Bonavita S, Sacco R, Esposito S, d'Ambrosio A, Della Corte M, Corbo D, Docimo R, Gallo A, Lavorgna L, Cirillo M, Bisecco A, Esposito F, Tedeschi G
Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Naples, Italy.
MRI Center 'SUN FISM', Neurological Institute for Diagnosis and Care 'Hermitage Capodimonte', Naples, Italy.
Eur J Neurol. 2017 Jan;24(1):27-36. doi: 10.1111/ene.13112. Epub 2016 Sep 16.
In multiple sclerosis (MS), depression is a common disorder whose pathophysiology is still debated. To gain insights into the pathophysiology of depression in MS, resting-state (RS) functional connectivity (FC) changes of the default mode network (DMN), salience network (SN) and executive control network (ECN) were assessed in a group of depressed MS (D-MS) patients and in appropriately matched control groups.
Sixteen D-MS patients, 17 non-depressed MS (ND-MS) patients, 17 non-depressed healthy controls and 15 depressed subjects (D-S), age, sex and education matched, cognitively preserved and non-fatigued, were enrolled. All participants underwent a neuropsychological evaluation and RS functional magnetic resonance imaging study.
Comparing D-MS patients with D-S, within the DMN, a significant RS-FC suppression was found in the posterior cingulate cortex (PCC); comparing D-MS with ND-MS, FC was significantly increased in the anterior cingulate cortex and significantly reduced in the PCC. Within the SN increased FC in the right supramarginal gyrus and right middle frontal gyrus was found in D-MS patients compared to D-S and to ND-MS; within the ECN increased FC in the right inferior parietal cortex was found in D-MS patients compared to ND-MS patients.
In cognitively preserved D-MS patients, FC derangement occurs in the SN, ECN and DMN. In the latter, changes occurring both in the anterior cingulate cortex and PCC suggest that depression in MS may be linked to MS itself and, in particular, to a peculiar pattern of network abnormalities favored by MS pathology through disconnection mechanisms. Reduced FC in the PCC, similar to MS patients with cognitive impairment, suggests a functional link between depression and cognitive impairment in MS.
在多发性硬化症（MS）中，抑郁症是一种常见疾病，其病理生理学仍存在争议。为深入了解MS中抑郁症的病理生理学，我们评估了一组抑郁型MS（D-MS）患者以及匹配恰当的对照组的默认模式网络（DMN）、突显网络（SN）和执行控制网络（ECN）的静息态（RS）功能连接（FC）变化。
纳入16例D-MS患者、17例非抑郁型MS（ND-MS）患者、17例非抑郁健康对照者以及15例年龄、性别和教育程度匹配、认知功能保留且无疲劳感的抑郁受试者（D-S）。所有参与者均接受了神经心理学评估和RS功能磁共振成像研究。
将D-MS患者与D-S比较，在DMN内，后扣带回皮质（PCC）出现显著的RS-FC抑制；将D-MS与ND-MS比较，前扣带回皮质的FC显著增加，而PCC的FC显著降低。与D-S和ND-MS相比，D-MS患者在SN内右侧缘上回和右侧额中回的FC增加；与ND-MS患者相比，D-MS患者在ECN内右侧顶下小叶的FC增加。
在认知功能保留的D-MS患者中，SN、ECN和DMN出现FC紊乱。在DMN中，前扣带回皮质和PCC均发生变化，这表明MS中的抑郁症可能与MS本身有关，尤其是与MS病理通过断开连接机制所导致的一种特殊网络异常模式有关。PCC中FC降低，类似于有认知障碍的MS患者，这表明MS中抑郁症与认知障碍之间存在功能联系。
