Age of onset of obsessive-compulsive disorder differentially affects white matter microstructure

Previous diffusion MRI studies have reported mixed findings on white matter microstructure alterations in obsessive-compulsive disorder (OCD), likely due to variation in demographic and clinical characteristics, scanning methods, and underpowered samples. The OCD global study was created across five international sites to overcome these challenges by harmonizing data collection to identify consistent brain signatures of OCD that are reproducible and generalizable. Single-shell diffusion measures (e.g., fractional anisotropy), multi-shell Neurite Orientation Dispersion and Density Imaging (NODDI) and fixel-based measures, were extracted from skeletonized white matter tracts in 260 medication-free adults with OCD and 252 healthy controls. We additionally performed structural connectome analysis. We compared cases with controls and cases with early (<18) versus late (18+) OCD onset using mixed-model and Bayesian multilevel analysis. Compared with healthy controls, adult OCD individuals showed higher fiber density in the sagittal stratum (B[SE] = 0.10[0.05], P = 0.04) and credible evidence for higher fiber density in several other tracts. When comparing early (n = 145) and late-onset (n = 114) cases, converging evidence showed lower integrity of the posterior thalamic radiation -particularly radial diffusivity (B[SE] = 0.28[0.12], P = 0.03)-and lower global efficiency of the structural connectome (B[SE] = 15.3[6.6], P = 0.03) in late-onset cases. Post-hoc analyses indicated divergent direction of effects of the two OCD groups compared to healthy controls. Age of OCD onset differentially affects the integrity of thalamo-parietal/occipital tracts and the efficiency of the structural brain network. These results lend further support for the role of the thalamus and its afferent fibers and visual attentional processes in the pathophysiology of OCD.

Global multi-center and multi-modal magnetic resonance imaging study of obsessive-compulsive disorder: Harmonization and monitoring of protocols in healthy volunteers and phantoms

OBJECTIVES

We describe the harmonized MRI acquisition and quality assessment of an ongoing global OCD study, with the aim to translate representative, well-powered neuroimaging findings in neuropsychiatric research to worldwide populations.

METHODS

We report on T1-weighted structural MRI, resting-state functional MRI, and multi-shell diffusion-weighted imaging of 140 healthy participants (28 per site), two traveling controls, and regular phantom scans.

RESULTS

Human image quality measures (IQMs) and outcome measures showed smaller within-site variation than between-site variation. Outcome measures were less variable than IQMs, especially for the traveling controls. Phantom IQMs were stable regarding geometry, SNR, and mean diffusivity, while fMRI fluctuation was more variable between sites.

CONCLUSIONS

Variation in IQMs persists, even for an a priori harmonized data acquisition protocol, but after pre-processing they have less of an impact on the outcome measures. Continuous monitoring IQMs per site is valuable to detect potential artifacts and outliers. The inclusion of both cases and healthy participants at each site remains mandatory.

Exercise modifies hypothalamic connectivity and brain functional networks in women after bariatric surgery: a randomized clinical trial

BACKGROUND

Obesity is a disease that may involve disrupted connectivity of brain networks. Bariatric surgery is an effective treatment for obesity, and the positive effects on obesity-related conditions may be enhanced by exercise. Herein, we aimed to investigate the possible synergistic effects of Roux-en-Y Gastric Bypass (RYGB) and exercise training on brain functional networks.

METHODS

Thirty women eligible for bariatric surgery were randomly assigned to a Roux-en-Y gastric bypass (RYGB: n = 15, age = 41.0 ± 7.3 years) or RYGB plus Exercise Training (RYGB + ET: n = 15, age = 41.9 ± 7.2 years). Clinical, laboratory, and brain functional connectivity parameters were assessed at baseline, and 3 (POST3) and 9 months (POST9) after surgery. The 6-month, three-times-a-week, exercise intervention (resistance plus aerobic exercise) was initiated 3 months post-surgery (for RYGB + ET).

RESULTS

Exercise superimposed on bariatric surgery (RYGB + ET) increased connectivity between hypothalamus and sensorial regions (seed-to-voxel analyses of hypothalamic connectivity), and decreased default mode network (DMN) and posterior salience (pSAL) network connectivity (ROI-to-ROI analyses of brain networks connectivity) when compared to RYGB alone (all p-FDR < 0.05). Increases in basal ganglia (BG) network connectivity were only observed in the exercised training group (within-group analyses).

CONCLUSION

Exercise training is an important component in the management of post-bariatric patients and may improve the hypothalamic connectivity and brain functional networks that are involved in controlling food intake.

