Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response.
Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response.
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DOI：
10.1016/j.jad.2014.05.008
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发表时间：
2014-09
影响因子：
6.6
通讯作者：
Alexopoulos GS
中科院分区：
文献类型：
--
作者：
Yuen GS;Gunning FM;Woods E;Klimstra SA;Hoptman MJ;Alexopoulos GS
冷漠是老年抑郁症的一个显著特征，它预示着不良的临床结局并阻碍抑郁症的治疗。然而，人们对晚年抑郁症中冷漠的神经生物学和治疗知之甚少。本研究探讨了冷漠的患病率在抑郁症的老年人，冷漠的选择性5-羟色胺再摄取抑制剂（SSRI）治疗的反应，神经解剖学的相关性，区分反应者和无反应者和健康对照的临床样本。参与者包括45名非痴呆的老年抑郁症患者和43名老年对照者。在为期2周的单盲安慰剂期后，抑郁症参与者每天接受10 mg艾司西酞普兰，持续12周。分别于治疗前和治疗12周采用冷漠评定量表（AES）和24项汉密尔顿抑郁量表（HDRS）进行评定。在基线时采集MRI扫描，用于前扣带回灰质和相关白色物质束的并行结构和扩散张量成像。35.5%的抑郁症患者存在情感淡漠。治疗后这一比例下降到15.6%（p <0.1），但43%的初始患者继续报告明显的冷漠。SSRI改善情感淡漠与抑郁的变化无关，但与较大的左后膝下扣带回体积和较大的左钩束各向异性分数相关。适度的样本量，无安慰剂对照，事后二次分析，使用1.5T MRI扫描仪虽然在老年抑郁症中普遍存在，但就药物反应而言，冷漠与抑郁是分开的。后膝下扣带束和钩束的结构异常可能会通过干扰前额叶皮层招募对动机行为至关重要的边缘系统活动而使冷漠状态永久化。
Apathy is a prominent feature of geriatric depression that predicts poor clinical outcomes and hinders depression treatment. Yet little is known about the neurobiology and treatment of apathy in late-life depression. This study examined apathy prevalence in a clinical sample of depressed elderly, response of apathy to selective serotonin reuptake inhibitor (SSRI) treatment, and neuroanatomical correlates that distinguished responders from nonresponders and healthy controls. Participants included 45 non-demented, elderly with major depression and 43 elderly comparison individuals. After a 2-week single-blind placebo period, depressed participants received escitalopram 10mg daily for 12 weeks. The Apathy Evaluation Scale (AES) and 24-item Hamilton Depression Rating Scale (HDRS) were administered at baseline and 12 weeks. MRI scans were acquired at baseline for concurrent structural and diffusion tensor imaging of anterior cingulate grey matter and associated white matter tracts. 35.5% of depressed patients suffered from apathy. This declined to 15.6% (p<0.1) following treatment, but 43% of initial sufferers continued to report significant apathy. Improvement of apathy with SSRI was independent of change in depression but correlated with larger left posterior subgenual cingulate volumes and greater fractional anisotropy of left uncinate fasciculi. modest sample size, no placebo control, post-hoc secondary analysis, use of 1.5T MRI scanner While prevalent in geriatric depression, apathy is separable from depression with regards to medication response. Structural abnormalities of the posterior subgenual cingulate and uncinate fasciculus may perpetuate apathetic states by interfering with prefrontal cortical recruitment of limbic activity essential to motivated behavior.
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影响因子：
6.6
作者：
Alexopoulos, George S.;Hoptman, Matthew J.;Yuen, Genevieve;Kanellopoulos, Dora;Seirup, Joanna K.;Lim, Kelvin O.;Gunning, Faith M.
通讯作者：
Gunning, Faith M.
影响因子：
7.2
作者：
Groeneweg-Koolhoven, Isis;de Waal, Margot W. M.;van der Mast, Roos C.
通讯作者：
van der Mast, Roos C.
影响因子：
17.7
作者：
Alexopoulos, George S.;Murphy, Christopher F.;Hoptman, Matthew J.
通讯作者：
Hoptman, Matthew J.
影响因子：
3.3
作者：
Drevets, Wayne C.;Savitz, Jonathan
通讯作者：
Savitz, Jonathan
影响因子：
3.7
作者：
Chase, Thomas N.
通讯作者：
Chase, Thomas N.