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Abstract
PURPOSE OF REVIEW The complex nature of narcolepsy symptoms, along with the use of stimulants and anticataplectic medications, poses diagnostic difficulties in terms of underlying neuropsychiatric comorbidities. This study reviews recent evidence for the association between narcolepsy and neuropsychiatric disorders. We also critically analyze studies that have addressed the neuropsychiatric correlates of patients with narcolepsy, with a discussion of the possible pathophysiological mechanisms linking narcolepsy and neuropsychiatric disorders. RECENT FINDINGS Neuropsychiatric manifestations are common among patients with narcolepsy as narcolepsy and some neuropsychiatric disorders share common clinical features. This may create challenges in making the correct diagnosis, and hence result in a delay in starting appropriate treatment. Comorbid neuropsychiatric manifestations in patients with narcolepsy include depression, anxiety, psychosis, rapid eye movement (REM) sleep behavior disorder, and cognitive impairment. Although hypocretin deficiency has been proposed as a pathophysiological mechanism underlying both narcolepsy and neuropsychiatric disorders, further research is necessary to identify the exact mechanisms. Narcolepsy patients often manifest comorbid neuropsychiatric symptoms, which makes the diagnosis difficult. Therefore, it is essential to address neuropsychiatric symptoms in the clinical care of patients with narcolepsy.
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McDermott KD, Williams SE, Espeland MA, Erickson K, Neiberg R, Wadden TA, Bryan RN, Desiderio L, Leckie RL, Falconbridge LH, Jakicic JM, Alonso-Alonso M, Wing RR. Impact of Intensive Lifestyle Intervention on Neural Food Cue Reactivity: Action for Health in Diabetes Brain Ancillary Study. Obesity (Silver Spring) 2019; 27:1076-1084. [PMID: 31112370 PMCID: PMC6591068 DOI: 10.1002/oby.22496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 03/06/2019] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The Action for Health in Diabetes (Look AHEAD) research study was a randomized trial comparing the effects of an intensive lifestyle intervention (ILI) versus a diabetes support and education (DSE) control group in adults with type 2 diabetes and overweight or obesity. Functional magnetic resonance imaging was used to determine whether neural food cue reactivity differed for these groups 10 years after randomization. METHODS A total of 232 participants (ILI, n = 125, 72% female; DSE, n = 107, 64% female) were recruited at three of the Look AHEAD sites for functional magnetic resonance imaging. Neural response to high-calorie foods compared with nonfoods was assessed in DSE versus ILI. Exploratory correlations were conducted within ILI to identify regions in which activity was associated with degree of weight loss. RESULTS Voxel-wise whole-brain comparisons revealed greater reward-processing activity in left caudate for DSE compared with ILI and greater activity in attention- and visual-processing regions for ILI than DSE (P < 0.05, family-wise error corrected). Exploratory analyses revealed that greater weight loss among ILI participants from baseline was associated with brain activation indicative of increased cognitive control and attention and visual processing in response to high-calorie food cues (P < 0.001, uncorrected). CONCLUSIONS These findings suggest there may be legacy effects of participation in a behavioral weight loss intervention, with reduced reward-related activity and enhanced attention or visual processing in response to high-calorie foods.
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Affiliation(s)
- Kathryn Demos McDermott
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
| | - Samantha E Williams
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
- Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
| | - Mark A Espeland
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kirk Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rebecca Neiberg
- Department of Psychology, Saint Louis University, St. Louis, Missouri, USA
| | - Thomas A Wadden
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - R Nick Bryan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Desiderio
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Regina L Leckie
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Psychology, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Lucy H Falconbridge
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John M Jakicic
- Department of Health and Physical Activity, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Miguel Alonso-Alonso
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island, USA
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van Holst RJ, Janssen LK, van Mierlo P, Lammers GJ, Cools R, Overeem S, Aarts E. Enhanced food-related responses in the ventral medial prefrontal cortex in narcolepsy type 1. Sci Rep 2018; 8:16391. [PMID: 30401926 PMCID: PMC6219562 DOI: 10.1038/s41598-018-34647-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/08/2018] [Indexed: 11/13/2022] Open
Abstract
Narcolepsy type 1 is a chronic sleep disorder caused by a deficiency of the orexin (hypocretin) neuropeptides. In addition to sleep regulation, orexin is important for motivated control processes. Weight gain and obesity are common in narcolepsy. However, the neurocognitive processes associated with food-related control and overeating in narcolepsy are unknown. We explored the neural correlates of general and food-related attentional control in narcolepsy-type-1 patients (n = 23) and healthy BMI-matched controls (n = 20). We measured attentional bias to food words with a Food Stroop task and general executive control with a Classic Stroop task during fMRI. Moreover, using multiple linear regression, we assessed the relative contribution of neural responses during Food Stroop and Classic Stroop to spontaneous snack intake. Relative to healthy controls, narcolepsy patients showed enhanced ventral medial prefrontal cortex responses and connectivity with motor cortex during the Food Stroop task, but attenuated dorsal medial prefrontal cortex responses during the Classic Stroop task. Moreover, the former activity but not the latter, was a significant predictor of spontaneous snack intake. These findings demonstrate that narcolepsy, characterized by orexin deficiency, is associated with decreased dorsal medial prefrontal cortex responses during general executive control and enhanced ventral medial prefrontal cortex responses during food-driven attention.
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Affiliation(s)
- Ruth Janke van Holst
- Department of Neurology, Radboud university medical center, Nijmegen, The Netherlands. .,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands. .,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Lieneke K Janssen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | | | - Gert Jan Lammers
- Sleep-Wake Center SEIN, Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Roshan Cools
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Psychiatry, Radboud university medical center, Nijmegen, The Netherlands
| | - Sebastiaan Overeem
- Sleep Medicine Center Kempenhaeghe, Heeze, The Netherlands.,Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Esther Aarts
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
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