TRIAL REGISTRATION

Clinicaltrial.gov: NCT02441361.

Lower Ventromedial Prefrontal Cortex Glutamate Levels in Patients With Obsessive-Compulsive Disorder

Background: Recent studies using magnetic resonance spectroscopy (¹H-MRS) indicate that patients with obsessive-compulsive disorder (OCD) present abnormal levels of glutamate (Glu) and gamma aminobutyric acid (GABA) in the frontal and striatal regions of the brain. These abnormalities could be related to the hyperactivation observed in cortico-striatal circuits of patients with OCD. However, most of the previous ¹H-MRS studies were not capable of differentiating the signal from metabolites that overlap in the spectrum, such as Glu and glutamine (Gln), and referred to the detected signal as the composite measure-Glx (sum of Glu and Gln). In this study, we used a two-dimensional JPRESS ¹H-MRS sequence that allows the discrimination of overlapping metabolites by observing the differences in J-coupling, leading to higher accuracy in the quantification of all metabolites. Our objective was to identify possible alterations in the neurometabolism of OCD, focusing on Glu and GABA, which are key neurotransmitters in the brain that could provide insights into the underlying neurochemistry of a putative excitatory/inhibitory imbalance. Secondary analysis was performed including metabolites such as Gln, creatine (Cr), N-acetylaspartate, glutathione, choline, lactate, and myo-inositol. Methods: Fifty-nine patients with OCD and 42 healthy controls (HCs) underwent 3T ¹H-MRS in the ventromedial prefrontal cortex (vmPFC, 30 × 25 × 25 mm³). Metabolites were quantified using ProFit (version 2.0) and Cr as a reference. Furthermore, Glu/GABA and Glu/Gln ratios were calculated. Generalized linear models (GLMs) were conducted using each metabolite as a dependent variable and age, sex, and gray matter fraction (fGM) as confounding factors. GLM analysis was also used to test for associations between clinical symptoms and neurometabolites. Results: The GLM analysis indicated lower levels of Glu/Cr in patients with OCD (z = 2.540; p = 0.011). No other comparisons reached significant differences between groups for all the metabolites studied. No associations between metabolites and clinical symptoms were detected. Conclusions: The decreased Glu/Cr concentrations in the vmPFC of patients with OCD indicate a neurochemical imbalance in the excitatory neurotransmission that could be associated with the neurobiology of the disease and may be relevant for the pathophysiology of OCD.

Toward identifying reproducible brain signatures of obsessive-compulsive profiles: rationale and methods for a new global initiative

BACKGROUND

Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results.

METHODS

We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations.

DISCUSSION

Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it.

Chronic traumatic encephalopathy – a study in Brazilian retired soccer players

Objective

Evaluate the neurological, neuopsychological and electroencephalogram (EEG) findings in a cohort of retired soccer players.

Background

Chronic traumatic encephalopathy (CTE) is considered to be a consequence of exposure to repeated head traumas, but evidence suggests that a single moderate or severe traumatic brain injury can also induce progressive neuropathological changes.

Design/Methods

Prospective observational study that evaluated 26 retired soccer players and 14 controls. The retired athletes and controls were submitted to neurological evaluation, neuropsychological evaluation and EEG.

Results

In general, the soccer players performed well in tests, within the normal range. 15 soccer players had a history of previous TBI/concussion. In the retired group the average age was 60.4 years (55.7 in the CG), average of 11.7 schooling years (13.7 in the CG). The average results in MMSE was 26.6 (29 in the CG), the average digit span in backwards was 3.1 (3.8 in the CG), the average verbal fluency for animals was 15.6 (24 in the CG) and the average clock-drawing test was 8.96 (9 in the CG). Visual EEG analysis showed a predominance of posterior alpha activity between 9.0 and 12.0 Hz (mean 10.3 Hz) in the soccer participants and 11 Hz in the control group (CG). The analysis wiht low resolution electromagnetic tomography (LORETA) showed that 11 soccer players had hippocampal asymmetry (5 had less activity in the right hippocampus and 6 had less activity in the left hippocampus).

Conclusions

Although the performance of the athletes in the tests was within the normal range, the means were always inferior to those of the controls. Almost half of the players presented asymmetry in the analysis by LORETA, although visual EEG analysis was normal. This may indicate that EEG changes may be earlier and more sensitive than clinical changes. These data are preliminary and further analysis are needed.

