101
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Shad MU, Muddasani S, Rao U. Gray matter differences between healthy and depressed adolescents: a voxel-based morphometry study. J Child Adolesc Psychopharmacol 2012; 22:190-7. [PMID: 22537357 PMCID: PMC3373217 DOI: 10.1089/cap.2011.0005] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) frequently begins during adolescence and is associated with significant morbidity and mortality. However, little is known about the neurobiology of adolescent depression. A better understanding of the neurobiology will be helpful in developing more effective preventive and treatment interventions for this highly disabling illness. METHODS Using a voxel-based morphometric method, the study compared gray matter and white matter volumes in 22 adolescents with MDD and 22 age- and gender-matched normal controls. RESULTS Compared with controls, depressed adolescents had smaller gray matter volume in the frontal lobe and caudate nucleus bilaterally and right superior and middle temporal gyri. However, the groups did not differ significantly on white matter volume. CONCLUSIONS These findings in depressed adolescents are consistent with the previous findings of gray matter abnormalities in frontolimbic areas and the striatum in depressed adults and suggest the presence of these structural changes at the onset of depressive illness.
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Affiliation(s)
- Mujeeb U. Shad
- Department of Psychiatry, University of Texas Health Sciences Center at Houston, Houston, Texas
| | - Srirangam Muddasani
- Department of Psychiatry, University of Texas, Southwestern Medical Center, Dallas, Texas
| | - Uma Rao
- Mehary Medical College, Nashville, Tennessee.,Vanderbilt University School of Medicine, Nashville, Tennessee
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102
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Haubold A, Peterson BS, Bansal R. Annual research review: progress in using brain morphometry as a clinical tool for diagnosing psychiatric disorders. J Child Psychol Psychiatry 2012; 53:519-35. [PMID: 22394424 PMCID: PMC4235515 DOI: 10.1111/j.1469-7610.2012.02539.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Brain morphometry in recent decades has increased our understanding of the neural bases of psychiatric disorders by localizing anatomical disturbances to specific nuclei and subnuclei of the brain. At least some of these disturbances precede the overt expression of clinical symptoms and possibly are endophenotypes that could be used to diagnose an individual accurately as having a specific psychiatric disorder. More accurate diagnoses could significantly reduce the emotional and financial burden of disease by aiding clinicians in implementing appropriate treatments earlier and in tailoring treatment to the individual needs. Several methods, especially those based on machine learning, have been proposed that use anatomical brain measures and gold-standard diagnoses of participants to learn decision rules that classify a person automatically as having one disorder rather than another. We review the general principles and procedures for machine learning, particularly as applied to diagnostic classification, and then review the procedures that have thus far attempted to diagnose psychiatric illnesses automatically using anatomical measures of the brain. We discuss the strengths and limitations of extant procedures and note that the sensitivity and specificity of these procedures in their most successful implementations have approximated 90%. Although these methods have not yet been applied within clinical settings, they provide strong evidence that individual patients can be diagnosed accurately using the spatial pattern of disturbances across the brain.
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Affiliation(s)
- Alexander Haubold
- Columbia College of Physicians & Surgeons and New York State Psychiatric Institute, New York, NY, USA
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103
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Thomas AG, Dennis A, Bandettini PA, Johansen-Berg H. The effects of aerobic activity on brain structure. Front Psychol 2012; 3:86. [PMID: 22470361 PMCID: PMC3311131 DOI: 10.3389/fpsyg.2012.00086] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 03/05/2012] [Indexed: 01/13/2023] Open
Abstract
Aerobic activity is a powerful stimulus for improving mental health and for generating structural changes in the brain. We review the literature documenting these structural changes and explore exactly where in the brain these changes occur as well as the underlying substrates of the changes including neural, glial, and vasculature components. Aerobic activity has been shown to produce different types of changes in the brain. The presence of novel experiences or learning is an especially important component in how these changes are manifest. We also discuss the distinct time courses of structural brain changes with both aerobic activity and learning as well as how these effects might differ in diseased and elderly groups.
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Affiliation(s)
- Adam G Thomas
- Functional MRI Facility, NIMH, NIH, DHHS Bethesda, MD, USA
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104
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Fotuhi M, Do D, Jack C. Modifiable factors that alter the size of the hippocampus with ageing. Nat Rev Neurol 2012; 8:189-202. [PMID: 22410582 DOI: 10.1038/nrneurol.2012.27] [Citation(s) in RCA: 214] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The hippocampus is particularly vulnerable to the neurotoxic effects of obesity, diabetes mellitus, hypertension, hypoxic brain injury, obstructive sleep apnoea, bipolar disorder, clinical depression and head trauma. Patients with these conditions often have smaller hippocampi and experience a greater degree of cognitive decline than individuals without these comorbidities. Moreover, hippocampal atrophy is an established indicator for conversion from the normal ageing process to developing mild cognitive impairment and dementia. As such, an important aim is to ascertain which modifiable factors can have a positive effect on the size of the hippocampus throughout life. Observational studies and preliminary clinical trials have raised the possibility that physical exercise, cognitive stimulation and treatment of general medical conditions can reverse age-related atrophy in the hippocampus, or even expand its size. An emerging concept--the dynamic polygon hypothesis--suggests that treatment of modifiable risk factors can increase the volume or prevent atrophy of the hippocampus. According to this hypothesis, a multidisciplinary approach, which involves strategies to both reduce neurotoxicity and increase neurogenesis, is likely to be successful in delaying the onset of cognitive impairment with ageing. Further research on the constellation of interventions that could be most effective is needed before recommendations can be made for implementing preventive and therapeutic strategies.
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Affiliation(s)
- Majid Fotuhi
- Neurology Institute for Brain Health and Fitness, 1205 York Road, Suite 18, Lutherville, MD 21093, USA.
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105
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Lane RM, He Y. Butyrylcholinesterase genotype and gender influence Alzheimer's disease phenotype. Alzheimers Dement 2012; 9:e1-73. [PMID: 22402324 DOI: 10.1016/j.jalz.2010.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 09/04/2010] [Accepted: 12/02/2010] [Indexed: 10/28/2022]
Abstract
Retrospective data are presented to support a spectrum of early Alzheimer's disease (AD) along a continuum defined by gender and genotype. The putative neurodegenerative mechanisms driving distinct phenotypes at each end of the spectrum are glial hypoactivity associated with early failure of synaptic cholinergic neurotransmission and glial overactivation associated with loss of neural network connectivity due to accelerated age-related breakdown of myelin. In early AD, male butyrylcholinesterase K-variant carriers with one or two apolipoprotein ɛ4 alleles have prominent medial temporal atrophy, synaptic failure, cognitive decline, and accumulation of aggregated beta-amyloid peptide. Increasing synaptic acetylcholine in damaged but still functional cholinergic synapses improves cognitive symptoms, whereas increasing the ability of glia to support synapses and to clear beta-amyloid peptide might be disease-modifying. Conversely, chronic glial overactivation can also drive degenerative processes and in butyrylcholinesterase K-variant negative females generalized glial overactivation may be the main driver from mild cognitive impairment to AD. Females are more likely than males to have accelerated age-related myelin breakdown, more widespread white matter loss, loss of neural network connectivity, whole brain atrophy, and functional decline. Increasing extracellular acetylcholine levels blocks glial activation, reduces myelin loss and damage to neural network connectivity, and is disease-modifying. Between extremes characterized by gender, genotype, and age, pathophysiology may be mixed and this spectrum may explain much of the heterogeneity of amnestic mild cognitive impairment. Preservation of the functional integrity of the neural network may be an important component of strengthening cognitive reserve and significantly delaying the onset and progression of dementia, particularly in females. Prospective confirmation of these hypotheses is required. Implications for future research and therapeutic opportunities are discussed.
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Affiliation(s)
- Roger M Lane
- Bristol-Myers Squibb Global Clinical Research, Wallingford, CT, USA.
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106
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Hulvershorn LA, Cullen K, Anand A. Toward dysfunctional connectivity: a review of neuroimaging findings in pediatric major depressive disorder. Brain Imaging Behav 2012; 5:307-28. [PMID: 21901425 DOI: 10.1007/s11682-011-9134-3] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Child and adolescent psychiatric neuroimaging research typically lags behind similar advances in adult disorders. While the pediatric depression imaging literature is less developed, a recent surge in interest has created the need for a synthetic review of this work. Major findings from pediatric volumetric and functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI) and resting state functional connectivity studies converge to implicate a corticolimbic network of key areas that work together to mediate the task of emotion regulation. Imaging the brain of children and adolescents with unipolar depression began with volumetric studies of isolated brain regions that served to identify key prefrontal, cingulate and limbic nodes of depression-related circuitry elucidated from more recent advances in DTI and functional connectivity imaging. Systematic review of these studies preliminarily suggests developmental differences between findings in youth and adults, including prodromal neurobiological features, along with some continuity across development.
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Affiliation(s)
- Leslie A Hulvershorn
- Mood and Emotional Disorders Across the Lifespan Center, Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
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107
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Erickson KI, Miller DL, Roecklein KA. The aging hippocampus: interactions between exercise, depression, and BDNF. Neuroscientist 2012; 18:82-97. [PMID: 21531985 PMCID: PMC3575139 DOI: 10.1177/1073858410397054] [Citation(s) in RCA: 337] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Late adulthood is associated with increased hippocampal atrophy and dysfunction. Although there are multiple paths by which hippocampal deterioration occurs in late life, the authors discuss the evidence that a single nucleotide polymorphism in the brain-derived neurotrophic factor (BDNF) gene and age-related changes in BDNF protein or receptor expression contribute to hippocampal atrophy. The authors conclude that few studies have tested whether BDNF mediates age-related hippocampal atrophy and memory impairment. However, there is strong evidence that decreased BDNF is associated with age-related hippocampal dysfunction, memory impairment, and increased risk for depression, whereas increasing BDNF by aerobic exercise appears to ameliorate hippocampal atrophy, improve memory function, and reduce depression. Importantly, the most consistent associations between BDNF and hippocampal dysfunction have emerged from research on BDNF protein expression in rodents and serum and plasma concentrations of BDNF in humans. Current research suggests that the BDNF val66met polymorphism may be only weakly associated with hippocampal atrophy in late adulthood. These conclusions are interpreted in relation to age-related memory impairment and preventions for hippocampal atrophy.
