Neuroanatomic Pathways Associated with Poststroke Affective and Apathetic Depression

Murakami, Taro; Hama, Seiji; Yamashita, Hidehisa; Onoda, Keiichi; Kobayashi, Masuki; Kanazawa, Junichi; Yamawaki, Shigeto; Kurisu, Kaoru

doi:10.1016/j.jagp.2013.01.057

Cited by 49 publications

(22 citation statements)

References 29 publications

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“…This hypothesis is consistent with the findings of Onoda et al, 19 who used using single photon emission computed tomography scanning among 37 stroke patients with apathy and found blood flow was reduced in the basal ganglia compared with 65 nonapathetic stroke patients. Similar findings were reported by Murakami et al 20 Okada et al, 21 using xenon inhalation methods, found that apathy after stroke was associated with reduced regional cerebral blood flow in the right dorsal lateral frontal and left frontotemporal regions. It is plausible that hypoactivity in frontal and temporal cortex and basal ganglia regions may lead to reduced input to the core circuit and ultimately to poststroke apathy.…”

Section: Discussionsupporting

confidence: 89%

Incident Apathy During the First Year After Stroke and Its Effect on Physical and Cognitive Recovery

Mikami

Jorge

Moser

et al. 2013

The American Journal of Geriatric Psychiatry

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Section: Discussionsupporting

confidence: 89%

Incident Apathy During the First Year After Stroke and Its Effect on Physical and Cognitive Recovery

Mikami

Jorge

Moser

et al. 2013

The American Journal of Geriatric Psychiatry

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“…The finding of decreased left frontal CBF is consistent with the well-known association of left dorsolateral prefrontal cortical dysfunction and depressed mood. Just as ischemic stroke, arteriovenous malformations, and neoplastic mass lesions in this area are often associated with depressed mood, this study suggests that TBI induces a ‘functional lesion’ of this area altering self-perception of health in a manner consistent with depressive thinking (anhedonia and despair) [51], [52], [53].…”

Section: Discussionmentioning

confidence: 73%

Clinical Comparison of 99mTc Exametazime and 123I Ioflupane SPECT in Patients with Chronic Mild Traumatic Brain Injury

et al. 2014

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BackgroundThis study evaluated the clinical interpretations of single photon emission computed tomography (SPECT) using a cerebral blood flow and a dopamine transporter tracer in patients with chronic mild traumatic brain injury (TBI). The goal was to determine how these two different scan might be used and compared to each other in this patient population.Methods and FindingsTwenty-five patients with persistent symptoms after a mild TBI underwent SPECT with both 99mTc exametazime to measure cerebral blood flow (CBF) and 123I ioflupane to measure dopamine transporter (DAT) binding. The scans were interpreted by two expert readers blinded to any case information and were assessed for abnormal findings in comparison to 10 controls for each type of scan. Qualitative CBF scores for each cortical and subcortical region along with DAT binding scores for the striatum were compared to each other across subjects and to controls. In addition, symptoms were compared to brain scan findings. TBI patients had an average of 6 brain regions with abnormal perfusion compared to controls who had an average of 2 abnormal regions (p<0.001). Patient with headaches had lower CBF in the right frontal lobe, and higher CBF in the left parietal lobe compared to patients without headaches. Lower CBF in the right temporal lobe correlated with poorer reported physical health. Higher DAT binding was associated with more depressive symptoms and overall poorer reported mental health. There was no clear association between CBF and DAT binding in these patients.ConclusionsOverall, both scans detected abnormalities in brain function, but appear to reflect different types of physiological processes associated with chronic mild TBI symptoms. Both types of scans might have distinct uses in the evaluation of chronic TBI patients depending on the clinical scenario.

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“…This model may also substantiate our finding of the inadequacy of SSRIs as a treatment and suggest the utility of exploring treatments that would more adequately engage this dopamine-sensitive limbic system. Consistent with this notion, a recent MRI study of post-stroke depression concluded that affective versus apathetic symptoms of the depression were associated with different monoaminergic neuroanatomic pathways (serotonergic and dopaminergic, respectively) (Murakami et al, 2013). Also of note, our parcellation of posterior subgenual cingulate overlapped with BA25, which exhibits aberrant metabolic activity in treatment-resistant depression and is a focus of deep brain stimulation (Mayberg et al, 2005).…”

Section: Discussionmentioning

confidence: 87%

Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response

Yuen

Gunning

Woods

et al. 2014

Journal of Affective Disorders

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Background 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. Methods 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. Results 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. Limitations modest sample size, no placebo control, post-hoc secondary analysis, use of 1.5T MRI scanner Conclusions 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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Neuroanatomic Pathways Associated with Poststroke Affective and Apathetic Depression

Cited by 49 publications

References 29 publications

Incident Apathy During the First Year After Stroke and Its Effect on Physical and Cognitive Recovery

Incident Apathy During the First Year After Stroke and Its Effect on Physical and Cognitive Recovery

Clinical Comparison of 99mTc Exametazime and 123I Ioflupane SPECT in Patients with Chronic Mild Traumatic Brain Injury

Neuroanatomical correlates of apathy in late-life depression and antidepressant treatment response

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