Neuroimaging studies examining the effects of aging and neuropsychiatric disorders on the cerebral cortex have largely been based on measures of cortical volume. Given that cortical volume is a product of thickness and surface area, it is plausible that measures of volume capture at least 2 distinct sets of genetic influences. The present study aims to examine the genetic relationships between measures of cortical surface area and thickness. Participants were men in the Vietnam Era Twin Study of Aging (110 monozygotic pairs and 92 dizygotic pairs). Mean age was 55.8 years (range: 51-59). Bivariate twin analyses were utilized in order to estimate the heritability of cortical surface area and thickness, as well as their degree of genetic overlap. Total cortical surface area and average cortical thickness were both highly heritable (0.89 and 0.81, respectively) but were essentially unrelated genetically (genetic correlation = 0.08). This pattern was similar at the lobar and regional levels of analysis. These results demonstrate that cortical volume measures combine at least 2 distinct sources of genetic influences. We conclude that using volume in a genetically informative study, or as an endophenotype for a disorder, may confound the underlying genetic architecture of brain structure.

consumer (DTC) advertising of prescription drugs in the United States totaled $3.2 billion in 2003. 1 Although expenditures may be leveling off, 2 DTC advertisements have become a stable, if controversial, feature of the media landscape. [3][4][5][6] Critics charge that DTC advertisements lead to overprescribing of unnecessary, expensive, and potentially harmful medications, while proponents counter that they can serve a useful educational function and help avert underuse of effective treatments for conditions that may be poorly recognized, highly stigmatized, or both. 7 Antidepressant medications consistently rank among the top DTC advertising categories. 8,9 Major depressive disorder (defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition as Ն5 depressive symptoms lasting at least 2 weeks and accompanied by functional impairment) 10 carries stigma, [11][12][13] is frequentlyFor editorial comment see p 2030.

Surface area of the cerebral cortex is a highly heritable trait, yet little is known about genetic influences on regional cortical differentiation in humans. Using a data-driven, fuzzy clustering technique with magnetic resonance imaging data from 406 twins, we parceled cortical surface area into genetic subdivisions, creating a human brain atlas based solely on genetically informative data. Boundaries of the genetic divisions corresponded largely to meaningful structural and functional regions; however, the divisions represented previously undescribed phenotypes different from conventional (non–genetically based) parcellation systems. The genetic organization of cortical area was hierarchical, modular, and predominantly bilaterally symmetric across hemispheres. We also found that the results were consistent with human-specific regions being subdivisions of previously described, genetically based lobar regionalization patterns.

Summary Personality is influenced by genetic and environmental factors1, and associated with mental health. However, the underlying genetic determinants are largely unknown. We identified six genetic loci, including five novel loci2,3, significantly associated with personality traits in a meta-analysis of genome-wide association studies (N=123,132–260,861). Of these genome-wide significant loci, extraversion was associated with variants in WSCD2 and near PCDH15, and neuroticism with variants on chromosome 8p23.1 and in L3MBTL2. We performed a principal component analysis to extract major dimensions underlying genetic variations among five personality traits and six psychiatric disorders (N=5,422–18,759). The first genetic dimension separated personality traits and psychiatric disorders, except that neuroticism and openness to experience were clustered with the disorders. High genetic correlations were found between extraversion and attention-deficit/hyperactivity disorder (ADHD), and between openness and schizophrenia/bipolar disorder. The second genetic dimension was closely aligned with extraversion-introversion and grouped neuroticism with internalizing psychopathology (e.g., depression/anxiety).

Significance How diverse functional cortical regions develop is an important neuroscience question. Animal experiments show that regional differentiation is controlled by genes that express in a graded and regionalized pattern; however, such investigation in humans is scarce. Using noninvasive imaging techniques to acquire brain structure data of genetically related subjects (i.e., twins), we estimated the spatial pattern of genetic influences on cortical structure. We developed a genetic parcellation of cortical thickness to delineate the boundaries of cortical divisions that are—within each division—maximally under control of shared genetic influences. We also found differences in genetic influences on cortical surface area and thickness along two orthogonal axes. The concept of gradations is crucial for understanding the organization of the human brain.