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Affiliation(s)
- Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
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108
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Colloby SJ, Vasudev A, O'Brien JT, Firbank MJ, Parry SW, Thomas AJ. Relationship of orthostatic blood pressure to white matter hyperintensities and subcortical volumes in late-life depression. Br J Psychiatry 2011; 199:404-10. [PMID: 21903666 DOI: 10.1192/bjp.bp.110.090423] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Structural brain abnormalities are associated with late-life major depression, with numerous studies reporting increased white matter hyperintensities (WMH) and reduced cortical/subcortical grey matter volumes. There is strong evidence linking vascular disease to WMH, but limited evidence on its association with subcortical volumes. AIMS To investigate the relationship of orthostatic blood pressure changes to WMH and subcortical grey matter volumes in late-life depression. METHOD Thirty-eight people with depression and a similarly aged comparison group (n = 30) underwent fluid attenuated inversion recovery (FLAIR) and T(1)-weighted magnetic resonance imaging as well as systematic orthostatic blood pressure assessments. Volumetric estimates of WMH and subcortical grey matter were obtained for each participant and the relationship to blood pressure drop on active stand was examined. RESULTS An association between orthostatic systolic blood pressure drop and WMH volumes in temporal and parietal regions was found in the depression group (age-corrected partial correlation r' = 0.31-0.35, P<0.05). Subcortical volumes were not related to blood pressure changes or WMH volumes in either group. CONCLUSIONS We found evidence for an association between the degree of orthostatic systolic blood pressure drop and WMH volume in the depression group. Since blood pressure drops lead to WMH in animals our findings suggest systolic blood pressure drops may be a factor contributing to these lesions in late-life depression.
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Affiliation(s)
- Sean J Colloby
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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109
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Wu M, Andreescu C, Butters MA, Tamburo R, Reynolds CF, Aizenstein H. Default-mode network connectivity and white matter burden in late-life depression. Psychiatry Res 2011; 194:39-46. [PMID: 21824753 PMCID: PMC3189685 DOI: 10.1016/j.pscychresns.2011.04.003] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2010] [Revised: 02/23/2011] [Accepted: 04/10/2011] [Indexed: 02/07/2023]
Abstract
The brain's default-mode network has been the focus of intense research. This study characterizes the default-mode network activity in late-life depression and the correlation of the default-mode network activity changes with the white-matter hyperintensities burden. We hypothesized that elderly depressed subjects would have altered default-mode network activity, which would correlate with the increased white-matter hyperintensities burden. Twelve depressed subjects (mean Hamilton Depression Rating Scale 19.8±4.1, mean age 70.5±4.9) and 12 non-depressed, comparison subjects (mean age 69±6.5) were included. Functional magnetic resonance imaging (fMRI) data were collected while subjects performed a low cognitive load, event-related task. We compared the default-mode network activity in these groups (including depressed subjects pre- and post-antidepressant treatment). We analyzed the resting connectivity patterns of the posterior cingulate cortex. Deconvolution was used to evaluate the correlation of resting-state connectivity scores with the white-matter hyperintensities burden. Compared with non-depressed elderly, depressed subjects pretreatment had decreased connectivity in the subgenual anterior cingulate cortex and increased connectivity in the dorsomedial prefrontal cortex and the orbito-frontal cortex. The abnormal connectivity was significantly correlated with the white-matter hyperintensities burden. Remitted elderly depressed subjects had improved functional connectivity compared to pretreatment, although alterations persisted in the anterior cingulate and the prefrontal cortex when remitted elderly depressed subjects were compared with non-depressed elderly. Our study provides evidence for altered default-mode network connectivity in late-life depression. The correlation between white-matter hyperintensities burden and default-mode network connectivity emphasizes the role of vascular changes in late-life depression etiopathogenesis.
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Affiliation(s)
- Minjie Wu
- Department of Bioengineering, University of Pittsburgh, Pittsburgh
| | - Carmen Andreescu
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A. Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh,Corresponding author: Carmen Andreescu, M.D., Assistant Professor of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh; Phone: 412-383-5164; Fax: 412-383-5458;
| | - Meryl A. Butters
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A. Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh
| | - Robert Tamburo
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A. Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh
| | - Charles F. Reynolds
- The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A. Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh
| | - Howard Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh,The Advanced Center for Interventions and Services Research for Late-life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine and the John A. Hartford Center of Excellence in Geriatric Psychiatry, Pittsburgh
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110
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Hou Z, Yuan Y, Zhang Z, Bai F, Hou G, You J. Longitudinal changes in hippocampal volumes and cognition in remitted geriatric depressive disorder. Behav Brain Res 2011; 227:30-5. [PMID: 22036698 DOI: 10.1016/j.bbr.2011.10.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 10/10/2011] [Accepted: 10/16/2011] [Indexed: 11/24/2022]
Abstract
Growing evidences suggest that the abnormality of hippocampal volume may occur in the process of depression. In this longitudinal study, we calculated the hippocampal volume of 14 remitted geriatric depressed (RGD) patients and 19 healthy participants at baseline and follow-up. We found significant improvement of performance in Trail Making Test-A (P=0.038) and Test-B (P=0.032), and the right hippocampal volume increased mildly in RGD. However, in RGD patients, positive correlations were seen between the changes in right hippocampal volumes and Symbol Digit Modality Test scores (r=0.675, P=0.008), and changes in left hippocampal volumes and Mini-Mental State Examination scores (r=0.743, P=0.002). Our findings suggest that hippocampus related cognitive impairment and previously addressed decreased hippocampal volume might represent a state rather than a permanent trait of the depressive disorder. The results suggest that hippocampal volume may be a useful risk marker for conversion to Alzheimer's disease in RGD patients. Additionally, our study indicates that effective antidepressants treatment might postpone and even revise the deterioration of hippocampus to some degree.
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Affiliation(s)
- Zhenghua Hou
- Department of Psychiatry, Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing 210029, PR China
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111
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Hayward RD, Owen AD, Koenig HG, Steffens DC, Payne ME. Associations of religious behavior and experiences with extent of regional atrophy in the orbitofrontal cortex during older adulthood. RELIGION, BRAIN & BEHAVIOR 2011; 1:103-118. [PMID: 22611519 PMCID: PMC3352675 DOI: 10.1080/2153599x.2011.598328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The orbitofrontal cortex (OFC) is a region of the brain that has been empirically linked with religious or spiritual activity, and atrophy in this region has been shown to contribute to serious mental illness in late life. This study used structural magnetic resonance imaging to examine the association between religious or spiritual factors and volume of the orbitalfrontal cortex (OFC). Change in the volume of participants' left and right OFC was measured longitudinally over a period of two to eight years. Multiple linear regression analyses showed that religious or spiritual factors were related to extent of atrophy in the left OFC. Significantly less atrophy of the left OFC was observed in participants who reported a life-changing religious or spiritual experience during the course of the study, and in members of Protestant religious groups who reported being born-again when entering the study. Significantly greater atrophy of the left OFC was also associated with more frequent participation in public religious worship. No significant relationship was observed between religious or spiritual factors and extent of atrophy in the right OFC. These results support the presence of a long-term relationship between religious or spiritual experience and brain structure, which may have clinical implications.
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Affiliation(s)
- R. David Hayward
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Neuropsychiatric Research Imaging Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Amy D. Owen
- Center for Spirituality, Theology and Health, Duke University Medical Center, Durham, NC, USA
| | - Harold G. Koenig
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Center for Spirituality, Theology and Health, Duke University Medical Center, Durham, NC, USA
| | - David C. Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Neuropsychiatric Research Imaging Laboratory, Duke University Medical Center, Durham, NC, USA
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112
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Avila R, Ribeiz S, Duran FL, Arrais JP, Moscoso MA, Bezerra DM, Jaluul O, Castro CC, Busatto GF, Bottino CM. Effect of temporal lobe structure volume on memory in elderly depressed patients. Neurobiol Aging 2011; 32:1857-67. [DOI: 10.1016/j.neurobiolaging.2009.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 10/29/2009] [Accepted: 11/09/2009] [Indexed: 12/01/2022]
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113
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Colloby SJ, Firbank MJ, Vasudev A, Parry SW, Thomas AJ, O'Brien JT. Cortical thickness and VBM-DARTEL in late-life depression. J Affect Disord 2011; 133:158-64. [PMID: 21550668 DOI: 10.1016/j.jad.2011.04.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2011] [Revised: 04/13/2011] [Accepted: 04/13/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Numerous studies have revealed structural brain changes in late life depression, mainly in white matter or whole lobes with few focussing just on grey matter (GM). The objective was to investigate GM changes in older depressed and similar aged healthy subjects using two different methods, cortical thickness in frontal lobe structures and voxel-based morphometry (VBM). METHODS Sixty eight subjects participated (30 healthy comparison subjects, 38 depressed) and underwent 3T T1 MR imaging as well as clinical and cognitive assessments. Frontal cortical thickness was measured using FreeSurfer while VBM was undertaken using the DARTEL algorithm in SPM8. Group differences in cortical thickness and GM volumes were assessed using ANCOVA. Effects of cortical thickness and VBM results on cognitive and depression variables were also investigated. RESULTS No significant differences in frontal lobe cortical thickness were observed between groups (F(1, 62) ≤ 2.7, p ≥ 0.1). In addition, no significant relationships of cortical thickness on cognitive and depression scores were identified (partial correlation |r'|=0.01-0.31, p ≥ 0.06). VBM showed that GM volumes were indistinguishable between groups but significant age effects were apparent, independent of diagnosis. CONCLUSIONS Results suggest that cortical GM changes in late life depression (LLD) are similar to healthy older subjects and appear to be related to age rather than cognitive or depressive symptoms. Changes to white matter and subcortical GM structures may be more relevant in explaining the underlying neurobiology of LLD.
