Associations between vascular risk factors and brain MRI indices in UK Biobank.

AIMS: Several factors are known to increase risk for cerebrovascular disease and dementia, but there is limited evidence on associations between multiple vascular risk factors (VRFs) and detailed aspects of brain macrostructure and microstructure in large community-dwelling populations across middle and older age. METHODS AND RESULTS: Associations between VRFs (smoking, hypertension, pulse pressure, diabetes, hypercholesterolaemia, body mass index, and waist-hip ratio) and brain structural and diffusion MRI markers were examined in UK Biobank (N = 9722, age range 44-79 years). A larger number of VRFs was associated with greater brain atrophy, lower grey matter volume, and poorer white matter health. Effect sizes were small (brain structural R2 ≤1.8%). Higher aggregate vascular risk was related to multiple regional MRI hallmarks associated with dementia risk: lower frontal and temporal cortical volumes, lower subcortical volumes, higher white matter hyperintensity volumes, and poorer white matter microstructure in association and thalamic pathways. Smoking pack years, hypertension and diabetes showed the most consistent associations across all brain measures. Hypercholesterolaemia was not uniquely associated with any MRI marker. CONCLUSION: Higher levels of VRFs were associated with poorer brain health across grey and white matter macrostructure and microstructure. Effects are mainly additive, converging upon frontal and temporal cortex, subcortical structures, and specific classes of white matter fibres. Though effect sizes were small, these results emphasize the vulnerability of brain health to vascular factors even in relatively healthy middle and older age, and the potential to partly ameliorate cognitive decline by addressing these malleable risk factors.

Sex Differences in the Adult Human Brain: Evidence from 5216 UK Biobank Participants.

Sex differences in the human brain are of interest for many reasons: for example, there are sex differences in the observed prevalence of psychiatric disorders and in some psychological traits that brain differences might help to explain. We report the largest single-sample study of structural and functional sex differences in the human brain (2750 female, 2466 male participants; mean age 61.7 years, range 44-77 years). Males had higher raw volumes, raw surface areas, and white matter fractional anisotropy; females had higher raw cortical thickness and higher white matter tract complexity. There was considerable distributional overlap between the sexes. Subregional differences were not fully attributable to differences in total volume, total surface area, mean cortical thickness, or height. There was generally greater male variance across the raw structural measures. Functional connectome organization showed stronger connectivity for males in unimodal sensorimotor cortices, and stronger connectivity for females in the default mode network. This large-scale study provides a foundation for attempts to understand the causes and consequences of sex differences in adult brain structure and function.

Characteristics of NPS use in patients admitted to acute psychiatric services in Southeast Scotland: a retrospective cross-sectional analysis following public health interventions.

OBJECTIVES: Assess the impact of selective prohibition and seizure of novel psychoactive substances (NPS) supply on NPS use prevalence within psychiatric admissions and evaluate demographic characteristics of current NPS users. DESIGN: A 6-month retrospective cross-sectional analysis of discharge letters between 1 October 2015 and 31 March 2016. SETTING: General psychiatry inpatients and intensive home treatment team (IHTT) community patients at a psychiatric hospital in a Scottish city. PARTICIPANTS: All participants were between the ages of 18 and 65 years. After application of exclusion criteria, 473 discharge letters of general psychiatry patients were deemed suitable for analysis and 264 IHTT patient discharge letters were analysed. INTERVENTIONS: A nationwide temporary class drug order (TCDO) was placed on 10 April 2015 reclassifying methylphenidate-related compounds as class B substances. On 15 October 2015, local forfeiture orders were granted to trading standards permitting the seizure of NPS supplies. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was to determine the prevalence of NPS use in two cohorts. Second, demographic features of patients and details regarding their psychiatric presentation were analysed. RESULTS: The prevalence of NPS use in general psychiatry and IHTT patients was 6.6% and 3.4%, respectively. Inpatients using NPS compared with non-users were more likely to be men (OR 2.92, 95% CI 1.28 to 6.66, P=0.009), have a forensic history (OR 5.03, CI 2.39 to 10.59, P<0.001) and be detained under an Emergency Detention Certificate (OR 3.50, CI 1.56 to 7.82, P=0.004). NPS users were also more likely to be diagnosed under International Statistical Classification of Diseases and Related Health Problems, Version 10, F10-19 (OR 9.97, CI 4.62 to 21.49, P<0.001). CONCLUSIONS: Compared with previous work, psychiatric inpatient NPS use has fallen. NPS continue to be used by a demographic previously described resulting in presentations consistent with a drug-induced psychosis and at times requiring detention under the Mental Health Act. Further research is required to evaluate the effectiveness of the recent prohibition of all NPS.

A functional dissociation of the anterior and posterior pedunculopontine tegmental nucleus: excitotoxic lesions have differential effects on locomotion and the response to nicotine.

