背景:强迫症(OCD)是一种慢性精神疾病,其特征是分布的大脑区域之间的功能连接异常。以前的研究主要集中在无方向的功能连接,很少从网络的角度报道。
方法:为了更好地理解OCD之间或网络内的连通性,通过频谱动态因果建模评估大规模网络的有效连通性(EC),从默认模式(DMN)的八个关键兴趣区域,显著性(SN),额顶(FPN)和小脑网络,基于包括100名强迫症患者和120名健康对照(HC)在内的大样本量。使用参数经验贝叶斯(PEB)框架来识别两组之间的差异。我们进一步分析了联系与耶鲁-布朗强迫症量表(Y-BOCS)之间的关系。
结果:OCD和HC在静息状态下具有一些网络间和网络内模式的相似性。相对于HC,患者显示从左前岛叶(LAI)到内侧前额叶皮质的ECs增加,右前岛(RAI)至左背外侧前额叶皮质(L-DLPFC),右背外侧前额叶(R-DLPFC)至小脑前叶(CA),CA至后扣带皮质(PCC)和前扣带皮质(ACC)。此外,从LAI到L-DLPFC较弱,RAI到ACC,以及R-DLPFC的自连接。从ACC到CA以及从L-DLPFC到PCC的联系与强迫和强迫得分呈正相关(r=0.209,p=0.037;r=0.199,p=0.047,未校正)。
结论:我们的研究揭示了DMN之间的失调,SN,FPN,和小脑强迫症,强调这四个网络在实现对目标导向行为的自上而下控制方面的作用。这些网络之间存在自上而下的中断,构成病理生理和临床基础。
BACKGROUND: Obsessive-compulsive disorder (OCD) is a chronic mental illness characterized by abnormal functional connectivity among distributed brain regions. Previous studies have primarily focused on undirected functional connectivity and rarely reported from network perspective.
METHODS: To better understand between or within-network connectivities of OCD, effective connectivity (EC) of a large-scale network is assessed by spectral dynamic causal modeling with eight key regions of interests from default mode (DMN), salience (SN), frontoparietal (FPN) and cerebellum networks, based on large sample size including 100 OCD patients and 120 healthy controls (HCs). Parametric empirical Bayes (PEB) framework was used to identify the difference between the two groups. We further analyzed the relationship between connections and Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
RESULTS: OCD and HCs shared some similarities of inter- and intra-network patterns in the resting state. Relative to HCs, patients showed increased ECs from left anterior insula (LAI) to medial prefrontal cortex, right anterior insula (RAI) to left dorsolateral prefrontal cortex (L-DLPFC), right dorsolateral prefrontal cortex (R-DLPFC) to cerebellum anterior lobe (CA), CA to posterior cingulate cortex (PCC) and to anterior cingulate cortex (ACC). Moreover, weaker from LAI to L-DLPFC, RAI to ACC, and the self-connection of R-DLPFC. Connections from ACC to CA and from L-DLPFC to PCC were positively correlated with compulsion and obsession scores (r = 0.209, p = 0.037; r = 0.199, p = 0.047, uncorrected).
CONCLUSIONS: Our study revealed dysregulation among DMN, SN, FPN, and cerebellum in OCD, emphasizing the role of these four networks in achieving top-down control for goal-directed behavior. There existed a top-down disruption among these networks, constituting the pathophysiological and clinical basis.