Andreescu Carmen, Sheu Lei K, Tudorascu Dana, Gross James J, Walker Sarah, Banihashemi Layla, Aizenstein Howard
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Department of Psychology, University of Pittsburgh, Pittsburgh, PA.
Am J Geriatr Psychiatry. 2015 Feb;23(2):200-14. doi: 10.1016/j.jagp.2014.05.003. Epub 2014 May 17.
Generalized anxiety disorder (GAD) is one of the most prevalent mental disorders in the elderly, but its functional neuroanatomy is not well understood. Given the role of emotion dysregulation in GAD, we sought to describe the neural bases of emotion regulation in late-life GAD by analyzing the functional connectivity (FC) in the Salience Network and the Executive Control Network during worry induction and worry reappraisal.
The study included 28 elderly GAD and 31 non-anxious comparison participants. Twelve elderly GAD completed a 12-week pharmacotherapy trial. We used an in-scanner worry script that alternates blocks of worry induction and reappraisal. We assessed network FC, using the following seeds: anterior insula (AI), dorsolateral prefrontal cortex (dlPFC), the bed nucleus of stria terminalis (BNST), and the paraventricular nucleus (PVN).
GAD participants exhibited greater FC during worry induction between the left AI and the right orbitofrontal cortex, and between the BNST and the subgenual cingulate. During worry reappraisal, the non-anxious participants had greater FC between the left dlPFC and the medial PFC, as well as between the left AI and the medial PFC, and elderly GAD patients had greater FC between the PVN and the amygdala. Following 12 weeks of pharmacotherapy, GAD participants had greater connectivity between the dlPFC and several prefrontal regions during worry reappraisal.
FC during worry induction and reappraisal points toward abnormalities in both worry generation and worry reappraisal. Following successful pharmacologic treatment, we observed greater connectivity in the prefrontal nodes of the Executive Control Network during reappraisal of worry.
广泛性焦虑障碍（GAD）是老年人中最常见的精神障碍之一，但其功能性神经解剖学尚未得到充分了解。鉴于情绪调节障碍在GAD中的作用，我们试图通过分析在诱发担忧和重新评估担忧期间突显网络和执行控制网络中的功能连接（FC），来描述老年GAD患者情绪调节的神经基础。
该研究纳入了28名老年GAD患者和31名非焦虑对照参与者。12名老年GAD患者完成了为期12周的药物治疗试验。我们使用了一种扫描时的担忧脚本，该脚本交替进行诱发担忧和重新评估的阶段。我们使用以下种子点评估网络FC：前岛叶（AI）、背外侧前额叶皮质（dlPFC）、终纹床核（BNST）和室旁核（PVN）。
GAD参与者在诱发担忧期间，左侧AI与右侧眶额叶皮质之间以及BNST与膝下扣带回之间表现出更强的FC。在重新评估担忧期间，非焦虑参与者在左侧dlPFC与内侧前额叶皮质之间以及左侧AI与内侧前额叶皮质之间具有更强的FC，而老年GAD患者在PVN与杏仁核之间具有更强的FC。经过12周的药物治疗后，GAD参与者在重新评估担忧期间，dlPFC与几个前额叶区域之间的连接性更强。
诱发担忧和重新评估担忧期间的FC表明在担忧产生和担忧重新评估方面均存在异常。在成功进行药物治疗后，我们观察到在重新评估担忧期间执行控制网络的前额叶节点之间的连接性更强。
