Jain Felipe A, Connolly Colm G, Moore Leonardo C, Leuchter Andrew F, Abrams Michelle, Ben-Yelles Ramzi W, Chang Sarah E, Ramirez Gomez Liliana A, Huey Nora, Lavretsky Helen, Iacoboni Marco
Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.
Department of Biomedical Sciences, College of Medicine, Florida State University, Tallahassee, FL, United States.
Front Hum Neurosci. 2019 May 14;13:155. doi: 10.3389/fnhum.2019.00155. eCollection 2019.
: Family dementia caregivers often suffer from an immense toll of grief while caring for their loved ones. We sought to identify the clinical relationship between grief, depression and mindfulness and identify neural predictors of symptomatology and improvement. : Twenty three family dementia caregivers were assessed at baseline for grief, mindfulness and depression, of which 17 underwent functional magnetic resonance imaging (fMRI). During fMRI, caregivers were shown faces of either their dementia-stricken relative or that of a stranger, paired with grief-related or neutral words. In nine subjects, post fMRI scans were also obtained after 4 weeks of either guided imagery or relaxation. Robust regression was used to predict changes in symptoms with longitudinal brain activation (BA) changes as the dependent variable. : Grief and depression symptoms were correlated ( = 0.50, = 0.01), and both were negatively correlated with mindfulness ( = -0.70, = 0.0002; = -0.52, = 0.01). Relative to viewing strangers, caregivers showed pictures of their loved ones (picture factor) exhibited increased activation in the dorsal anterior cingulate gyrus and precuneus. Improvement in grief but not mindfulness or depression was predicted by increased relative BA in the precuneus and anterior cingulate (different subregions from baseline). Viewing grief-related vs. neutral words elicited activity in the medial prefrontal cortex and precuneus. : Caregiver grief, depression and mindfulness are interrelated but have at least partially nonoverlapping neural mechanisms. Picture and word stimuli related to caregiver grief evoked brain activity in regions previously identified with bereavement grief. These activation foci might be useful as biomarkers of treatment response.
家庭痴呆症照料者在照顾亲人时常常承受着巨大的悲痛。我们试图确定悲痛、抑郁与正念之间的临床关系，并找出症状学及改善情况的神经预测指标。23名家庭痴呆症照料者在基线时接受了悲痛、正念和抑郁评估，其中17人接受了功能磁共振成像（fMRI）检查。在fMRI检查期间，向照料者展示其患有痴呆症的亲属或陌生人的面孔，并配以与悲痛相关或中性的词语。在9名受试者中，在进行4周的引导式意象或放松训练后，也进行了fMRI扫描后的检查。使用稳健回归以纵向脑激活（BA）变化作为因变量来预测症状变化。悲痛和抑郁症状相关（r = 0.50，p = 0.01），且二者均与正念呈负相关（r = -0.70，p = 0.0002；r = -0.52，p = 0.01）。相对于观看陌生人的面孔，照料者观看其亲人的照片（照片因素）时，背侧前扣带回和楔前叶的激活增加。楔前叶和前扣带回（与基线不同的亚区域）相对BA增加可预测悲痛的改善，但不能预测正念或抑郁的改善。观看与悲痛相关的词语与中性词语相比，内侧前额叶皮质和楔前叶出现活动。照料者的悲痛、抑郁和正念相互关联，但至少部分具有不重叠的神经机制。与照料者悲痛相关的图片和词语刺激在先前已确定与丧亲悲痛相关的区域诱发了脑活动。这些激活灶可能作为治疗反应的生物标志物。
