Amen Clinics Inc., Costa Mesa, CA, USA.
UCLA Medical Center, Los Angeles, CA, USA.
J Alzheimers Dis. 2018;63(2):529-538. doi: 10.3233/JAD-170855.
Depression remains an important risk factor for Alzheimer's disease, yet few neuroimaging biomarkers are available to identify treatment response in depression.
To analyze and compare functional perfusion neuroimaging in persons with treatment resistant depression (TRD) compared to those experiencing full remission.
A total of 951 subjects from a community psychiatry cohort were scanned with perfusion single photon emission computed tomography (SPECT) of the brain in both resting and task related settings. Of these, 78% experienced either full remission (n = 506) or partial remission (n = 237) and 11% were minimally responsive (n = 103) or non-responsive (11%. n = 106). Severity of depression symptoms were used to define these groups with changes in the Beck Depression Inventory prior to and following treatment. Voxel-based analyses of brain SPECT images from full remission compared to the worsening group was conducted with the statistical parametric mapping software, version 8 (SPM 8). Multiple comparisons were accounted for with a false discovery rate (p < 0.001).
Persons with depression that worsened following treatment had reduced cerebral perfusion compared to full remission in the multiple regions including the bilateral frontal lobes, right hippocampus, left precuneus, and cerebellar vermis. Such differences were observed on both resting and concentration SPECT scans.
Our findings identify imaging-based biomarkers in persons with depression related to treatment response. These findings have implications in understanding both depression to prognosis and its role as a risk factor for dementia.
抑郁症仍然是阿尔茨海默病的一个重要危险因素，但目前可用的神经影像学生物标志物很少能够识别抑郁症的治疗反应。
分析和比较治疗抵抗性抑郁症（TRD）与完全缓解患者的功能性灌注神经影像学。
对来自社区精神病队列的 951 名受试者进行大脑灌注单光子发射计算机断层扫描（SPECT）检查，包括静息和任务相关状态。其中，78%的患者经历了完全缓解（n=506）或部分缓解（n=237），11%的患者反应轻微（n=103）或无反应（n=106）。使用贝克抑郁量表（Beck Depression Inventory）的变化来定义这些组，这些变化是在治疗前后进行的。使用统计参数映射软件（SPM 8）对完全缓解与恶化组的大脑 SPECT 图像进行基于体素的分析。使用假发现率（p<0.001）对多重比较进行了校正。
与完全缓解组相比，治疗后病情恶化的抑郁症患者大脑多个区域的灌注减少，包括双侧额叶、右侧海马体、左侧楔前叶和小脑蚓部。在静息和集中 SPECT 扫描中都观察到了这些差异。
我们的发现确定了与治疗反应相关的基于影像的生物标志物，这些发现对于理解抑郁症的预后及其作为痴呆风险因素的作用具有重要意义。
