Frontostriatal and limbic dysfunction in late-life depression.
Frontostriatal and limbic dysfunction in late-life depression.
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DOI：
10.1097/00019442-200211000-00007
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发表时间：
2002-11
期刊：
影响因子：
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通讯作者：
G. Alexopoulos
中科院分区：
文献类型：
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作者：
G. Alexopoulos
使用不同方法的研究已经证明了在晚年抑郁症中发生的额纹状体和边缘功能障碍。尽管这些损伤可能是由与抑郁症无关的衰老引起的大脑变化引起的，但至少有两个原因表明它们在老年抑郁症中起着致病作用。首先，至少在一些没有已知神经异常的年轻抑郁受试者中发现了额纹状体功能障碍。其次，额纹状体功能障碍可能与晚期抑郁症的短期和长期预后不良有关。考虑到没有生物学测试可以作为验证标准，将额纹状体和边缘功能障碍与晚年抑郁症的过程联系起来是研究其病理生理学相关性的合适方法。然而，这种方法有实验局限性。预后良好的抑郁症患者选择性生存可能影响晚期抑郁症病程的研究；与抑郁症生物学相关的外围因素，例如，身体缺陷；以及与特定生物学异常关系不明确的临床因素，例如人格障碍。尽管如此，将抑郁症患者与对照对象进行比较，并辅以病程研究的研究，可以在研究导致晚年抑郁症易感、加剧和延续的网络时，运用迅速发展的认知神经科学和脑成像技术。
Studies using diverse methods have documented frontostriatal and limbic dysfunction occurring in late-life depression. Although such impairments may result from aging-induced brain changes unrelated to depression, there are at least two reasons to suggest that they play a pathogenetic role in geriatric depression. First, frontostriatal dysfunction has been identified in at least some younger depressed subjects without known neurological abnormalities. Second, frontostriatal dysfunction may be associated with poor short- and long-term outcomes of late-life depression. Relating frontostriatal and limbic dysfunction to the course of late-life depression is an appropriate way for investigating its pathophysiological relevance, given that no biological test can be used as a validating criterion. However, this approach has experimental limitations. Studies of the course of late-life depression may be influenced by selective survival of depressed patients with favorable prognosis; factors peripherally related to the biology of depression, for example, physical handicaps; and clinical factors with unclear relationship to specific biological abnormalities, for example, personality disorders. Nonetheless, studies comparing depressed patients with control subjects complemented with studies of course of illness can bring to bear the rapidly evolving cognitive-neuroscience and brain-imaging techniques in an investigation of the networks responsible for predisposing, precipitating, and perpetuating late-life depression.