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Affiliation(s)
- Sean J Colloby
- Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
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114
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Veena J, Srikumar BN, Mahati K, Raju TR, Shankaranarayana Rao BS. Oxotremorine treatment restores hippocampal neurogenesis and ameliorates depression-like behaviour in chronically stressed rats. Psychopharmacology (Berl) 2011; 217:239-53. [PMID: 21494789 DOI: 10.1007/s00213-011-2279-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 03/22/2011] [Indexed: 12/21/2022]
Abstract
RATIONALE Chronic stress results in cognitive impairment, affects hippocampal neurogenesis and is known to precipitate affective disorders such as depression. In addition to stress, neurotransmitters such as acetylcholine (ACh) modulate adult neurogenesis. Earlier, we have shown that oxotremorine, a cholinergic muscarinic agonist, ameliorates stress-induced cognitive impairment and restores cholinergic function. OBJECTIVES In the current study, we have looked into the possible involvement of adult neurogenesis in cognitive restoration by oxotremorine. Further, we have assessed the effect of oxotremorine treatment on depression-like behaviour and hippocampal volumes in stressed animals. METHODS Chronic restraint stressed rats were treated with either vehicle or oxotremorine. For neurogenesis studies, proliferation, survival and differentiation of the progenitor cells in the hippocampus were examined using 5'-bromo-2-deoxyuridine immunohistochemistry. Depression-like behaviour was evaluated using forced swim test (FST) and sucrose consumption test (SCT). Volumes were estimated using Cavalieri's estimator. RESULTS Hippocampal neurogenesis was severely decreased in stressed rats. Ten days of oxotremorine treatment to stressed animals partially restored proliferation and survival, while it completely restored the differentiation of the newly formed cells. Stressed rats showed increased immobility and decreased sucrose preference in the FST and SCT, respectively, and oxotremorine ameliorated this depression-like behaviour. In addition, oxotremorine treatment recovered the stress-induced decrease in hippocampal volume. CONCLUSIONS These results indicate that the restoration of impaired neurogenesis and hippocampal volume could be associated with the behavioural recovery by oxotremorine. Our results imply the muscarinic regulation of adult neurogenesis and incite the potential utility of cholinomimetics in ameliorating cognitive dysfunction in stress-related disorders.
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Affiliation(s)
- J Veena
- Department of Neurophysiology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Hosur Road, PB # 2900, Bangalore, 560 029, India
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115
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A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development. Dev Psychopathol 2011; 23:725-76. [DOI: 10.1017/s0954579411000289] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AbstractThe allostatic load (AL) model represents an interdisciplinary approach to comprehensively conceptualize and quantify chronic stress in relation to pathologies throughout the life cycle. This article first reviews the AL model, followed by interactions among early adversity, genetics, environmental toxins, as well as distinctions among sex, gender, and sex hormones as integral antecedents of AL. We next explore perspectives on severe mental illness, dementia, and caregiving as unique human models of AL that merit future investigations in the field of developmental psychopathology. A complimenting transdisciplinary perspective is applied throughout, whereby we argue that the AL model goes beyond traditional stress–disease theories toward the advancement of person-centered research and practice that promote not only physical health but also mental health.
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116
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Depressive symptoms, brain volumes and subclinical cerebrovascular disease in postmenopausal women: the Women's Health Initiative MRI Study. J Affect Disord 2011; 132:275-84. [PMID: 21349587 PMCID: PMC3109161 DOI: 10.1016/j.jad.2011.01.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Accepted: 01/29/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Late-life depressive symptoms (DS) increase the risk of incident mild cognitive impairment and probable dementia in the elderly. Our objectives were to examine the relationship between elevated DS and regional brain volumes including frontal lobe subregions, hippocampus and amygdala, and to determine whether elevated DS were associated with increased subclinical cerebrovascular disease in postmenopausal women. METHODS DS were assessed an average of 8years prior to structural brain MRI in 1372 women. The 8-item Burnam regression algorithm was used to define DS with a cut-point of 0.009. Adjusting for potential confounders, mean differences in total brain, frontal lobe subregions, hippocampus and amygdala volumes and total ischemic lesion volumes in the basal ganglia and the cerebral white and gray matter outside the basal ganglia were compared between women with and without DS. RESULTS Depressed women had lower baseline global cognition and were more likely to have prior hormone therapy history. After full adjustment, DS at baseline were associated with smaller superior and middle frontal gyral volumes. Hippocampal and amygdala volumes, and ischemic lesion volumes were similar in depressed and non-depressed women. LIMITATIONS Depression was not assessed based on semi-structured interview, and MRI scans were obtained cross-sectionally rather than longitudinally. Longitudinal MRI assessments will be necessary to define the temporal relationships between DS and frontal lobe volumes. CONCLUSIONS Elevated DS were associated with lower volumes in certain frontal lobe subregions but not in the medial temporal lobe structures. Our findings support the role of frontal lobe structures in late-life DS among women.
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117
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Abstract
There is a large literature on the neuroanatomy of late-life depression that continues to grow with the discovery of novel structural imaging techniques along with innovative methods to analyze the images. Such advances have helped identify specific areas, characteristic lesions, and changes in the chemical composition in these regions that might be important in the pathophysiology of this complex disease. This article reviews relevant findings by each structural neuroimaging technique. When validated across many studies, such findings can serve as neuroanatomic markers that can help generate rational hypotheses for future studies to further understanding of geriatric depression.
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Affiliation(s)
- Sophiya Benjamin
- Department of Psychiatry, Duke University Medical Center, DHSP, Box 3837, Durham- 27710, NC, USA
| | - David C Steffens
- Department of Psychiatry, Duke University Medical Center, DHSP, Box 3837, Durham- 27710, NC, USA,Duke Neuropsychiatric Imaging Research Laboratory, 2200 West Main Street, Suite B210, Durham, NC 27705
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Loftis JM. Sertoli cell therapy: a novel possible treatment strategy for treatment-resistant major depressive disorder. Med Hypotheses 2011; 77:35-42. [PMID: 21454019 DOI: 10.1016/j.mehy.2011.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 03/03/2011] [Accepted: 03/07/2011] [Indexed: 12/27/2022]
Abstract
By the year 2020, depression will be the 2nd most common health problem in the world. Current medications to treat depression are effective in less than 50% of patients. There is the need for novel treatments for depression to address the high rates of resistance to current treatment and the chronic residual symptoms in many patients treated for depression. The heterogeneity of major depressive disorder suggests that multiple neurocircuits and neurochemicals are involved in its pathogenesis thus, finding an alternative to neurotransmitter agonist- or antagonist-based treatments offers an important new approach. Cellular therapy is an emerging treatment strategy for multiple diseases, including depression. Based upon their in vivo function as "nurse cells" within the testis and the documented viability, efficacy, and safety of Sertoli cells transplanted into multiple tissues, including brain, the potential for these cells to provide a neuroprotective, anti-inflammatory, and trophic environment for neurons should be considered. It is proposed that the combination of self-protective, immunoregulatory and trophic properties of Sertoli cells may confer a unique potential for depression treatment and avoid many of the risks and challenges associated with stem cell therapies. At the very least, studies of the effects of Sertoli cell transplantation will add substantially to our understanding of the cellular and molecular processes that underlie depression.
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Affiliation(s)
- J M Loftis
- Research & Development Service, Portland VA Medical Center, 3710 SW U.S. Veterans Hospital Rd., Portland, OR 97239, USA.
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119
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Owen AD, Hayward RD, Koenig HG, Steffens DC, Payne ME. Religious factors and hippocampal atrophy in late life. PLoS One 2011; 6:e17006. [PMID: 21479219 PMCID: PMC3068149 DOI: 10.1371/journal.pone.0017006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 01/06/2011] [Indexed: 02/05/2023] Open
Abstract
Despite a growing interest in the ways spiritual beliefs and practices are reflected in brain activity, there have been relatively few studies using neuroimaging data to assess potential relationships between religious factors and structural neuroanatomy. This study examined prospective relationships between religious factors and hippocampal volume change using high-resolution MRI data of a sample of 268 older adults. Religious factors assessed included life-changing religious experiences, spiritual practices, and religious group membership. Hippocampal volumes were analyzed using the GRID program, which is based on a manual point-counting method and allows for semi-automated determination of region of interest volumes. Significantly greater hippocampal atrophy was observed for participants reporting a life-changing religious experience. Significantly greater hippocampal atrophy was also observed from baseline to final assessment among born-again Protestants, Catholics, and those with no religious affiliation, compared with Protestants not identifying as born-again. These associations were not explained by psychosocial or demographic factors, or baseline cerebral volume. Hippocampal volume has been linked to clinical outcomes, such as depression, dementia, and Alzheimer's Disease. The findings of this study indicate that hippocampal atrophy in late life may be uniquely influenced by certain types of religious factors.
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Affiliation(s)
- Amy D. Owen
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, United States of America
| | - R. David Hayward
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, North Carolina, United States of America
- * E-mail:
| | - Harold G. Koenig
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - David C. Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Martha E. Payne
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, United States of America
- Neuropsychiatric Imaging Research Laboratory, Duke University Medical Center, Durham, North Carolina, United States of America
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120
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Goveas JS, Espeland MA, Woods NF, Wassertheil-Smoller S, Kotchen JM. Depressive symptoms and incidence of mild cognitive impairment and probable dementia in elderly women: the Women's Health Initiative Memory Study. J Am Geriatr Soc 2011; 59:57-66. [PMID: 21226676 DOI: 10.1111/j.1532-5415.2010.03233.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To examine whether significant depressive symptoms in postmenopausal women increases the risk of subsequent mild cognitive impairment (MCI) and dementia. DESIGN Prospective cohort study. SETTING Thirty nine of the 40 Women's Health Initiative (WHI) clinical centers that participated in a randomized clinical trial of hormone therapy. PARTICIPANTS Six thousand three hundred seventy-six postmenopausal women without cognitive impairment aged 65 to 79 at baseline. MEASUREMENTS Depressive disorders were assessed using an eight-item Burnam algorithm and followed annually for a mean period of 5.4 years. A central adjudication committee classified the presence of MCI and probable dementia based on an extensive neuropsychiatric examination. RESULTS Eight percent of postmenopausal women in this sample reported depressive symptoms above a 0.06 cut point on the Burnam algorithm. Depressive disorder at baseline was associated with greater risk of incident MCI (hazard ratio (HR)=1.98, 95% confidence interval (CI)=1.33-2.94), probable dementia (HR=2.03, 95% CI=1.15-3.60), and MCI or probable dementia (HR=1.92, 95% CI=1.35-2.73) after controlling for sociodemographic characteristics, lifestyle and vascular risk factors, cardiovascular and cerebrovascular disease, antidepressant use, and current and past hormone therapy status. Assignment to hormone therapy and baseline cognitive function did not affect these relationships. Women without depression who endorsed a remote history of depression had a higher risk of developing dementia. CONCLUSION Clinically significant depressive symptoms in women aged 65 and older are independently associated with greater incidence of MCI and probable dementia.
