Microstructural white matter abnormalities and remission of geriatric depression
Microstructural white matter abnormalities and remission of geriatric depression
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DOI：
10.1176/appi.ajp.2007.07050744
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发表时间：
2008-02-01
影响因子：
17.7
通讯作者：
Hoptman, Matthew J.
中科院分区：
文献类型：
--
作者：
Alexopoulos, George S.;Murphy, Christopher F.;Hoptman, Matthew J.
目的：白质异常可能干扰边缘皮质平衡并导致慢性抑郁综合征。作者使用弥散张量成像来检验以下假设：未能实现缓解的老年抑郁症患者在与老年抑郁症相关的皮质 - 纹状体 - 边缘网络中存在白质微观结构异常。
方法：研究对象为无精神病性重度抑郁症的非痴呆个体。经过2周的安慰剂期后，汉密尔顿抑郁量表（HAM - D）评分在18分及以上的受试者接受艾司西酞普兰治疗，每日10mg，持续12周。缓解定义为连续2周HAM - D评分在7分及以下。在1.5特斯拉扫描仪上进行弥散张量成像，并以年龄为协变量进行基于体素的各向异性分数分析。
结果：与实现缓解的受试者（N = 25）相比，未能实现缓解的受试者（N = 23）在多个额叶边缘脑区的各向异性分数较低，包括喙部和背侧前扣带回、背外侧前额叶皮质、胼胝体膝部、海马旁白质、多个后扣带回皮质区域以及岛叶白质。此外，在新纹状体和中脑以及部分颞叶和顶叶区域也检测到较低的各向异性分数。
结论：分布在大脑网络中的较低各向异性分数与老年抑郁症的抗抑郁反应不佳有关，可能代表了一种易患该疾病的神经解剖学基础。
Objective: White matter abnormalities may interfere with limbic cortical balance and lead to chronic depressive syndromes. The authors used diffusion tensor imaging to test the hypothesis that depressed elders who fail to achieve remission have microstructural white matter abnormalities in cortico-striato-limbic networks implicated in geriatric depression.Method: The subjects were nondemented individuals with nonpsychotic major depression. After a 2-week placebo period, those subjects who had a Hamilton Depression Rating Scale (HAM-D) score of 18 or greater received escitalopram, 10 mg daily, for 12 weeks. Remission was defined as a HAM-D score of 7 or below for 2 consecutive weeks. Diffusion tensor imaging was performed at a 1.5 Tesla scanner, and voxel-based analysis of fractional anisotropy was conducted using age as the covariate.Results: Subjects who failed to achieve remission (N=23) had lower fractional anisotropy in multiple frontal limbic brain areas, including the rostral and dorsal anterior cingulate, dorsolateral prefrontal cortex, genu of the corpus callosum, white matter adjacent to the hippocampus, multiple posterior cingulate cortex regions, and insular white matter, relative to those who achieved remission (N=25). In addition, lower fractional anisotropy was detected in the neostriatum and midbrain as well as select temporal and parietal regions.Conclusions: Lower fractional anisotropy in distributed cerebral networks is associated with poor antidepressant response of geriatric depression and may represent a neuroanatomical substrate that predisposes to this disorder.