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: 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: This article describes the design, methods, and participant characteristics of the second phase of the Concussion Assessment, Research, and Education (CARE) Consortium study ("CARE 2.0") of the effects of concussion and repetitive head impact exposure on neuropsychiatric health.

Methods: The authors conducted a prospective multisite observational study of male and female collegiate athletes and military service academy cadets and midshipmen participating in the CARE study. Participants were assessed at three time points: undergraduate baseline (UB), before departure from university or service academy (exit), and up to 6 years following graduation (postgrad) via an online battery of brain health assessments. Participant characteristics were compared across the three time points and four levels of head impact exposure.

Results: A total of 4,643 participants completed the exit assessment, and 3,981 completed the postgrad assessment. Relative to the UB assessment cohort, the exit and postgrad assessment cohorts differed with respect to the percentage of women, baseline Wechsler Test of Adult Reading scores, National Collegiate Athletic Association division category, sport contact level, and number of previous concussions. The median standardized difference across balancing variables, assessment time points, and degree of head impact exposure was 0.12 (with 90% of effect sizes ≤0.29).

Conclusions: Although there were some statistically significant differences between participants across assessments, the effect sizes were modest, and overall the data suggest that the exit and postgrad cohorts reflect the characteristics of the baseline cohort. The CARE study design and its large, richly characterized sample provide an opportunity to answer important questions about cumulative and persistent effects of concussion and repetitive head impact exposure on neuropsychiatric health.

Objective: Persistent headache is the most common and debilitating chronic condition after traumatic brain injury (TBI), affecting mood and reducing quality of life. The investigators examined in a community-based setting whether repetitive transcranial magnetic stimulation (rTMS) for management of major depression among outpatients with TBI histories was associated with improvement in the functional impact of headache (FH) and whether improvements were related to treatment at a specific site in the dorsolateral prefrontal cortex (DLPFC).

Methods: In the discovery phase (posttraumatic headache 1 [PTH-1] group, N=21), the association of rTMS treatment at DLPFC targets and improvement in headache and depression and anxiety were studied. Associations between functional connectivity of the patient-specific TMS treatment sites and changes in patients' FH were used to identify a target for simultaneous treatment of behavioral and headache symptoms. Patients in the translational phase (PTH-2 group, N=7) received TMS treatment at this target.

Results: The patients in the PTH-1 group had significant improvements in depression and anxiety but not FH, and more than half had a reduction in FH and reported an improvement in headache severity and duration. Increased functional connectivity between TMS sites and a subregion in the left DLPFC and bilateral precuneus was related to improved FH. Unlike the PTH-1 group, the PTH-2 group exhibited significant reductions in FH after 4 weeks of treatment and in anxiety and depression after 1-2 weeks of treatment.

Conclusions: TMS treatment targeting the left DLPFC coordinate identified in this study may help improve treatment for both FH and anxiety and depression among PTH patients.