Journal of Neuropsychiatry and Clinical Neurosciences最新文献

Objective: The authors examined differences in resting-state functional connectivity (rsFC) in the brain between nontreatment-seeking adults with alcohol use disorder (case group) and recreational drinkers without alcohol use disorder (control group) and explored behavioral and psychological mechanisms underlying these differences.

Methods: This case-control study included 140 adults (N=71 with alcohol use disorder and N=69 demographically matched control individuals) who completed a 9-minute resting-state functional MRI scan. About 45% were men, and the mean±SD age was 32.7±10.4 years. Seed-based rsFC analyses were conducted. Psychological mechanisms included alcohol-reinforcing value (assessed with the Alcohol Purchase Task), immediate reward orientation (delay-discounting task), and internalizing psychopathology (a composite of depression, anxiety, and posttraumatic stress measures).

Results: Significant rsFC differences were found between seed-target regions, including the inferior frontal gyrus and lingual gyrus, lingual gyrus and inferior occipital gyrus, nucleus accumbens and lingual gyrus, and supplementary motor cortex and temporal pole. Connectivity in these regions was significantly higher in the alcohol use disorder group, except for the supplementary motor cortex seed. Indirect effects of group differences in rsFC were found for alcohol-reinforcing value indicators and internalizing psychopathology but not delay discounting.

Conclusions: This study provides initial evidence of diagnostically distinct rsFC patterns in alcohol use disorder, reflecting higher incentive salience for alcohol and elevated negative reinforcement motivation.

Objective: One of the most frequent neuropsychiatric complications after a stroke is poststroke depression (PSD). However, it is unclear whether disparities exist in PSD diagnosis. The authors examined a 10-year trend in PSD by socioeconomic and clinical characteristics.

Methods: A retrospective cohort study of acute ischemic stroke (AIS) patients admitted to a stroke network in 2014-2023 was performed. PSD was defined as newly diagnosed major depression or initiation of antidepressant medication up to 1 year poststroke. Trend, bivariate, and multivariable logistic regression analyses of patient sociodemographic and clinical characteristics and discharge stroke outcomes were conducted.

Results: Of 23,514 AIS patients, 15.0% (N=3,534) met the criteria for PSD. Women and non-Hispanic Whites were diagnosed as having PSD at a higher proportion than were men and non-White patients, respectively. Higher odds of PSD were associated with female sex (OR=1.32, 95% CI=1.22-1.43), ages 18-49 years (OR=1.30, 95% CI=1.08-1.56) and 50-79 years (OR=1.26, 95% CI=1.15-1.38), National Institutes of Health Stroke Scale score of 6-15 at hospital admission (OR=1.23, 95% CI=1.10-1.37), and modified Rankin Scale score of 2-3 at hospital discharge (OR=1.32, 95% CI=1.19-1.46) and 4-5 (OR=1.38, 95% CI=1.24-1.53).

Conclusions: Women, non-Hispanic White patients, and middle-aged patients and patients with moderate stroke severity on initial examination and poor functional outcomes at discharge were more likely to have a PSD diagnosis. Long-term depression screening is a pressing need among stroke patients, especially among racial-ethnic minority populations that may be underdiagnosed or undertreated for PSD.

Objective: Positive signs are clinical signs that are not explained by a structural neurological lesion and are considered the hallmark of functional neurological disorder (FND). In the literature and in clinical experience, positive signs are observed among patients without FND. The aim of the study was to examine the significance of positive signs among headache patients.

Methods: The authors of this prospective study recruited patients in headache consultation at the University Hospital Inselspital, Bern, Switzerland. Inclusion criteria were headache or facial pain in the past 3 months and age ≥18 years. The exclusion criterion was a known diagnosis of FND. All patients were examined for 14 validated positive signs: give-way weakness, co-contraction, sternocleidomastoid sign, trapezius elevation test, head flexion test, drift without pronation, Hoover I and II, spinal injury test, arm drop test, lip-pulling sign, midline splitting, splitting of vibration sign at the front, and expressive behavior sign.

