van Duinkerken Eelco, Ryan Christopher M, Schoonheim Menno M, Barkhof Frederik, Klein Martin, Moll Annette C, Diamant Michaela, IJzerman Richard G, Snoek Frank J
From the Diabetes Center/Department of Internal Medicine (van Duinkerken, Diamant, IJzerman), and Departments of Medical Psychology (van Duinkerken, Klein, Snoek), Anatomy and Neuroscience (Schoonheim), Radiology and Nuclear Medicine (Barkhof), and Ophthalmology (Moll), VU University Medical Center, Amsterdam, the Netherlands; Department of Psychology (van Duinkerken), Pontifícia Universidade Católica-PUC-Rio, Rio de Janeiro, Brazil; Department of Psychiatry (Ryan), University of California San Francisco, San Francisco, California, Department of Medical Psychology (Snoek), Academic Medical Center, Amsterdam, the Netherlands.
Psychosom Med. 2016 Jul-Aug;78(6):740-9. doi: 10.1097/PSY.0000000000000335.
Patients with Type 1 diabetes mellitus (T1DM) are at an increased risk for major depression, but its underlying mechanisms are still poorly understood. In nondiabetic participants, mood disturbances are related to altered subgenual cingulate cortex (SGC) resting-state functional connectivity. We tested for SGC connectivity alterations in T1DM, whether these alterations were related to depressive symptoms, and if depressive symptoms were associated with cognition.
A bilateral SGC seed-based resting-state functional magnetic resonance imaging analysis was performed in 104 T1DM patients and 49 controls without known psychiatric diagnosis or treatment. Depressive symptoms were self-reported using the Center for Epidemiological Studies Depression scale. Cognition was assessed with a battery of standardized tests.
In patients versus controls, SGC to right inferior frontal gyrus and frontal pole connectivity was decreased (52 voxels, z valuepeak = 3.56, pcluster-FWE = .002), whereas SGC to bilateral precuneus (33 voxels, z valuepeak = 3.34, pcluster-FWE = .04) and left inferior parietal lobule (50 voxels, z valuepeak = 3.50, pcluster-FWE = .003) connectivity was increased. In all participants, increased depressive symptoms was related to lower SGC to inferior frontal gyrus and frontal pole connectivity (β = -0.156, p = .053), and poorer general cognitive ability (β = -0.194, p = .023), information processing speed (β = -0.222, p = .008), and motor speed (β = -0.180, p = .035).
T1DM patients showed a pattern of SGC connectivity that is characterized by lower executive control and higher default mode network connectivity. Depressive symptoms are partially related to these alterations and seem to exacerbate T1DM-related cognitive dysfunction. Future studies should detail the effect of diagnosed major depressive disorder in this population and establish what alterations are diabetes specific.
1型糖尿病（T1DM）患者患重度抑郁症的风险增加，但其潜在机制仍知之甚少。在非糖尿病参与者中，情绪障碍与膝下扣带回皮质（SGC）静息态功能连接改变有关。我们测试了T1DM患者的SGC连接性改变，这些改变是否与抑郁症状相关，以及抑郁症状是否与认知相关。
对104例T1DM患者和49例无已知精神疾病诊断或治疗的对照者进行基于双侧SGC种子点的静息态功能磁共振成像分析。使用流行病学研究中心抑郁量表自我报告抑郁症状。通过一系列标准化测试评估认知能力。
与对照组相比，患者的SGC与右侧额下回和额极的连接性降低（52个体素，z值峰值 = 3.56，p簇FWE = 0.002），而SGC与双侧楔前叶（33个体素，z值峰值 = 3.34，p簇FWE = 0.04）和左侧顶下小叶（50个体素，z值峰值 = 3.50，p簇FWE = 0.003）的连接性增加。在所有参与者中，抑郁症状增加与SGC与额下回和额极的连接性降低有关（β = -0.156，p = 0.053），以及一般认知能力较差（β = -0.194，p = 0.023）、信息处理速度较慢（β = -0.222，p = 0.008）和运动速度较慢（β = -0.180，p = 0.035）。
T1DM患者表现出一种SGC连接模式，其特征是执行控制较低和默认模式网络连接性较高。抑郁症状部分与这些改变有关，似乎会加剧T1DM相关的认知功能障碍。未来的研究应详细说明已诊断的重度抑郁症在该人群中的影响，并确定哪些改变是糖尿病特有的。
