To Investigate The Correlation Between The Changes Of Executive Function And Functional Connectivity Imaging Of The Amygdala In Adolescents With Major Depressive Disorder Before And After Treatment

Objective To investigate the changes of executive function and functional connectivity(FC)in adolescents with major depressive disorder(MDD)before and after treatment.And to explore the correlation between the changes of executive function before and after treatment and the differences of brain FC imaging with the amygdala as the seed,so as to further explore the brain imaging characteristics of executive function defects in adolescent MDD patients.Methods A self-controlled follow-up study design was used to enroll patients with MDD according to DSM-5 criteria.Depressive symptoms were assessed by Patient Health Questionnaire-9(PHQ-9),Hamilton Depression Scale(HAMD-17)and Pediatric Depression Inventory(CDI)using the Cambridge Cognitive Testing System(CANTAB)Motor Screening task(MOT)and spatial working memory(SW M),Rapid Visual information processing(RVP),and Cambridge Stocking Experiment(SOC)to assess executive function.The study subjects were 23 adolescent inpatients with MDD from January 2020 to December 2022 in the Department of Child and Adolescent Psychiatry,Shenzhen Kangning Hospital.Study 1: Paired non-rank sum test was used to compare the differences of depressive symptoms and executive function in adolescents with MDD before and after treatment.Spearman correlation was used to analyze the relationship between depressive symptoms and executive function changes in adolescents with MDD before and after treatment.Study 2: Spearman correlation analysis was used to analyze the correlation between the FC of the left amygdala and the left occipital lingual gyrus and depressive symptoms,anxiety symptoms,and executive function in adolescent MDD patients before treatment.Study 3: Spearman correlation analysis was used to analyze the correlation between the FC of left amygdala and left occipital lingual gyrus and depressive symptoms and executive function in adolescent MDD patients after treatment.Study 4: The FC between bilateral amygdala and whole brain voxels before and after treatment was compared by paired sample t test in DPABI toolkit.Spearman correlation analysis was used to analyze the correlation between the changes of depressive symptoms,executive function and the changes of FC between the left amygdala and the left occipital lingual gyrus in adolescent MDD patients before and after treatment.Results Study 1: The total scores of the PHQ-9 and the 17-HAMD were significantly lower in adolescent MDD patients after treatment than before treatment(P<0.05).In the SWM and SOC tasks,adolescent MDD patients after treatment had fewer total error responses between groups,fewer total error responses,more minimum steps to solve problems,and shorter average subsequent thinking time than before treatment(P<0.05).This study found that the difference in the total score of PHQ-9 before and after treatment was correlated with the difference in the A’ score of the RVP task(r =-0.437,P<0.05).Study 2: Pre-treatment FC between left amygdala and left occipital-lingual gyrus was not associated with depressive symptoms in adolescent MDD patients(P > 0.05).There was a negative correlation between the FC of left amygdala and left occipital lingual gyrus and the average number of steps in SOC task in adolescent MDD patients before treatment(r =-0.474,P<0.05).Study 3: Post-treatment FC between left amygdala and left occipital-lingual gyrus was not associated with depressive symptoms in adolescent MDD patients(P > 0.05).There is no correlation between the functional connectivity of left amygdala and left occipital lingual gyrus and MOT,SWM,RVP and SOC tasks in adolescent MDD patients after treatment.Study 4: This study found that adolescent MDD patients showed enhanced FC in the left occipital-lingual gyrus with the left amygdala as the seed point after treatment compared with pre-treatment.In the RVP task,the difference between the FC of the left amygdala and the left occipital lingual gyrus before and after treatment was negatively correlated with the difference in the total number of false reports(r =-0.503,P<0.05).Conclusions Compared with pre-treatment,depressive symptoms and spatial working memory were improved in adolescent MDD patients after treatment.Depressive symptoms before and after treatment are associated with changes in attention in adolescent MDD patients.This study provides a dynamic observation of executive function and clinical symptoms in adolescent MDD patients,and clinical treatment can improve mood-related symptoms and attention deficits.The current study further validated the finding that changes in depressive symptoms could improve executive function performance in MDD patients.Adolescent MDD patients showed enhanced FC in the left amygdala and left occipital lingual gyrus after treatment compared with before treatment.The abnormal amygdala-centered brain function before and after treatment in adolescent MDD patients is related to the changes of attention.The increased functional connectivity between amygdala and occipital lingual gyrus may represent an enhanced ability to perceive emotional information to a certain extent in adolescent MDD patients.The amygdala and occipital-lingual gyrus,which are involved in attention,showed increased activity to mobilize attention in response to external stimuli.