Agudelo Christian, Aizenstein Howard J, Karp Jordan F, Reynolds Charles F
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Dialogues Clin Neurosci. 2015 Jun;17(2):151-69. doi: 10.31887/DCNS.2015.17.2/cagudelo.
Late-life depression (LLD) is a growing public and global health concern with diverse clinical manifestations and etiology. This literature review summarizes neuroimaging findings associated with depression in older adults and treatment-response variability. LLD has been associated with cerebral atrophy, diminished myelin integrity, and cerebral lesions in frontostriatal-limbic regions. These associations help explain the depression-executive dysfunction syndrome observed in LLD, and support cerebrovascular burden as a pathogenic mechanism. Furthermore, this review suggests that neuroimaging determinants of treatment resistance also reflect cerebrovascular burden. Of the theoretical etiologies of LLD, cerebrovascular burden may mediate treatment resistance. This review proposes that neuroimaging has the potential for clinical translation. Controlled trials may identify neuroimaging biomarkers that may inform treatment by identifying depressed adults likely to remit with pharmacotherapy, identifying individualized therapeutic dose, and facilitating earlier treatment response measures. Neuroimaging also has the potential to similarly inform treatment response variability from treatment with aripiprazole (dopamine modulator) and buprenorphine (opiate modulator).
晚年抑郁症（LLD）是一个日益受到公众和全球关注的健康问题，具有多样的临床表现和病因。这篇文献综述总结了与老年人抑郁症及治疗反应变异性相关的神经影像学研究结果。LLD与脑萎缩、髓鞘完整性降低以及额纹状体-边缘区域的脑损伤有关。这些关联有助于解释在LLD中观察到的抑郁-执行功能障碍综合征，并支持脑血管负担作为一种致病机制。此外，这篇综述表明，治疗抵抗的神经影像学决定因素也反映了脑血管负担。在LLD的理论病因中，脑血管负担可能介导治疗抵抗。这篇综述提出，神经影像学具有临床转化的潜力。对照试验可能会识别出神经影像学生物标志物，这些标志物可通过识别可能通过药物治疗缓解的抑郁症成年人、确定个体化治疗剂量以及促进早期治疗反应测量来为治疗提供信息。神经影像学同样有可能为阿立哌唑（多巴胺调节剂）和丁丙诺啡（阿片类调节剂）治疗的反应变异性提供类似的信息。