Results: In total, 101 patients were recruited (69% female; mean±SD age=40.8±16.3 years), of whom 43% showed positive signs. Splitting of vibration was the most common sign (27%); the other signs were less frequent (≤10%). Patients with positive signs were older than patients without such signs and had more monthly headache days and exacerbations as well as more intense headache at examination. Multivariable logistic regression revealed a significant association between positive signs and exacerbation days per month (OR=1.08, 95% CI=1.01-1.14, per exacerbation day; p=0.019).

Conclusions: Positive signs are frequent among headache patients and point toward a more severe headache condition. This finding suggests overlapping mechanisms in headache and FND.

Objective: The authors explored classes of neuropsychiatric symptoms (NPSs) in Alzheimer's disease (AD), examined the relationship between NPS classes on rate of functional decline over time, and determined whether effects of individual symptoms on functional decline remained after controlling for NPS classes.

Methods: The authors longitudinally analyzed 9,797 study participants with mild cognitive impairment or AD at baseline in the National Alzheimer's Coordinating Center Uniform Data Set. Function was measured with the Functional Assessment Questionnaire, and NPSs were assessed by using clinician judgment. Latent class analysis (LCA) was used to identify clusters of individuals who shared similar NPS profiles. Linear mixed models were used to estimate the relationship between NPS classes and individual symptom profiles in functional decline over time.

Results: LCA revealed four distinct NPS classes: an asymptomatic-mild group (48.2% of the sample, N=4,721), a second group predominantly having apathy and depression (36.4%, N=3,562), a third group with high rates of multiple symptoms except for hallucinations (12.8%, N=1,250), and a small group with high rates of all symptoms (complex class, 2.7%, N=264). NPS classes differed in baseline function but were not significantly associated with rate of functional decline. When NPS classes were controlled for, persistent apathy remained strongly associated with a faster rate of functional decline. Effects of apathy were observed across NPS classes and disease severity levels.

Conclusions: Specific symptoms rather than classes of symptoms were associated with the trajectory of functional decline in AD. Apathy may be particularly useful for tracking longitudinal changes in function.

Objective: Depression is known to be highly heterogeneous, with distinct clusters of symptoms. Whether this heterogeneity exists after traumatic brain injury (TBI) and how clusters of depression symptoms after TBI may relate to clinical symptoms, functional outcomes, and underlying neurobiology are largely unknown.

Methods: The authors investigated depression symptom clusters after subacute TBI and evaluated their clinical, functional, and neural correlates. Community-dwelling participants with complicated mild, moderate, or severe TBI (N=53) were evaluated on average 5 months postinjury. Participants were administered the 17-item Hamilton Depression Rating Scale (HDRS), the Rivermead Post-Concussion Symptom Questionnaire, the Glasgow Outcome Scale-Extended, and a neuropsychological test battery. A subset of participants completed a resting-state functional MRI scan.

Results: Principal component analysis on the HDRS items yielded a two-component solution that accounted for 40% of the variance. Component 1 encompassed mood and affective symptoms as well as agitation and loss of libido, and component 2 encompassed anxiety, insomnia, and most somatic symptoms of the HDRS. Component 2 was associated with greater TBI symptom burden and disability and worse executive functions but not resting-state functional connectivity. Component 1 was not related to TBI symptom burden, neuropsychological function, or disability, but there was a trend-level association between higher negative affect scores and greater functional connectivity between the dorsal attention and default mode networks.

Conclusions: The findings suggest that depression after TBI may not be a unitary syndrome but rather may be composed of clusters of symptoms that have different associations with TBI symptom burden, disability, and brain connectivity.

Objective: Catatonia is an underdiagnosed disorder characterized by speech and motor abnormalities. EEG examinations may improve the accuracy of a catatonia diagnosis, but clinical and electrographic correlations have not been established. The authors describe catatonic features and EEG findings in a large multisite retrospective cohort.

Methods: The clinical records in two health care systems were searched for patients with an EEG recording and a catatonia assessment with the Bush-Francis Catatonia Rating Scale conducted within 24 hours of each other. Included patients were retrospectively screened for delirium through a chart-based assessment. Augmented inverse propensity weighting (AIPW) was used to estimate the causal effects of delirium and catatonia on the presence of an abnormal EEG finding.

