[Risk Factors for Disability Pensioning Caused by Mental Disorders - A Systematic Review]

Background: Meanwhile, mental disorders are the main reason for receiving a disability pension. The present study aimed at providing an overview of the German literature on characteristics and factors related to ERMD and pointing out the current state in this field of research. Revealing parameters that are accompanied by an ERMD is a precondition to prospectively prevent this trend. Methods: A systematic literature review was conducted from 2001 through to 2014. All results regarding German statutory pension insurants pensioned due to mental disorders after 2001 were included. Studies were considered if they reported 2 or more relevant results. Research design was not limited, except for excluding anonymous questionnaires. Results: 20 studies were found meeting eligibility criteria. All included studies were based on secondary analyses of data derived from the German statutory pension insurance. By means of gender-specific regression analyses the level of qualification and the geographical region were unveiled to be significant predictors of the ERMD. Basically, most reported results were descriptive or explorative. Besides various single results and evidence for interactions, frequently reported results are that: (i) female insurants get pensioned more frequently due to mental disorders than male insurants, (ii) affective disorders are the most frequent diagnoses, (iii) insurants with mental disorders are younger than insurants with somatic disorders when they get pensioned and (iv) insurants with schizophrenic disorders are younger than insurants with other mental disorders when they get pensioned. The utilisation of rehabilitative services before getting pensioned is limited at 50%. Conclusion: This work demonstrates a lack of empirical evidence of how (and what) disability risks are associated with ERMD in Germany. Furthermore, our results illustrate that a major part of the insurants do not attend rehabilitative services before their retirement, even though rehabilitation of mental illness is assumed to be effective. Future studies should hence focus on identifying disability related risk factors and barriers to using rehabilitative services in order to develop starting points for preventive and individual strategies.

Adult age-dependent differences in resting-state connectivity within and between visual-attention and sensorimotor networks

Healthy aging is accompanied by structural and functional changes in the brain, among which a loss of neural specificity (i.e., dedifferentiation) is one of the most consistent findings. Little is known, however, about changes in interregional integration underlying a dedifferentiation across different functional systems. In a large sample (n = 399) of healthy adults aged from 18 to 85 years, we analyzed age-dependent differences in resting-state (RS) (task-independent) functional connectivity (FC) of a set of brain regions derived from a previous fMRI study. In that study, these regions had shown an age-related loss of activation specificity in visual-attention (superior parietal area 7A and dorsal premotor cortex) or sensorimotor (area OP4 of the parietal operculum) tasks. In addition to these dedifferentiated regions, the FC analysis of the present study included “task-general” regions associated with both attention and sensorimotor systems (rostral supplementary motor area and bilateral anterior insula) as defined via meta-analytical co-activation mapping. Within this network, we observed both selective increases and decreases in RS-FC with age. In line with regional activation changes reported previously, we found diminished anti-correlated FC for inter-system connections (i.e., between sensorimotor-related and visual attention-related regions). Our analysis also revealed reduced FC between system-specific and task-general regions, which might reflect age-related deficits in top-down control possibly leading to dedifferentiation of task-specific brain activity. Together, our results underpin the notion that RS-FC changes concur with regional activity changes in the healthy aging brain, presumably contributing jointly to age-related behavioral changes.

The role of anterior midcingulate cortex in cognitive motor control: evidence from functional connectivity analyses

The rostral cingulate cortex has been associated with a multitude of cognitive control functions. Recent neuroimaging data suggest that the anterior midcingulate cortex (aMCC) has a key role for cognitive aspects of movement generation, i.e., intentional motor control. We here tested the functional connectivity of this area using two complementary approaches: (1) resting-state connectivity of the aMCC based on fMRI scans obtained in 100 subjects, and (2) functional connectivity in the context of explicit task conditions using meta-analytic connectivity modeling (MACM) over 656 imaging experiment. Both approaches revealed a convergent functional network architecture of the aMCC with prefrontal, premotor and parietal cortices as well as anterior insula, area 44/45, cerebellum and dorsal striatum. To specifically test the role of the aMCC's task-based functional connectivity in cognitive motor control, separate MACM analyses were conducted over "cognitive" and "action" related experimental paradigms. Both analyses confirmed the same task-based connectivity pattern of the aMCC. While the "cognition" domain showed higher convergence of activity in supramodal association areas in prefrontal cortex and anterior insula, "action" related experiments yielded higher convergence in somatosensory and premotor areas. Secondly, to probe the functional specificity of the aMCC's convergent functional connectivity, it was compared with a neural network of intentional movement initiation. This exemplary comparison confirmed the involvement of the state independent FC network of the aMCC in the intentional generation of movements. In summary, the different experiments of the present study suggest that the aMCC constitute a key region in the network realizing intentional motor control.