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Affiliation(s)
- Joseph S Goveas
- From the Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
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121
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Sameti M, Smith S, Patenaude B, Fein G. Subcortical volumes in long-term abstinent alcoholics: associations with psychiatric comorbidity. Alcohol Clin Exp Res 2011; 35:1067-80. [PMID: 21332530 DOI: 10.1111/j.1530-0277.2011.01440.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Research in chronic alcoholics on memory, decision-making, learning, stress, and reward circuitry has increasingly highlighted the importance of subcortical brain structures. In addition, epidemiological studies have established the pervasiveness of co-occurring psychiatric diagnoses in alcoholism. Subcortical structures have been implicated in externalizing pathology, including alcohol dependence, and in dysregulated stress and reward circuitry in anxiety and mood disorders and alcohol dependence. Most studies have focused on active or recently detoxified alcoholics, while subcortical structures in long-term abstinent alcoholics (LTAA) have remained relatively uninvestigated. METHODS Structural MRI was used to compare volumes of 8 subcortical structures (lateral ventricles, thalamus, caudate, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens) in 24 female and 28 male LTAA (mean abstinence=6.3 years, mean age= 46.6 years) and 23 female and 25 male nonalcoholic controls (NAC) (mean age=45.6 years) to explore relations between subcortical brain volumes and alcohol use measures in LTAA and relations between subcortical volumes and psychiatric diagnoses and symptom counts in LTAA and NAC. RESULTS We found minimal differences between LTAA and NAC in subcortical volumes. However, in LTAA, but not NAC, volumes of targeted subcortical structures were smaller in individuals with versus without comorbid lifetime or current psychiatric diagnoses, independent of lifetime alcohol consumption. CONCLUSIONS Our finding of minimal differences in subcortical volumes between LTAA and NAC is consistent with LTAA never having had volume deficits in these regions. However, given that imaging studies have frequently reported smaller subcortical volumes in active and recently detoxified alcoholics compared to controls, our results are also consistent with the recovery of subcortical volumes with sustained abstinence. The finding of persistent smaller subcortical volumes in LTAA, but not NAC, with comorbid psychiatric diagnoses, suggests that the smaller volumes are a result of the combined effects of chronic alcohol dependence and psychiatric morbidity and suggests that a comorbid psychiatric disorder (even if not current) interferes with the recovery of subcortical volumes.
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Affiliation(s)
- Mohammad Sameti
- Neurobehavioral Research, Inc., 1585 Kapiolani Blvd., Honolulu, HI 96814, USA
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Goveas J, Xie C, Wu Z, Douglas Ward B, Li W, Franczak MB, Jones JL, Antuono PG, Yang Z, Li SJ. Neural correlates of the interactive relationship between memory deficits and depressive symptoms in nondemented elderly: resting fMRI study. Behav Brain Res 2011; 219:205-12. [PMID: 21238490 DOI: 10.1016/j.bbr.2011.01.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 11/15/2010] [Accepted: 01/09/2011] [Indexed: 01/09/2023]
Abstract
Prospective studies have shown an association between depressive symptoms and cognitive impairment among older adults. However, the neural correlates of this relationship are poorly understood. Our aim was to examine whether interactive effects of memory deficits and depressive symptoms are present in the memory-associated functional networks, in nondemented elderly subjects. Fifteen subjects with amnestic mild cognitive impairment (aMCI) and 20 age-matched normal (CN) elderly subjects participated in this cross-sectional study. Resting-state functional connectivity MRI (R-fMRI) measured the hippocampal functional connectivity (HFC) alterations between the two groups. Voxelwise linear regression analysis was performed to correlate hippocampal network strength with the Rey Auditory Verbal Learning Test delayed recall and the Geriatric Depression Scale scores, after adjusting for age and group effects. Poorer memory performance was associated with decreased positively correlated HFC connectivity in the specific frontal lobe and default mode network (DMN) structures. Poorer memory performance also was associated with decreased anticorrelated HFC connectivity in the bilateral inferior parietal and right dorsolateral prefrontal cortices. In contrast, greater depressive symptom severity was associated with increased HFC connectivity in several frontal lobes and DMN regions. Depressive symptoms and memory functions had interactive effects on the HFC, in the frontal, temporal, and PCC structures. Our findings suggest that the R-fMRI technique can be used to examine the changes in functional neural networks where memory deficits and depressive symptoms coexist in the geriatric population.
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Affiliation(s)
- Joseph Goveas
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Steffens DC, McQuoid DR, Payne ME, Potter GG. Change in hippocampal volume on magnetic resonance imaging and cognitive decline among older depressed and nondepressed subjects in the neurocognitive outcomes of depression in the elderly study. Am J Geriatr Psychiatry 2011; 19:4-12. [PMID: 20808107 PMCID: PMC3010251 DOI: 10.1097/jgp.0b013e3181d6c245] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION previous studies have linked hippocampal volume change and cognitive decline in older adults with dementia. The authors examined hippocampal volume change and cognitive change in older nondemented adults with and without major depression. METHODS the sample consisted of 90 depressed individuals and 72 healthy, nondepressed individuals aged 60 years and older who completed at least 2 years of follow-up data. All patients underwent periodic clinical evaluation by a geriatric psychiatrist as well as baseline and 2-year magnetic resonance imaging. RESULTS over 2 years, the depressed group showed a greater reduction in left hippocampal volume (normalized for total cerebral volume) compared with the nondepressed group (mean difference = 0.013 ± 0.0059, t = 2.18, df = 160, p <0.0305). The difference remained significant after controlling for age, sex, and baseline normalized left hippocampal volume. The authors also found that hippocampal change from baseline to 2 years was associated with subsequent change in Mini-Mental State Examination score from 2 years to 2½ years (left t = 2.81, df = 66, p = 0.0066; right t = 2.40, df = 66, p = 0.0193) among the depressed group. CONCLUSIONS these findings add to the literature linking hippocampal volume loss and late-life depression. Depressed patients with hippocampal volume loss are at greater risk of cognitive decline.
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Affiliation(s)
- David C Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
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Boccardi M, Ganzola R, Bocchetta M, Pievani M, Redolfi A, Bartzokis G, Camicioli R, Csernansky JG, de Leon MJ, deToledo-Morrell L, Killiany RJ, Lehéricy S, Pantel J, Pruessner JC, Soininen H, Watson C, Duchesne S, Jack CR, Frisoni GB. Survey of protocols for the manual segmentation of the hippocampus: preparatory steps towards a joint EADC-ADNI harmonized protocol. J Alzheimers Dis 2011; 26 Suppl 3:61-75. [PMID: 21971451 PMCID: PMC3829626 DOI: 10.3233/jad-2011-0004] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Manual segmentation from magnetic resonance imaging (MR) is the gold standard for evaluating hippocampal atrophy in Alzheimer's disease (AD). Nonetheless, different segmentation protocols provide up to 2.5-fold volume differences. Here we surveyed the most frequently used segmentation protocols in the AD literature as a preliminary step for international harmonization. The anatomical landmarks (anteriormost and posteriormost slices, superior, inferior, medial, and lateral borders) were identified from 12 published protocols for hippocampal manual segmentation ([Abbreviation] first author, publication year: [B] Bartzokis, 1998; [C] Convit, 1997; [dTM] deToledo-Morrell, 2004; [H] Haller, 1997; [J] Jack, 1994; [K] Killiany, 1993; [L] Lehericy, 1994; [M] Malykhin, 2007; [Pa] Pantel, 2000; [Pr] Pruessner, 2000; [S] Soininen, 1994; [W] Watson, 1992). The hippocampi of one healthy control and one AD patient taken from the 1.5T MR ADNI database were segmented by a single rater according to each protocol. The accuracy of the protocols' interpretation and translation into practice was checked with lead authors of protocols through individual interactive web conferences. Semantically harmonized landmarks and differences were then extracted, regarding: (a) the posteriormost slice, protocol [B] being the most restrictive, and [H, M, Pa, Pr, S] the most inclusive; (b) inclusion [C, dTM, J, L, M, Pr, W] or exclusion [B, H, K, Pa, S] of alveus/fimbria; (c) separation from the parahippocampal gyrus, [C] being the most restrictive, [B, dTM, H, J, Pa, S] the most inclusive. There were no substantial differences in the definition of the anteriormost slice. This survey will allow us to operationalize differences among protocols into tracing units, measure their impact on the repeatability and diagnostic accuracy of manual hippocampal segmentation, and finally develop a harmonized protocol.
