School of Psychology, Nanjing Normal University, Nanjing 210097, China.
Mood Disorders Department, Nanjing Brain Hospital, Nanjing Medical University, Nanjing 210029, China.
J Affect Disord. 2015 Sep 1;183:49-56. doi: 10.1016/j.jad.2015.04.052. Epub 2015 May 8.
BACKGROUND: Convergent studies have highlighted the dysfunction of default mode network (DMN) in major depressive disorder (MDD). The altered connectivity in posterior cingulate cortex (PCC) and medial prefrontal cortex (mPFC) was especially found to be of interest in the resting state functional connectivity analysis. Recently, more attention has turned to the internal functional connectivity within the DMN. However, the internal connection patterns within the DMN remain unclear at the initial onset of MDD. METHODS: Resting-state fMRI was performed on 38 first-episode, treatment-naïve MDD patients along with 38 matched healthy controls. Seed-based analysis was used to define the DMN and then a region-to-region connectivity analysis was performed to inspect the functional connectivity within the DMN. Spearman׳s rank correlation analysis was performed between significantly abnormal connectivities in MDD patients and clinical measurements. RESULTS: Decreased region-to-region connectivities within DMN were found between the PCC and dorsal medial prefrontal cortex (dmPFC), between PCC and the right inferior parietal gyrus/angular, as well as between the left thalamus and cerebellar tonsil. No significant increase in connectivity was found. Moreover, functional connectivity between the left thalamus and cerebellar tonsil revealed a marginal significant negative correlation with clinical Hamilton Depression Rating Scale (HDRS) scores. LIMITATIONS: Noteworthiness in morbidity, a high risk of mortality, and a high rate of medical service utilization of MDD make the current results uncertain to apply to the more complicated situations. CONCLUSIONS: Each region within DMN may have a specific, individual functional role. The reason to identify the pathological mechanism of MDD may not lie in the abnormal DMN functional connectivity, but rather in the abnormal functional connectivity within DMN.
背景:汇聚性研究强调了在重度抑郁症(MDD)中默认模式网络(DMN)的功能障碍。在后扣带皮层(PCC)和内侧前额叶皮层(mPFC)中发现的连接改变,尤其是在静息状态功能连接分析中,尤其受到关注。最近,更多的注意力转向了 DMN 内部的功能连接。然而,在 MDD 的初始发作时,DMN 内部的连接模式仍不清楚。
方法:对 38 名首次发作、未经治疗的 MDD 患者和 38 名匹配的健康对照组进行静息态 fMRI 检查。采用种子点分析法定义 DMN,然后进行区域间连接分析,以检查 DMN 内部的功能连接。对 MDD 患者异常连接与临床测量之间的相关性进行 Spearman 秩相关分析。
结果:发现 DMN 内的区域间连接性降低,包括 PCC 与背内侧前额叶皮层(dmPFC)之间、PCC 与右顶下小叶/角之间以及左丘脑与小脑扁桃体之间。未发现明显的连接性增加。此外,左丘脑与小脑扁桃体之间的功能连接与临床汉密尔顿抑郁评定量表(HDRS)评分呈边缘显著负相关。
局限性:MDD 的发病率、高死亡率和高医疗服务利用率,使得当前的结果不确定是否适用于更复杂的情况。
结论:DMN 内的每个区域可能具有特定的、个体的功能作用。识别 MDD 病理机制的原因可能不在于 DMN 功能连接的异常,而在于 DMN 内的功能连接异常。
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