Activation shift in elderly subjects across functional systems: an fMRI study

The functional specificity of brain areas is diminished with age and accompanied by the recruitment of additional brain regions in healthy older adults. This process has repeatedly been demonstrated within distinct functional domains, in particular the visual system. However, it is yet unclear, whether this phenomenon in healthy aging, i.e., a reduced activation of task-associated areas and increased activation of additional regions, is also present across different functional systems. In the present functional imaging study, comprising 102 healthy subjects, we therefore assessed two distinct tasks engaging the sensory-motor system and the visual attention system, respectively. We found a significant interaction between age and task in the parietal operculum bilaterally. This area as a part of the sensory-motor system showed an age-related decrease in its BOLD-response to the motor task and an age-related increase of neural activity in response to the visual attention task. The opposite response pattern, i.e., reduced visual attention activation and increased response to the motor task, was observed for regions associated with the visual task: the superior parietal area 7A and the dorsal pre-motor cortex. Importantly, task performance was not correlated with age in either task. This age-by-task interaction indicates that a reduction of functional specificity in the aging brain may be counteracted by the increased recruitment of additional regions not only within, but also across functional domains. Our results thus emphasize the need for comparisons across different functional domains to gain a better understanding of age-related effects on the specificity of functional systems.

Task- and resting-state functional connectivity of brain regions related to affection and susceptible to concurrent cognitive demand

A recent fMRI-study revealed neural responses for affective processing of stimuli for which overt attention irrespective of stimulus valence was required in the orbitofrontal cortex (OFC) and bilateral amygdala (AMY): activation decreased with increasing cognitive demand. To further characterize the network putatively related to this attenuation, we here characterized these regions with respect to their functional properties and connectivity patterns in task-dependent and task-independent states. All experiments of the BrainMap database activating the seed regions OFC and bilateral AMY were identified. Their functional characteristics were quantitatively inferred using the behavioral meta-data of the retrieved experiments. Task-dependent functional connectivity was characterized by meta-analytic connectivity modeling (MACM) of significant co-activations with these seed regions. Task-independent resting-state functional connectivity analysis in a sample of 100 healthy subjects complemented these analyses. All three seed regions co-activated with subgenual cingulum (SGC), precuneus (PCu) and nucleus accumbens (NAcc) in the task-dependent MACM analysis. Task-independent resting-state connectivity revealed significant coupling of the seeds only with the SGC, but not the PCu and the NAcc. The former region (SGC) moreover was shown to feature significant resting-state connectivity with all other regions implicated in the network connected to regions where emotional processing may be modulated by a cognitive distractor. Based on its functional profile and connectivity pattern, we suggest that the SGC might serve as a key hub in the identified network, as such linking autobiographic information [PCu], reward [NAcc], (reinforce) values [OFC] and emotional significance [AMY]. Such a role, in turn, may allow the SGC to influence the OFC and AMY to modulate affective processing.

Differentiated parietal connectivity of frontal regions for "what" and "where" memory

In a previous meta-analysis across almost 200 neuroimaging experiments, working memory for object location showed significantly stronger convergence on the posterior superior frontal gyrus, whereas working memory for identity showed stronger convergence on the posterior inferior frontal gyrus (dorsal to, but overlapping with Brodmann’s area BA 44). As similar locations have been discussed as part of a dorsal frontal—superior parietal reach system and an inferior frontal grasp system, the aim of the present study was to test whether the regions of working-memory related “what” and “where” processing show a similar distinction in parietal connectivity. The regions that were found in the previous meta-analysis were used as seeds for functional connectivity analyses using task-based meta-analytic connectivity modelling and task-independent resting state correlations. While the ventral seed showed significantly stronger connectivity with the bilateral intraparietal sulcus (IPS), the dorsal seed showed stronger connectivity with the bilateral posterior inferior parietal and the medial superior parietal lobule. The observed connections of regions involved in memory for object location and identity thus clearly demonstrate a distinction into separate pathways that resemble the parietal connectivity patterns of the dorsal and ventral premotor cortex in non-human primates and humans. It may hence be speculated that memory for a particular location and reaching towards it as well as object memory and finger positioning for manipulation may rely on shared neural systems. Moreover, the ensuing regions, in turn, featured differential connectivity with the bilateral ventral and dorsal extrastriate cortex, suggesting largely segregated bilateral connectivity pathways from the dorsal visual cortex via the superior and inferior parietal lobules to the dorsal posterior frontal cortex and from the ventral visual cortex via the IPS to the ventral posterior frontal cortex that may underlie action and cognition.

