Romy Henze

Reduced prefrontal and orbitofrontal gray matter in female adolescents with borderline personality disorder: Is it disorder specific?

There is evidence that adults with borderline personality disorder (BPD) are characterized by abnormalities in frontolimbic brain areas. In this study we aimed to determine whether brain volume alterations already exist in adolescents with BPD. Sixty female right-handed individuals (age range, 14-18 years), 20 with a DSM-IV diagnosis of borderline personality disorder, 20 patients with a DSM-IV defined current psychiatric disorder and 20 healthy control subjects were included. Groups were matched for age and IQ. Using a 3 T MRI scanner, we collected 1 mm axial sections using a three-dimensional sagittal isotropic Magnetization Prepared Rapid Acquisition Gradient Echo (MPRAGE) sequence. Images were analyzed using voxel-based morphometry (VBM). Voxel-based analysis revealed that adolescents with BPD showed reduced gray matter in the dorsolateral cortex (DLPFC) bilaterally and in the left orbitofrontal cortex (OFC) relative to healthy control subjects. Adolescent clinical control subjects displayed significantly decreased gray matter volume in the right DLPFC in comparison with healthy control subjects. No significant gray matter differences were detected between the BPD group and the clinical control group. No group differences were found in the limbic system or in any white matter structures. The present study indicates that the early morphological changes in BPD are located in the PFC. However, these changes may not be BPD specific since similar changes were found in the clinical control group. Changes in limbic brain volumes and white matter structures might occur over the course of the illness.

Fronto-temporal disconnectivity and symptom severity in children with autism spectrum disorder

Abstract Objectives. There is increasing evidence that many of the core behavioural impairments in autism spectrum disorders (ASD) emerge from disconnectivity of networks that are important for social communication. The present study aimed at investigating which specific fibre tracts are impaired in ASD and if possible alterations of white matter are associated with clinical symptomatology. Methods. Eighteen children with ASD and 18 carefully matched typically developing controls aged 6–12 years were examined using diffusion tensor imaging (DTI) and voxel-based morphometry (VBM). Fractional anisotropy (FA) values were correlated with symptom severity as indexed by the childrens scores on the Autisms Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). Results. Decreased FA values were identified for the fornix (FO), the superior longitudinal fasciculus (SLF) the corpus callosum and the uncinate fasciculus (UF) in the ASD group compared to controls, with most prominent differences in the UF bilaterally and the right SLF. FA values of affected fibre tracts were negatively associated with clinical measures of autistic symptomatology. We did not observe significantly altered grey or white matter concentration after correction for multiple comparisons. Conclusion. Our findings support the hypothesis of abnormal white matter microstructure of fronto-temporal cortical networks in ASD, which are associated with core symptoms of the disorder.

Disorder-Specific White Matter Alterations in Adolescent Borderline Personality Disorder

BACKGROUND The pathogenesis of borderline personality disorder (BPD) is complex and not fully understood. Using diffusion tensor imaging, recent studies suggest that white matter abnormalities may occur in adult patients with BPD. However, deeper insight into the disorder-specific developmental psychobiology (e.g., analysis of adolescents with BPD; inclusion of clinical control groups) is missing. METHODS Twenty adolescent patients with BPD (aged 14-18 years), 20 healthy, and 20 clinical control subjects were assessed using diffusion tensor imaging. All subjects were right-handed girls, matched for age and IQ. Microstructural parameters were analyzed via tractography of the main bundles in the limbic system and using Tract-Based Spatial Statistics, an explorative, global approach. RESULTS BPD was associated with decreased fractional anisotropy in the fornix when compared with clinical (p < .001) or healthy (nonsignificant trend) control subjects. Using Tract-Based Spatial Statistics, significant disorder-specific white matter alterations were found in the long association bundles interconnecting the heteromodal association cortex and in connections between the thalamus and hippocampus. CONCLUSIONS The study strongly supports the hypothesis that white matter alterations play a key role in the pathogenesis of BPD. These disorder-specific alterations include white matter pathways involved in emotion regulation but also affect parts of the heteromodal association cortex that are related to emotion recognition. Our findings unify previously documented deficits in emotion recognition and regulation and suggest that a large-scale network of emotion processing is disrupted in BPD. Continued research is essential to evaluate the predictive value of these early disruptions in a clinical context.

