Anxiety and depression severity in neuropsychiatric SLE are associated with perfusion and functional connectivity changes of the frontolimbic neural circuit: a resting-state f(unctional) MRI study

Antypa, Despina; Simos, Nicholas J; Kavroulakis, Eleftherios; Βertsias, George; Fanouriakis, Antonis; Sidiropoulos, Prodromos; Boumpas, Dimitrios T.; Papadaki, Efrosini

doi:10.1136/lupus-2020-000473

Cited by 11 publications

(14 citation statements)

References 61 publications

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“…Higher volume of the left and right caudate nuclei was also correlated with disease activity (measured by SLEDAI-2K) in patients with NPSLE [36]. Advanced MRI techniques may convey more subtle insights on brain alterations, e.g., the severity of depression and anxiety in patients with NPSLE was associated with hemodynamic and functional connectivity changes of the frontolimbic neural circuit [37].…”

Section: Discussionmentioning

confidence: 95%

Neuropsychiatric manifestations and their attribution to SLE: a retrospective single-center study in the Polish population

Pawlak-Buś¹,

Schmidt²,

Leszczyński³

2022

Polish Archives of Internal Medicine

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In this retrospective cross-sectional study, we assessed the prevalence of primary neuropsychiatric systemic lupus erythematosus (NPSLE) using the Italian attribution model in the Polish cohort of patients with SLE. To the best of our knowledge, there are no published studies on the attribution of NP manifestations to primary NPSLE, together with a detailed characterization of disease activity and symptoms in Polish patients. Our study demonstrates that primary NP manifestations occurred mainly in young patients with high disease activity (measured by the SLEDAI-2K, SLEDAI-2K without NP manifestations, cSLEDAI, and the Physician Global Assessment [PGA]). The most frequent manifestations of NPSLE were cerebrovascular disease, seizures, psychosis, cognitive dysfunction, and cranial neuropathy.

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Section: Discussionmentioning

confidence: 95%

Neuropsychiatric manifestations and their attribution to SLE: a retrospective single-center study in the Polish population

Pawlak-Buś¹,

Schmidt²,

Leszczyński³

2022

Polish Archives of Internal Medicine

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“…Further studies have shown that individual differences in anxiety symptoms in NPSLE are related to specific and complex hemodynamics in the limbic system and prefrontal brain regions, as anxiety symptoms are mainly related to the increased perfusion dynamics in the right amygdala ( Antypa et al, 2021 ). This study found changes in the CBF of the right insula/Heschl’s cortex and postcentral gyrus in anxiety patients with pulmonary nodules, of which the insula is currently considered to belong to the limbic system.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Perfusion Patterns of Anxiety State in Patients With Pulmonary Nodules: A Study of Cerebral Blood Flow Based on Arterial Spin Labeling

Wang

Liu

et al. 2022

Front. Neurosci.

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Background and PurposeThe proportion of patients with somatic diseases associated with anxiety is increasing each year, and pulmonary nodules have become a non-negligible cause of anxiety, the mechanism of which is unclear. The study focus on the cerebral blood flow (CBF) of anxiety in patients with pulmonary nodules to explore the cerebral perfusion pattern of anxiety associated with pulmonary nodules, blood perfusion status and mode of pulmonary nodule induced anxiety state.Materials and MethodsPatients with unconfirmed pulmonary nodules were evaluated by Hamilton Anxiety Scale (HAMA). The total score > 14 was defined as anxiety group, and the total score ≤ 14 points was defined as non-anxiety group. A total of 38 patients were enrolled, of which 19 patients were the anxiety group and 19 were the non-anxiety group. All subjects underwent arterial spin labeling imaging using a 3.0 T MRI. A two-sample t-test was performed to compare the CBF between the two groups. The CBF was extracted in brain regions with difference, and Spearman correlation was used to analyze the correlation between CBF and HAMA scores; ROC was used to analyze the performance of CBF to distinguish between the anxiety group and the non-anxiety group.ResultsThe CBF in the right insula/Heschl’s cortex of the anxiety group decreased (cluster = 109, peak t = 4.124, and P < 0.001), and the CBF in the right postcentral gyrus increased (cluster = 53, peak t = −3.912, and P < 0.001) in the anxiety group. But there was no correlation between CBF and HAMA score. The ROC analysis of the CBF of the right insula/Heschl’s cortex showed that the AUC was 0.856 (95%CI, 0.729, 0.983; P < 0.001), the optimal cutoff value of the CBF was 50.899, with the sensitivity of 0.895, and specificity of 0.789. The ROC analysis of CBF in the right postcentral gyrus showed that the AUC was 0.845 (95%CI, 0.718, 0.972; P < 0.001), the optimal cutoff value of CBF was 43.595, with the sensitivity of 0.737, and specificity of 0.842.ConclusionThe CBF of the right insula/Heschl’s cortex decreased and the CBF of the right postcentral gyrus increased in patients with pulmonary nodules under anxiety state, and the CBF of the aforementioned brain regions can accurately distinguish the anxiety group from the non-anxiety group.

