Cerebral Energy Metabolism in Geriatric Bipolar Depression

描述（由申请人提供）：福雷斯特博士的目标是成为一个独立的研究者在老年双相情感障碍领域使用磁共振波谱（MRS）研究治疗反应的生化标志物。长期的职业目标包括与其他采用磁共振成像（MRI）技术的中心合作，研究老年双相情感障碍，重点是开发安全有效的治疗干预措施。Forester博士将在姆克林医院接受布鲁斯科恩博士的指导，他是姆克林医院的前任院长和弗雷泽研究所的现任主任，弗雷泽研究所是一个跨学科的联盟，使用临床药理学、MRS、功能性MR和实验室技术研究双相情感障碍，并由姆克林医院脑成像中心的佩里伦肖博士共同指导。Forester博士将通过MRI技术和应用，生物统计学和负责任的研究行为的正式培训来提高他的临床技能。拟议的研究计划将采用MRS研究35名患有双相抑郁症的老年人和25名年龄匹配的健康对照者的大脑能量代谢指标。符合入选标准的受试者将在基线时通过结构化精神病学访谈和神经心理学测试进行临床表征，并将在4特斯拉下接受质子（1H）MRS研究。然后，双相抑郁受试者将接受拉莫三嗪单药治疗或连续治疗8周的开放标签治疗。在8周结束时，两组将在4特斯拉下进行第二次1H MRS扫描。将在基线和治疗后分析对照受试者和双相情感障碍受试者的脑能量代谢物、谷氨酸盐、谷氨酰胺、N-乙酰天冬氨酸盐和乳酸盐的组间差异。公共卫生相关性：双相情感障碍是老年人的一个重要卫生保健问题，与残疾、功能下降、死亡率和对公共卫生系统的需求增加有关。双相抑郁症在晚年的治疗是复杂和具有挑战性的，几乎没有系统的研究来指导治疗干预。这项研究将检查与大脑能量代谢相关的生化物质，在使用情绪稳定药物治疗前后。来自老年双相抑郁症的这项和未来相关研究的信息可能有助于开发更有效和安全的治疗方法。

DESCRIPTION (provided by applicant): Dr. Forester aims to become an independent investigator in the field of geriatric bipolar disorder using magnetic resonance spectroscopy (MRS) to study biochemical markers of treatment response. Long-term career goals include collaboration with other centers employing MR imaging (MRI) technologies to study geriatric bipolar disorder with a focus on developing safe and effective therapeutic interventions. Dr. Forester will be mentored at McLean Hospital by Dr. Bruce Cohen, past President of McLean Hospital and current Director of the Frazier Institute, an interdisciplinary consortium studying bipolar disorder using clinical pharmacology, MRS, functional MR and laboratory techniques, and co-mentored by Dr. Perry Renshaw, of the McLean Hospital Brain Imaging Center. Dr. Forester will enhance his clinical skills with formal training in MRI techniques and applications, biostatistics and the responsible conduct of research. The proposed research plan will employ MRS to study measures of brain energy metabolism in 35 older adults with bipolar depression and 25 healthy age-matched controls. Subjects meeting inclusion criteria will be clinically characterized at baseline with a structured psychiatric interview and neuropsychological testing and will undergo proton (1H) MRS study at 4 Tesla. Subjects with bipolar depression will then receive open label treatment with lamotrigine as monotherapy or adjunctive therapy for eight weeks. At the end of 8 weeks, both groups will undergo a second 1H MRS scan at 4 Tesla. Group differences in the brain energy metabolites, glutamate, glutamine, N-acetyl aspartate and lactate, among control subjects and subjects with bipolar disorder will be analyzed at baseline and after treatment. PUBLIC HEALTH RELEVANCE: Bipolar disorder is a significant health care issue for elderly individuals, which is associated with disability, functional decline, mortality and increased demands on the public health system. The treatment of bipolar depression in later life is complex and challenging, with little systematic research available to guide therapeutic interventions. This study will examine biochemicals associated with brain energy metabolism before and after treatment with a mood stabilizing medication. Information from this and future related studies of geriatric bipolar depression might help inform the development of more effective and safe treatments.