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Affiliation(s)
- Marina Boccardi
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS – S. Giovanni di Dio – Fatebenefratelli Brescia, Italy
| | - Rossana Ganzola
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS – S. Giovanni di Dio – Fatebenefratelli Brescia, Italy
| | - Martina Bocchetta
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS – S. Giovanni di Dio – Fatebenefratelli Brescia, Italy
| | - Michela Pievani
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS – S. Giovanni di Dio – Fatebenefratelli Brescia, Italy
| | - Alberto Redolfi
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS – S. Giovanni di Dio – Fatebenefratelli Brescia, Italy
| | - George Bartzokis
- Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Richard Camicioli
- Department of Biomedical Engineering, Centre for Neuroscience, University of Alberta, Edmonton, AB, Canada
| | - John G. Csernansky
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mony J. de Leon
- Center for Brain Health, New York University School of Medicine, New York, NY, USA
| | | | - Ronald J. Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Stéphane Lehéricy
- Center for NeuroImaging Research - CENIR and Dept of Neuroradiology, Université Pierre et Marie Curie-Paris 6, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Johannes Pantel
- Department of Psychiatry and Psychoterapy, University of Frankfurt/Main, Germany
| | - Jens C. Pruessner
- McGill Centre for Studies in Aging, Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - H. Soininen
- Department of Neurology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Craig Watson
- Department of Neurology, Wayne State University School of Medicine, 8D-University Health Center, St. Antoine, Detroit, MI, USA
| | - Simon Duchesne
- Department of Radiology, Université Laval and Centre de Recherche Université Laval – Robert Giffard, Quebec City, Canada
| | - Clifford R. Jack
- Department of Diagnostic Radiology, Mayo Clinic and Foundation, Rochester, MN, USA
| | - Giovanni B. Frisoni
- LENITEM (Laboratory of Epidemiology, Neuroimaging and Telemedicine) IRCCS – S. Giovanni di Dio – Fatebenefratelli Brescia, Italy
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125
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Kanellopoulos D, Gunning FM, Morimoto SS, Hoptman MJ, Murphy CF, Kelly RE, Glatt C, Lim KO, Alexopoulos GS. Hippocampal volumes and the brain-derived neurotrophic factor val66met polymorphism in geriatric major depression. Am J Geriatr Psychiatry 2011; 19:13-22. [PMID: 21218562 PMCID: PMC3058412 DOI: 10.1097/jgp.0b013e3181f61d62] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES structural abnormalities in the hippocampus have been implicated in the pathophysiology of major depressive disorder (MDD). The brain-derived neurotrophic factor (BDNF) val66met polymorphism may contribute to these abnormalities and therefore confer vulnerability to MDD. This study examined whether there is a relationship among BDNF genotype, hippocampal volumes, and MDD in older adults. METHODS thirty-three older adults with MDD and 23 psychiatrically normal comparison subjects were studied. Structural magnetic resonance imaging analysis was used to quantify hippocampal volumes. A repeated-measures analysis of covariance examined the relationships among BDNF val66met (val/val, met carrier), diagnosis (depressed, nondepressed), and hippocampal volumes (right, left). Age, gender, education, and whole brain volume were included as covariates. RESULTS elderly MDD BDNF val/val homozygotes had significantly higher right hippocampal volumes compared with nondepressed val/val subjects. However, there was no difference between the depressed and healthy nondepressed met carriers. In addition, depressed met carriers had an earlier age of onset of depressive illness than val/val homozygotes, but age of onset did not moderate the relationship between hippocampal volumes and MDD diagnosis. CONCLUSION these results provide preliminary evidence of a neuroprotective role of the val/val genotype, suggesting that neurotrophic factor production protects against pathophysiological processes triggered by depression in older adults with later age of onset of MDD. The BDNF val66met polymorphism may play a salient role in structural alterations of the hippocampus in older adults with MDD.
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Affiliation(s)
- Dora Kanellopoulos
- Weill-Cornell Institute of Geriatric Psychiatry, Weill-Cornell Medical College, White Plains, NY, USA.
| | - Faith M. Gunning
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | - Sarah S. Morimoto
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | - Matthew J. Hoptman
- Nathan S. Kline Institute for Psychiatric Research,Department of Psychiatry, New York University School of Medicine
| | | | - Robert E. Kelly
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
| | - Charles Glatt
- Weill Cornell Medical College, Weill-Cornell Institute of Geriatric Psychiatry
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Chen F, Madsen TM, Wegener G, Nyengaard JR. Imipramine treatment increases the number of hippocampal synapses and neurons in a genetic animal model of depression. Hippocampus 2010; 20:1376-84. [DOI: 10.1002/hipo.20718] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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127
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Nifosì F, Toffanin T, Follador H, Zonta F, Padovan G, Pigato G, Carollo C, Ermani M, Amistà P, Perini GI. Reduced right posterior hippocampal volume in women with recurrent familial pure depressive disorder. Psychiatry Res 2010; 184:23-8. [PMID: 20817488 DOI: 10.1016/j.pscychresns.2010.05.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 05/24/2010] [Accepted: 05/27/2010] [Indexed: 12/14/2022]
Abstract
Volumetric changes in mood-relevant distributed limbic/paralimbic structures have been reported in the recent literature on the course of mood disorders. Patients with unipolar and bipolar disorders have been found to have smaller hippocampal and anterior cingulate volumes. We examined hippocampal, amygdalar and anterior cingulate cortex (ACC) volumes in female patients with recurrent familial pure depressive disorder (rFPDD). We used semi-automated software for magnetic resonance imaging (MRI) to measure the volumes of the hippocampus, amygdala, ACC and subgenual prefrontal cortex (SGPFC) in 15 female patients with familial recurrent major depression (MD) and 15 healthy female subjects. Analysis of covariance, with whole brain volume as covariate, was used to compare volumetric measurements in the two groups. Volumes of the right hippocampal body and tail were significantly smaller in female patients with familial depressive disorder than in healthy subjects. Our data provide evidence of structural lateralized hippocampal body and tail abnormalities in women with familial history and recurrent episodes of depression. Although global reduction of hippocampal volume has been widely reported, data on lateralized regional reductions in familial recurrent depression had not been previously reported. Reduced volume of the right posterior hippocampus could be a structural endophenotype for recurrent depressive disorders in women.
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128
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McHugh PC, Rogers GR, Glubb DM, Joyce PR, Kennedy MA. Proteomic analysis of rat hippocampus exposed to the antidepressant paroxetine. J Psychopharmacol 2010; 24:1243-51. [PMID: 19346281 DOI: 10.1177/0269881109102786] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Antidepressant drugs can exert significant effects on the mood of a patient suffering major depression and other disorders. These drugs generally have pharmacological actions on the uptake or metabolism of the neurotransmitters serotonin, noradrenaline and, to a lesser extent, dopamine. However, there are many aspects of antidepressant action we do not understand. We have applied proteomic analysis in a rat hippocampal model in an attempt to identify relevant molecules that operate in pathways functionally relevant to antidepressant action. Rats were administered either 5 mg/kg daily of the antidepressant paroxetine or vehicle for 12 days, then hippocampal protein was recovered and resolved by 2-D gel electrophoresis. After antidepressant exposure, we observed increased expression or modification of cytochrome c oxidase, subunit Va, cyclin-dependent kinase inhibitor 2A interacting protein, dynein, axonemal, heavy polypeptide 3 and RHO GDP-dissociation inhibitor alpha. Decreased expression or modification was observed for complexin 1 (CPLX1), alpha-synuclein, parvalbumin, ribosomal protein large P2, prohibitin, nerve growth factor, beta subunit (NGFB), peroxiredoxin 6 (PRDX6), 1-acylglycerol-3-phosphate O-acyltransferase 2_predicted, cystatin B (CYTB) and lysosomal membrane glycoprotein 1. CPLX1, the most strongly regulated protein observed, mediates the fusion of cellular transport vesicles with their target membranes and has been implicated in the pathophysiology of mood disorders, as well as antidepressant action. CPLX1 and the other proteins identified may represent links into molecular processes of importance to mood dysregulation and control, and their respective genes may represent novel candidates for studies of antidepressant pharmacogenetics.
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Affiliation(s)
- P C McHugh
- Department of Pathology, University of Otago, Christchurch, New Zealand.
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129
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Srivastava K, Ryali V, Prakash J, Bhat PS, Shashikumar R, Khan S. Neuropsychophysiological correlates of depression. Ind Psychiatry J 2010; 19:82-9. [PMID: 22174528 PMCID: PMC3237136 DOI: 10.4103/0972-6748.90336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The neuropsychiatric and cognitive deficits have been shown to exist in various psychiatric disorders. An attempt has been made by authors to evaluate the evidence pertaining to electrophysiological, structural and neuropsychological domains in depression. Renewal of interest in testing patients with depression on a broad range of neuropsychological tasks has revealed distinct pattern of cognitive impairment in cases with depression. The review focuses on structural and neuropsychological evidence of deficit in cases of depression.
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Affiliation(s)
- Kalpana Srivastava
- Department of Psychiatry, Armed Forces Medical College, Pune, Maharashtra, India
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130
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Jalenques I, Legrand G, Vaille-Perret E, Tourtauchaux R, Galland F. Efficacité et tolérance de la stimulation magnétique transcrânienne (SMTr) dans le traitement des dépressions chez le sujet âgé : revue de la littérature. Encephale 2010; 36 Suppl 2:D105-18. [DOI: 10.1016/j.encep.2009.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 09/07/2009] [Indexed: 10/20/2022]
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131
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Rosnick CB, Small BJ, Burton AM. The Effect of Spousal Bereavement on Cognitive Functioning in a Sample of Older Adults. AGING NEUROPSYCHOLOGY AND COGNITION 2010; 17:257-69. [DOI: 10.1080/13825580903042692] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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132
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The brain-derived neurotrophic factor Val66Met polymorphism, hippocampal volume, and cognitive function in geriatric depression. Am J Geriatr Psychiatry 2010; 18:323-31. [PMID: 20220593 PMCID: PMC2928477 DOI: 10.1097/jgp.0b013e3181cabd2b] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The Val66Met polymorphism of the brain-derived neurotrophic factor (BDNF) gene is associated with geriatric depression. In studies of younger adults without depression, met allele carriers exhibit smaller hippocampal volumes and have poorer performance on neuropsychological tests. The authors examined the relationship between the BDNF gene and hippocampal volumes in depressed and nondepressed older individuals and its relationship with memory functions mediated by the hippocampus. DESIGN One hundred seventy-six elderly depressed white participants and 88 nondepressed participants completed clinical assessments, neuropsychological testing, and provided blood samples for genotyping. One hundred seventy-three participants also underwent brain magnetic resonance imaging. Statistical modeling tested the relationship between genotype and hippocampal volume and function while controlling for diagnosis and other covariates. RESULTS BDNF genotype was not associated with a difference in performance on tests mediated by the hippocampus, including word list learning, prose recall, nonverbal memory, or digit span. After controlling for covariates, BDNF genotype was not significantly associated with hippocampal volume (F[1, 171] = 1.10, p = 0.30). CONCLUSION Despite different findings in younger populations, the BDNF Val66Met polymorphism is not significantly associated with hippocampal volume or function in a geriatric population. The authors hypothesize that other factors may have a stronger effect on hippocampal structure in older individuals and that the association between the Val66Met polymorphism and geriatric depression is mediated through other mechanisms.