Results: Overall, 178 patients met inclusion criteria, 144 (81%) of whom had catatonia. Among the patients with catatonia, 43% also had delirium. EEG abnormalities were present among 43% of patients with catatonia, including 28% of patients with catatonia without delirium and 69% of the patients with co-occurring catatonia and delirium. Individual catatonic signs and EEG abnormalities showed only a weak correlation. In AIPW models, a delirium diagnosis was associated with significantly higher odds for an abnormal EEG finding (OR=6.75; 95% CI=2.83-16.14), whereas a diagnosis of catatonia was not (OR=1.83, 95% CI=0.79-4.24).

Conclusions: EEG abnormalities are common among individuals with catatonia, but these are difficult to disentangle from abnormalities resulting from co-occurring delirium. Further research is needed to define the role of EEG examinations in the assessments of catatonia and delirium.

Objective: COVID-19 has been associated with a wide range of systemic and neurological complications, known as long COVID or postacute sequelae of COVID-19 (PASC). Such sequelae can be observed among all infected individuals, even among those with a mild disease course. Dysbiosis, a common condition associated with low-grade inflammation, has been proposed as a potential mechanism of PASC by altering levels of circulating lipopolysaccharide (LPS) and the tryptophan pathway metabolites kynurenine and quinolinic acid, known to affect neurocognitive function. The authors evaluated the evolution of neurological, neurocognitive, and neuropsychiatric COVID-19 sequelae and their relationship with circulating LPS and kynurenine and quinolinic acid levels.

Methods: A prospective, longitudinal, and analytical study was conducted. Neurological, neurocognitive, and neuropsychiatric assessments of participants who had recovered from COVID-19 and did not require hospitalization during the acute stages of the infection were performed. Peripheral levels of LPS and tryptophan metabolites were measured 1, 3, 6, and 12 months after infection.

Results: Of 95 participants recruited, 67 COVID-19-convalescent individuals and 20 COVID-19-free individuals were included. Significantly higher occurrences of asthenia, olfaction and taste alterations, headache, memory dysfunction, and systemic symptoms such as dyspnea, cough, and periodontal diseases were found among participants in the COVID-19-convalescent group compared with participants in the comparison group. A significant decrease in kynurenine levels, which correlated with cognitive impairment, was observed among PASC convalescents.

Conclusions: Significant neurocognitive and neuropsychiatric impairments were observed among COVID-19-convalescent individuals, along with decreased kynurenine levels, which recovered during a 12-month follow-up period.

Objective: Cortical regions such as parietal area H (PH) and the fundus of the superior temporal sulcus (FST) are involved in higher visual function and may play a role in dementia with Lewy bodies (DLB), which is frequently associated with hallucinations. The authors evaluated functional connectivity between these two regions for distinguishing participants with DLB from those with Alzheimer's disease (AD) or mild cognitive impairment (MCI) and from cognitively normal (CN) individuals to identify a functional connectivity MRI signature for DLB.

Methods: Eighteen DLB participants completed cognitive testing and functional MRI scans and were matched to AD or MCI and CN individuals whose data were obtained from the Alzheimer's Disease Neuroimaging Initiative database (https://adni.loni.usc.edu). Images were analyzed with data from Human Connectome Project (HCP) comparison individuals by using a machine learning-based subject-specific HCP atlas based on diffusion tractography.

Results: Bihemispheric functional connectivity of the PH to left FST regions was reduced in the DLB group compared with the AD and CN groups (mean±SD connectivity score=0.307±0.009 vs. 0.456±0.006 and 0.433±0.006, respectively). No significant differences were detected among the groups in connectivity within basal ganglia structures, and no significant correlations were observed between neuropsychological testing results and functional connectivity between the PH and FST regions. Performances on clock-drawing and number-cancelation tests were significantly and negatively correlated with connectivity between the right caudate nucleus and right substantia nigra for DLB participants but not for AD or CN participants.

Conclusions: The functional connectivity between PH and FST regions is uniquely affected by DLB and may help distinguish this condition from AD.