Prefrontal-limbic connectivity during worry in older adults with generalized anxiety disorder

Abstract

Results elucidate a different neurobiology of pathological versus normal worry in later life. A limited resource model is implicated wherein worry in GAD competes for the same neural resources (e.g. prefrontal cortical areas) that are involved in the adaptive regulation of emotion through cognitive and behavioral strategies.

Systematic review and meta-analyses of neural structural and functional differences in generalized anxiety disorder and healthy controls using magnetic resonance imaging

“…1 for flow diagram). Of the included records, 35 included structural analyses (Abdallah et al., 2013; Andreescu et al., 2017; Brambilla et al., 2012; Cha et al., 2016a; Cha et al., 2014b; Cha et al., 2016b; Chen and Etkin, 2013; De Bellis et al., 2000, 2002; Etkin et al., 2009; Hettema et al., 2012; Hilbert et al., 2015; Karim et al., 2016; Liao et al., 2013, 2014a, 2014b; Makovac et al., 2016a; Mohlman et al., 2009; Molent et al., 2017; Moon and Jeong, 2015a, 2016, 2017a, 2017b; Moon et al., 2015a, 2014, 2015b; Mueller et al., 2013; Schienle et al., 2011; Strawn et al., 2014, 2013; Terlevic et al., 2013; Tromp et al., 2012; Wang et al., 2016b; Zhang et al., 2011; Zhang et al., 2013), 32 included FC analyses (Andreescu et al., 2015; Andreescu et al., 2014; Buff et al., 2016; Cha et al., 2014a; Cha et al., 2016b; Chen and Etkin, 2013; Cui et al., 2016; Etkin et al., 2010; Etkin et al., 2009; Etkin and Schatzberg, 2011; Fonzo et al., 2014; Greenberg et al., 2013; Hölzel et al., 2013; Laufer et al., 2016; Li et al., 2018; Li et al., 2016; Liu et al., 2015; Makovac et al., 2016b; Makovac et al., 2018; McClure et al., 2007; Mohlman et al., 2017; Monk et al., 2008; Oathes et al., 2015; Pace-Schott et al., 2017; Qiao et al., 2017; Rabany et al., 2017; Roy et al., 2013; Strawn et al., 2012; Toazza et al., 2016; Tromp et al., 2012; Wang et al., 2016a;…”

Ventromedial prefrontal cortex activity and pathological worry in generalised anxiety disorder

“…This result is in agreement with the findings of prior work suggesting a differentiated brain network for healthy v . pathological worries, with GAD being associated with a unique and more complex network than in controls – including the vmPFC, the dorsolateral prefrontal and the amygdala 28 . Taking both results together, these differences in brain activation and connectivity might be associated with the development of two differentiated circuits: an adaptive one supporting worrying as a problem-solving strategy and another representing pathological changes associated with the constant anticipation of negative consequences – a system that would be insufficient to support worrying as an emotional strategy to face threat or uncertainty 27 .…”

Structural and functional neuroimaging studies in generalized anxiety disorder: a systematic review

“…Further, Ellard et al,113 by exploring the mechanisms of emotion acceptance as an alternate emotion regulation strategy to worry or emotion suppression in GAD, found that emotion acceptance resulted in lower ratings of distress than worry and was associated with increased dorsal ACC activation and increased VLPFC-amygdala functional connectivity. Interestingly, two studies also reported that worry was associated with hyperactivation of amygdala, in both adult and elderly GAD patients,108,119 as well as of insula and frontal regions, only in elderly GAD patients,119 compared to HCs. Similarly, Karim et al126 showed that worry induction was associated with increased activation in middle and superior frontal gyrus as well as in the visual and parietal cortices compared to non-anxious patients.…”