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抑郁症是一种以情感、认知和躯体症状为特征的精神疾病,是最常见的精神疾病之一,2019年全球抑郁症患者数量超过3.5亿,到2030年,该病将成为世界第一大负担疾病[1]。除了情绪症状(情绪低落、对日常令人愉快的活动失去兴趣等)外,抑郁症患者常合并不同领域的认知功能障碍,包括执行功能、工作记忆、注意力、语言功能及精神运动速度等,而执行功能障碍与抑郁症患者较差的预后有关[2]。MRI可以有效反映人脑的结构及功能状态,对于探索疾病背后的神经机制具有重要意义。我们对执行功能的概念及抑郁症相关执行功能障碍的磁共振结构成像[包括弥散张量成像(diffusion tensor imaging, DTI)和形态结构成像]及功能成像的研究进展进行综述,从影像学视角对执行功能进行更加全面地评估,并为临床抑郁症的相关治疗提供客观依据。
抑郁症相关执行功能障碍的磁共振成像研究进展
Advances in magnetic resonance imaging of depression-related executive dysfunction
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摘要: 抑郁症患者常合并执行功能障碍,这种认知障碍会影响其日常生活质量及预后。执行功能需要额叶皮质、边缘系统、颞顶叶、丘脑、小脑、岛叶、脑干网状系统等协同作用,相应神经回路(主要包括默认模式网络、执行控制网络、突显网络和边缘系统)及其关键区域之间连接的破坏会导致执行功能的破坏。MRI可以非侵入性地显示大脑及其神经网络的结构和功能改变,识别抑郁症相关执行功能障碍及其治疗反应的异常表现,从而评估其功能背后相关的神经机制。笔者综述了目前抑郁症相关执行功能障碍的磁共振结构成像(包括弥散张量成像、形态结构成像)及功能成像的研究进展。Abstract: Depression is often associated with executive dysfunction, a cognitive impairment that can have an effect on quality of daily life and prognosis. Executive function requires the synergy among the frontal cortex, limbic system, temporal parietal lobe, thalamus, cerebellum, insular lobe, and brainstem reticular system. The damage of the corresponding neural circuit (mainly including the default mode network, executive control network, salience network, and limbic system) and the inter-regional connections of the important network components of these neural circuits leads to the destruction of executive function. MRI can noninvasively reveal structural and functional changes in the brain and its neural networks and can be used as a biomarker to identify depression-related executive dysfunction and its response to treatment to assess the related neural mechanisms underlying its function. In this work, the authors review the current research progress of structural (diffusion tensor imaging and morphological structural imaging) and functional MRI for depression-related executive dysfunction.
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