Brain connectivity and response to Tai Chi in geriatric depression

 描述(由申请人提供)：老年性抑郁症与治疗反应和依从性差以及服用多种药物有关。只有大约30%的老年抑郁症患者在一线抗抑郁药物治疗后获得缓解和功能恢复。在有抑郁症状的老年人中使用补充的心身干预可能对通过减轻压力、改善身体功能、增加社交和降低服用多种药物的风险来治疗和预防重大抑郁障碍的复发和复发很重要。我们对112名患有严重抑郁症的老年人进行的初步研究表明，与健康教育相比，73名部分应答者在标准抗抑郁药物治疗的基础上增加为期10周的太极拳(TCC)，改善了对抗抑郁药物的总体反应，但也导致了生活质量和认知功能的改善，并降低了C反应蛋白水平。这项拟议的随机试验旨在通过使用情绪调节和认知的fMRI生物标记物，比较TCC对伸展运动或健康和健康教育课程的反应时，研究大脑连接的神经机制。对照组将包括拉伸运动和健康教育计划(STRAGE和HEW)，这些计划将有助于控制非生气运动和非特定社会支持因素的影响。主要结果包括抑郁症状严重程度的测量，以及相关功能网络中情绪处理和连接性的功能磁共振相关。次要结果包括认知、恢复力、健康功能、生活质量、工作记忆的神经关联和大脑结构。在6个月的随访中，将确定是否维持反应和重度抑郁症的复发。我们将调查情绪调节的变化是否会缓和或预测与TCC相关的情绪和功能改善。我们将招募330名有抑郁症状的未经药物治疗的老年人，他们将被随机分配到12周的课程中：1.达之(TCC)课程；或2.健康/健康教育计划(HEW)；或3.伸展运动(Stretch)课程--每周120分钟。所有受试者将在基线、12周和6个月接受情绪、心理和身体健康以及认知的全面评估。随着时间的推移，抑郁症状、恢复力、生活质量和认知水平的变化将通过随机回归模型进行评估。我们预计，情绪和认知的临床改善将与情感标记任务中右腹外侧前额叶皮质(VLPFC)和杏仁核激活的变化、与工作记忆相关的背外侧前额叶皮质(DLPFC)激活以及脑网络活动中功能连接的变化有关。这是第一个研究的随机试验 TCC反应的神经机制，整合使用功能磁共振生物标记物的反应，以指导老年抑郁症治疗和预防方法的发展。

 DESCRIPTION (provided by applicant): Geriatric depression is associated with poor treatment response and compliance and polypharmacy. Only about 30% of elderly depressed patients achieve remission and functional recovery in response to first-line antidepressant pharmacotherapy. Complementary mind-body interventions used in older adults with depressive symptoms may be important in treatment and prevention of relapse and recurrence of major depressive disorders via stress-reduction, improved physical functioning, increased socialization, and reduced risks of polypharmacy. Our pilot study of 112 older adults with major depression demonstrated that the addition of 10-week Tai-Chi-Chih (TCC) to the standard antidepressant treatment in 73 partial responders improved the overall response to an antidepressant but also resulted in the improved quality of life and cognitive function, and reduced levels of C-reactive protein when compared to the Health Education. The proposed randomized trial aims to investigate neural mechanisms of brain connectivity when comparing response to TCC to stretching exercise or to health and wellness education classes using fMRI biomarkers of emotional regulation and cognition. Control groups will include stretch exercise and health wellness education programs (STRETCH and HEW) that will help to control for the effect of non-chi generating exercise and non-specific social support factors. Primary outcomes include measures of depressive symptom severity and fMRI correlates of emotional processing and connectivity in related functional networks. Secondary outcomes include cognition, resilience, health functioning, quality of life, neural correlates of working memory, and brain structure. Maintenance of response and relapse of major depression will be determined during 6 month follow-up. We will investigate whether variations in emotional regulation will moderate or predict emotional and functional improvement linked to TCC. We will recruit 330 un-medicated older adults with depressive symptoms who will be randomly assigned to 12 weeks of: 1.Ta-Chi-Chih (TCC) class; or 2. Health/Wellness Education Program (HEW); or 3. Stretching exercise (STRETCH) class - all for 120 minutes per week. All subjects will receive comprehensive evaluations of mood, mental and physical health, and cognition at baseline, 12 weeks, and 6 months. Changes over time in measures of depressive symptoms, resilience, quality of life, and cognition will be assessed in random regression models. We anticipate that clinical improvement in mood and cognition will occur in association with change in the activation in the right ventro-lateral prefrontal cortex (VLPFC) and amygdala in an affect labeling task, and working memory-related activation of dorso-lateral prefrontal cortex (DLPFC), and change in functional connectivity in brain network activity. This is the first randomized trial investigating neural mechanisms of response to TCC that integrates the use of fMRI biomarkers of response to guide the development of treatment and preventive approaches to geriatric depression.