Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic,3811 O’Hara Street, Pittsburgh, PA, USA.
Depress Anxiety. 2011 Mar;28(3):202-9. doi: 10.1002/da.20799.
Generalized anxiety disorder (GAD) is the most prevalent anxiety disorder among the elderly and has high functional and cognitive morbidity. However, late-life GAD is relatively understudied and its functional neuroanatomy is uncharted. Several imaging studies have suggested abnormalities in the cognitive control systems of emotion regulation in anxiety disorders in young adults. The aim of this study was to examine the neural correlates of emotion regulation in late-life GAD.
We compared 7 elderly GAD subjects and 10 elderly nonanxious comparison subjects using functional MRI. Regional cerebral blood flow (rCBF) was measured using pulsed arterial spin labeling perfusion MRI at rest and during an emotion regulation paradigm.
Relative to the rest condition, elderly nonanxious comparison subjects had increased rCBF during worry induction (WI) in the right insula, bilateral amygdala, and associative temporooccipital areas. Elderly GAD subjects had increased rCBF during WI in the associative temporooccipital areas, but not in the insula or the amygdala. During worry suppression (WS), elderly nonanxious comparison subjects had increased rCBF in the prefrontal cortex (PFC) and dorsal ACC. Elderly GAD subjects had no changes in rCBF during WS in the PFC.
When attempting to regulate their emotional responses, elderly anxious subjects failed to activate prefrontal regions involved in the downregulation of negative emotions. These results, showing that elderly anxious subjects are not effectively engaging the PFC in suppressing worry, may be clinically relevant for developing personalized therapeutic strategies for the treatment of late-life GAD.
广泛性焦虑障碍（GAD）是老年人中最常见的焦虑障碍，具有较高的功能和认知发病率。然而，老年 GAD 的研究相对较少，其功能神经解剖结构尚不清楚。几项影像学研究表明，在年轻成年人的焦虑障碍中，情绪调节的认知控制系统存在异常。本研究旨在探讨老年 GAD 患者情绪调节的神经相关性。
我们使用功能磁共振成像（fMRI）比较了 7 名老年 GAD 患者和 10 名老年非焦虑对照者。使用脉冲动脉自旋标记灌注 MRI 在静息状态和情绪调节范式下测量局部脑血流（rCBF）。
与静息状态相比，老年非焦虑对照组在担忧诱发（WI）期间右岛叶、双侧杏仁核和相关颞枕叶区域 rCBF 增加。老年 GAD 患者在 WI 期间 rCBF 增加，但在岛叶或杏仁核中没有增加。在担忧抑制（WS）期间，老年非焦虑对照组的前额叶皮层（PFC）和背侧 ACC 的 rCBF 增加。老年 GAD 患者在 WS 期间 PFC 中 rCBF 没有变化。
当试图调节情绪反应时，老年焦虑患者未能激活与下调负性情绪相关的前额叶区域。这些结果表明，老年焦虑患者在抑制担忧时不能有效地利用前额叶区域，这可能与开发针对老年 GAD 的个性化治疗策略具有临床相关性。