Temperamental patterns in female adolescents with borderline personality disorder.

Abstract A specific composition of temperament traits with high novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) has been attributed to adult patients with borderline personality disorder (BPD). This study examined whether an analogue personality profile is specifically associated with adolescent BPD. The female study sample comprised 33 adolescents with BPD, 35 clinical controls (CCs), and 31 healthy controls (HCs). Dimensions of temperament and character were measured according to Cloninger’s biopsychosocial model of personality. Significantly higher means of NS and HA but lower means of RD could be determined in the adolescents with BPD compared with the CCs and the HCs. The comparable findings of this specific temperament constellation in adolescents and adult patients with BPD suggest that heritable factors such as temperamental traits may contribute to the vulnerability for developing BPD. Early identification of a “borderline temperament” may facilitate early intervention and lower the risk for developing BPD.

Gray Matter Alterations in First‐Admission Adolescents with Schizophrenia

Imaging studies of patients with schizophrenia have described a variety of cerebral alterations. However, long‐term medication and the chronicity of the disorder may have contributed substantially to these alterations. Studies examining patients in the early stages of the disorder reduce the possibility of such confounding factors but are rare. In light of this, the aim of the present study was to examine adolescents in the early stages of the disorder to observe primary structural brain abnormalities.

Impaired cerebral glucose metabolism in prodromal Alzheimer's disease differs by regional intensity normalization

Using [(18)F] fluorodeoxyglucose (FDG) positron emission tomography (PET) patients with Alzheimers disease show impairment of cerebral glucose metabolism in bilateral frontotemporoparietal association cortices and posterior cingulate cortex whereas in patients with mild cognitive impairment (MCI) results are heterogeneous. For the first time, the present study examined alterations of the cerebral glucose metabolism in patients with prodromal AD as compared to patients with AD dementia and healthy controls depending on intensity normalization. 15 patients with AD (69.8±8.5 years) and 28 with prodromal AD (67.4±9.1 years) as well as 10 healthy controls (58.8±5.9 years) underwent FDG PET under resting conditions. By statistical parametric mapping 8, analyses were performed using (a) cerebellar cortex or (b) whole brain as reference region for intensity normalization. Patients with AD dementia showed reductions in bilateral temporoparietal regions and posterior cingulate gyrus as compared to controls. By contrast, patients with prodromal AD had only reductions in the left posterior temporal lobe and left angular gyrus as compared with controls. Cerebellar normalization was superior in differentiating patients with prodromal AD or AD dementia from healthy controls, but global normalization provided slightly better contrasts for the differentiation between patients with prodromal AD and AD dementia in AD-typical regions. Unexpected hypermetabolism in patients was only revealed using global normalization and has to be regarded as an artifact of intensity normalization to a reference region affected by the disease.

Regional Cerebral Perfusion Alterations in Patients with Mild Cognitive Impairment and Alzheimer Disease Using Dynamic Susceptibility Contrast MRI

RATIONALE AND OBJECTIVES The purpose of this study was to assess regional cerebral perfusion distribution in patients with Alzheimer disease (AD) or mild cognitive impairment (MCI) using dynamic susceptibility contrast magnetic resonance imaging. MATERIALS AND METHODS Regional changes of perfusion were evaluated in 34 patients with AD, 51 patients with MCI, and 23 healthy controls (HCs). Using region of interest analyses, regional cerebral blood flow (CBF), cerebral blood volume, and mean transit time were measured bilaterally in the hippocampus; the temporal, temporoparietal, frontal, and sensomotoric cortices; the anterior and posterior cingulate gyri; the lentiform nucleus; and the cerebellum. RESULTS A significant reduction of CBF in patients with AD compared to HCs was shown in the frontal and temporoparietal cortices bilaterally, the lentiform nuclei bilaterally, the left posterior cingulate gyrus, and the cerebellum. Compared with patients with MCI, patients with AD presented a reduction of CBF in the frontal cortices bilaterally, the left temporoparietal cortex, and the left anterior and posterior cingulate gyrus. In both hippocampi and the posterior cingulate gyrus, a trend to a slight increase of CBF in patients with MCI was noticed with a decrease in patients with AD. CONCLUSIONS Using dynamic susceptibility contrast magnetic resonance imaging, pathologic alterations of regional brain perfusion can be demonstrated in patients with AD compared to patients with MCI or HCs.

