Release date: 2018-05-18
Depression, also known as depressive disorder, is a long-lasting and obvious depression. Depression is a mental illness that has a certain impact on people both physically and psychologically. According to the latest statistics of the World Health Organization, about 350 million people worldwide suffer from major depression and cause more than 1 million people to commit suicide every year. The economic cost of major depression has surpassed many common diseases such as cancer and diabetes. disease.
For patients with major depression, there are still many problems to be solved in the current treatment. Brain imaging undoubtedly provides a new and effective way to treat major depression.
Brain imaging, see if your brain is abnormal
Brain imaging is to take pictures of the brain. At present, brain imaging has become one of the necessary means for the study of brain diseases. By using imaging techniques such as magnetic fields and pulses, brain tissue structure and neuronal functional activities are obtained.
Different "photos" can provide different information about the function or structure of the brain:
Functional magnetic resonance imaging (fMRI), based on blood oxygen level-dependent signals, reflects the neuronal activity of the brain region when the brain performs a certain task or resting state;
Structural magnetic resonance imaging (sMRI), which provides information about the structure of the brain, such as gray matter, white matter, and cerebrospinal fluid;
Diffusion magnetic resonance imaging (dMRI) tracks the white matter fibers of the brain and reflects its anatomical connectivity by measuring the random motion of water molecules in human tissue.
Scientists have found that the severity or cognitive performance of patients with mental illness is often closely related to structural damage or dysfunction in specific brain regions. For example, the hippocampus of patients with Alzheimer's disease shows varying degrees of atrophy with the severity of the disease. In turn, it affects a series of cognitive and memory functions related to it.
However, the brain structure and dysfunction of most psychiatric diseases are extremely invisible to the naked eye and difficult to quantify. For example, in patients with severe depression, their gray matter density and fractional low-frequency oscillation amplitude (fALFF) in the prefrontal-edge system (amygdala, hippocampus, etc.) are significantly lower than those in healthy people.
However, this difference is difficult to quantify. At present, the diagnosis of mental illness is mostly based on the patient's behavior and the personal experience of the physician, qualitative analysis and reasonable speculation, so the subjective factors of the doctor are inevitable. In addition, due to the overlapping of cognitive or behavioral manifestations of multiple mental illnesses, the diagnosis of symptoms alone or behavioral manifestations is clearly insufficient.
Therefore, there is an urgent need for an objective neuroimaging marker that can aid diagnosis or treatment in time. Recently, scientists from the Institute of Automation of the Chinese Academy of Sciences have made a series of progress in this field.
Accurately predict the efficacy of electroconvulsive therapy for major depression
Major depression is a chronic mental illness with a low cure rate and a high recurrence rate. At present, although the traditional treatment strategies combining psychotherapy and drug therapy have achieved certain effects, the pathogenesis of mental illness is complicated and the clinical biology is varied. For any of the above treatments, usually only 50%. The patient is able to return to health.
To a large extent, it is difficult to pinpoint exactly which treatment is most likely to be effective for a particular depressed patient. This means that patients need to try a range of other treatments after the initial treatment failure.
The therapeutic effect of electroconvulsive therapy (ECT) is stable and rapid, and it is widely recognized in clinical practice, especially for patients with severe depression who are ineffective in drug treatment and have a strong suicidal tendency. Electrostimulation therapy has a high cure rate. However, electrical stimulation therapy has great damage to human cognition. Therefore, electrical stimulation therapy is usually the treatment plan that patients choose after the failure of drug therapy.
Then, if the patient can be accurately predicted before the treatment is received before the patient receives the electrical stimulation treatment, this will not allow the doctors to make the most medical decisions, and minimize the economic burden and spirit of the patients. Damaged!
According to this idea, the team of professors from the Institute of Automation of the Chinese Academy of Sciences conducted exploration and research. Scientists used structural magnetic resonance imaging (SMRI) features before treatment in patients with major depression to quantify the recovery of symptoms after treatment.
The results of the study showed that the right hippocampus, the right temporal prefrontal cortex, the right temporal anterior humerus, the left anterior wedge, the left auxiliary motion zone, and the left lingual gyrus in the brain can be used as predictors of depression in patients with ECT. The potential biomarker for recovery (as shown below).
Target for predicting the efficacy of ECT in depression. Jiang R. et alNeuropsychopharmacology 43:1078–87 (2018)
The results show that the prediction accuracy of this method is more than 85% in 3 centers, which has great clinical application value. Scientists hope to apply this technology to the brain imaging features of other mentally ill patients to predict and analyze many different types of treatments.
Using genetic factors to influence data to study brain abnormalities in patients with depression
The heritability of depression is 30%–40%, and epigenetic factors play an important role in depression. MicroRNAs are an important class of epigenetic regulators that regulate more than 50% of human genes. Among them, miR-132 is considered to be an epigenetic factor closely related to the pathogenesis and neuronal mechanisms of depression symptoms.
Recently, the team of professors from the Institute of Automation of the Chinese Academy of Sciences and the team of Professor Ma Xiaohong from West China Hospital of Sichuan University, for the first time, attempted to explore the relationship between multimodal brain imaging and abnormal expression of miR-132 in patients with untreated depression.
The results showed that the level of miR-132 highly expressed in patients with untreated depression was associated with decreased fALFF (fractional low frequency oscillation amplitude) and GM (grey matter) in the prefrontal-edge system (amygdala, hippocampus, etc.) of the human brain, and connected Brain function-structural co-variation of brain white matter fiber bundles - prethalamic radiation (ATR), impaired corpus callosum/knee integrity (reduced fractional anisotropy). More importantly, the functional and structural changes in the brain regions described above are also associated with impaired attention and executive control in patients with depression (as shown below).
A multimodal public variant pattern associated with abnormal expression of mir-132 in untreated depression. Qi S. et al Brain 141(3): 916-926.
This study provides a new way of image genetic association research, which provides a new idea for the treatment of depression.
Now that we have learned about the help of brain imaging in the treatment of patients with major depressive disorder, scientists are continuing to conduct in-depth research, hoping to explore and try more in this area, and to make more effective treatments. Really applied to the clinic, bring more hope for patients with major depression.
Source: Institute of Automation, Chinese Academy of Sciences
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