Soufer R, Bremner J D, Arrighi J A, Cohen I, Zaret B L, Burg M M, Goldman-Rakic P
Yale University/VA Positron Imaging Center, VA Connecticut Healthcare System, Department of Diagnostic Radiology, Yale University School of Medicine, 950 Campbell Avenue, West Haven, CT 06516, USA.
Proc Natl Acad Sci U S A. 1998 May 26;95(11):6454-9. doi: 10.1073/pnas.95.11.6454.
The central nervous system (CNS) effects of mental stress in patients with coronary artery disease (CAD) are unexplored. The present study used positron emission tomography (PET) to measure brain correlates of mental stress induced by an arithmetic serial subtraction task in CAD and healthy subjects. Mental stress resulted in hyperactivation in CAD patients compared with healthy subjects in several brain areas including the left parietal cortex [angular gyrus/parallel sulcus (area 39)], left anterior cingulate (area 32), right visual association cortex (area 18), left fusiform gyrus, and cerebellum. These same regions were activated within the CAD patient group during mental stress versus control conditions. In the group of healthy subjects, activation was significant only in the left inferior frontal gyrus during mental stress compared with counting control. Decreases in blood flow also were produced by mental stress in CAD versus healthy subjects in right thalamus (lateral dorsal, lateral posterior), right superior frontal gyrus (areas 32, 24, and 10), and right middle temporal gyrus (area 21) (in the region of the auditory association cortex). Of particular interest, a subgroup of CAD patients that developed painless myocardial ischemia during mental stress had hyperactivation in the left hippocampus and inferior parietal lobule (area 40), left middle (area 10) and superior frontal gyrus (area 8), temporal pole, and visual association cortex (area 18), and a concomitant decrease in activation observed in the anterior cingulate bilaterally, right middle and superior frontal gyri, and right visual association cortex (area 18) compared with CAD patients without myocardial ischemia. These findings demonstrate an exaggerated cerebral cortical response and exaggerated asymmetry to mental stress in individuals with CAD.
冠心病（CAD）患者精神压力对中枢神经系统（CNS）的影响尚未得到研究。本研究采用正电子发射断层扫描（PET）来测量CAD患者和健康受试者在算术连续减法任务诱导的精神压力下大脑的相关变化。与健康受试者相比，精神压力导致CAD患者的几个脑区出现过度激活，包括左侧顶叶皮质[角回/平行沟（39区）]、左侧前扣带回（32区）、右侧视觉联合皮质（18区）、左侧梭状回和小脑。在精神压力状态与对照状态下，CAD患者组内这些相同区域被激活。在健康受试者组中，与计数对照相比，精神压力期间仅左侧额下回激活显著。与健康受试者相比，精神压力也使CAD患者右侧丘脑（背外侧、后外侧）、右侧额上回（32、24和10区）以及右侧颞中回（21区）（听觉联合皮质区域）的血流减少。特别值得注意的是，在精神压力期间发生无痛性心肌缺血的CAD患者亚组，与无心肌缺血的CAD患者相比，左侧海马和顶下小叶（40区）、左侧额中回（10区）和额上回（8区）、颞极以及视觉联合皮质（18区）出现过度激活，同时双侧前扣带回、右侧额中回和额上回以及右侧视觉联合皮质（18区）的激活减少。这些发现表明CAD患者对精神压力存在夸大的大脑皮质反应和夸大的不对称性。
