静息态功能连接与老年期抑郁症的治疗反应。
Resting state functional connectivity and treatment response in late-life depression.
机构信息
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
出版信息
Psychiatry Res. 2013 Dec 30;214(3):313-21. doi: 10.1016/j.pscychresns.2013.08.007. Epub 2013 Oct 18.
Indices of functional connectivity in the default mode network (DMN) are promising neural markers of treatment response in late-life depression. We examined the differences in DMN functional connectivity between treatment-responsive and treatment-resistant depressed older adults. Forty-seven depressed older adults underwent MRI scanning pre- and post-pharmacotherapy. Forty-six never depressed older adults underwent MR scanning as comparison subjects. Treatment response was defined as achieving a Hamilton Depression Rating Scale of 10 or less post-treatment. We analyzed resting state functional connectivity using the posterior cingulate cortex as the seed region-of-interest. The resulting correlation maps were employed to investigate between-group differences. Additionally we examined the association between white matter hyperintensity burden and functional connectivity results. Comparison of pre- and post-treatment scans of depressed participants revealed greater post-treatment functional connectivity in the frontal precentral gyrus. Relative to treatment-responsive participants, treatment-resistant participants had increased functional connectivity in the left striatum. When adjusting for white matter hyperintensity burden, the observed differences lost significance for the PCC-prefrontal functional connectivity, but not for the PCC-striatum functional connectivity. The post-treatment "frontalization" of the DMN connectivity suggests a normalizing effect of antidepressant treatment. Moreover, our study confirms the central role of white matter lesions in disrupting brain functional connectivity.
静息态功能连接网络中默认模式网络(DMN)的各项指标是预测老年抑郁症患者药物治疗反应的有前途的神经学标志物。我们研究了药物治疗有效和无效的老年抑郁症患者 DMN 功能连接的差异。47 名老年抑郁症患者在药物治疗前后接受 MRI 扫描,46 名从未患过抑郁症的老年成年人作为对照进行 MRI 扫描。治疗反应的定义为治疗后汉密尔顿抑郁量表(Hamilton Depression Rating Scale)得分为 10 或更低。我们使用后扣带回皮层作为种子区域感兴趣区(ROI),分析静息状态功能连接。使用相关映射来研究组间差异。此外,我们还检查了脑白质高信号负荷与功能连接结果之间的关联。与治疗有效组相比,治疗无效组患者左侧纹状体的功能连接增加。调整脑白质高信号负荷后,后扣带回-额前叶功能连接的差异不再具有统计学意义,但后扣带回-纹状体功能连接的差异仍具有统计学意义。DMN 连接的这种治疗后“额叶化”提示抗抑郁治疗具有正常化效应。此外,我们的研究证实了脑白质病变在破坏脑功能连接中的核心作用。
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