Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China.
The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
Dialogues Clin Neurosci. 2024;26(1):38-52. doi: 10.1080/19585969.2024.2373075. Epub 2024 Jul 4.
One major challenge in developing personalised repetitive transcranial magnetic stimulation (rTMS) is that the treatment responses exhibited high inter-individual variations. Brain morphometry might contribute to these variations. This study sought to determine whether individual's brain morphometry could predict the rTMS responders and remitters.
This was a secondary analysis of data from a randomised clinical trial that included fifty-five patients over the age of 60 with both comorbid depression and neurocognitive disorder. Based on magnetic resonance imaging scans, estimated brain age was calculated with morphometric features using a support vector machine. Brain-predicted age difference (brain-PAD) was computed as the difference between brain age and chronological age.
The rTMS responders and remitters had younger brain age. Every additional year of brain-PAD decreased the odds of relieving depressive symptoms by ∼25.7% in responders (Odd ratio [OR] = 0.743, = .045) and by ∼39.5% in remitters (OR = 0.605, = .022) in active rTMS group. Using brain-PAD score as a feature, responder-nonresponder classification accuracies of 85% (3 week) and 84% (12 week), respectively were achieved.
In elderly patients, younger brain age appears to be associated with better treatment responses to active rTMS. Pre-treatment brain age models informed by morphometry might be used as an indicator to stratify suitable patients for rTMS treatment.
ClinicalTrials.gov Identifier: ChiCTR-IOR-16008191.
开发个性化重复经颅磁刺激（rTMS）的一个主要挑战是，治疗反应表现出高度的个体间差异。脑形态可能对此差异有贡献。本研究旨在确定个体的脑形态是否可以预测 rTMS 的反应者和缓解者。
这是一项随机临床试验数据的二次分析，该试验纳入了 55 名年龄在 60 岁以上、合并抑郁和神经认知障碍的患者。基于磁共振成像扫描，使用支持向量机通过形态特征计算估计的脑龄。脑预测年龄差（brain-PAD）计算为脑龄与实际年龄之间的差异。
rTMS 的反应者和缓解者的脑龄更年轻。反应者中，每增加 1 年的 brain-PAD 会使缓解抑郁症状的可能性降低约 25.7%（优势比 [OR] = 0.743，.045），缓解者中降低约 39.5%（OR = 0.605，.022）。在活跃 rTMS 组中，使用 brain-PAD 评分作为特征，反应者和非反应者的分类准确率分别达到 85%（3 周）和 84%（12 周）。
在老年患者中，较年轻的脑龄似乎与积极 rTMS 治疗的反应更好相关。基于形态学的预治疗脑龄模型可能被用作分层合适患者进行 rTMS 治疗的指标。
ClinicalTrials.gov 标识符：ChiCTR-IOR-16008191。
