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Winter A, Gruber M, Thiel K, Flinkenflügel K, Meinert S, Goltermann J, Winter NR, Borgers T, Stein F, Jansen A, Brosch K, Wroblewski A, Thomas-Odenthal F, Usemann P, Straube B, Alexander N, Jamalabadi H, Nenadić I, Bonnekoh LM, Dohm K, Leehr EJ, Opel N, Grotegerd D, Hahn T, van den Heuvel MP, Kircher T, Repple J, Dannlowski U. Shared and distinct structural brain networks related to childhood maltreatment and social support: connectome-based predictive modeling. Mol Psychiatry 2023; 28:4613-4621. [PMID: 37714950 PMCID: PMC10914611 DOI: 10.1038/s41380-023-02252-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/30/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
Childhood maltreatment (CM) has been associated with changes in structural brain connectivity even in the absence of mental illness. Social support, an important protective factor in the presence of childhood maltreatment, has been positively linked to white matter integrity. However, the shared effects of current social support and CM and their association with structural connectivity remain to be investigated. They might shed new light on the neurobiological basis of the protective mechanism of social support. Using connectome-based predictive modeling (CPM), we analyzed structural connectomes of N = 904 healthy adults derived from diffusion-weighted imaging. CPM predicts phenotypes from structural connectivity through a cross-validation scheme. Distinct and shared networks of white matter tracts predicting childhood trauma questionnaire scores and the social support questionnaire were identified. Additional analyses were applied to assess the stability of the results. CM and social support were predicted significantly from structural connectome data (all rs ≥ 0.119, all ps ≤ 0.016). Edges predicting CM and social support were inversely correlated, i.e., positively correlated with CM and negatively with social support, and vice versa, with a focus on frontal and temporal regions including the insula and superior temporal lobe. CPM reveals the predictive value of the structural connectome for CM and current social support. Both constructs are inversely associated with connectivity strength in several brain tracts. While this underlines the interconnectedness of these experiences, it suggests social support acts as a protective factor following adverse childhood experiences, compensating for brain network alterations. Future longitudinal studies should focus on putative moderating mechanisms buffering these adverse experiences.
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Affiliation(s)
- Alexandra Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Marius Gruber
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Katharina Thiel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Kira Flinkenflügel
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Institute for Translational Neuroscience, University of Münster, Münster, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils R Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tiana Borgers
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Frederike Stein
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
- Core-Facility Brainimaging, Faculty of Medicine, University of Marburg, Marburg, Germany
| | - Katharina Brosch
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Adrian Wroblewski
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Florian Thomas-Odenthal
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Paula Usemann
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Nina Alexander
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Hamidreza Jamalabadi
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Igor Nenadić
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Linda M Bonnekoh
- Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils Opel
- Department of Psychiatry and Psychotherapy, University of Jena, Jena, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tim Hahn
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Martijn P van den Heuvel
- Connectome Lab, Department of Complex Trait Genetics, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
- Department of Child Psychiatry, Amsterdam University Medical Center, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
- Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Giessen, Germany
| | - Jonathan Repple
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany.
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Hirabayashi N, Honda T, Hata J, Furuta Y, Shibata M, Ohara T, Tatewaki Y, Taki Y, Nakaji S, Maeda T, Ono K, Mimura M, Nakashima K, Iga JI, Takebayashi M, Ninomiya T. Association Between Frequency of Social Contact and Brain Atrophy in Community-Dwelling Older People Without Dementia: The JPSC-AD Study. Neurology 2023; 101:e1108-e1117. [PMID: 37438128 DOI: 10.1212/wnl.0000000000207602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/16/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Epidemiologic evidence has shown that social isolation, a low frequency of social contact with others, is associated with the risk of dementia and late-life depressive symptoms. Therefore, we hypothesized that low frequency of social contact may be involved in brain atrophy, and depressive symptoms may play some role in this relationship. We aimed to evaluate the association between low frequency of social contact and the volumes of various brain regions and to assess the extent to which depressive symptoms mediate these relationships from a large population-based multisite cohort study. METHODS Dementia-free community-dwelling Japanese aged 65 years or older underwent brain MRI scans and a comprehensive health examination. Frequency of contact with noncohabiting relatives and friends was determined by asking a single question with 4 categories: everyday, several times a week, several times a month, and seldom. Total and regional brain volumes, intracranial volume (ICV), and white matter lesion volume were estimated using FreeSurfer software. The associations between frequency of social contact and brain volumes per ICV were examined using analyses of covariance. Mediation analyses were conducted to calculate the proportion of the associations explained by depressive symptoms. RESULTS We included 8,896 participants. The multivariable-adjusted mean of the total brain volume in the group with the lowest frequency of social contact was significantly lower compared with that in the group with the highest frequency of social contact (67.3% vs 67.8%), with a significant increasing trend across the groups (p value for trend <0.001). The white matter lesion volume increased significantly with lower frequency of social contact (0.30% in the lowest frequency group vs 0.26% in the highest frequency group, p value for trend <0.001). Lower frequency of social contact was associated with smaller volumes in the temporal lobe, occipital lobe, cingulum, hippocampus, and amygdala (all q values of false discovery rate correction <0.05). The relationships seemed to be partly mediated by depressive symptoms, which accounted for 15%-29% of the observed associations. DISCUSSION Lower frequency of social contact was associated with decreased total and cognitive function-related regional brain volumes. In addition, depressive symptoms partially explained the association in community-dwelling older people without dementia in Japan.
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Affiliation(s)
- Naoki Hirabayashi
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Takanori Honda
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Jun Hata
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Yoshihiko Furuta
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Mao Shibata
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Tomoyuki Ohara
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Yasuko Tatewaki
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Yasuyuki Taki
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Shigeyuki Nakaji
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Tetsuya Maeda
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Kenjiro Ono
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Masaru Mimura
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Kenji Nakashima
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Jun-Ichi Iga
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Minoru Takebayashi
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan
| | - Toshiharu Ninomiya
- From the Department of Epidemiology and Public Health (N.H., T.H., J.H., Y.F., M.S., T.O., T.N.), Department of Psychosomatic Medicine (N.H., M.S.), Ito Clinic (N.H.), Center for Cohort Studies (T.H., J.H., M.S., T.N.), Department of Medicine and Clinical Science (J.H., Y.F.), and Department of Neuropsychiatry (T.O.), Graduate School of Medical Sciences, Kyushu University, Fukuoka; Department of Aging Research and Geriatric Medicine (Y. Tatewaki, Y. Taki), Institute of Development, Aging and Cancer, Tohoku University, Sendai; Department of Social Medicine (S.N.), Graduate School of Medicine, Hirosaki University; Division of Neurology and Gerontology (T.M.), Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba; Department of Neurology (K.O.), Kanazawa University Graduate School of Medical Sciences, Kanazawa University; Department of Neuropsychiatry (M.M.), Keio University School of Medicine, Tokyo; National Hospital Organization (K.N.), Matsue Medical Center; Department of Neuropsychiatry (J.I.), Ehime University Graduate School of Medicine, Ehime University, Matsuyama; and Department of Neuropsychiatry (M.T.), Faculty of Life Sciences, Kumamoto University, Japan.
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