parameters is an independent risk factor for depression.
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Affiliation(s)
- Ji Hyun Baek
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Hyewon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Jin Park
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Ji Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.
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13
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Zanardi R, Poletti S, Prestifilippo D, Attanasio F, Barbini B, Colombo C. Transcranial direct current stimulation: A novel approach in the treatment of vascular depression. Brain Stimul 2020; 13:1559-1565. [PMID: 32896644 DOI: 10.1016/j.brs.2020.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Despite the impact of depression in terms of personal suffering and socioeconomic burden, most currently available treatment options are often ineffective. A particularly difficult-to-treat depressive disorder characteristic of the elderly is vascular depression, a late-life depressive syndrome related to a variety of potential vascular mechanisms. Transcranial Direct Current Stimulation (tDCS), a non-invasive and effective somatic approach to depression, also showed positive effects on cognitive deficits. AIM We performed a double-blind randomized study to investigate the efficacy of tDCS as augmentation strategy to sertraline in the treatment of vascular depression, hypothesizing a positive effect in both depressive symptoms and cognitive functions. METHODS We enrolled 93 inpatients over 60 years of age with a diagnosis of vascular depression. Depressive symptoms were weekly assessed (T0, T1, T2) with the 21-items Hamilton depression rating scale (HDRS). Cognitive functioning was evaluated with the Milan Overall Dementia Assessment (MODA) at baseline and after the treatment protocol. All patients were randomly assigned into three groups, Group I: one tDCS stimulation per day, Group II: two tDCS stimulations per day, Sham group: one sham tDCS stimulation per day. Stimulation was performed for 10 consecutive working days. RESULTS A significant interaction time∗treatment was observed on HDRS scores (F = 14, p < 0.001). All groups improved at T1 but whereas Group II significantly differed from the Sham group (p < 0.001) we observed no difference between Sham and Group I. At T2 all groups improved but Group II showed the greater improvement (vs. Sham p < 0.001; vs. Group I p < 0.001) and the Sham group the smallest (vs. Group I p = 0.005). A significant interaction time∗treatment was also observed on MODA scores (F = 3.31, p = 0.04). Only subjects treated with tDCS improved at T2 (Group I: p < 0.001; Group II: p = 0.007). However, no difference between Group I and II was shown. CONCLUSION tDCS as augmentation treatment of an adequate pharmacotherapy is a potential strategy in the management of vascular depression, a disease known to be often unresponsive to antidepressants only. Non-invasiveness, the absence of severe side effects and the possibility of administering it to outpatients at an affordable price make tDCS an important tool in clinical practice.
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Affiliation(s)
- Raffaella Zanardi
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Mood Disorder Unit, Milan, Italy; University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy.
| | - Sara Poletti
- University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
| | - Dario Prestifilippo
- University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
| | - Francesco Attanasio
- University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
| | - Barbara Barbini
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Mood Disorder Unit, Milan, Italy; University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
| | - Cristina Colombo
- IRCCS San Raffaele Scientific Institute, Department of Clinical Neurosciences, Mood Disorder Unit, Milan, Italy; University Vita-Salute San Raffaele, Department of Clinical Neurosciences, Milan, Italy
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14
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Sahib AK, Loureiro JRA, Vasavada MM, Kubicki A, Joshi SH, Wang K, Woods RP, Congdon E, Wang DJJ, Boucher ML, Espinoza R, Narr KL. Single and repeated ketamine treatment induces perfusion changes in sensory and limbic networks in major depressive disorder. Eur Neuropsychopharmacol 2020; 33:89-100. [PMID: 32061453 PMCID: PMC8869841 DOI: 10.1016/j.euroneuro.2020.01.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/10/2020] [Accepted: 01/26/2020] [Indexed: 12/15/2022]
Abstract
Ketamine infusion therapy can produce fast-acting antidepressant effects in patients with major depressive disorder (MDD). Yet, how single and repeated ketamine treatment induces brain systems-level neuroplasticity underlying symptom improvement is unknown. Advanced multiband imaging (MB) pseudo-continuous arterial spin labeling (pCASL) perfusion MRI data was acquired from patients with treatment resistant depression (TRD) (N = 22, mean age=35.2 ± 9.95 SD, 27% female) at baseline, and 24 h after receiving single, and four subanesthetic (0.5 mg/kg) intravenous ketamine infusions. Changes in global and regional CBF were compared across time points, and relationships with overall mood, anhedonia and apathy were examined. Comparisons between patients at baseline and controls (N = 18, mean age=36.11 ± 14.5 SD, 57% female) established normalization of treatment effects. Results showed increased regional CBF in the cingulate and primary and higher-order visual association regions after first ketamine treatment. Baseline CBF in the fusiform, and acute changes in CBF in visual areas were related to symptom improvement after single and repeated ketamine treatment, respectively. In contrast, after serial infusion therapy, decreases in regional CBF were observed in the bilateral hippocampus and right insula with ketamine treatment. Findings demonstrate that neurophysiological changes occurring with single and repeated ketamine treatment follow both a regional and temporal pattern including sensory and limbic regions. Initial changes are observed in the posterior cingulate and precuneus and primary and higher-order visual areas, which relate to clinical responses. However, repeated exposure to ketamine, though not relating to clinical outcome, appears to engage deeper limbic structures and insula. ClinicalTrials.gov: Biomarkers of Fast Acting Therapies in Major Depression, https://clinicaltrials.gov/ct2/show/NCT02165449, NCT02165449.
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Affiliation(s)
- Ashish K Sahib
- Department of Neurology, Ahamason-Lovelace Brain Mapping Center, United States
| | - Joana R A Loureiro
- Department of Neurology, Ahamason-Lovelace Brain Mapping Center, United States
| | - Megha M Vasavada
- Department of Neurology, Ahamason-Lovelace Brain Mapping Center, United States
| | - Antoni Kubicki
- Department of Neurology, Ahamason-Lovelace Brain Mapping Center, United States
| | - Shantanu H Joshi
- Department of Neurology, Ahamason-Lovelace Brain Mapping Center, United States
| | - Kai Wang
- Laboratory of FMRI Technology (LOFT), Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Roger P Woods
- Department of Neurology, Ahamason-Lovelace Brain Mapping Center, United States
| | - Eliza Congdon
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 635 Charles E Young Drive South Suite, Los Angeles, CA 90095-7334, United States
| | - Danny J J Wang
- Laboratory of FMRI Technology (LOFT), Stevens Neuroimaging and Informatics Institute, University of Southern California, Los Angeles, CA, United States
| | - Michael L Boucher
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 635 Charles E Young Drive South Suite, Los Angeles, CA 90095-7334, United States
| | - Randall Espinoza
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 635 Charles E Young Drive South Suite, Los Angeles, CA 90095-7334, United States
| | - Katherine L Narr
- Department of Neurology, Ahamason-Lovelace Brain Mapping Center, United States; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, 635 Charles E Young Drive South Suite, Los Angeles, CA 90095-7334, United States.
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