The impact of genetic and environmental factors on human brain structure is of great importance for understanding normative cognitive and brain aging as well as neuropsychiatric disorders. However, most studies of genetic and environmental influences on human brain structure have either focused on global measures or have had samples that were too small for reliable estimates. Using the classical twin design, we assessed genetic, shared environmental, and individualspecific environmental influences on individual differences in the size of 96 brain regions of interest (ROIs). Participants were 474 middle-aged male twins (202 pairs; 70 unpaired) in the Vietnam Era Twin Study (VETSA). They were 51-59 years old, and were similar to U.S. men in their age range in terms of sociodemographic and health characteristics. We measured thickness of cortical ROIs and volume of other ROIs. On average, genetic influences accounted for © 2009 Elsevier Inc. All rights reserved.Correspondence to: William S. Kremen, Ph.D., Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (MC 0738), La Jolla, CA 92093 Tel: 858-822-2393 Fax: 858-822-5856 wkremen@ucsd.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptNeuroimage. Author manuscript; available in PMC 2012 July 16. Elucidating the extent to which genetic and environmental factors influence adult brain structure is of great importance for understanding age-related normal and pathological changes in brain and cognition. Twin studies provide the optimal behavioral genetic method for clarifying this issue because they make it possible to decompose the variance of any variable into genetic, shared environmental influences, and individual-specific environmental influences. The twin method also complements molecular genetic approaches in that heritability-the proportion of phenotypic variance due to genes-is a key component for selection of phenotypes.Despite many published magnetic resonance imaging (MRI) studies involving twins (reviewed by Glahn et al., 2007;Peper et al., 2007;Schmitt et al., 2007a), the picture regarding the heritability of specific brain regions remains incomplete. In some studies, samples sizes were quite small and are thus likely to provide unstable estimates (Visscher, 2004). With a couple of exceptions, relatively few specific regions of interest (ROIs) have been examined. The different ROIs that have been measured in previous studies have often been examined in different samples. It would be advantageous to be able to compare heritabilities of differen...

OBJECTIVES:To examine how practice constraints contribute to barriers in the health care of persons with dementia and their families, particularly with respect to behavioral aspects of care. DESIGN:Cross-sectional qualitative interview study of primary care physicians. SETTING: Physicians' offices.PARTICIPANTS: Forty primary care physicians in Northern California. MEASUREMENTS:Open-ended interviews lasted 30-60 minutes and were structured by an interview guide covering clinician background and practice setting, clinical care of a particular patient, and general approach to managing patients with AD or dementia. Interviews were transcribed and themes reflecting constraints of practice were identified through a systematic coding process. RESULTS:Recurring themes (i.e., those present in ≥25% of physician interviews) included insufficient time, difficulty in accessing and communicating with specialists, low reimbursement, poor connections with community social service agencies, and lack of interdisciplinary teams. Physician narratives suggest that these constraints may lead to delayed detection of behavior problems, "reactive" as opposed to proactive management of dementia, and increased reliance on pharmacological rather than psychosocial approaches. CONCLUSION:Physicians often feel challenged in caring for dementia patients, particularly those who are more behaviorally complex, because of time and reimbursement constraints as well as other perceived barriers. Our results suggest that more effective educational interventions (for families and physicians) and broader structural changes are needed to better meet the needs of the elderly with dementia and their families now and in the future. Without these changes, dementia care is likely to continue to fall short.KEY WORDS: dementia; quality of care; barriers; qualitative.

Summary Animal data demonstrate that the development of distinct cortical areas is influenced by genes that exhibit highly regionalized expression patterns. In this paper, we show genetic patterning of cortical surface area derived from MRI data from 406 adult human twins. We mapped genetic correlations of areal expansion between selected seed regions and all other cortical locations, with the selection of seed points based on results from animal studies. “Marching seeds” and a data-driven, hypothesis-free, fuzzy clustering approach provided convergent validation. The results reveal strong anterior-to-posterior graded, bilaterally symmetric patterns of regionalization, largely consistent with patterns previously reported in non-human mammalian models. Broad similarities in genetic patterning between rodents and humans may suggest a conservation of cortical patterning mechanisms while dissimilarities might reflect the functionalities most essential to each species.