Differentiating Unipolar and Bipolar Depression by Alterations in Large-Scale Brain Networks
Differentiating Unipolar and Bipolar Depression by Alterations in Large-Scale Brain Networks
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DOI：
10.1002/hbm.23070
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发表时间：
2016-02-01
影响因子：
4.8
通讯作者：
Gruber, Oliver
中科院分区：
文献类型：
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作者：
Goya-Maldonado, Roberto;Brodmann, Katja;Gruber, Oliver
背景：双相抑郁症的误诊会导致非常有害的虐待后果。虽然抑郁症状在单相和双相情感障碍中的表达相似，但特定脑网络的变化可能非常不同，因此可以作为鉴别诊断的信息标记。我们的目的是表征特定的变化，在候选人的大规模网络（额顶叶，扣带-盖，和默认模式）在有症状的单极和双相患者使用静息状态功能磁共振成像，认知要求低的范式理想的调查患者。研究方法：在独立成分分析后选择网络，比较40名急性抑郁症患者（20名单极，20名双相）和20名年龄，性别和教育水平匹配的对照组，并将变化与临床参数相关。结果：尽管症状相似，但患者组通过大规模网络改变进行了强有力的区分。双相情感障碍患者的差异是由额顶叶网络（一个中央执行和外部导向的网络）的功能连接增加所驱动的。相反，单极患者在默认模式网络（一种内省和自我参照网络）中表现出功能连接性增加，扣带回-鳃盖神经网络与默认模式区域的连接性减少，该网络参与检测内部和外部导向需求之间的切换需求。这些结果大多不受当前药物、合并症和结构变化的影响。此外，单相患者的网络改变与抑郁发作次数显著相关。结论：单极和双极组显示类似的神经病学可以清楚地区分大规模网络的特征变化，鼓励进一步研究网络指纹的临床应用。(C)2015年威利期刊公司
Background: Misdiagnosing bipolar depression can lead to very deleterious consequences of mistreatment. Although depressive symptoms may be similarly expressed in unipolar and bipolar disorder, changes in specific brain networks could be very distinct, being therefore informative markers for the differential diagnosis. We aimed to characterize specific alterations in candidate large-scale networks (frontoparietal, cingulo-opercular, and default mode) in symptomatic unipolar and bipolar patients using resting state fMRI, a cognitively low demanding paradigm ideal to investigate patients. Methods: Networks were selected after independent component analysis, compared across 40 patients acutely depressed (20 unipolar, 20 bipolar), and 20 controls well-matched for age, gender, and education levels, and alterations were correlated to clinical parameters. Results: Despite comparable symptoms, patient groups were robustly differentiated by large-scale network alterations. Differences were driven in bipolar patients by increased functional connectivity in the frontoparietal network, a central executive and externally-oriented network. Conversely, unipolar patients presented increased functional connectivity in the default mode network, an introspective and self-referential network, as much as reduced connectivity of the cingulo-opercular network to default mode regions, a network involved in detecting the need to switch between internally and externally oriented demands. These findings were mostly unaffected by current medication, comorbidity, and structural changes. Moreover, network alterations in unipolar patients were significantly correlated to the number of depressive episodes. Conclusion: Unipolar and bipolar groups displaying similar symptomatology could be clearly distinguished by characteristic changes in large-scale networks, encouraging further investigation of network fingerprints for clinical use. (C) 2015 Wiley Periodicals, Inc.