Huaxi MR Research Center (HMRRC), Functional and molecular imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China.
Huaxi MR Research Center (HMRRC), Functional and molecular imaging Key Laboratory of Sichuan Province, Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China; Psychoradiology Research Unit of the Chinese Academy of Medical Sciences (2018RU011), West China Hospital of Sichuan University, Chengdu, Sichuan, China.
J Affect Disord. 2022 Feb 1;298(Pt A):421-430. doi: 10.1016/j.jad.2021.11.005. Epub 2021 Nov 5.
Age of onset may be an important feature associated with distinct subtypes of obsessive-compulsive disorder (OCD). The amygdala joined neurocircuitry models of OCD for its role in mediating fear and regulating anxiety. The present study aims to identify the underlying pathophysiological specifics in OCD with different onset times by assessing amygdala subregional functional connectivity (FC) alterations in early-onset OCD (EO-OCD) and late-onset OCD (LO-OCD).
Resting-state functional magnetic resonance imaging data were acquired from 88 medication-free OCD patients (including 30 EO-OCD and 58 LO-OCD) and age- and sex-matched healthy controls (HC) for each patient group. Onset-by-diagnosis interactions were examined and comparisons between each OCD group and the corresponding HC group were performed regarding the FC of amygdala subregions including the basolateral amygdala (BLA), centromedial amygdala (CMA), superficial amygdala (SFA) and amygdalostriatal transition area (Astr).
Significant onset-by-diagnosis interactions were found in FC between bilateral SFA, right CMA, left Astr and the cerebellum. EO-OCD patients showed abnormally increased BLA/SFA-cerebellum, BLA-precuneus and BLA/SFA-fusiform connectivity in addition to decreased BLA/SFA-orbitofrontal cortex connectivity. In contrast, LO-OCD patients exhibited increased CMA/Astr-precentral/postcentral gyrus and CMA-cuneus connectivity as well as decreased CMA/Astr-cerebellum and BLA-striatum connectivity.
The exclusion of comorbidity may reduce the generalizability of our results.
These findings emphasized the different patterns of amygdala subregional connectivity alterations associated with EO-OCD and LO-OCD patients. These results provide unique insights into constructing evidence-based distinct OCD subtypes based on brain intrinsic connectivity and point to the need of specified management for EO-OCD and LO-OCD in clinical setting.
发病年龄可能是与强迫症（OCD）不同亚型相关的一个重要特征。杏仁核在强迫症的神经回路模型中起作用，调节恐惧和焦虑。本研究旨在通过评估早发性 OCD（EO-OCD）和晚发性 OCD（LO-OCD）患者杏仁核亚区功能连接（FC）改变，来确定不同发病时间 OCD 的潜在病理生理特征。
为每位患者组采集 88 名未服用药物的 OCD 患者（包括 30 名 EO-OCD 和 58 名 LO-OCD）和年龄及性别匹配的健康对照组（HC）的静息态功能磁共振成像数据。对发病时间与诊断的交互作用进行了检验，并对每个 OCD 组与相应的 HC 组之间的杏仁核亚区 FC 进行了比较，包括基底外侧杏仁核（BLA）、中央杏仁核（CMA）、浅层杏仁核（SFA）和杏仁核纹状体过渡区（Astr）。
在双侧 SFA、右侧 CMA、左侧 Astr 和小脑之间的 FC 中发现了显著的发病时间与诊断的交互作用。EO-OCD 患者表现出异常增加的 BLA/SFA-小脑、BLA-楔前叶和 BLA/SFA-梭状回连接，以及减少的 BLA/SFA-眶额皮质连接。相比之下，LO-OCD 患者表现出增加的 CMA/Astr-中央前回/中央后回和 CMA-楔叶连接，以及减少的 CMA/Astr-小脑和 BLA-纹状体连接。
排除共病可能会降低我们结果的普遍性。
这些发现强调了与 EO-OCD 和 LO-OCD 患者相关的杏仁核亚区连接改变的不同模式。这些结果为基于大脑内在连接构建基于证据的不同 OCD 亚型提供了独特的见解，并指出在临床实践中需要对 EO-OCD 和 LO-OCD 进行特定的管理。