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Abstract
BACKGROUND Cognitive deficits persist despite clinical recovery in subjects with late-life depression, but more needs to be known about their longer-term outcome and factors affecting their course. To investigate this, we followed the pattern of cognitive impairments over time and examined the effects of current mood, remission status, age of depression onset and antidepressant (AD) treatment on these deficits. METHOD Sixty-seven subjects aged > or = 60 years with DSM-IV major depressive disorder and 36 healthy comparison subjects underwent tests of global cognition, memory, executive functioning and processing speed at baseline, 6 and 18 months, with some subjects tested again after 4 years. z scores were compared between groups, with analyses of clinical factors that may have influenced cognitive performance in depressed subjects. RESULTS Half of the patients exhibited a generalized cognitive impairment (GCI) that persisted after 18 months. Patients performed worse across all cognitive domains at all time points, without substantial variability due to current mood, remission status or AD treatment. Late age of onset was associated significantly with decline in memory and executive functioning. Impaired processing speed may be a partial mediator of some deficits, but was insufficient to explain differences between patients and controls. Four-year follow-up data suggest impairments persist, but do not further decline. CONCLUSIONS Cognitive deficits in late-life depression persist up to 4 years, affect multiple domains and are related to trait rather than state effects. Differences in severity and course between early and late onset depression suggest different pathogenic processes.
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Affiliation(s)
- S Köhler
- Wolfson Research Centre, Institute for Ageing and Health, Newcastle University, Campus for Ageing and Vitality, Newcastle upon Tyne NE4 5PL, UK
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134
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Hindmarch I, Hashimoto K. Cognition and depression: the effects of fluvoxamine, a sigma-1 receptor agonist, reconsidered. Hum Psychopharmacol 2010; 25:193-200. [PMID: 20373470 DOI: 10.1002/hup.1106] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cognitive impairment is a primary feature of patients with major depressive disorder (MDD) and is characterised by stress-induced neural atrophy. Via alpha-adrenergic, anti-cholinergic and anti-histaminic activities, several antidepressants can cause significant counter-therapeutic cognitive impairment. Evidence is emerging of the involvement of sigma-1 receptor agonism in the mechanism of action of some antidepressants, notably fluvoxamine. Sigma-1 receptors are abundant in areas affected by depression/stress-induced cerebral atrophy and their ligands have a unique pharmacological profile; they may promote neurogenesis and initiate adaptive neural plasticity as a protection/reaction to stress. Fluvoxamine, as a potent sigma-1 receptor agonist, has shown ameliorating effects in animal models of psychosis, depression, stress, anxiety, obsessive-compulsive disorder (OCD) and aggression and has been shown to improve cognitive impairments. In humans, fluvoxamine may repair central nervous system (CNS) atrophy and restore cognitive function. The current review explores the mechanisms through which sigma-1 receptors can modulate cognitive function and examines how antidepressant therapy with fluvoxamine may help improve cognitive outcomes in patients with depression.
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135
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Kaymak SU, Demir B, Sentürk S, Tatar I, Aldur MM, Uluğ B. Hippocampus, glucocorticoids and neurocognitive functions in patients with first-episode major depressive disorders. Eur Arch Psychiatry Clin Neurosci 2010; 260:217-23. [PMID: 19756819 DOI: 10.1007/s00406-009-0045-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 08/27/2009] [Indexed: 12/19/2022]
Abstract
The aim of this study was to determine whether there was any relationship between hippocampal volume, and glucocorticoid regulation, and cognitive dysfunctions in drug-naïve major depressive disorder (MDD) patients during their first episode. Twenty drug-free female MDD patients in their first episode and 15 healthy females as control subjects were included in the study. All subjects underwent 3.0 Tesla (T) magnetic resonance imaging (MRI), comprehensive neuropsychological testing and dexamethasone suppression tests (DST). The volumes of the right and left hippocampus of the patients were found to be significantly smaller than those of the controls. Patients were found to have significantly lower scores on measures of attention, working memory, psychomotor speed, executive functions, and visual and verbal memory fields. The performance of the patients only in the recollection memory and memory of reward-associated rules were positively correlated with hippocampal volumes. The volumes of the left and right hippocampus did not correlate with basal or post-dexamethasone cortisol levels. Our findings indicate that depressed patients have smaller hippocampi even in the earlier phase of their illness. Further research efforts are needed to explain the mechanisms that are responsible for the small hippocampus in depressed patients.
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Affiliation(s)
- Semra Ulusoy Kaymak
- Ankara Oncology Training and Research Hospital Psychiatry Clinic, 06600 Kolej, Ankara, Turkey.
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136
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Meta-analysis of the BDNF Val66Met polymorphism in major depressive disorder: effects of gender and ethnicity. Mol Psychiatry 2010; 15:260-71. [PMID: 18852698 DOI: 10.1038/mp.2008.109] [Citation(s) in RCA: 347] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Brain-derived neurotrophic factor (BDNF) is a nerve growth factor that has antidepressant-like effects in animals and may be implicated in the etiology of mood-related phenotypes. However, genetic association studies of the BDNF Val66Met polymorphism (single nucleotide polymorphism rs6265) in major depressive disorder (MDD) have produced inconsistent results. We conducted a meta-analysis of studies comparing the frequency of the BDNF Val66Met-coding variant in depressed cases (MDD) and nondepressed controls. A total of 14 studies involving 2812 cases with DSM-III or -IV defined MDD and 10 843 nondepressed controls met the inclusion criteria. Analyses were stratified either by gender or ethnicity (Asian and Caucasian) because MDD is more prevalent in women and in Caucasians and because BDNF allele frequencies differ by ethnicity. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were provided for allelic analyses (Met versus Val), as well as for genotypic analyses (Met/Met and Val/Met versus Val/Val). In the total sample, the BDNF Val66Met polymorphism was not significantly associated with depression. However, the gender stratified analyses revealed significant effects in both the allelic and genotypic analyses in men (OR(MET), 95% CI; 1.27 (1.10-1.47); OR(MET/MET), 95% CI; 1.67 (1.19-2.36)). Stratification according to ethnicity did not show significant effects of the Val66Met polymorphism on MDD. Our results suggest that the BDNF Val66Met polymorphism is of greater importance in the development of MDD in men than in women. Future research into gender issues will be of interest.
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137
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Köhler S, Thomas AJ, Lloyd A, Barber R, Almeida OP, O'Brien JT. White matter hyperintensities, cortisol levels, brain atrophy and continuing cognitive deficits in late-life depression. Br J Psychiatry 2010; 196:143-9. [PMID: 20118461 DOI: 10.1192/bjp.bp.109.071399] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cerebrovascular changes and glucocorticoid mediated hippocampal atrophy are considered relevant for depression-related cognitive deficits, forming putative treatment targets. AIMS This study examined the relative contribution of cortisol levels, brain atrophy and white matter hyperintensities to the persistence of cognitive deficits in older adults with depression. METHOD Thirty-five people aged > or =60 years with DSM-IV major depression and twenty-nine healthy comparison controls underwent magnetic resonance imaging (MRI) and were followed up for 18 months. We analysed the relationship between baseline salivary cortisol levels, whole brain, frontal lobe and hippocampal volumes, severity of white matter hyperintensities and follow-up cognitive function in both groups by testing the interaction between the groups and these biological measures on tests of memory, executive functions and processing speed in linear regression models. RESULTS Group differences in memory and executive function follow-up scores were associated with ratings of white matter hyperintensities, especially of the deep white matter and periventricular regions. Compared with healthy controls, participants with depression scoring within the third tertile of white matter hyperintensities dropped two and three standard deviations in executive function and memory scores respectively. No biological measure related to group differences in processing speed, and there were no significant interactions between group and cortisol levels, or volumetric MRI measures. CONCLUSIONS White matter hyperintensities, rather than cortisol levels or brain atrophy, are associated with continuing cognitive impairments in older adults with depression. The findings suggest that cerebrovascular disease rather than glucocorticoid-mediated brain damage are responsible for the persistence of cognitive deficits associated with depression in older age.
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Affiliation(s)
- Sebastian Köhler
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
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138
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Abe O, Yamasue H, Kasai K, Yamada H, Aoki S, Inoue H, Takei K, Suga M, Matsuo K, Kato T, Masutani Y, Ohtomo K. Voxel-based analyses of gray/white matter volume and diffusion tensor data in major depression. Psychiatry Res 2010; 181:64-70. [PMID: 19959342 DOI: 10.1016/j.pscychresns.2009.07.007] [Citation(s) in RCA: 157] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 04/15/2009] [Accepted: 07/07/2009] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to use voxel-based analysis to simultaneously elucidate regional changes in gray/white matter volume, mean diffusivity (MD), and fractional anisotropy (FA) in patients with unipolar major depressive disorder. We studied 21 right-handed patients and 42 age- and gender-matched right-handed normal subjects. Local areas showing significant gray matter volume reduction in depressive patients compared with controls were observed in the right parahippocampal gyrus, hippocampus, bilateral middle frontal gyri, bilateral anterior cingulate cortices, left parietal and occipital lobes, and right superior temporal gyrus. Local areas showing an increase of MD in depressive patients were observed in the bilateral parahippocampal gyri, hippocampus, pons, cerebellum, left frontal and temporal lobes, and right frontal lobe. There was no significant difference between the two groups for FA and white matter volume in the entire brain. Although there was no local area where brain volume and MD were significantly correlated with disease severity, FA tended to correlate negatively with total days depressed in the right anterior cingulate and the left frontal white matter. These results suggest that the frontolimbic neural circuit might play an important role in the neuropathology of patients with major depressive disorder.
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Affiliation(s)
- Osamu Abe
- Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
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139
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Koolschijn PCMP, van Haren NEM, Lensvelt-Mulders GJLM, Hulshoff Pol HE, Kahn RS. Brain volume abnormalities in major depressive disorder: a meta-analysis of magnetic resonance imaging studies. Hum Brain Mapp 2010; 30:3719-35. [PMID: 19441021 DOI: 10.1002/hbm.20801] [Citation(s) in RCA: 611] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE So far, there have been no attempts to integrate the growing number of all brain volumetric magnetic resonance imaging studies in depression. In this comprehensive meta-analysis the magnitude and extent of brain volume differences between 2,418 patients with major depressive disorder and 1,974 healthy individuals from 64 studies was determined. METHODS A systematic research was conducted for volumetric magnetic resonance imaging studies of patients with major depressive disorder in relation to healthy control subjects. Studies had to report sufficient data for computation of effect sizes. For each study, the Cohen's d was calculated. All analyses were performed using the random effects model. Additionally, meta-regression analyses were done to explore the effects of potential sources of heterogeneity. RESULTS Patients showed large volume reductions in frontal regions, especially in the anterior cingulate and orbitofrontal cortex with smaller reductions in the prefrontal cortex. The hippocampus, the putamen and caudate nucleus showed moderate volume reductions. CONCLUSIONS This is the first comprehensive meta-analysis in major depressive disorder demonstrating structural brain abnormalities, particularly in those brain areas that are involved in emotion processing and stress-regulation.
