Disrupted Amygdalar Subregion Functional Connectivity and Evidence of a Compensatory Network in Generalized Anxiety Disorder
Disrupted Amygdalar Subregion Functional Connectivity and Evidence of a Compensatory Network in Generalized Anxiety Disorder
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DOI：
10.1001/archgenpsychiatry.2009.104
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发表时间：
2009-12-01
影响因子：
--
通讯作者：
Greicius, Michael D.
中科院分区：
文献类型：
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作者：
Etkin, Amit;Prater, Katherine E.;Greicius, Michael D.
背景：对广泛性焦虑症(GAD)潜在的神经异常知之甚少。对其他焦虑症的研究与杏仁核有关，但在GAD的研究得出了相互矛盾的结果。杏仁核由不同的亚区组成，这些亚区与可分离的大脑网络相互作用，这只在实验动物中进行了研究。目的：确定人类杏仁核基底外侧(BLA)和中央内侧(CMA)亚区是否可以可靠地识别不同的连接模式，并检查GAD的次区域连接模式和潜在的代偿性杏仁核连接。设计：横断面研究。背景：学术医学中心。参与者：两组健康对照受试者(包括17名和31名受试者)和16名GAD患者。主要观察指标：在受试者安静地躺在扫描仪中进行功能磁共振成像时，测量与细胞结构确定的感兴趣的BLA和CMA区域的功能连通性。杏仁核灰质体积也通过基于体素的形态计量学进行了研究。结果：在两组健康对照组中，在大规模连接方面存在可重复的次区域差异。BLA与初级、高级感觉和内侧前额叶皮质有不同的联系。CMA与中脑、丘脑和小脑有联系。在广泛性AD患者中，BLA和CMA的连接模式明显不明显，灰质体积增加主要见于CMA。在各个亚区，GAD患者与先前特征的额顶执行控制网络的连通性增加，与以岛和扣带为基础的突出网络的连通性降低。结论：我们的发现为人类杏仁核的功能神经解剖学提供了新的见解，并与实验动物的连通性研究相一致。在广泛性痴呆症中，我们发现了杏仁核内异常和代偿性额顶执行控制网络参与的证据，这与广泛性痴呆症的认知理论一致。
Context: Little is known about the neural abnormalities underlying generalized anxiety disorder (GAD). Studies in other anxiety disorders have implicated the amygdala, but work in GAD has yielded conflicting results. The amygdala is composed of distinct subregions that interact with dissociable brain networks, which have been studied only in experimental animals. A functional connectivity approach at the subregional level may therefore yield novel insights into GAD.Objectives: To determine whether distinct connectivity patterns can be reliably identified for the basolateral (BLA) and centromedial (CMA) subregions of the human amygdala, and to examine subregional connectivity patterns and potential compensatory amygdalar connectivity in GAD.Design: Cross-sectional study.Setting: Academic medical center.Participants: Two cohorts of healthy control subjects (consisting of 17 and 31 subjects) and 16 patients with GAD.Main Outcome Measures: Functional connectivity with cytoarchitectonically determined BLA and CMA regions of interest, measured during functional magnetic resonance imaging performed while subjects were resting quietly in the scanner. Amygdalar gray matter volume was also investigated with voxel-based morphometry.Results: Reproducible subregional differences in large-scale connectivity were identified in both cohorts of healthy controls. The BLA was differentially connected with primary and higher-order sensory and medial prefrontal cortices. The CMA was connected with the midbrain, thalamus, and cerebellum. In GAD patients, BLA and CMA connectivity patterns were significantly less distinct, and increased gray matter volume was noted primarily in the CMA. Across the subregions, GAD patients had increased connectivity with a previously characterized frontoparietal executive control network and decreased connectivity with an insula- and cingulate-based salience network.Conclusions: Our findings provide new insights into the functional neuroanatomy of the human amygdala and converge with connectivity studies in experimental animals. In GAD, we find evidence of an intra-amygdalar abnormality and engagement of a compensatory frontoparietal executive control network, consistent with cognitive theories of GAD.