Reduced cortical and subcortical volumes in female adolescents with borderline personality disorder.

Volumetric alterations in limbic structures have been detected in adults, but not in adolescents with borderline personality disorder (BPD). We examined adolescents in the early stages of BPD to provide a unique opportunity to investigate which parts of the brain are initially affected by the disorder before confounding factors such as long-term medication or chronicity can mask them. A group of 60 right-handed female adolescents between 14 and 18 years of age (20 patients with BPD, 20 clinical controls, and 20 healthy controls) underwent magnetic resonance imaging (MRI). Focus was on the examination of hippocampal and amygdalar volume differences. Furthermore, a cortical thickness analysis was conducted. FreeSurfer software detected significant group differences in the right and left hippocampus and in the right amygdala. Additionally, significant volume reductions in frontal (right middle frontal gyrus, orbital part of the inferior frontal gyrus bilaterally), and parietal regions (superior parietal gyrus bilaterally) were found in adolescents with BPD compared with controls. No group differences in cortical thickness were revealed.

Reduced cortical thickness and its association with social reactivity in children with autism spectrum disorder.

Symptomatology and behavioral characteristics in autism spectrum disorders (ASD) have increasingly been linked to abnormalities in early brain growth patterns of affected children. Studies investigating specific components of gray matter structure, such as cortical thickness (CT), have produced conflicting results, and have rarely included additional measures of social impairment. In the present study, we applied a surface-based whole brain analysis to investigate CT in a sample of 36 pre-adolescent children [18 subjects with ASD (IQ mean: 111) and 18 healthy controls (IQ mean: 112.8), age range 6-12 years]. The CT analysis revealed widespread, but mostly left-hemispheric thinning in frontal, temporal, parietal and occipital brain areas related to the theory-of-mind network and the heteromodal association cortex. In an exploratory analysis, CT was observed to be differently associated with social impairment in children with ASD compared with typically developing children. The affected neuroanatomical regions are related to characteristic deficits in language, cognition and behavior that are often observed in the disorder. The relationship between social impairment and CT in children with ASD and controls seems to indicate aberrant developmental trajectories in ASD emerging early in life.

Reduced lateralization in early onset schizophrenia.

BACKGROUND AND PURPOSE Previous imaging studies have described gray and white matter alterations in the cerebellum, the posterior aspects of the visual system and in the corpus callosum in patients with schizophrenia. Here, we investigated these regions in more detail using tract-based spatial statistics (TBSS). Additionally, we evaluated potential changes in lateralization of the optic radiation and the superior cerebellar peduncle. MATERIAL AND METHODS We studied 12 patients with first-admission schizophrenia and a group of age-matched healthy controls. The diffusion tensor imaging data were preprocessed using tract-based spatial statistics and the obtained white matter skeleton was used to perform a regional analysis of fractional anisotropy in the corpus callosum, the optic radiation, and the superior and middle cerebellar peduncles. RESULTS Using TBSS, a significant reduction of fractional anisotropy in the whole corpus callosum and the optic radiation but not in the middle and superior cerebellar peduncles was found. Furthermore, a significantly decreased lateralization of the optic radiation and the superior cerebellar peduncles in patients was observed. CONCLUSION Our findings substantiate the concept that schizophrenia is a neurodevelopmental disorder and indicate that changes in lateralization may play a key role in the pathogenesis of this disease.