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Affiliation(s)
- P Cédric M P Koolschijn
- Department of Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
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140
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Werner NS, Meindl T, Materne J, Engel RR, Huber D, Riedel M, Reiser M, Hennig-Fast K. Functional MRI study of memory-related brain regions in patients with depressive disorder. J Affect Disord 2009; 119:124-31. [PMID: 19346000 DOI: 10.1016/j.jad.2009.03.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 03/03/2009] [Accepted: 03/03/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Structural imaging studies of patients suffering from depressive disorder have revealed reduced hippocampal volume in the majority of cases. The present study aimed specifically at investigating the hippocampal function in unipolar depression using functional magnetic resonance imaging (fMRI). METHODS Eleven unipolar depressed patients and eleven healthy control participants matched for age, gender and years of education underwent an associative learning paradigm during fMRI scanning. In the encoding condition of the paradigm, participants had to learn face-profession pairs. These pairs had to be remembered in the retrieval condition. RESULTS Hippocampal activity did not differ between depressive patients and control participants during encoding or retrieval. However, during encoding, depressive patients showed increased activity in the left parahippocampal gyrus and decreased activity in frontal and parietal regions. Retrieval of the associative pairs also yielded decreased activation patterns in depressive patients in frontal and parietal areas. LIMITATIONS The present findings may be limited by the small sample size of participants. Additionally the comparatively young age of the depressive sample could indicate a comparatively shorter duration of illness, and thereby less salient measurable hippocampal abnormalities. CONCLUSION The current study suggests that depression is associated with modified memory-related brain function. In particular the parahippocampal gyrus, the prefrontal cortex and parietal regions show functional alterations during associative learning. These structures as well as their interrelationships may play an important role in the pathogenesis of depressive disorder.
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Affiliation(s)
- Natalie S Werner
- Clinic of Psychiatry and Psychotherapy, Ludwig-Maximilians-University Munich, Germany.
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141
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Savitz JB, Drevets WC. Imaging phenotypes of major depressive disorder: genetic correlates. Neuroscience 2009; 164:300-30. [PMID: 19358877 PMCID: PMC2760612 DOI: 10.1016/j.neuroscience.2009.03.082] [Citation(s) in RCA: 140] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 03/20/2009] [Accepted: 03/30/2009] [Indexed: 02/06/2023]
Abstract
Imaging techniques are a potentially powerful method of identifying phenotypes that are associated with, or are indicative of, a vulnerability to developing major depressive disorder (MDD). Here we identify seven promising MDD-associated traits identified by magnetic resonance imaging (MRI) or positron emission tomography (PET). We evaluate whether these traits are state-independent, heritable endophenotypes, or state-dependent phenotypes that may be useful markers of treatment efficacy. In MDD, increased activity of the amygdala in response to negative stimuli appears to be a mood-congruent phenomenon, and is likely moderated by the 5-HT transporter gene (SLC6A4) promoter polymorphism (5-HTTLPR). Hippocampal volume loss is characteristic of elderly or chronically-ill samples and may be impacted by the val66met brain-derived neurotrophic factor (BDNF) gene variant and the 5-HTTLPR SLC6A4 polymorphism. White matter pathology is salient in elderly MDD cohorts but is associated with cerebrovascular disease, and is unlikely to be a useful marker of a latent MDD diathesis. Increased blood flow or metabolism of the subgenual anterior cingulate cortex (sgACC), together with gray matter volume loss in this region, is a well-replicated finding in MDD. An attenuation of the usual pattern of fronto-limbic connectivity, particularly a decreased temporal correlation in amygdala-anterior cingulate cortex (ACC) activity, is another MDD-associated trait. Concerning neuroreceptor PET imaging, decreased 5-HT(1A) binding potential in the raphe, medial temporal lobe, and medial prefrontal cortex (mPFC) has been strongly associated with MDD, and may be impacted by a functional single nucleotide polymorphism in the promoter region of the 5-HT(1A) gene (HTR1A: -1019 C/G; rs6295). Potentially indicative of inter-study variation in MDD etiology or mood state, both increased and decreased binding potential of the 5-HT transporter has been reported. Challenges facing the field include the problem of phenotypic and etiological heterogeneity, technological limitations, the confounding effects of medication, and non-disease related inter-individual variation in brain morphology and function. Further advances are likely as epigenetic, copy-number variant, gene-gene interaction, and genome-wide association (GWA) approaches are brought to bear on imaging data.
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Affiliation(s)
- J B Savitz
- Mood and Anxiety Disorders Program, NIH/NIMH, Bethesda, MD 20892, USA.
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142
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Morra JH, Tu Z, Apostolova LG, Green AE, Avedissian C, Madsen SK, Parikshak N, Hua X, Toga AW, Jack CR, Schuff N, Weiner MW, Thompson PM. Automated 3D mapping of hippocampal atrophy and its clinical correlates in 400 subjects with Alzheimer's disease, mild cognitive impairment, and elderly controls. Hum Brain Mapp 2009; 30:2766-88. [PMID: 19172649 DOI: 10.1002/hbm.20708] [Citation(s) in RCA: 150] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We used a new method we developed for automated hippocampal segmentation, called the auto context model, to analyze brain MRI scans of 400 subjects from the Alzheimer's disease neuroimaging initiative. After training the classifier on 21 hand-labeled expert segmentations, we created binary maps of the hippocampus for three age- and sex-matched groups: 100 subjects with Alzheimer's disease (AD), 200 with mild cognitive impairment (MCI) and 100 elderly controls (mean age: 75.84; SD: 6.64). Hippocampal traces were converted to parametric surface meshes and a radial atrophy mapping technique was used to compute average surface models and local statistics of atrophy. Surface-based statistical maps visualized links between regional atrophy and diagnosis (MCI versus controls: P = 0.008; MCI versus AD: P = 0.001), mini-mental state exam (MMSE) scores, and global and sum-of-boxes clinical dementia rating scores (CDR; all P < 0.0001, corrected). Right but not left hippocampal atrophy was associated with geriatric depression scores (P = 0.004, corrected); hippocampal atrophy was not associated with subsequent decline in MMSE and CDR scores, educational level, ApoE genotype, systolic or diastolic blood pressure measures, or homocysteine. We gradually reduced sample sizes and used false discovery rate curves to examine the method's power to detect associations with diagnosis and cognition in smaller samples. Forty subjects were sufficient to discriminate AD from normal and correlate atrophy with CDR scores; 104, 200, and 304 subjects, respectively, were required to correlate MMSE with atrophy, to distinguish MCI from normal, and MCI from AD.
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Affiliation(s)
- Jonathan H Morra
- Laboratory of Neuro Imaging, Department of Neurology, UCLA School of Medicine, Los Angeles, California 90095-1769, USA
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143
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Becker JT, Chang YF, Lopez OL, Dew MA, Sweet RA, Barnes D, Yaffe K, Young J, Kuller L, Reynolds CF. Depressed mood is not a risk factor for incident dementia in a community-based cohort. Am J Geriatr Psychiatry 2009; 17:653-63. [PMID: 19634208 PMCID: PMC2714703 DOI: 10.1097/jgp.0b013e3181aad1fe] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the relationship between depressed mood and the development of Alzheimer disease in cognitively normal individuals. DESIGN Longitudinal and observational. SETTING Community-based cohort study. PARTICIPANTS A total of 288 participants in the Cardiovascular Health Study-Cognition Study (mean age: 77.52, SD =3.65, range: 70-89). All of the participants were adjudicated as cognitively normal in 1998/1999, and all had at least three visits before 1998/1999 with measures of cognition and mood state. The mean length of follow-up from 1998-1999 to 2007 was 7.1 years (range: 1-9 years, median =9 years). MEASUREMENTS The Center for Epidemiological Studies-Depression Scale (CESD) was used to index mood state, and the Modified Mini-Mental State Examination (3MSE) was the index of cognitive function among participants before 1998/1999. These measures were considered in two ways: participants were classified according to: 1) whether they showed a high-negative correlation between their CESD and 3MSE scores (i.e., indicating that greater depression was linked to poorer cognition) and 2) whether they showed persistently elevated CESD scores. The study outcome, development of dementia (N = 48), was based on consensus classifications, which was based on detailed neuropsychological and neurological exams. RESULTS The authors could find no consistent relationship between mood state, either alone or in relation to cognitive status, and the subsequent development of dementia. Those individuals whose cognitive functions were highly correlated with their mood state were no more likely to develop dementia than other participants. Those who had persistently depressed mood were also no more likely to develop dementia than those without persistently depressed mood. CONCLUSION Within the confines of this prospective, community-based study of elderly adults, the authors could not find strong evidence to support the hypothesis that mood disturbance was linked with the development of dementia.
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Affiliation(s)
- James T Becker
- Department of Psychiatry, School of Medicine, Graduate School of Public Health, University of Pittsburgh, 3501 Forbes Avenue, Pittsburgh, PA 15213, USA.
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144
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Tamburo RJ, Siegle GJ, Stetten GD, Cois CA, Butters MA, Reynolds CF, Aizenstein HJ. Amygdalae morphometry in late-life depression. Int J Geriatr Psychiatry 2009; 24:837-46. [PMID: 19085964 PMCID: PMC2872075 DOI: 10.1002/gps.2167] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The amygdalae have been a focus of mood disorder research due to their key role in processing emotional information. It has been long known that depressed individuals demonstrate impaired functional performance while engaged in emotional tasks. The structural basis for these functional differences has been investigated via volumetric analysis with mixed findings. In this study, we examined the morphometric basis for these functional changes in late-life depression (LLD) by analyzing both the size and shape of the amygdalae with the hypothesis that shape differences may be apparent even when overall volume differences are inconsistent. METHODS Magnetic resonance imaging data were acquired from 11 healthy, elderly individuals and 14 depressed, elderly individuals. Amygdalar size was quantified by computing total volume and amygdalar shape was quantified with a shape analysis method that we have developed. RESULTS No significant volumetric differences were found for either amygdala. Nevertheless, localized regions of significant shape variation were detected for the left and right amygdalae. The most significant difference was contraction (LLD subjects as compared to control subjects) in a region typically associated with the basolateral nucleus, which plays a key role in emotion recognition in neurobiologic models of depression. CONCLUSIONS In this LLD study, we have shown that, despite insignificant amygdalar volumetric findings, variations of amygdalar shape can be detected and localized. With further investigation, morphometric analysis of various brain structures may help elucidate the neurobiology associated with LLD and other mood disorders.
