老年期抑郁症患者脑白质高信号对结构连接组学的影响：与执行功能的关系。
The impact of white matter hyperintensities on the structural connectome in late-life depression: Relationship to executive functions.
机构信息
Department of Psychiatry, Weill Cornell Medicine, 525 E 68(th) St, New York, NY 10065, USA; Weill Cornell Institute of Geriatric Psychiatry, 21 Bloomingdale Road, White Plains, NY 10605, USA.
Department of Psychiatry, Weill Cornell Medicine, 525 E 68(th) St, New York, NY 10065, USA; Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 E 68(th) St, New York, NY 10065, USA.
出版信息
Neuroimage Clin. 2019;23:101852. doi: 10.1016/j.nicl.2019.101852. Epub 2019 May 3.
BACKGROUND
White matter hyperintensities (WMH) represent ischemic white matter damage in late-life depression (LLD) and are associated with cognitive control dysfunction. Understanding the impact of WMH on the structural connectivity of gray matter and the cognitive control correlates of WMH-related structural dysconnectivity can provide insight into the pathophysiology of LLD.
METHODS
We compared WMH burden and performance on clinical measures of cognitive control in patients with LLD (N = 44) and a control group of non-depressed older adults (N = 59). We used the Network Modification (NeMo) Tool to investigate the impact of WMH on structural dysconnectivity in specific gray matter regions, and how such connectivity was related to cognitive control functions.
RESULTS
Compared to the control group, LLD participants had greater WMH burden, poorer performance on Trail Making Test (TMT) A & B, and greater self-reported dysexecutive behavior on the Frosntal Systems Behavior Scale-Executive Function subscale (FrSBe-EF). Within the LLD group, disrupted connectivity in the left supramarginal gyrus, paracentral lobule, thalamus, and pallidum was associated with psychomotor slowing (TMT-A). Altered connectivity in the left supramarginal gyrus, paracentral lobule, precentral gyrus, postcentral gyrus, thalamus, and pallidum was associated with poor attentional set-shifting (TMT-B). A follow-up analysis that isolated set-shifting ability (TMT-B/A ratio) confirmed the association with dysconnectivity in the bilateral paracentral lobule, right thalamus, left precentral gyrus, postcentral gyrus, and pallidum; additionally, it revealed associations with dysconnectivity in the right posterior cingulate, and left anterior cingulate, middle frontal cortex, and putamen.
CONCLUSIONS
In LLD, WMH are associated with region-specific disruptions in cortical and subcortical gray matter areas involved in attentional aspects of cognitive control systems and sensorimotor processing, which in turn are associated with slower processing speed, and reduced attentional set-shifting.
CLINICAL TRIALS REGISTRATION
背景
脑白质高信号（WMH）代表老年期抑郁症（LLD）中的缺血性脑白质损伤，与认知控制功能障碍有关。了解 WMH 对灰质结构连接的影响，以及与 WMH 相关结构连接障碍相关的认知控制的相关性，可以深入了解 LLD 的病理生理学。
方法
我们比较了 LLD 患者（N=44）和非抑郁老年对照组（N=59）的 WMH 负担和认知控制临床测量的表现。我们使用网络修改（NeMo）工具来研究 WMH 对特定灰质区域结构连接的影响，以及这种连接如何与认知控制功能相关。
结果
与对照组相比，LLD 患者的 WMH 负担更大，在连线测试（TMT）A 和 B 上的表现更差，在 FrSBe-EF 子量表上的自我报告执行功能障碍行为更多。在 LLD 组中，左侧缘上回、旁中央小叶、丘脑和苍白球的连接中断与运动速度减慢（TMT-A）有关。左侧缘上回、旁中央小叶、中央前回、中央后回、丘脑和苍白球的连接改变与注意力定势转移（TMT-B）不良有关。一项后续的分析，即分离出定势转移能力（TMT-B/A 比值），证实了双侧旁中央小叶、右侧丘脑、左侧中央前回、中央后回和苍白球连接中断与认知控制系统和感觉运动处理的注意力方面的功能障碍有关；此外，它还揭示了与右侧后扣带回和左侧前扣带回、额中回和纹状体连接中断的关联。
结论
在 LLD 中，WMH 与涉及注意力认知控制系统和感觉运动加工方面的皮质和皮质下灰质区域的特定区域的破坏有关，这反过来又与较慢的加工速度和注意力定势转移减少有关。
临床试验注册
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