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Neuropsychopharmacology (1998) 18 407-430.10.1038/sj.npp.1395175
Serotonin in Aging, Late-Life Depression, and Alzheimer's Disease: The Emerging Role of Functional Imaging
Carolyn Cidis Meltzer MD, Gwenn Smith Ph.D, Steven T DeKosky MD, Bruce G Pollock MD, Ph.D, Chester A Mathis Ph.D, Robert Y Moore MD, Ph.D, David J Kupfer MD and Charles F Reynolds III MD |
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MHCRC for Late-Life Mood Disorders, Alzheimer's Disease Research Center and the Functional Brain Imaging Research Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania USA
Correspondence: Dr Carolyn Cidis Meltzer, University of Pittsburgh Medical Center, PET Facility, B-938, 200 Lothrop Street, Pittsburgh, PA 15213-2582
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ABSTRACT
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Serotonin (5-HT) neuron and neurotransmitter loss in normal aging and neuropsychiatric diseases of late life may contribute to behavioral changes commonly observed in the elderly population. Extensive evidence implicates a deficit in serotonergic neurotransmission in the development of major depression. It has been further suggested that the age-related changes in 5-HT neurons may predispose the elderly to develop depression. There is also increasing evidence that a combination of disturbances in cholinergic and serotonergic function may play a role in cognitive impairment in Alzheimer's disease (AD), with serotonergic dysfunction potentially responsible for a significant portion of the behavioral aspects of the disease. This implication of the 5-HT system in aging and age-related cognitive and mood disorders rests in large part on post mortem studies and animal models, which are limited in their capacity to predict dynamic human biochemical-behavior relationships or to accurately model the living human brain. Initial applications of functional brian imaging with positron emission tomography (PET) in the in vivo study of the brain in aging, depression, and dementia focused on characterizing alterations in physiological measurements of cerebral metabolism and perfusion. However, recent advances in PET radiochemistry, instrumentation, and image processing have paved the way for noninvasive means to test specific hypotheses regarding the direct involvement of 5-HT neurons in the behavioral features of aging and to define and monitor therapeutic regimens for neuropsychiatric conditions of late life. Coupling of clinical trials in well-characterized subject populations with PET imaging using ligands specific for 5-HT receptor subtypes and transporter proteins promises to increase our understanding of the role of the 5-HT system in affective and cognitive aspects of treatment response. Longitudinal studies in aging, late-life depression, and AD are also needed to evaluate the complex interplay between neurodegenerative processes and serotonergic neurotransmission.
Keywords: Serotonin; Receptors; Alzheimer's disease; Depression; Aging; Emission computed tomography |
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