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Compensatory prefrontal activation during planning in major depressive disorder; An event related fMRI study
Abstracts / Journal of Affective Disorders 107 (2008) S53–S122
[P1.25] Compensatory prefrontal activation during planning in major depressive disorder; An event related fMRI study M.J. van Tola, N.J. van der Wee*,a, M.M. Nielenb, A. Alemanc, D. Demenescuc, D.J. Veltmanb
S79
[P1.26] Hippocampus related cognitive impairment in remitted depressed patients L.B. Hviid*, B. RavnKilde, J. Ahdidan, R. Rosenberg Aarhus University Hospital, Denmark
a
Leiden University Medical Centre, The Netherlands b Vrije Universiteit, The Netherlands c University of Groningen, The Netherlands Introduction: Neuropsychological studies in Major Depression Disorder (MDD) have revealed decreased performance in executive functioning, like planning. A frequently used test to probe planning processes is the Tower of London task (ToL). In MDD a reduced performance and abnormal brain activation pattern during the TOL was found. (Elliot et al., 1996, 1997). Recently, a parametric self-paced pseudorandomized event-related version of the ToL, suitable for fMRI was developed and used in studies of healthy volunteers and patients with obsessive–compulsive disorder (van den Heuvel et al., 2003). We employed this novel fMRI version of the TOL in patients with MDD and matched controls. Methods: 21 matched healthy control subjects (HC) and 15 medication-free subjects with a primary diagnosis of MDD as current diagnosis or diagnosis in the past six months and no other axis I or II disorder participated (mean MADRS-score 13.29; SD 9.52). The present pilot study is part of the larger neuroimaging-study within the The Netherlands Study on Depression and Anxiety (NESDA), involving 320 subjects. All subjects performed a 17-minute parametric version of the TOL-task which consisted of five levels of difficulty and baseline items (3). Items were presented in a pseudo-randomized order. Scanning was performed on a Philips Intera 3T scanner. Data were analyzed with SPM5 in the context of the General Linear Model. Results: MDD-subjects and HC did not show any difference in performance and reaction times. However, MDD subjects showed an increase in activation in the left limbic anterior cingulate gyrus, right MTL and right medial frontal gyrus with increasing difficulty. Conclusion: Our data suggest that MDD-subjects needed more active control of attention than controls while performing this executive task. MDD-subjects might compensate with cingulate and bilateral activation of the DLPFC in order to obtain the same level of performance as the control subjects. Keywords: Depression, fMRI, Cognitive functioning doi:10.1016/j.jad.2007.12.058
Introduction: A meta-analysis has shown that a volumetric shrinkage of the hippocampus occurs after several episodes of Major Depression1. We have previously studied depressed patients using positron emission tomography (PET). These patients, while in a resting state, were found to have significantly increased regional cerebral blood flow (rCBF) in the right hippocampus2. In this study our aim was to measure rCBF in the right hippocampus of remitted depressed patients during a 3D virtual reality navigation task (3D-VRNT). Assessment of rCBF level in the right hippocampus and the navigation ability of remitted depressed patients are important when evaluating whether increased rCBF during Major Depression impairs the right hippocampus. Methods: We compared rCBF in the right hippocampus and cognitive performance: nine remitted depressed patients who in the initial study displayed the highest level of rCBF in the hippocampus, in nine patients who had the lowest level of rCBF and 13 healthy participants with an average level of rCBF. rCBF in the right hippocampus (using PET) and the cognitive performance were measured while the participants performed the 3D-VRNT. The 3D-VRNT was designed specifically to test right hippocampal cognitive functioning. Navigation of large-scale space, like the 3D-VRNT, is widely acknowledged to involve the right hippocampus 3 . Besides the 3D-VRNT, participants underwent PET rest-measurements (baseline), magnetic resonance imaging, and extensive neuropsychological testing. Results: Remitted depressed patients did not differ significantly from healthy subjects, with respect to either cognitive performance or rCBF in the right hippocampus. Discussion: This study questions the significance of rCBF in the right hippocampus of depressed patients, while in a resting state. If impairment is measured in terms of difference in rCBF and navigation ability, our results suggest that increased rCBF in the right hippocampus of depressed patients does not herald impairment of the right hippocampus in the remitted state, as earlier suggested2. 1 Videbech, P. and Ravnkilde. “Hippocampal Volume and Depression: a Meta-analysis of MRI studies” Am J Psychiatry. 2004 Nov; 161(11):1957–1966 2 Videbech et al. “The Danish PET/depression Project” Psychological Med. 2001 Oct: 31(7):1147–1158
