Browsing by Author "Roth, Robert M."

Now showing 1 - 4 of 4
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    Apathy Is Associated With Ventral Striatum Volume in Schizophrenia Spectrum Disorder
    (American Psychiatric Association, 2016) Roth, Robert M.; Garlinghouse, Matthew A.; Flashman, Laura A.; Koven, Nancy S.; Pendergrass, J. Cara; Ford, James C.; McAllister, Thomas W.; Saykin, Andrew J.; Psychiatry, School of Medicine
    Apathy is prevalent in schizophrenia, but its etiology has received little investigation. The ventral striatum (VS), a key brain region involved in motivated behavior, has been implicated in studies of apathy. We therefore evaluated whether apathy is associated with volume of the VS on MRI in 23 patients with schizophrenia using voxel-based morphometry. Results indicated that greater self-reported apathy severity was associated with smaller volume of the right VS even when controlling for age, gender, depression, and total gray matter volume. The finding suggests that apathy is related to abnormality of brain circuitry subserving motivated behavior in patients with schizophrenia.
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    Left versus right subcallosal cingulate deep brain stimulation for treatment-resistant depression
    (Elsevier, 2021-03) Conroy, Susan K.; Malloy, Shannon; Kelley, Mary E.; Filkowski, Megan M.; Trimble, Ryan M.; Pirtle, Megan E.; Maher, Ashley; Dreyer-Oren, Sarah; Doucette, Wilder; Roth, Robert M.; Aronson, Joshua P.; Roberts, David W.; Choi, Ki Sueng; Mayberg, Helen S.; Holtzheimer, Paul E.; Psychiatry, School of Medicine
    Deep brain stimulation (DBS) of the subcallosal cingulate has emerged as a promising therapy for treatment-resistant depression (TRD). To date, all studies have employed bilateral stimulation; however, the physiology of affect and pathophysiology of depression are known to be asymmetric across hemispheres. Unilateral stimulation may provide efficacy while decreasing risk. Five patients were exposed to unilateral open-label DBS to the subcallosal cingulate for 12 weeks each to the left and then right hemispheres in a double-blind, crossover fashion. After 12 weeks of stimulation to each hemisphere, bilateral stimulation was initiated, and patients were followed for 12 additional weeks. Additionally, nine months of long-term follow up data were collected. Left, but not right, unilateral stimulation was associated with significant decrease in depression scores; with bilateral stimulation, all patients improved and one patient remitted. No serious adverse events were associated with surgery or acute or chronic stimulation. This small study suggests that unilateral DBS to the subcallosal cingulate may be an effective treatment for TRD. All patients improved with bilateral stimulation, though antidepressant effects following 12 weeks were modest. These findings contrast somewhat with prior open-label trials, though duration of bilateral stimulation was shorter in this trial. The current study continues to confirm safety of implantation and use of DBS to the subcallosal cingulate for patients with TRD and highlights the importance of personalization of therapy, for example by hemisphere, in future trials.
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    Long-term seizure, cognitive, and psychiatric outcome following trans–middle temporal gyrus amygdalohippocampectomy and standard temporal lobectomy
    (American Association of Neurological Surgeons, 2013) Bujarski, Krzysztof A.; Hirashima, Fuyuki; Roberts, David W.; Jobst, Barbara C.; Gilbert, Karen L.; Roth, Robert M.; Flashman, Laura A.; McDonald, Brenna C.; Saykin, Andrew J.; Scott, Rod C.; Dinnerstein, Eric; Preston, Julie; Williamson, Peter D.; Thadani, Vijay M.; Psychiatry, School of Medicine
    Object: Previous comparisons of standard temporal lobectomy (STL) and selective amygdalohippocampectomy (SelAH) have been limited by inadequate long-term follow-up, variable definitions of favorable outcome, and inadequate consideration of psychiatric comorbidities. Methods: The authors performed a retrospective analysis of seizure, cognitive, and psychiatric outcomes in a noncontemporaneous cohort of 69 patients with unilateral refractory temporal lobe epilepsy and MRI evidence of mesial temporal sclerosis after either an STL or an SelAH and examined seizure, cognitive, and psychiatric outcomes. Results: The mean duration of follow-up for STL was 9.7 years (range 1-18 years), and for trans-middle temporal gyrus SelAH (mtg-SelAH) it was 6.85 years (range 1-15 years). There was no significant difference in seizure outcome when "favorable" was defined as time to loss of Engel Class I or II status; better seizure outcome was seen in the STL group when "favorable" was defined as time to loss of Engel Class IA status (p=0.034). Further analysis revealed a higher occurrence of seizures solely during attempted medication withdrawal in the mtg-SelAH group than in the STL group (p=0.016). The authors found no significant difference in the effect of surgery type on any cognitive and most psychiatric variables. Standard temporal lobectomy was associated with significantly higher scores on assessment of postsurgical paranoia (p=0.048). Conclusions: Overall, few differences in seizure, cognitive, and psychiatric outcome were found between STL and mtg-SelAH on long-term follow-up. Longer exposure to medication side effects after mtg-SelAH may adversely affect quality of life but is unlikely to cause additional functional impairment. In patients with high levels of presurgical psychiatric disease, mtg-SelAH may be the preferred surgery type.
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    Stability of Subjective Executive Functioning in Older Adults with aMCI and Subjective Cognitive Decline
    (Oxford University Press, 2021) Carmasin, Jeremy S.; Roth, Robert M.; Rabin, Laura A.; Englert, Jessica J.; Flashman, Laura A.; Saykin, Andrew J.; Radiology and Imaging Sciences, School of Medicine
    Objective: Subjective memory concerns are characteristic of individuals with amnestic mild cognitive impairment (aMCI) and subjective cognitive decline (SCD), though subjective changes in executive functions have also been reported. In a cohort study, we examined the temporal stability of subjective report of executive functioning in a high education (mean = 16.8 years) sample of cognitively normal (CN) older adults and those with aMCI or SCD. Method: Participants (CN, n = 22; aMCI, n = 21; SCD, n = 24) and their informants completed the BRIEF-A and neuropsychological tests at two time points separated by approximately 1 year. Results: Analyses focused on those with diagnostic stability (95.7%). Participants with aMCI and SCD, and their informants, endorsed worse executive functions relative to CN at both time points. No group by time interaction was observed for subjective or objective measures of executive function. Conclusions: Diagnostically stable CN older adults, and those with prodromal dementia conditions, report stable executive functioning at 1-year follow-up.