[Different patterns of brain activation between patients of Alzheimer's disease with and without depression: a functional MRI study during emotion Stroop task].

OBJECTIVE: To examine whether emotional factor influences the depression onset in Alzheimer's disease (AD).

METHODS: Twenty mild AD patients conforming to the of DSM-IV criteria with a clinical dementia rating score of 1.0 were divided into 2 groups: 11 patients without depression (AD group), and 9 patients with depression confirming to the National Institute of Mental Health-dAD criteria with a Cornell scale for depression in dementia score>12 (dAD group), without significant differences in age, gender, educational level, onset duration, and MMSE scores between these 2 groups. Ten age-and gender ratio-matched healthy elderly subjects were used as controls. Emotion Stroop task was performed to these 3 groups: emotion Stroop task images were presented with colored positive or negative emotion words (such as HAPPY or SUICIDE, etc.) at the left part of the image to induce emotional responses and with pure color at the right part of the image. The subjects were asked to press the right button when the ink color of the emotion word was congruent with the color at the right part, and press the left button when the ink color of the word was not congruent with the color at the right part. Neutral words were used in the test of general word task. The reaction time, false ratio, and missing ratio were recorded. Functional MRI (fMRI) was conducted. The behavioral data were analyzed with SPSS 11.0 software and the fMRI data were analyzed with SPM2 software.

RESULTS: The emotion Stroop task showed that the reaction time of the normal control group was 848 ms+/-320 ms, significantly shorter than those of the dAD and AD groups (1528 ms+/-302 ms and 1173 ms+/-237 ms respectively, both P<0.01), and the reaction time of the AD group was significantly shorter than that of the dAD group too (P=0.04). The false ratio of the normal control group was 0.5%, significantly lower than those of the AD and dAD groups (7.6% and 9.7% respectively, both P<0.01), and there was not a significant difference between the latter 2 groups (P=0.22). The missing ratio of the normal control group was 0, significantly lower than those of the AD and dAD groups (3.1% and 2.5% respectively, both P<0.01), and there was not a significant difference between the latter 2 groups (P=0.29). The fMRI results showed that the bilateral amygdala, left parietal lobe, and left prefrontal lobe were activated in the normal control group, bilateral parietal lobe were activated in the AD group; and bilateral prefrontal cortex in dAD group. The subtraction of the results of emotion Stroop task and general word task showed the brain function area activation images as follows simple emotion factors activated the right amygdala, left parietal lobe, and bilateral prefrontal cortices and occipital lobes in the normal control group; bilateral parietal lobes and left dorsal lateral frontal cortex in the AD group; and bilateral prefrontal cortices in the dAD group;

CONCLUSION: With quite different brain activation pattern, the dAD patients are more susceptible to the influence of emotional factors than AD patients. Impaired emotional neurocircus and emotional reaction may play an important role in the depression onset in AD.