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Association between brain structural alteration and emotional change in depressive patients with suicidal ideation with GQI1Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan, 2School of Medicine, Chang Gung University, Taoyuan, Taiwan, 3Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan, 4Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan, 5Medical Imaging Research Center, Institute for Radiological Research, Chang Gung University and Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
Synopsis
Over 300 million people are suffering from various degrees of depression worldwide. The level of depression severity is a significant risk factor for suicidal behavior. In this study, we used generalized q-sampling imaging (GQI) integrating with clinical diagnostic scale in the suicidal ideation and non-suicidal ideation depressive patients. The multiple regression was performed to identify the association between the GQI indices and the clinical scales. Our results indicated that the demyelination of precuneus may relate to the suicidal ideation in depressive patients.
Introduction
Over 300 million people are having various degrees of depression worldwide. The severeness of depression is a significant risk factor for suicidal behavior. In the pathological perspective of depressive disorder, the white matter integrity is considered to be associated with melancholy. In light of this, we used generalized q-sampling imaging (GQI) with clinical diagnostic scales to investigate the relationship between the white matter alteration and the clinical scale change in depressive patients with suicidal ideation.Methods
In our study, 3T MRI (Verio, Siemens) was used to acquire GQI images of 44 depressive patients with suicidal ideation (ID) and 56 depressive patients without suicidal ideation (non-ID). Both patient groups received two separate tests to assess the severity of depression, including the Hamilton Depression Rating Scale (HAM-D) for evaluating depression level, as well as the Hospital Anxiety and Depression Scale (HADS) for assessing emotional changes.The diffusion MRI images were adjusted by eddy current correction with FMRIB Software Library (FSL) and spatial normalization with Statistical Parametric Mapping (SPM). The GQI indices, including normalized quantitative anisotropy (NQA), generalized fractional anisotropy (GFA), and isotropic value of the orientation distribution function (ISO), were calculated using DSI Studio. Multiple regression was used to identify the association between the GQI indices and the clinical scales for the ID and non-ID patients. Additionally, age, gender, and education years were varied across the subjects and used as covariates in this study.
Results
In the non-ID participators group, a significant negative correlation between NQA and HAM-D scores was shown in the rolandic operculum (Fig. 1A). The same demyelination region (Fig. 1B) was also obtained between the NQA and HADS depression subscale. Moreover, white matter integrity significantly reduced in the precentral gyrus and postcentral gyrus while the scales score increased — a highly negative correlation between the NQA and HADS anxiety subscale was found in the precentral gyrus (Fig. 1C). A positive correlation between ISO and HADS anxiety subscale was also found in the postcentral gyrus (Fig. 1D).For the ID depressive patients, a highly negative correlation between HAM-D scores and GFA (Fig. 2A), NQA values (Fig. 2B) were shown in the precuneus. A significant negative correlation between the HADS anxiety subscale and GFA (Fig. 2C), NQA values (Fig. 2D) were found in the caudate nucleus.
Discussion
The statistical analysis showed tremendous heterogeneity white matter demyelination in the results between ID and non-ID depressive patients with the clinical scales. Rolandic operculum plays a pivotal role in articulatory1. The module degree and the resting-state functional connectivity of rolandic operculum were also showed a negative correlation with the depression severity2. The precentral gyrus is part of the core brain network and related to the distinguish of basic emotions3. It is also involved in emotional regulation and emotional processing4,5. Postcentral gyrus is a representation of the emotional response6. All of these regions indicated that the severity of depression and anxiety scales related to the white matter demyelination.Furthermore, patients with suicidal ideation are having critical levels of depression. The white matter integrity decreased more significantly when the patients get higher scores in the clinical scales. The precuneus has been reported as maladjustment for the neural substrate of melancholy and involved the pathophysiology of depression7,8. The previously resting-state default mode network studies also indicated decreasing connectivity in the precuneus of MDD patients8. The caudate nucleus deformity perceived for associating with suicidal ideation and impulsivity in major depressive patients9.
Conclusion
Our results indicated that the rolandic operculum and precuneus might affect the human formation of depressive behavior. The myelination of precuneus significantly reduced in ID depressive patients, which suggested it is the critical brain area that causing suicidal ideation. The precentral gyrus, postcentral gyrus, and caudate nucleus also showed a significant negative correlation with HADS anxiety subscale. Both of these areas are concerned with emotional processing and it indicated that patients with depression may also be perturbed by anxiety. All of these results can be facilitated by the clinical diagnosis as imaging biomarkers and the understanding of the pathophysiology for depressive disorder and suicidal ideation.Acknowledgements
This study was supported by the research programs NSC102-2314-B-182-068-MY3, MOST105-2314-B-182-028, and MOST106-2314-B-182-040-MY3, which were sponsored by the Ministry of Science and Technology, Taipei, Taiwan.References
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