Objectives
Generalized anxiety disorder (GAD) is one of the most prevalent mental disorders in
the elderly, but its functional neuroanatomy is not well understood. Given the role
of emotion dysregulation in GAD, we sought to describe the neural bases of emotion
regulation in late-life GAD by analyzing the functional connectivity (FC) in the Salience
Network and the Executive Control Network during worry induction and worry reappraisal.
Methods
The study included 28 elderly GAD and 31 non-anxious comparison participants. Twelve
elderly GAD completed a 12-week pharmacotherapy trial. We used an in-scanner worry
script that alternates blocks of worry induction and reappraisal. We assessed network
FC, using the following seeds: anterior insula (AI), dorsolateral prefrontal cortex
(dlPFC), the bed nucleus of stria terminalis (BNST), and the paraventricular nucleus
(PVN).
Results
GAD participants exhibited greater FC during worry induction between the left AI and
the right orbitofrontal cortex, and between the BNST and the subgenual cingulate.
During worry reappraisal, the non-anxious participants had greater FC between the
left dlPFC and the medial PFC, as well as between the left AI and the medial PFC,
and elderly GAD patients had greater FC between the PVN and the amygdala. Following
12 weeks of pharmacotherapy, GAD participants had greater connectivity between the
dlPFC and several prefrontal regions during worry reappraisal.
Conclusion
FC during worry induction and reappraisal points toward abnormalities in both worry
generation and worry reappraisal. Following successful pharmacologic treatment, we
observed greater connectivity in the prefrontal nodes of the Executive Control Network
during reappraisal of worry.
Key Words
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Article info
Publication history
Published online: May 17, 2014
Accepted:
May 12,
2014
Received in revised form:
April 25,
2014
Received:
February 13,
2014
Identification
Copyright
© 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.