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“…Their use has also been studied in NPSLE. Resting state (Rs-) fMRI studies, performed in the absence of cognitive stimuli, have demonstrated altered brain activity and inter-and intra-network connectivity in both NPSLE and non-neuropsychiatric SLE populations, with more severe findings shown in the former, as well as associations with disease activity, duration, cognitive performance, anxiety, and depression (133)(134)(135)(136)(137). Arterial spin labelling (ASL), a contrast-free MR perfusion technique, has also demonstrated changes in cerebral blood perfusion in both NPSLE and non-neuropsychiatric SLE cohorts, although again with greater abnormalities and at higher incidence in the former (138,139).…”

Section: Novel Neuroimaging Studies 431 Quantitative Mri Studiesmentioning

confidence: 99%

The conundrum of neuropsychiatric systemic lupus erythematosus: Current and novel approaches to diagnosis

et al. 2023

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Recognising neuropsychiatric involvement by systemic lupus erythematosus (SLE) is of growing importance, however many barriers to this exist at multiple levels of our currently available diagnostic algorithms that may ultimately delay its diagnosis and subsequent treatment. The heterogeneous and non-specific clinical syndromes, serological and cerebrospinal fluid (CSF) markers and neuroimaging findings that often do not mirror disease activity, highlight important research gaps in the diagnosis of neuropsychiatric SLE (NPSLE). Formal neuropsychological assessments or the more accessible screening metrics may also help improve objective recognition of cognitive or mood disorders. Novel serum and CSF markers, including autoantibodies, cytokines and chemokines have also shown increasing utility as part of diagnosis and monitoring, as well as in distinguishing NPSLE from SLE patients without SLE-related neuropsychiatric manifestations. Novel neuroimaging studies also expand upon our existing strategy by quantifying parameters that indicate microarchitectural integrity or provide an assessment of neuronal function. Some of these novel markers have shown associations with specific neuropsychiatric syndromes, suggesting that future research move away from considering NPSLE as a single entity but rather into its individually recognized neuropsychiatric manifestations. Nevertheless, it is likely that a composite panel of these investigations will be needed to better address the gaps impeding recognition of neuropsychiatric involvement by SLE.

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Anxiety and depression severity in neuropsychiatric SLE are associated with perfusion and functional connectivity changes of the frontolimbic neural circuit: a resting-state f(unctional) MRI study

Cited by 11 publications

References 61 publications

Neuropsychiatric manifestations and their attribution to SLE: a retrospective single-center study in the Polish population

Neuropsychiatric manifestations and their attribution to SLE: a retrospective single-center study in the Polish population

Cerebral Perfusion Patterns of Anxiety State in Patients With Pulmonary Nodules: A Study of Cerebral Blood Flow Based on Arterial Spin Labeling

The conundrum of neuropsychiatric systemic lupus erythematosus: Current and novel approaches to diagnosis

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