Huang Sheng-Min, Hsu Yen-Hsuan, Yang Jir-Jei, Lin Chien-Yuan, Tu Min-Chien, Kuo Li-Wei
Department of Pharmacology, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Miaoli 350, Taiwan.
Department of Psychology, National Chung Cheng University, Chiayi 621, Taiwan.
Neuroimage Clin. 2025 Apr 6;46:103781. doi: 10.1016/j.nicl.2025.103781.
The overlapping features of depressive symptoms and apathy hinder their differentiation in clinical practice, and hence a greater understanding of their neurosubstrates in dementia and its subtypes is necessary. Ninety-two dementia patients (Alzheimer's disease [AD, n = 52]; subcortical ischemic vascular disease [SIVD, n = 40]), and 30 cognitively normal subjects were evaluated using the Apathy Evaluation Scale (AES), Beck's Depression Inventory (BDI), and brain magnetic resonance imaging (MRI). Grouped by AES/BDI scores, and hubs of depression/apathy were identified by comparing MRI metrics including fractional amplitude of low-frequency fluctuation (fALFF) of resting-state functional MRI, and mean kurtosis (MK) of diffusion kurtosis imaging. Associations between the hubs with depressive and apathy symptoms were analyzed. Comparing low-AES and high-AES groups, fALFF indicated pervasive changes mainly within the default mode network (DMN) and frontoparietal network (FPN). Comparing low-BDI and high-BDI groups, fALFF reflected changes within the DMN, FPN, and salience network (SAN). Contrarily, MK showed focal changes within DMN and SAN regions from the same group-wise comparisons. While fALFF was more correlated with DMN/FPN for AES than BDI and more significantly correlated with SIVD than AD, MK was more correlated with the left anterior cingulate cortex and right insula for AES than BDI, but more significantly correlated with AD than SIVD (all P < 0.01). Topologically, the fALFF hubs for AES and BDI centered at the posterior and anterior poles, respectively. These findings suggest that dual-modal MRI could reflect the distinct neuropathological basis for apathy and depressive symptoms in AD and SIVD.
抑郁症状和冷漠的重叠特征阻碍了它们在临床实践中的区分，因此有必要更深入地了解痴呆症及其亚型中它们的神经基质。使用冷漠评估量表（AES）、贝克抑郁量表（BDI）和脑磁共振成像（MRI）对92名痴呆症患者（阿尔茨海默病[AD，n = 52]；皮质下缺血性血管病[SIVD，n = 40]）和30名认知正常的受试者进行了评估。根据AES/BDI评分进行分组，并通过比较包括静息态功能MRI的低频振幅分数（fALFF）和扩散峰度成像的平均峰度（MK）在内的MRI指标来确定抑郁/冷漠的中枢。分析了这些中枢与抑郁和冷漠症状之间的关联。比较低AES组和高AES组，fALFF表明主要在默认模式网络（DMN）和额顶叶网络（FPN）内存在普遍变化。比较低BDI组和高BDI组，fALFF反映了DMN、FPN和突显网络（SAN）内的变化。相反，MK在相同的分组比较中显示出DMN和SAN区域内的局灶性变化。虽然fALFF与AES的DMN/FPN相关性比BDI更高，且与SIVD的相关性比AD更显著，但MK与AES的左前扣带回皮质和右岛叶的相关性比BDI更高，但与AD的相关性比SIVD更显著（所有P < 0.01）。在拓扑结构上，AES和BDI的fALFF中枢分别位于后极和前极。这些发现表明，双模态MRI可以反映AD和SIVD中冷漠和抑郁症状的不同神经病理学基础。