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Affiliation(s)
- Robert J. Tamburo
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
,Correspondence to: R. J. Tamburo, 3811 O’Hara Street Pittsburgh, PA 15213, USA. E-mail:
| | - Greg J. Siegle
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - George D. Stetten
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
,The Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - C. Aaron Cois
- Information Services Division, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Meryl A. Butters
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
,Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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145
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Smith GS, Kramer E, Ma Y, Kingsley P, Dhawan V, Chaly T, Eidelberg D. The functional neuroanatomy of geriatric depression. Int J Geriatr Psychiatry 2009; 24:798-808. [PMID: 19173332 PMCID: PMC2730507 DOI: 10.1002/gps.2185] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Positron Emission Tomography (PET) studies of cerebral glucose metabolism have demonstrated sensitivity in evaluating the functional neuroanatomy of treatment response variability in depression, as well as in the early detection of functional changes associated with incipient cognitive decline. The evaluation of cerebral glucose metabolism in late life depression may have implications for understanding treatment response variability, as well as evaluating the neurobiological basis of depression in late life as a risk factor for dementia. METHODS Sixteen patients with geriatric depression and 13 comparison subjects underwent resting PET studies of cerebral glucose metabolism, as well as magnetic resonance (MR) imaging scans to evaluate brain structure. RESULTS Cerebral glucose metabolism was elevated in geriatric depressed patients relative to comparison subjects in anterior (right and left superior frontal gyrus) and posterior (precuneus, inferior parietal lobule) cortical regions. Cerebral atrophy (increased cerebrospinal fluid [CSF] and decreased grey and white matter volumes) were observed in some of these regions, as well. Regional cerebral metabolism was positively correlated with severity of depression and anxiety symptoms. CONCLUSIONS In contrast to decreased metabolism observed in normal aging and neurodegenerative conditions such as Alzheimer's disease, cortical glucose metabolism was increased in geriatric depressed patients relative to demographically matched controls, particularly in brain regions in which cerebral atrophy was observed, which may represent a compensatory response.
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Affiliation(s)
- Gwenn S Smith
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, New York, USA.
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146
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Leung KK, Lee TMC, Wong MMC, Li LSW, Yip PSF, Khong PL. Neural correlates of attention biases of people with major depressive disorder: a voxel-based morphometric study. Psychol Med 2009; 39:1097-1106. [PMID: 18945378 DOI: 10.1017/s0033291708004546] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Patients with major depressive disorder are found to show selective attention biases towards mood-congruent information. Although previous studies have identified various structural changes in the brains of these patients, it remains unclear whether the structural abnormalities are associated with these attention biases. In this study, we used voxel-based morphometry (VBM) to explore the structural correlates of attention biases towards depression-related stimuli. METHOD Seventeen female patients with major depressive disorder and 17 female healthy controls, matched on age and intelligence, underwent magnetic resonance imaging (MRI). They also performed positive-priming (PP) and negative-priming (NP) tasks involving neutral and negative words that assessed selective attention biases. The reaction time (RT) to a target word that had been attended to or ignored in a preceding trial was measured on the PP and NP tasks respectively. The structural differences between the two groups were correlated with the indexes of attention biases towards the negative words. RESULTS The enhanced facilitation of attention to stimuli in the PP task by the negative valence was only found in the depressed patients, not in the healthy controls. Such attention biases towards negative stimuli were found to be associated with reduced gray-matter concentration (GMC) in the right superior frontal gyrus, the right anterior cingulate gyrus and the right fusiform gyrus. No differential effect in inhibition of attention towards negative stimuli in the NP task was found between the depressed patients and the healthy controls. CONCLUSIONS Specific structural abnormalities in depression are associated with their attention biases towards mood-congruent information.
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Affiliation(s)
- K-K Leung
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong
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147
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Thomas AJ, Gallagher P, Robinson LJ, Porter RJ, Young AH, Ferrier IN, O'Brien JT. A comparison of neurocognitive impairment in younger and older adults with major depression. Psychol Med 2009; 39:725-733. [PMID: 18667097 DOI: 10.1017/s0033291708004042] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Neurocognitive impairment is a well-recognized feature of depression that has been reported in younger and older adults. Similar deficits occur with ageing and it is unclear whether the greater deficits in late-life depression are an ageing-related phenomenon or due to a difference in the nature of late-life depression itself. We hypothesized that ageing alone would not fully explain the increased neurocognitive impairment in late-life depression but that differences in the illness explain the greater decrements in memory and executive function. METHOD Comparison of the neuropsychological performance of younger (<60 years) and older (60 years) adults with major depressive disorder (MDD) and healthy comparison subjects. Scores for each depression group were normalized against their respective age-matched control group and the primary comparisons were on four neurocognitive domains: (i) attention and executive function; (ii) verbal learning and memory; (iii) visuospatial learning and memory; and (iv) motor speed. RESULTS We recruited 75 subjects with MDD [<60 years (n=44), 60 years (n=31)] and 82 psychiatrically healthy comparison subjects [<60 years (n=42), 60 years (n=40)]. The late-life depression group had greater impairment in verbal learning and memory and motor speed but not in executive function. The two depressed groups did not differ in depression severity, global cognitive function, intelligence or education. CONCLUSIONS Late-life depression is associated with more severe impairment in verbal learning and memory and motor speed than depression in earlier adult life and this is not due to ageing alone.
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Affiliation(s)
- A J Thomas
- Institute for Ageing and Health, Newcastle University, UK.
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Posterior Cingulate and Lateral Parietal Gray Matter Volume in Older Adults with Depressive Symptoms. Brain Imaging Behav 2009; 3:233-239. [PMID: 19701486 PMCID: PMC2728909 DOI: 10.1007/s11682-009-9065-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 03/11/2009] [Indexed: 12/03/2022]
Abstract
Depressive symptoms occurring late in life are an important risk factor for Alzheimer’s disease (AD). The latest research finds that onset of depressive symptoms in late life may herald the development of AD, not only for amnestic Mild Cognitive Impairment (aMCI) patients, but also for cognitively-normal older adults. Neuroimaging of brain structure, blood flow, and glucose metabolism indicates that depressive symptoms in late life are accompanied by structural and functional changes in limbic brain regions vulnerable to AD. The present cross-sectional study was guided by the hypothesis that compared to their non-depressed counterparts, older adults with mild to moderate depressive symptoms have less volume in limbic structures vulnerable to changes in AD—specifically, cortical midline structures such as anterior cingulate and posterior cingulate cortex as well as mesial temporal regions such as bilateral hippocampi and amygdalae. Consistent with our hypothesis, results of a voxel-based morphometry analysis revealed smaller retrosplenial, posterior cingulate, and precuneus gray matter volumes in depressed individuals relative to healthy controls. Right lateral parietal cortex—another region vulnerable to change in AD—was also smaller in the group with depressive symptoms. Contrary to our hypothesis, no volumetric differences were found in the anterior cingulate cortex or mesial temporal lobe. Results of this study show a relationship between geriatric depressive symptoms and brain volume in regions vulnerable to AD. Follow-up of participants over time will tell if brain changes detected here predict development of AD.
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149
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Bipolar and major depressive disorder: neuroimaging the developmental-degenerative divide. Neurosci Biobehav Rev 2009; 33:699-771. [PMID: 19428491 DOI: 10.1016/j.neubiorev.2009.01.004] [Citation(s) in RCA: 361] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 01/14/2009] [Indexed: 01/30/2023]
Abstract
Both major depressive disorder and bipolar disorder are the subject of a voluminous imaging and genetics literature. Here, we attempt a comprehensive review of MRI and metabolic PET studies conducted to date on these two disorders, and interpret our findings from the perspective of developmental and degenerative models of illness. Elevated activity and volume loss of the hippocampus, orbital and ventral prefrontal cortex are recurrent themes in the literature. In contrast, dorsal aspects of the PFC tend to display hypometabolism. Ventriculomegaly and white matter hyperintensities are intimately associated with depression in elderly populations and likely have a vascular origin. Important confounding influences are medication, phenotypic and genetic heterogeneity, and technological limitations. We suggest that environmental stress and genetic risk variants interact with each other in a complex manner to alter neural circuitry and precipitate illness. Imaging genetic approaches hold out promise for advancing our understanding of affective illness.
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Dillon C, Allegri RF, Serrano CM, Iturry M, Salgado P, Glaser FB, Taragano FE. Late- versus early-onset geriatric depression in a memory research center. Neuropsychiatr Dis Treat 2009; 5:517-26. [PMID: 19851519 PMCID: PMC2762368 DOI: 10.2147/ndt.s7320] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To contrast early-onset (<60 years) and late-onset (>60 years) depression in geriatric patients by evaluating differences in cognition, vascular comorbidity and sociological risk factors. Both patient groups were compared with normal subjects. MATERIALS AND METHODS We recruited 76 patients with depressive symptoms (37 late onset and 39 early onset) and 17 normal controls matched by age and educational level. All subjects were assessed using a semistructured neuropsychiatric interview and an extensive neuropsychological battery. Vascular and sociological risk factors were also evaluated. RESULTS We found a significant variation in performance between depressive patients and normal controls in most cognitive functions, especially memory (P < 0.0001), semantic fluency (P < 0.0001), verbal fluency, and digit-symbol (P < 0.0001). Late-onset depression patients scored lower and exhibited more severe impairment in memory domains than early-onset depression patients (P < 0.05). Cholesterol levels and marital status were significantly (P < 0.05) different between the depressive groups. Both depressed groups (early- and late-onset) were more inactive than controls (P < 0.05; odds ratio: 6.02). CONCLUSION Geriatric depression may be a manifestation of brain degeneration, and the initial symptom of a dementia. It is important to consider this in the treatment of patients that exhibit late-onset depressive symptoms.
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Affiliation(s)
- Carol Dillon
- Memory Research Center, Department of Neurology, Hospital General Abel Zubizarreta, GCBA Buenos Aires, Argentina. , http//www.cemic.edu.ar/
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