Distinct Basal Brain Functional Activity and Connectivity in the Emotional-Arousal Network and Thalamus in Patients With Functional Constipation Associated With Anxiety and/or Depressive Disorders

Abstract

Objective: Functional constipation (FC) is a common gastrointestinal disorder. Anxiety and/or depressive disorders are common in patients with FC (FCAD). Brain dysfunction may play a role in FC, but the contribution of comorbid anxiety and/or depression in patients with FC is poorly understood. Methods: Sixty-five FC patients and 42 healthy controls (HCs) were recruited, and a hierarchical clustering algorithm was used to classify FC patients into FCAD and patients without anxiety/depressive status (FCNAD) based on neuropsychological assessment. Resting-state functional magnetic resonance imaging measures including fractional amplitude of low-frequency fluctuation (fALFF) and functional connectivity were used to investigate brain functional differences. Results: Thirty-seven patients were classified as FCAD, and 28 patients were classified as FCNAD; as compared with HC, both groups showed decreased activity (fALFF) in the perigenual anterior cingulate cortex (pACC), dorsomedial prefrontal cortex (DMPFC), and precuneus; enhanced precentral gyrus-thalamus connectivity and attenuated precuneus-thalamus connectivity in FCAD/FCNAD highlighted the thalamus as a critical connectivity node in the brain network (p FWE < .05). In comparison with FCNAD/HC, the FCAD group also had decreased fALFF in the orbitofrontal cortex (OFC) and thalamus, and increased OFC-hippocampus connectivity. In the FCNAD group, brain activities (pACC/DMPFC) and connection (precuneus-thalamus) had correlations only with symptoms; in the FCAD group, brain activities (OFC, pACC/DMPFC) and connectivities (OFC-hippocampus/precentral gyrus-thalamus) showed correlations with both constipation symptoms and anxiety/depressive status ratings. Mediation analysis indicated that the relationship between abdominal distension and OFC activity was completely mediated by anxiety in FCAD. Conclusions: These findings provide evidence of differences in brain activity and functional connectivity between FCAD and FCNAD, potentially providing important clues for improving treatment strategies.

Improving Depressive Symptoms of Post-stroke Depression Using the Shugan Jieyu Capsule: A Resting-State Functional Magnetic Resonance Imaging Study

“…Regional homogeneity (ReHo) and fractional amplitude of low-frequency fluctuation (fALFF) are classic indicators of spontaneous functional activity. Previous studies have shown that ReHo and fALFF may be associated with depressive symptoms in patients with depression ( 18 , 19 ), which may help to find brain regions associated with improved depressive symptoms in PSD patients.…”

Anxiety Disorders in Children with Functional Constipation: A Case-Control Study

“…Moreover, FC is more common in children with psychological problems such as autism spectrum disorders (ASDs), attention deficit hyperactivity disorder (ADHD), and different types of anxiety (2,9,10). Another critical disease in such children is less frequent urinary tract dysfunctional disorders such as enuresis, which can simultaneously be observed with FC, thereby arousing further anxiety in children and parents (11,12). In these cases, where psychological problem is associated with FC, and there is two-way communication between the two variables, as stress can also affect FC, symptoms may persist by adulthood.…”

Aberrant functional brain network dynamics in patients with functional constipation

“…In recent years, the theory of brain–gut interaction was generally recognized (Drossman & Hasler, 2016 ; Mayer et al, 2019 ), which provided a new perspective to explain the occurrence and development of FCon from the central nervous system. Evidence from recent neuroimaging studies illustrated that FCon patients had significant structural and functional alterations in brain regions which involved visceral sensorimotor (SM), cognitive control (CC), and emotional regulation (Duan et al, 2021 ; Hu et al, 2020 ; Jin et al, 2019 ; Li et al, 2021 ; Liu et al, 2021 ; Peihong et al, 2021 ; Zhu et al, 2016 ). Among these altered brain regions in FCon patients, the anterior insula (aINS) was generally regarded as the critical node (Duan et al, 2021 ; Jin et al, 2019 ; Liu et al, 2021 ; Zhu et al, 2016 ) for its essential role in processing interoceptive signals (Mayer, 2011 ), modulating visceral activities (Rubio et al, 2015 ), and regulating emotions and cognitions (Craig, 2009 ).…”

“…As a typical disorder of brain–gut interaction, the alterations of the static brain rsFC pattern in FCon patients have been widely illustrated (Duan et al, 2021 ; Jin et al, 2019 ; Li et al, 2021 ; Liu et al, 2021 ). However, there was currently no study addressing the dFC patterns of FCon patients.…”