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1.
J Alzheimers Dis ; 63(2): 529-538, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29578481

RESUMO

BACKGROUND: Depression remains an important risk factor for Alzheimer's disease, yet few neuroimaging biomarkers are available to identify treatment response in depression. OBJECTIVE: To analyze and compare functional perfusion neuroimaging in persons with treatment resistant depression (TRD) compared to those experiencing full remission. METHODS: A total of 951 subjects from a community psychiatry cohort were scanned with perfusion single photon emission computed tomography (SPECT) of the brain in both resting and task related settings. Of these, 78% experienced either full remission (n = 506) or partial remission (n = 237) and 11% were minimally responsive (n = 103) or non-responsive (11%. n = 106). Severity of depression symptoms were used to define these groups with changes in the Beck Depression Inventory prior to and following treatment. Voxel-based analyses of brain SPECT images from full remission compared to the worsening group was conducted with the statistical parametric mapping software, version 8 (SPM 8). Multiple comparisons were accounted for with a false discovery rate (p < 0.001). RESULTS: Persons with depression that worsened following treatment had reduced cerebral perfusion compared to full remission in the multiple regions including the bilateral frontal lobes, right hippocampus, left precuneus, and cerebellar vermis. Such differences were observed on both resting and concentration SPECT scans. CONCLUSION: Our findings identify imaging-based biomarkers in persons with depression related to treatment response. These findings have implications in understanding both depression to prognosis and its role as a risk factor for dementia.


Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular , Transtorno Depressivo Resistente a Tratamento/diagnóstico por imagem , Fluxo Sanguíneo Regional , Tomografia Computadorizada de Emissão de Fóton Único , Adolescente , Adulto , Idoso , Encéfalo/metabolismo , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/metabolismo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuroimagem , Imagem de Perfusão , Prognóstico , Indução de Remissão , Adulto Jovem
2.
J Alzheimers Dis ; 60(2): 605-614, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28777753

RESUMO

BACKGROUND: Studies have reported that females have widespread increases in regional cerebral blood flow, but the studies were relatively small and inconsistent. OBJECTIVE: Here we analyzed a healthy and a very large clinical psychiatric population to determine the effect of gender, using single photon emission computed tomography (SPECT). METHODS: Whole brain and region of interest (ROI) gender differences were analyzed in a total of 46,034 SPECT scans at baseline and concentration. The sample included 119 healthy subjects and 26,683 patients (60.4% male, 39.6% female); a subset of 11,587 patients had complete diagnostic information. A total of 128 regions were analyzed according to the AAL Atlas, using ROI Extract and SPSS statistical software programs, controlling for age, diagnoses, and correcting for multiple comparisons. RESULTS: Compared to males, healthy females showed significant whole brain (p < 0.01) and ROI increases in 65 baseline and 48 concentration regions (p < 0.01 corrected). Healthy males showed non-significant increases in 9 and 22 regions, respectively. In the clinical group, there were widespread significant increases in females, especially in the prefrontal and limbic regions, and specific increases in males in the inferior occipital lobes, inferior temporal lobes, and lobule 7 and Crus 2 of the cerebellum. These findings were replicated in the subset of 11,587 patients with the effect of diagnoses removed. CONCLUSIONS: Our results demonstrated significant gender differences in a healthy and clinical population. Understanding these differences is crucial in evaluating functional neuroimaging and may be useful in understanding the epidemiological gender differences among psychiatric disorders.


Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Circulação Cerebrovascular/fisiologia , Neuroimagem Funcional , Transtornos Mentais/diagnóstico por imagem , Caracteres Sexuais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento Tridimensional , Masculino , Transtornos Mentais/patologia , Pessoa de Meia-Idade , Adulto Jovem
3.
Adv Mind Body Med ; 27(2): 6-16, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23709407

RESUMO

BACKGROUND: Psychiatric diagnoses are made primarily through clinical histories, with psychiatrists searching for DSM (Diagnostic and Statistical Manual of Mental Disorders)-driven symptom clusters, and outcomes for patients have not substantially improved in decades for many disorders. PRIMARY STUDY OBJECTIVE: In this study, the research team examined the outcome impact of the addition of single photon emission computed tomography (SPECT) to the assessment of complex patients. DESIGN: The research team designed a multisite, prospective, 6-mo outcome study. The study was completed after final outcome measures were obtained on 500 participants. SETTING: The study occurred in four psychiatric clinics, the Amen Clinics in Newport Beach and San Francisco, CA; Bellevue, WA; and Reston, VA. PARTICIPANTS: Participants were new outpatients at the four clinics who were entered into the study between January 2011 and August 2012. PRIMARY OUTCOME MEASURES: Evaluations included (1) histories, (2) mental-status examinations, (3) a Structured Clinical Interview for DSM-IV (SCID-IV), (4) the Beck Depression Inventory-II (BDI-II), (5) the Brief Symptom Inventory (BSI), (6) the Quality of Life Inventory (QOLI), and (7) brain SPECT scans during rest and concentration. At 6 mo, standardized outcome measurements were readministered (BDI-II, BSI, QOLI), and the research team asked questions about improvement and compliance. RESULTS: Seventy-five percent of participants reported significant clinical improvement; 55% reported being "very compliant," 41% "somewhat compliant," and 4% "noncompliant." Significant improvements were observed across all three assessments: (1) BDI, 360 out of 500 (72%) participants decreased, mean difference=-6.92; (2) BSI, 367 out of 461 (80%) participants decreased, mean difference=-0.39.; (3) QOLI, 427 (85%) of participants improved) at 6 mo (Hotelling T2=460; P<.0001), mean difference=+1.65. Net improvement was measured at 81% (n=405). CONCLUSIONS: To the research team's knowledge, this study is the first outcome study of complex psychiatric patients using SPECT as an additional diagnostic tool and demonstrating significant improvement. Further studies comparing the addition of brain SPECT to "treatment as usual" groups are warranted.


Assuntos
Transtornos Mentais/diagnóstico , Escalas de Graduação Psiquiátrica , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Feminino , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
4.
Adv Mind Body Med ; 27(2): 24-33, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23709409

RESUMO

CONTEXT: In a prior open trial of professional football players who displayed the effects of traumatic brain injury, the current reserach team reported significant improvements in clinical symptoms, neuropsychological testing and regional cerebral blood flow (rCBF) following the use of brain-directed nutrients (BDNs) and lifestyle interventions. OBJECTIVE: The current study intended to determine whether supplementation with BDNs improved rCBF and neuropsychological function in healthy individuals. DESIGN: The current study was a randomized, doubleblind, placebo-controlled, crossover trial, which was a more rigorous reseach design than the prior study and did not include lifestyle interventions. SETTING: Participants underwent evaluation and testing at the Amen Clinics, Inc, a private medical facility in Newport Beach, CA. PARTICIPANTS: Thirty healthy adult (15 male and 15 female) participants were recruited from the community though local advertising and met the requirements for eligibility into the study. Twenty-five individuals completed the study, with dropout due to events unrelated to the study itself. INTERVENTION: The participants were randomly assigned to a treatment order for intervention, either placebo or brain supplements first. The BDNs treatment was comprised of three supplements: fish oil; a high-potency, multiple vitamin/mineral supplement; and a brainenhancement supplement. The placebo treatment was two supplements comprised of rice flour to replace the multiple vitamin/mineral complex and the brain-enhancement supplement and one supplement made of other oils to replace the fish-oil mixture. After 2 mo of this first intervention, a crossover intervention occurred for a final 2 mo, in which participants formerly receiving BDNs received a placebo treatment and participants formerly treated with placebo received the BDNs treatment. OUTCOME MEASURES: Primary outcome measures included (1) an analysis of the changes in rCBF using SPECT and (2) an assessment of the differences in cognitive and emotional function using the MicroCog (cognitive performance), the WebNeuro (emotional state), and three psychological inventories-the Beck Depression Inventory (BDI-II), Brief Symptom Inventory (BSI), and Quality of Life Inventory (QOLI). RESULTS: A region of interest (ROI) analysis for each of the 2-mo phases (baseline, then placebo and treatment according to randomized order) showed significant improvement in rCBF for the BDNs as compared to the placebo (as assigned at the start of the first intervention) in the prefrontal cortex, anterior and posterior cingulate gyrus, hippocampus, and cerebellum. Significant improvements were observed for the BDNs (1) on the MicroCog-reasoning, P=.008; memory, P=.014; information processing accuracy, P=.027; (2) on the WebNeuro-executive function, P=.002, information processing efficiency, P=.015; depressed mood, P=.017, and emotional identification, P=.041; and (3) on the BSI-positive symptom total, P=.024 and reduced hostility, P=.018. For the last, significance occurred upon accounting for the effect of order. CONCLUSION: This study demonstrates the potential effectiveness of BDNs in enhancing rCBF and neuropsychological function across various cognitive and psychological domains.


Assuntos
Encéfalo/irrigação sanguínea , Encéfalo/metabolismo , Circulação Cerebrovascular/efeitos dos fármacos , Cognição/efeitos dos fármacos , Suplementos Nutricionais , Adulto , Estudos Cross-Over , Método Duplo-Cego , Emoções/efeitos dos fármacos , Feminino , Óleos de Peixe/administração & dosagem , Ginkgo biloba , Hostilidade , Humanos , Masculino , Testes Neuropsicológicos , Extratos Vegetais/administração & dosagem , Tomografia Computadorizada de Emissão de Fóton Único , Vitaminas
5.
J Psychoactive Drugs ; 44(2): 96-106, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22880537

RESUMO

Our objective was to ascertain in a prospective case series how often brain single photon emission computed tomography (SPECT) neuroimaging adds relevant information for diagnosis and/or treatment beyond current standard assessment tools in complex psychiatric cases. Charts of 109 consecutively evaluated outpatients from four psychiatrics clinics that routinely utilize SPECT imaging for complex cases were analyzed in two stages. In stage one, psychiatrists reviewed detailed clinical histories, mental status exams, and the structured clinical interview for DSM-IV, but not the results of SPECT studies, assigned a diagnosis based on DSM-IV criteria, and then developed a comprehensive treatment plan. In stage two, evaluators were given access to the SPECT studies for each patient. The addition of SPECT modified the diagnosis or treatment plan in 78.9% (n=86; rated level 2 or 3 change) of cases. The most clinically significant changes were undetected brain trauma (22.9%), toxicity patterns (22.9%) and the need for a structural imaging study (9.2%). Specific functional abnormalities were seen as follows that potentially could impact treatment: temporal lobe dysfunction (66.1%) and prefrontal hypoperfusion (47.7%). SPECT has the potential to add clinically meaningful information to enhance patient care beyond current assessment tools in complex or treatment resistant cases.


Assuntos
Encéfalo/diagnóstico por imagem , Transtornos Mentais/diagnóstico por imagem , Neuroimagem/métodos , Tomografia Computadorizada de Emissão de Fóton Único , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Compostos Radiofarmacêuticos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico por imagem , Transtornos Relacionados ao Uso de Substâncias/psicologia , Tecnécio Tc 99m Exametazima , Estados Unidos , Adulto Jovem
6.
J Neurotrauma ; 29(1): 168-85, 2012 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-22026588

RESUMO

This is a preliminary report on the safety and efficacy of 1.5 ATA hyperbaric oxygen therapy (HBOT) in military subjects with chronic blast-induced mild to moderate traumatic brain injury (TBI)/post-concussion syndrome (PCS) and post-traumatic stress disorder (PTSD). Sixteen military subjects received 40 1.5 ATA/60 min HBOT sessions in 30 days. Symptoms, physical and neurological exams, SPECT brain imaging, and neuropsychological and psychological testing were completed before and within 1 week after treatment. Subjects experienced reversible middle ear barotrauma (5), transient deterioration in symptoms (4), and reversible bronchospasm (1); one subject withdrew. Post-treatment testing demonstrated significant improvement in: symptoms, neurological exam, full-scale IQ (+14.8 points; p<0.001), WMS IV Delayed Memory (p=0.026), WMS-IV Working Memory (p=0.003), Stroop Test (p<0.001), TOVA Impulsivity (p=0.041), TOVA Variability (p=0.045), Grooved Pegboard (p=0.028), PCS symptoms (Rivermead PCSQ: p=0.0002), PTSD symptoms (PCL-M: p<0.001), depression (PHQ-9: p<0.001), anxiety (GAD-7: p=0.007), quality of life (MPQoL: p=0.003), and self-report of percent of normal (p<0.001), SPECT coefficient of variation in all white matter and some gray matter ROIs after the first HBOT, and in half of white matter ROIs after 40 HBOT sessions, and SPECT statistical parametric mapping analysis (diffuse improvements in regional cerebral blood flow after 1 and 40 HBOT sessions). Forty 1.5 ATA HBOT sessions in 1 month was safe in a military cohort with chronic blast-induced PCS and PTSD. Significant improvements occurred in symptoms, abnormal physical exam findings, cognitive testing, and quality-of-life measurements, with concomitant significant improvements in SPECT.


Assuntos
Traumatismos por Explosões/terapia , Oxigenoterapia Hiperbárica , Síndrome Pós-Concussão/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Adulto , Traumatismos por Explosões/complicações , Traumatismos por Explosões/fisiopatologia , Lesões Encefálicas/etiologia , Lesões Encefálicas/fisiopatologia , Lesões Encefálicas/terapia , Humanos , Interpretação de Imagem Assistida por Computador , Masculino , Testes Neuropsicológicos , Projetos Piloto , Síndrome Pós-Concussão/etiologia , Síndrome Pós-Concussão/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Tomografia Computadorizada de Emissão de Fóton Único
7.
Obesity (Silver Spring) ; 19(5): 1095-7, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21311507

RESUMO

Obesity is a risk factor for stroke and neurodegenerative disease. Excess body fat has been linked to impaired glucose metabolism, insulin resistance, and impulsivity and may be a precursor to decline in attention and executive cognitive function. Here, we investigated the effects of high BMI on regional cerebral blood flow (rCBF) using single photon emission computed tomography (SPECT) imaging in healthy subjects. A total of 16 adult men and 20 adult women were recruited from the community between January 2003 and July 2009 as part of a healthy brain study (HBS) conducted at the Amen Clinics, a private medical facility. Participants in the study were screened to exclude medical, neurological, and psychiatric conditions, including substance abuse. Subjects were categorized as normal or overweight according to BMI. Using a two sample t-test, we determined the effects of BMI on rCBF in normal vs. overweight subjects. Subjects were matched for age and gender. Statistical parametric mapping (SPM) revealed a higher BMI in healthy individuals that is associated with decreased rCBF in Broadmann areas 8, 9, 10, 11, 32, and 44, brain regions involved in attention, reasoning, and executive function (P < 0.05, corrected for multiple comparisons). We found that an elevated BMI is associated with decreased rCBF in the prefrontal cortex of a healthy cohort. These results indicate that elevated BMI may be a risk factor for decreased prefrontal cortex function and potentially impaired executive function.


Assuntos
Índice de Massa Corporal , Circulação Cerebrovascular , Sobrepeso/diagnóstico por imagem , Córtex Pré-Frontal/irrigação sanguínea , Córtex Pré-Frontal/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Estudos de Coortes , Feminino , Humanos , Comportamento Impulsivo , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Sobrepeso/fisiopatologia , Oximas , Compostos Radiofarmacêuticos , Tomografia Computadorizada de Emissão de Fóton Único/métodos
8.
Neuroinformatics ; 4(2): 199-212, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16845169

RESUMO

With the increased frequency of multisite, large-scale collaborative neuro-imaging studies, the need for a general, self-documenting framework for the storage and retrieval of activation maps and anatomical labels becomes evident. To address this need, we have developed and extensible markup language (XML) schema and associated tools for the storage of neuro-imaging activation maps and anatomical labels. This schema, as part of the XML-based Clinical Experiment Data Exchange (XCEDE) schema, provides storage capabilities for analysis annotations, activation threshold parameters, and cluster and voxel-level statistics. Activation parameters contain information describing the threshold, degrees of freedom, FWHM smoothness, search volumes, voxel sizes, expected voxels per cluster, and expected number of clusters in the statistical map. Cluster and voxel statistics can be stored along with the coordinates, threshold, and anatomical label information. Multiple threshold types can be documented for a given cluster or voxel along with the uncorrected and corrected probability values. Multiple atlases can be used to generate anatomical labels and stored for each significant voxel or cluter. Additionally, a toolbox for Statistical Parametric Mapping software (http://www. fil. ion.ucl.ac.uk/spm/) was created to capture the results from activation maps using the XML schema that supports both SPM99 and SPM2 versions (http://nbirn.net/Resources/Users/ Applications/xcede/SPM_XMLTools.htm). Support for anatomical labeling is available via the Talairach Daemon (http://ric.uthscsa. edu/projects/talairachdaemon.html) and Automated Anatomical Labeling (http://www. cyceron.fr/freeware/).


Assuntos
Mapeamento Encefálico , Encéfalo/anatomia & histologia , Sistemas de Gerenciamento de Base de Dados , Armazenamento e Recuperação da Informação/métodos , Imageamento por Ressonância Magnética , Linguagens de Programação , Animais , Humanos
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