[P1.25] Compensatory prefrontal activation during planning in major depressive disorder; An event related fMRI study M.J. van Tola, N.J. van der Wee*,a, M.M. Nielenb, A. Alemanc, D. Demenescuc, D.J. Veltmanb
S79
[P1.26] Hippocampus related cognitive impairment in remitted depressed patients L.B. Hviid*, B. RavnKilde, J. Ahdidan, R. Rosenberg Aarhus University Hospital, Denmark
a
Leiden University Medical Centre, The Netherlands b Vrije Universiteit, The Netherlands c University of Groningen, The Netherlands Introduction: Neuropsychological studies in Major Depression Disorder (MDD) have revealed decreased performance in executive functioning, like planning. A frequently used test to probe planning processes is the Tower of London task (ToL). In MDD a reduced performance and abnormal brain activation pattern during the TOL was found. (Elliot et al., 1996, 1997). Recently, a parametric self-paced pseudorandomized event-related version of the ToL, suitable for fMRI was developed and used in studies of healthy volunteers and patients with obsessive–compulsive disorder (van den Heuvel et al., 2003). We employed this novel fMRI version of the TOL in patients with MDD and matched controls. Methods: 21 matched healthy control subjects (HC) and 15 medication-free subjects with a primary diagnosis of MDD as current diagnosis or diagnosis in the past six months and no other axis I or II disorder participated (mean MADRS-score 13.29; SD 9.52). The present pilot study is part of the larger neuroimaging-study within the The Netherlands Study on Depression and Anxiety (NESDA), involving 320 subjects. All subjects performed a 17-minute parametric version of the TOL-task which consisted of five levels of difficulty and baseline items (3). Items were presented in a pseudo-randomized order. Scanning was performed on a Philips Intera 3T scanner. Data were analyzed with SPM5 in the context of the General Linear Model. Results: MDD-subjects and HC did not show any difference in performance and reaction times. However, MDD subjects showed an increase in activation in the left limbic anterior cingulate gyrus, right MTL and right medial frontal gyrus with increasing difficulty. Conclusion: Our data suggest that MDD-subjects needed more active control of attention than controls while performing this executive task. MDD-subjects might compensate with cingulate and bilateral activation of the DLPFC in order to obtain the same level of performance as the control subjects. Keywords: Depression, fMRI, Cognitive functioning doi:10.1016/j.jad.2007.12.058
Introduction: A meta-analysis has shown that a volumetric shrinkage of the hippocampus occurs after several episodes of Major Depression1. We have previously studied depressed patients using positron emission tomography (PET). These patients, while in a resting state, were found to have significantly increased regional cerebral blood flow (rCBF) in the right hippocampus2. In this study our aim was to measure rCBF in the right hippocampus of remitted depressed patients during a 3D virtual reality navigation task (3D-VRNT). Assessment of rCBF level in the right hippocampus and the navigation ability of remitted depressed patients are important when evaluating whether increased rCBF during Major Depression impairs the right hippocampus. Methods: We compared rCBF in the right hippocampus and cognitive performance: nine remitted depressed patients who in the initial study displayed the highest level of rCBF in the hippocampus, in nine patients who had the lowest level of rCBF and 13 healthy participants with an average level of rCBF. rCBF in the right hippocampus (using PET) and the cognitive performance were measured while the participants performed the 3D-VRNT. The 3D-VRNT was designed specifically to test right hippocampal cognitive functioning. Navigation of large-scale space, like the 3D-VRNT, is widely acknowledged to involve the right hippocampus 3 . Besides the 3D-VRNT, participants underwent PET rest-measurements (baseline), magnetic resonance imaging, and extensive neuropsychological testing. Results: Remitted depressed patients did not differ significantly from healthy subjects, with respect to either cognitive performance or rCBF in the right hippocampus. Discussion: This study questions the significance of rCBF in the right hippocampus of depressed patients, while in a resting state. If impairment is measured in terms of difference in rCBF and navigation ability, our results suggest that increased rCBF in the right hippocampus of depressed patients does not herald impairment of the right hippocampus in the remitted state, as earlier suggested2. 1 Videbech, P. and Ravnkilde. “Hippocampal Volume and Depression: a Meta-analysis of MRI studies” Am J Psychiatry. 2004 Nov; 161(11):1957–1966 2 Videbech et al. “The Danish PET/depression Project” Psychological Med. 2001 Oct: 31(7):1147–1158