Neuroanatomic pathways associated with monoaminergic dysregulation after stroke
Neuroanatomic pathways associated with monoaminergic dysregulation after stroke
复制标题
DOI：
10.1002/gps.4503
复制
发表时间：
2017-06-01
影响因子：
4
通讯作者：
Kurisu, Kaoru
中科院分区：
文献类型：
--
作者：
Hama, Seiji;Murakami, Taro;Kurisu, Kaoru
目的：探讨脑卒中后病变部位、抑郁症状（情感性和麻木性）和单胺功能障碍之间的复杂关系。方法：对48例脑卒中后患者分别采用医院焦虑抑郁量表和冷漠量表评估情感和冷漠症状，进行磁共振成像。取24h尿样测定去甲肾上腺素（NA）、多巴胺（DA）及其代谢物和血清素（5-HT）代谢物，取血样测定5-HT和3-甲氧基-4-羟基苯基乙二醇。我们开发了一个统计参数图，显示病变位置与单胺及其代谢物的阳性和阴性改变之间的关联。结果：多因素分析显示基底节区病变和5-HT与情感性症状相关，而同型香草酸与冷漠性症状相关。单变量分析显示没有这种关系。然而，NA和DA的减少以及NA和DA转换的增加与脑干病变有关，而NA和DA的增加以及NA和DA转换的减少与皮质和/或纹状体病变有关。5-羟色胺转换数据显示了与NA和DA转换相反的模式。结论：单胺能神经元通路受受体介导的反馈机制和转换机制共同控制；因此，单胺的消耗并不是抑郁和冷漠的唯一原因。此外，单胺神经网络可分为两个分支，儿茶酚胺（NA和DA）和5-羟色胺，两者在解剖学和功能上相互关联，分别影响抑郁症的冷漠和情感症状。
Objective: We examined the complex relationship between lesion location, symptoms of depression (affective and apathetic), and monoamine dysfunction after stroke.Methods: Magnetic resonance imaging was performed on 48 post-stroke patients that had been assessed for affective and apathetic symptoms using the Hospital Anxiety and Depression Scale and the Apathy Scale, respectively. Noradrenalin (NA), dopamine (DA), their metabolites, and a metabolite of serotonin (5-HT) were measured using 24-h urine samples, and 5-HT and 3-methoxy-4-hydroxyphenylglycol were measured using blood samples. We developed a statistical parametric map that displayed the associations between lesion location and both positive and negative alterations of monoamines and their metabolites.Results: Multivariate analysis indicated that basal ganglia lesions and 5-HT showed relationships with affective symptoms, whereas homovanillic acid was related to apathetic symptoms. Univariate analysis showed no such relationships. However, decreases in NA and DA and increases in NA and DA turnover were related to lesions in the brainstem, whereas increases in NA and DA as well as decreases in NA and DA turnover were related to cortical and/or striatum lesions. 5-HT turnover data showed a pattern opposite to that seen for NA and DA turnover.Conclusions: Monoaminergic neuronal pathways are controlled by both receptor-mediated feedback mechanisms and turnover; thus, depletion of monoamines is not the only cause of depression and apathy. Moreover, the monoamine neuronal network might be divided into two branches, catecholamine (NA and DA) and 5-HT, both of which are anatomically and functionally interconnected and could respectively influence apathetic and affective symptoms of depression.