Dyspnea-related cues engage the prefrontal cortex: evidence from functional brain imaging in COPD.
Dyspnea-related cues engage the prefrontal cortex: evidence from functional brain imaging in COPD.
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DOI：
10.1378/chest.15-0416
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发表时间：
2015-10
期刊：
影响因子：
9.6
通讯作者：
Pattinson KTS
中科院分区：
文献类型：
--
作者：
Herigstad M;Hayen A;Evans E;Hardinge FM;Davies RJ;Wiech K;Pattinson KTS
呼吸困难是COPD残疾的主要原因。在COPD中，环境因素（例如，不得不爬楼梯的前景）与呼吸困难相关，甚至可能在体力活动开始之前触发呼吸困难。我们假设，与这些线索相关的大脑激活在COPD患者和健康对照受试者之间是不同的，反映了患者更大的情感机制参与。使用功能磁共振成像（FMRI），我们调查了41例COPD患者和40名年龄匹配的健康对照组的大脑对呼吸困难相关的文字线索的反应。我们将这些发现与自我报告问卷的分数相结合，从而将功能磁共振成像任务与临床相关措施联系起来。这种方法是从疼痛研究中改编而来的，这些疼痛研究使我们能够识别负责疼痛处理的大脑网络，尽管没有身体上的挑战。COPD患者表现出内侧前额叶皮层和前扣带皮层的激活，这与视觉模拟量表（VAS）对文字提示的反应相关。这种活动与患者对抑郁、疲劳和呼吸困难警惕问卷的反应独立相关。前额叶、外侧前额叶皮质和楔前叶的激活与VAS呼吸困难量表相关，但与问卷调查无关。研究结果表明，参与大脑的情绪回路是重要的解释呼吸困难相关的线索在COPD和抑郁症，疲劳和警惕的影响。对显著线索的反应增强与慢性疼痛和哮喘的症状感知增加有关，研究结果表明，这种机制可能与COPD有关。
Dyspnea is the major source of disability in COPD. In COPD, environmental cues (eg, the prospect of having to climb stairs) become associated with dyspnea and may trigger dyspnea even before physical activity commences. We hypothesized that brain activation relating to such cues would be different between patients with COPD and healthy control subjects, reflecting greater engagement of emotional mechanisms in patients. Using functional MRI (FMRI), we investigated brain responses to dyspnea-related word cues in 41 patients with COPD and 40 healthy age-matched control subjects. We combined these findings with scores on self-report questionnaires, thus linking the FMRI task with clinically relevant measures. This approach was adapted from studies in pain that enabled identification of brain networks responsible for pain processing despite absence of a physical challenge. Patients with COPD demonstrated activation in the medial prefrontal cortex and anterior cingulate cortex, which correlated with the visual analog scale (VAS) response to word cues. This activity independently correlated with patient responses on questionnaires of depression, fatigue, and dyspnea vigilance. Activation in the anterior insula, lateral prefrontal cortex, and precuneus correlated with the VAS dyspnea scale but not with the questionnaires. The findings suggest that engagement of the emotional circuitry of the brain is important for interpretation of dyspnea-related cues in COPD and is influenced by depression, fatigue, and vigilance. A heightened response to salient cues is associated with increased symptom perception in chronic pain and asthma, and the findings suggest that such mechanisms may be relevant in COPD.