Excitotoxic lesions of posterior, but not anterior pedunculopontine tegmental nucleus (PPTg) change nicotine self-administration, consistent with the belief that the anterior PPTg (aPPTg) projects to substantia nigra pars compacta (SNC) and posterior PPTg (pPPTg) to the ventral tegmental area (VTA). The VTA is a likely site both of nicotine's reinforcing effect as well as its actions on locomotion. We hypothesized that pPPTg, but not aPPTg lesions, would alter locomotion in response to repeated nicotine administration by virtue of the fact that pPPTg appears to be more closely related to the VTA than is the aPPTg. Following excitotoxic lesions of aPPTg or pPPTg, rats were habituated to experimental procedures. Repeated (seven of each) nicotine (0.4 mg/kg) and saline injections were given following an on-off procedure. Measurement of spontaneous locomotion during habituation showed that aPPTg but not pPPTg lesioned rats were hypoactive relative to controls. Following nicotine, control rats showed locomotor depression for the first 2 days of treatment followed by enhanced locomotion relative to activity following saline treatment. Rats with aPPTg lesions showed a similar pattern, but the pPPTg lesioned rats showed no locomotor depression following nicotine treatment. These data confirm the role of the pPPTg in nicotine's behavioural effects--including the development of sensitization--and demonstrate for the first time that excitotoxic lesions of the aPPTg but not pPPTg generate a deficit in baseline activity. The finding that anterior but not posterior PPTg affects motor activity has significance for developing therapeutic strategies for Parkinsonism using deep brain stimulation aimed here.

Intravenous self-administration of nicotine is altered by lesions of the posterior, but not anterior, pedunculopontine tegmental nucleus.

The reinforcing properties of nicotine involve actions at nicotinic acetylcholine receptors located on dopamine (DA) neurons in the ventral tegmental area (VTA). The pedunculopontine tegmental nucleus (PPTg) is involved in the regulation of these DA neurons, and those of the substantia nigra pars compacta (SNc). The PPTg can be subdivided into anterior (aPPTg) and posterior (pPPTg) regions on the basis of its innervation of midbrain DA neurons - the pPPTg innervates both VTA and SNc while the aPPTg innervates SNc. As the reinforcing actions of nicotine depend on its actions in the VTA more than SNc, it was hypothesized that excitotoxic lesions of pPPTg would alter nicotine reinforcement, measured by intravenous self-administration, while lesions of aPPTg would not. Rats were given ibotenate lesions of pPPTg or aPPTg, followed by intravenous catheterization. Intravenous self-administration (IVSA) of nicotine (0.03 mg/kg/inf) was carried out until a stable response baseline was reached. A dose-response function for nicotine was then established. There was no significant effect of aPPTg lesions on nicotine IVSA, while IVSA was significantly elevated following pPPTg lesions, compared with both sham lesioned controls and aPPTg excitotoxin lesioned rats. This was found across all doses, including saline, of the dose-response function. The differential effect of aPPTg lesions and pPPTg lesions suggests that disruption of regulatory innervation from pPPTg results in altered regulation of VTA DA neurons. The resulting change in nicotine self-administration behaviour was hypothesized to reflect either a reduction in intrinsic nicotine reward value, or enhancement of associative incentive salience.

Involvement of the laterodorsal tegmental nucleus in the locomotor response to repeated nicotine administration.

The locomotor altering properties of nicotine depend on activation of nicotinic acetylcholine receptors in the ventral tegmental area (VTA). The laterodorsal tegmental nucleus (LDTg) provides a significant proportion of the cholinergic innervation of the VTA. We tested the hypothesis that the locomotor effects of nicotine depend on the functional integrity of the LDTg. The spontaneous locomotor activity of LDTg and sham-lesioned control rats was measured over seven sessions, after which we examined the effects of repeated injections of nicotine in a day on-day off design, giving injections of saline on the nicotine-off days. Spontaneous locomotor activity was significantly lower in LDTg lesioned compared to control rats. LDTg lesions also blunted the effects of nicotine: control rats showed an initial locomotor depression after nicotine, but on repeated testing showed a progressive increase in the amount of locomotion in response to drug challenge. LDTg lesioned rats showed no differences in responding to nicotine compared to saline. These data show that the functional integrity of the LDTg is required in order to show normal locomotor response to nicotine. One explanation for this is that loss of the LDTg affects synaptic activity in the VTA.

Determination of acetylcholine and dopamine content in thalamus and striatum after excitotoxic lesions of the pedunculopontine tegmental nucleus in rats.

The pedunculopontine tegmental nucleus (PPTg) contains cholinergic neurons whose principal ascending connections are with thalamic nuclei and structures associated with the striatum. It has been hypothesized that PPTg neurons are more closely associated with the substantia nigra (and therefore striatal motor systems) than with the ventral tegmental area (and therefore limbic striatal functions). In the present experiments we have examined the hypothesis that the PPTg is similarly associated with motor nuclei in the thalamus. Rats received unilateral ibotenate lesions of PPTg and were sacrificed 1, 2, 4 or 7 days later. Discrete thalamic nuclei, and samples of caudate-putamen and nucleus accumbens, were punched out and thalamic acetylcholine (ACh) and striatal ACh and dopamine (DA) content examined. Anteroventral nucleus had decreased ACh content after PPTg lesion, but a time dependent increase was found in mediodorsal nucleus; ACh concentration was unchanged in thalamic reticular nucleus or medial geniculate. No long-term lesion-dependent changes in striatal ACh or DA content were found. The effects of PPTg lesion on thalamic ACh content are consistent with the hypothesis that it has effects on motor nuclei, but also indicate that PPTg lesions have complex and dynamic effects on thalamic ACh content.