老年抑郁症恢复期患者认知损害与全脑白质纤维完整性的相关性研究

Association of white matter integrity of the whole brain and cognitive deficits in remitted geriatric depression

目的探讨恢复期老年抑郁症患者全脑白质纤维完整性是否受损，并进一步分析其与认知损害是否关联。方法对16例恢复期老年抑郁症患者（患者组）和14名健康老年人（对照组）进行汉密尔顿抑郁量表（HAMD）、简易智力状态检查（MMSE）和神经心理学评估后，行全脑弥散张量成像扫描，用SPM2软件处理图像，采用基于体素的分析方法进行组间比较分数各向异性（FA）值。结果（1）HAMD、MMSE评分和神经心理学测试：患者组HAMD和MMSE评分与正常对照组的差异无统计学意义（P〉0．05），但在听觉言语测验[（5．9±2．6）分]、连线测验A[（146±127）s]和B[（264±196）s]成绩均差于正常对照组[分别为（9．3±1．6）分，（73±25）s和（121±35）s；P〈0．01～0．05]。（2）FA值：患者组低于对照组的脑区主要包括：右侧额上回、左侧额下回、左侧颞中回、右侧顶下回、右侧枕中回、左侧舌回、右侧壳核和右侧尾状核（未校正，P〈0．001）。（3）患者组右侧额上回FA值与连线B测验成绩呈显著负相关（r=-0．556，P=0．049）。结论恢复期老年抑郁症患者多部位脑白质纤维的完整性受损，这可能是该类患者认知损害的神经病理基础。

Objective To investigate whether abnormalities were present in the whole white matter in patients with remitted geriatric depression （RGD） by diffusion tensor imaging, and the relationship between white matter integrity and cognitive impairment. Methods Sixteen remitted geriatric depression patients and 14 well-matched healthy controls had diffusion tensor imaging scans of MRI, which were analyzed by a rigorous voxel-based approach. The RGD patients and healthy controls received a cognitive battery using standardized administration. Results The fractional anisotropy in white matter of patients was lower than that of controls in the right superior frontal gyms, left inferior frontal gyms, left middle temporal gyms, right inferior parietal lobule, right middle occipital gyms, left lingual gyms, right putamen and right caudate. There were significant differences in the Rey Auditory Verbal Learning Test delayed recall score, TrailMakingTest A and B （seconds） between two groups （P 〈 0.001, P 〈 0.05 and P 〈 0.05, respectively）. And a significant negative correlation between the mean FA values of right superior frontal gyms and the Trail Making Test B Score （seconds） （r = - 0.556, P = 0.049） in patients with RGD. Conclusion The results suggested that white matter integrity of the whole brain is disrupted in patients with remitted geriatric depression, and the abnormalities are perhaps involved in the psychopathology and pathophysiology of cognitive impairment.