Department of Psychiatry and Clinical Neurosciences, Special Services Building, Room AW 258A, 1403 –29th Street NW, Calgary, Alberta, T2N 2T9, Canada.
Neuropsychiatr Dis Treat. 2008 Dec;4(6):1251-66. doi: 10.2147/ndt.s4246.
Methylphenidate (MP) is a dopamine- and noradrenaline-enhancing agent beneficial for post-stroke depression (PSD) and stroke recovery due to its therapeutic effects on cognition, motivation, and mood; however, the neural mechanisms underlying its clinical effects remain unknown. This study used functional magnetic resonance imaging (f MRI) to investigate the effect of MP on brain activity in response to cognitive tasks in patients with PSD.
Nine stroke outpatients with DSM IV defined major depression underwent fMRI during two cognitive tasks (2-back and serial subtraction) on four occasions, on the first and third day of a three-day treatment of MP and placebo. Nine healthy control (HC) subjects matched for age and sex scanned during a single session served as normative data for comparison. The main outcome measure was cognitive task-dependent brain activity.
For the 2-back task, left prefrontal, right parietal, posterior cingulate, and temporal and bilateral cerebellar regions exhibited significantly greater activity during the MP condition relative to placebo. Less activity was detected in rostral prefrontal and left parietal regions. For serial subtraction, greater activity was detected in medial prefrontal, biparietal, bitemporal, posterior cingulate, and bilateral cerebellar regions, as well as thalamus, putamen, and insula. Further, underactivation observed during the placebo condition relative to HC improved or reversed during MP treatment. No significant differences in behavioral measures were found between MP and placebo conditions or between patients and HC.
Short-term MP treatment may improve and normalize activity in cognitive neuronal networks in patients with PSD.
哌醋甲酯（MP）是一种多巴胺和去甲肾上腺素增强剂，对认知、动机和情绪有治疗作用，有益于治疗中风后抑郁（PSD）和中风恢复；但其临床疗效的神经机制尚不清楚。本研究采用功能磁共振成像（fMRI）研究 MP 对 PSD 患者认知任务反应时大脑活动的影响。
9 名符合 DSM-IV 定义的重性抑郁障碍的中风门诊患者，在服用 MP 和安慰剂的三天治疗的第一天和第三天进行了两次认知任务（2 次回扫和串行减法）的 fMRI 扫描，共 4 次。9 名年龄和性别相匹配的健康对照（HC）患者在单次扫描中作为标准数据进行比较。主要观察指标是认知任务相关的大脑活动。
对于 2 次回扫任务，MP 条件下左前额叶、右顶叶、后扣带回和颞叶以及双侧小脑区域的活动明显大于安慰剂。在前额叶和顶叶区域发现了较少的活动。对于串行减法，内侧前额叶、双侧顶叶、双侧颞叶、后扣带回和双侧小脑区域以及丘脑、壳核和脑岛的活动增加。此外，在安慰剂条件下相对于 HC 观察到的活动减少在 MP 治疗期间得到改善或逆转。在 MP 和安慰剂条件之间或患者和 HC 之间，行为测量没有发现显著差异。
短期 MP 治疗可能改善和正常化 PSD 患者的认知神经网络活动。
