Brown Vanessa M, Gujral Swathi, Chang Ya-Wen, Galfalvy Hanga, Szanto Katalin, Dombrovski Alexandre Y
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Psychology, Emory University, Atlanta, Georgia.
Biol Psychiatry Glob Open Sci. 2025 Jun 18;5(5):100552. doi: 10.1016/j.bpsgos.2025.100552. eCollection 2025 Sep.
In older adults, depression with cognitive impairment may be a harbinger of early dementia and a risk factor for suicidal behavior. However, the neuroanatomical correlates of these impairments are unknown, particularly when examined longitudinally.
Older adults ( = 153, mean [SD] age = 62.8 [7.7] years; 86/67 [56%/44%] female/male) with either a history of suicide attempts ( = 46), depression with no history of suicide attempts ( = 72), or no psychiatric history ( = 35) completed T1 structural magnetic resonance imaging scans. Of these participants, 51 had repeated scans (days between scans mean [SD] = 415 [252], range = 90-1091). Bayesian multilevel modeling with false discovery rate correction tested cross-sectional group differences and prospective changes in brain volumes as a function of suicide attempt history, depression severity, and cognitive functioning.
Three broad categories of individual differences emerged: 1) a history of attempted suicide and impaired executive functioning related to and predicted volumes in temporal areas, neighboring parietal and occipital regions, and the hippocampus; 2) frontal and subcortical volume reductions related to depression, particularly current episode severity; and 3) cognitive impairment typical of cortical dementia predicted medial temporal volume reduction.
A history of suicidal behavior, depression, and dementia-related cognitive decline are accompanied by reduced brain volumes in largely non-overlapping regions that nevertheless converge on the hippocampus. The hippocampus may be a nexus where independent changes associated with depression and suicide diathesis factors co-occur with dementia-related neurodegeneration. These results support distinct neurocognitive deficits in late-life suicide in older adults. A better understanding of hippocampal structure and function in people at risk of suicide will advance both risk prediction and treatment development.
在老年人中，伴有认知障碍的抑郁症可能是早期痴呆症的先兆以及自杀行为的危险因素。然而，这些障碍的神经解剖学相关性尚不清楚，尤其是在纵向研究时。
有自杀未遂史（n = 46）、无自杀未遂史的抑郁症患者（n = 72）或无精神病史（n = 35）的老年人（n = 153，平均[标准差]年龄 = 62.8 [7.7]岁；86/67 [56%/44%]为女性/男性）完成了T1结构磁共振成像扫描。在这些参与者中，51人进行了重复扫描（扫描间隔天数平均[标准差]= 415 [252]，范围 = 90 - 1091）。采用贝叶斯多级模型并进行错误发现率校正，以检验自杀未遂史、抑郁严重程度和认知功能对脑容量的横断面组间差异和前瞻性变化。
出现了三大类个体差异：1）自杀未遂史和执行功能受损与颞叶区域、相邻顶叶和枕叶区域以及海马体的体积相关并可预测其体积；2）额叶和皮质下体积减少与抑郁症有关，尤其是当前发作的严重程度；3）皮质性痴呆典型的认知障碍可预测内侧颞叶体积减少。
自杀行为史、抑郁症和与痴呆相关的认知衰退在很大程度上不重叠的区域伴有脑容量减少，但这些区域在海马体处汇聚。海马体可能是一个连接点，与抑郁和自杀素质因素相关的独立变化与痴呆相关的神经退行性变同时发生。这些结果支持老年人晚年自杀存在明显的神经认知缺陷。更好地了解有自杀风险人群的海马体结构和功能将推动风险预测和治疗发展。
