广泛性焦虑障碍（GAD）及伴发 GAD 和抑郁障碍患者认知功能损害与功能连接障碍的相关性：一项随访 fMRI 研究。
Disrupted functional connectivity associated with cognitive impairment in generalized anxiety disorder (GAD) and comorbid GAD and depression: a follow-up fMRI study.
机构信息
From the Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China (Han, Yan, Shan, Zhao, Guo); the Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China (H. Li); the Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China (Liu); the Department of Psychiatry, Qiqihar Medical University, Qiqihar, Heilongjiang, China (P. Li).
From the Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China (Han, Yan, Shan, Zhao, Guo); the Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China (H. Li); the Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China (Liu); the Department of Psychiatry, Qiqihar Medical University, Qiqihar, Heilongjiang, China (P. Li)
出版信息
J Psychiatry Neurosci. 2023 Nov 7;48(6):E439-E451. doi: 10.1503/jpn.230091. Print 2023 Nov-Dec.
BACKGROUND
Impaired functional connectivity between the bilateral hemispheres may serve as the neural substrate for anxiety and depressive disorders, yet its role in comorbid generalized anxiety disorder (GAD) and depression, as well as the effect of treatment on this connectivity, remains unclear. We sought to examine functional connectivity between homotopic regions of the 2 hemispheres (voxel-mirrored homotopic connectivity [VMHC]) among people with GAD with and without comorbid depression at baseline and after a 4-week paroxetine treatment.
METHODS
Drug-naïve patients with GAD, with or without comorbid depression and healthy controls underwent functional magnetic resonance imaging and clinical assessments at baseline and after treatment. We compared VMHC and seed-based functional connectivity across the 3 groups. We performed correlation analysis and support vector regression (SVR) to examine the intrinsic relationships between VMHC and symptoms.
RESULTS
Both patient groups ( = 40 with GAD only, = 58 with GAD and depression) showed decreased VMHC in the precuneus, posterior cingulate cortex and lingual gyrus compared with healthy controls ( = 54). Moreover, they showed decreased VMHC in different brain regions compared with healthy controls. However, we did not observe any significant differences between the 2 patient groups. Seeds from abnormal VMHC clusters in patient groups had decreased functional connectivity. Voxel-mirrored homotopic connectivity in the precuneus, posterior cingulate cortex and lingual gyrus was negatively correlated with cognitive impairment among patients with GAD only and among all patients. The SVR analysis based on abnormal VMHC showed significant positive correlations ( < 0.0001) between predicted and actual treatment responses. However, we did not observe significant differences in VMHC or functional connectivity after treatment.
LIMITATIONS
A notable dropout rate and intergroup somatic symptom variations may have biased the results.
CONCLUSION
Patients with GAD with or without comorbid depression exhibited shared and distinct abnormal VMHC patterns, which might be linked to their cognitive deficits. These patterns have the potential to serve as prognostic biomarkers for GAD. ClinicalTrials.gov NCT03894085.
背景
双侧半球之间功能连接的损害可能是焦虑和抑郁障碍的神经基础，但它在共患广泛性焦虑症（GAD）和抑郁症中的作用，以及治疗对这种连接的影响尚不清楚。我们试图在基线和帕罗西汀治疗 4 周后，检查 GAD 患者中伴或不伴共患抑郁症的双侧半球同源区域之间的功能连接（体素镜像同型连接[VMHC]）。
方法
未经药物治疗的 GAD 患者，伴或不伴共患抑郁症和健康对照组在基线和治疗后进行功能磁共振成像和临床评估。我们比较了 3 组之间的 VMHC 和基于种子的功能连接。我们进行了相关分析和支持向量回归（SVR），以检查 VMHC 与症状之间的内在关系。
结果
两组患者（伴 GAD 患者 40 例，伴 GAD 和抑郁症患者 58 例）与健康对照组（54 例）相比，后扣带回皮层和舌回的 VMHC 减少。此外，与健康对照组相比，他们在不同的脑区显示出 VMHC 减少。然而，我们没有观察到两组患者之间有任何显著差异。患者组异常 VMHC 簇的种子显示功能连接减少。仅 GAD 患者和所有患者中，后扣带回皮层和舌回的 VMHC 与认知障碍呈负相关。基于异常 VMHC 的 SVR 分析显示，预测和实际治疗反应之间存在显著正相关（<0.0001）。然而，我们没有观察到治疗后 VMHC 或功能连接有显著变化。
局限性
显著的脱落率和组间躯体症状变化可能会影响结果。
结论
伴或不伴共患抑郁症的 GAD 患者表现出共同和独特的异常 VMHC 模式，这可能与他们的认知缺陷有关。这些模式有可能成为 GAD 的预后生物标志物。ClinicalTrials.gov NCT03894085。
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