Brain connectivity and response to Tai Chi in geriatric depression

 描述（由申请人提供）：老年抑郁症与治疗反应和依从性差以及多种药物治疗相关。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。补充身心干预用于老年人抑郁症状可能是重要的治疗和预防复发和复发的主要抑郁症通过减轻压力，改善身体功能，增加社会化，并减少风险的多药。我们对112名老年抑郁症患者的初步研究表明，与健康教育相比，在73名部分应答者的标准抗抑郁药治疗中加入10周太极拳（TCC）改善了抗抑郁药的整体反应，但也改善了生活质量和认知功能，并降低了C反应蛋白水平。拟议的随机试验旨在研究大脑连接的神经机制，当比较TCC对拉伸运动或健康和健康教育课程的反应时，使用情绪调节和认知的fMRI生物标志物。对照组将包括伸展运动和健康教育计划（STRETCH和HEW），这将有助于控制非气生成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的严重程度和功能磁共振成像相关的情绪处理和相关功能网络的连接措施。次要结果包括认知，弹性，健康功能，生活质量，工作记忆的神经相关性和大脑结构。将在6个月随访期间确定重度抑郁症的缓解维持和复发。我们将研究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名有抑郁症状的未服药老年人，他们将被随机分配到12周的：1。太极拳（TCC）班;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个月时接受情绪、心理和身体健康以及认知的综合评估。将在随机回归模型中评估抑郁症状、恢复力、生活质量和认知指标随时间的变化。我们预计，情绪和认知的临床改善将与右腹外侧前额叶皮层（VLPFC）和杏仁核在情感标签任务中的激活变化，以及背外侧前额叶皮层（DLPFC）的工作记忆相关激活，以及大脑网络活动中功能连接的变化相关。这是第一个研究 TCC的神经反应机制，整合使用功能磁共振成像生物标志物的反应，以指导老年抑郁症的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.