Is there "one" DLPFC in cognitive action control? Evidence for heterogeneity from co-activation-based parcellation

The dorsolateral prefrontal cortex (DLPFC) has consistently been implicated in cognitive control of motor behavior. There is, however, considerable variability in the exact location and extension of these activations across functional magnetic resonance imaging (fMRI) experiments. This poses the question of whether this variability reflects sampling error and spatial uncertainty in fMRI experiments or structural and functional heterogeneity of this region. This study shows that the right DLPFC as observed in 4 different experiments tapping executive action control may be subdivided into 2 distinct subregions-an anterior-ventral and a posterior-dorsal one -based on their whole-brain co-activation patterns across neuroimaging studies. Investigation of task-dependent and task-independent connectivity revealed both clusters to be involved in distinct neural networks. The posterior subregion showed increased connectivity with bilateral intraparietal sulci, whereas the anterior subregion showed increased connectivity with the anterior cingulate cortex. Functional characterization with quantitative forward and reverse inferences revealed the anterior network to be more strongly associated with attention and action inhibition processes, whereas the posterior network was more strongly related to action execution and working memory. The present data provide evidence that cognitive action control in the right DLPFC may rely on differentiable neural networks and cognitive functions.

Co-activation patterns distinguish cortical modules, their connectivity and functional differentiation

The organization of the cerebral cortex into distinct modules may be described along several dimensions, most importantly, structure, connectivity and function. Identification of cortical modules by differences in whole-brain connectivity profiles derived from diffusion tensor imaging or resting state correlations has already been shown. These approaches, however, carry no task-related information. Hence, inference on the functional relevance of the ensuing parcellation remains tentative. Here, we demonstrate, that Meta-Analytic Connectivity Modeling (MACM) allows the delineation of cortical modules based on their whole-brain co-activation pattern across databased neuroimaging results. Using a model free approach, two regions of the medial pre-motor cortex, SMA and pre-SMA were differentiated solely based on their functional connectivity. Assessing the behavioral domain and paradigm class meta-data of the experiments associated with the clusters derived from the co-activation based parcellation moreover allows the identification of their functional characteristics. The ensuing hypotheses about functional differentiation and distinct functional connectivity between pre-SMA and SMA were then explicitly tested and confirmed in independent datasets using functional and resting state fMRI. Co-activation based parcellation thus provides a new perspective for identifying modules of functional connectivity and linking them to functional properties, hereby generating new and subsequently testable hypotheses about the organization of cortical modules.

Paternal deprivation alters region- and age-specific interneuron expression patterns in the biparental rodent, Octodon degus

The impact of paternal care on the postnatal development of inhibitory neuronal subpopulations in prefrontal and limbic brain regions was studied in the rodent Octodon degus. Comparing offspring from biparental families with animals raised by a single mother revealed region-specific deprivation-induced changes in the density of PARV- and CaBP-D28k expressing cells. Some deprivation-induced changes were only seen at P21: elevated CaBP-D28k-positive neurons in the orbitofrontal cortex, CA1, CA3, and dentate gyrus (DG) and elevated PARV-positive neurons in the lateral orbitofrontal, prelimbic/infralimbic (PL/IL), DG and CA1, nucleus accumbens, and amygdala. Some deprivation-induced changes were obvious in both age groups: increased CaBP-D28k-positive neurons in the nucleus accumbens shell and increased PARV-positive neurons in the ventral orbitofrontal. Some deprivation-induced changes were only seen in adulthood: increased CaBP-D28k-positive neurons in the amygdala and decreased PARV-positive neurons in the PL/IL and in CA3. In CA1, PARV-positive neurons were increased at P21 and decreased in adulthood. The functional significance of the deprivation-induced changes in PARV-positive neurons, which are involved in gamma oscillations and thereby affect information processing and which appear to be key players for critical period plasticity in sensory cortex development, as well as the behavioral implications remain to be further elucidated.