Reliability of brain localization using task-based fMRI for late-life depression with suicidal risk

Ai-Ling Hsu ¹, