NEUROIMAGING CORRELATES OF ECT OUTCOMES

神经影像学与 ECT 结果相关

• 批准号: 6665449
• 负责人: MITCHELL S NOBLER
• 金额: $ 38.25万
• 依托单位: NEW YORK STATE PSYCHIATRIC INSTITUTE DBA RESEARCH FOUNDATION FOR MENTAL HYGIENE, INC
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-24 至 2006-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6665449
• 关键词: behavioral /social science research tag; bioimaging /biomedical imaging; brain circulation; brain imaging /visualization /scanning; brain mapping; clinical research; electroconvulsive therapy; human subject; human therapy evaluation; major depression; memory disorders; patient oriented research; positron emission tomography; therapy adverse effect

DESCRIPTION (provided by applicant): ECT is a highly effective treatment tar major depressive episodes (MDE), but cognitive side effects limit its use. This study attempts to isolate the neural pathways and physiological alterations associated with ECTs most significant side effect. retrograde amnesia. At baseline, patients with MDE often have reductions in global and regional cerebral blood flow (rCBF). Paradoxically, ECT further reduces resting rCBF and rCMR, and our preliminary data indicate that a particular topographic alteration is strongly associated with efficacy. However, our data also suggest that regional changes in resting rCBF, rCMR, and EEG following ECT are each linked to the magnitude of distinct amnestic effects. These pilot data challenge the traditional view that the amnestic effects of ECT are uniformly due to disruption of medial temporal lobe function. Rather, reduced temporopolar and prefrontal function may strongly contribute to retrograde amnesia (RA), the most persistent adverse effect of ECT. ECT provides a unique context in which to investigate the mechanisms and neural systems underlying long-term memory and retrograde amnesia, since patients can be studied both before and after they develop amnestic effects, as well as after recovery from amnesia. Forty patients with MDE and 20 matched normal controls will participate. The ECT methods selected from a randomized study will result in the greatest level of RA and yet produce marked indivudal differences in the magnitude of amnestic effects, without differences in efficacy. All participants will undergo fully quantitative 0-15 PET assessments of resting rCBF and rCBF response to cognitive challenge, consisting of cued recall of recent and remote personal (episodic) and non-personal, fact-based (semantic) memories, using a matched task paradigm. Both groups will undergo serial neurocognitive testing with a focus on retrograde memory. Assessments will be conducted at three time points, corresponding to preECT, 3-5 days postECT, and two-month follow-up in patients. The follow-up data will provide critical information on the long-term impact of ECT on brain functional activity and the relations between these changes and the resolution/persistence of amnestic deficits. In addition to providing key information about the neurophysiology of the amnestic effects of ECT, this study will advance our understanding of (a) the functional abnormalities in MOE, (b) the pathways that subserve autobiographical (episodic) memory in normal functioning, and (c) the pathways compromised in RA. Furthermore. this work should inform the development of new therapies that more focally modulate the neural systems implicated in therapeutic response. and avoid stimulation of the neural systems implicated in the development of RA.

描述（由申请人提供）：ECT是一种高效的治疗焦油主要抑郁发作（MDE），但认知副作用限制了其使用。 这项研究试图隔离与ECTS最重要的副作用相关的神经途径和生理改变。逆行失忆症。在基线时，MDE患者的全球和区域脑血流（RCBF）通常会减少。矛盾的是，ECT进一步降低了静息RCBF和RCMR，我们的初步数据表明，特定的地形变化与功效密切相关。但是，我们的数据还表明，ECT静止的RCBF，RCMR和EEG的区域变化都与独特的弱化作用的大小有关。这些试点数据挑战了传统观点，即ECT的弱化作用均匀地归因于内侧颞叶功能的破坏。相反，颞polar和前额叶功能的降低可能会导致逆行性健忘症（RA），这是ECT最持续的不良影响。 ECT提供了一种独特的环境，可以在其中研究长期记忆和逆行性失忆的机制和神经系统，因为可以在患者发展前后患者发展炎症作用以及从健忘症中恢复后进行研究。 40例MDE和20例匹配的正常对照患者将参与。从随机研究中选择的ECT方法将导致RA的最高水平，但在弱化作用的大小上产生明显的差异，而疗效没有差异。所有参与者将使用匹配的任务范式组成，对静止RCBF和RCBF对认知挑战的静止率和RCBF的反应进行全面定量0-15宠物评估。两组将进行串行神经认知测试，重点是逆行记忆。评估将在三个时间点进行，对应于预先预先的，3-5天，并在患者中进行两个月的随访。后续数据将提供有关ECT对脑功能活动的长期影响以及这些变化之间的关系以及弱化缺陷的分辨率/持久性的关键信息。除了提供有关ECT的神经生理学的关键信息外，这项研究还将提高我们对（a）MOE的功能异常的理解，（b）在正常功能中提供自传（情节性）记忆的途径，以及（c）RA中损坏的途径。此外。这项工作应告知开发新疗法，该疗法更加重视与治疗反应有关的神经系统。并避免刺激与RA发展有关的神经系统。