Behavioral and neurochemical effects induced by chronic L-DOPA administration

L-DOPA, in combination with benserazide, in the ratio 4:1 (w/w), was administered orally to rats. In the staircase maze test a low dose of L-DOPA (3 mg/kg/day) reduced the increase in errors caused by 20 days interruption of daily training, while a higher dose (30 mg/kg/day) was ineffective. A decrease in levels of dopamine in the olfactory system and DOPAC in the striatum was seen at all tested doses of L-DOPA, while an increase in 5-HT levels was seen in the hippocampus and in the striatum. 5-HIAA levels did not change. Levels of ACh in the olfactory system were reduced at all doses of L-DOPA, while in the hippocampus this effect was seen only at the dose of 90 mg/kg/day. The density of muscarinic receptors was not altered. All tested doses of L-DOPA caused norepinephrine levels to fall in the hippocampus and increase in the striatum. The density of alpha 1-adrenoceptors was reduced only at the two lower doses of L-DOPA. A comparison of the neurochemical results with the behavioral modifications seen in the staircase maze test suggests that the catecolaminergic systems are implicated in the memory process.

Habituation of exploratory activity in rats: action of N6phenylisopropyladenosine, caffeine and their combination

1. L-PIA (0.2 mg/kg), caffeine (15 mg/kg) and their combination were given subcutaneously to rats tested in open field. 2. The acute administration of L-PIA reduced ambulation. Caffeine alone was ineffective but increased ambulation in combination with L-PIA. These effects may have been determined by an interaction of L-PIA and caffeine on adenosine receptors. 3. Tolerance to L-PIA was observed after a chronic administration (20 days). The chronic administration of caffeine alone or in combination with L-PIA increased ambulation. 4. In the habituation test the reduction of ambulation in the 3 successive trials was increased by L-PIA. Caffeine did not antagonize the L-PIA effect and, in part, had the same effect. These results suggest that L-PIA and, in part, caffeine improve memory consolidation in open field, and do not support the notion that L-PIA and caffeine action on memory processes is due to an interference on adenosine receptors.

The action of arecoline on retrieval and memory storage evaluated in the staircase maze

Rats were trained to run on a staircase stopping on the 3rd, 6th, 9th, and 12th steps (correct responses). Stopping on any other step was considered an error. Acute administration of 0.5 mg/kg of arecoline 15 min before the trial improved behavior and 3.5 mg/kg of arecoline caused a reduction of correct responses. An interruption of the daily training for 20 days caused a 15% reduction of correct responses in control animals. Chronic administration of arecoline during the first 15 days of a no-training period caused an increase of errors only at 3.5 and 8 mg/kg/day. The interpretation of these results is that arecoline improves the retrieval process and accelerates the spontaneous decay of memory. The increase of correct responses after the acute administration of 0.5 mg/kg of arecoline was not evident in rats treated for 15 days with arecoline 6.5 mg/kg/day. These results suggest that arecoline improves retrieval only in the absence of tolerance development.

Action of caffeine, L-PIA and their combination on memory retention in the rat

Rats were trained to run in a staircase and to stop on the 3rd, 6th, 9th and 12th steps. The increase of errors (arrest on any other step) after 2O days of interruption of the daily training was evaluated after a chronic administration (15 days) of L-PIA (N6-(L-phenylisopro-pyl)adenosine) 1 mg/kg/day; caffeine 15,45,8O mg/kg/day and of the combination of L-PIA 1 mg/kg/day with 15, 45 and 80 mg/kg/day of caffeine. In the controls and after caffeine administration, the interruption of the daily training caused a reduction of correct responses. After L-PIA alone or in combination with caffeine there was no reduction of correct responses after 2O days of no daily training. These results indicate that in the behavioral situation of our experiments there was no antagonism between caffeine and L-PIA.

Action of chronic choline administration on behavior and on cholinergic and noradrenergic systems

Chronic administration of low doses (0.2-0.8 g/kg/day) of choline caused in the rat an increase of errors evaluated in the staircase maze after 20 days of interruption of daily training. An analogous pharmacological treatment caused no modification of the acetylcholine (ACh) and norepinephrine (NE) levels and no consistent modification of the density of muscarinic and alpha 1-adrenergic receptors. Only at higher doses (2.5 g/kg/day) did chronic administration (20 days) of choline cause in several sections of the CNS, an increase of ACh and NE levels and of the muscarinic receptor density. These observations indicate that only at high doses of choline are there consistent modifications of the central cholinergic systems, suggesting that the behavioral modifications observed at low doses of choline are not determined by an upregulation of the central cholinergic system.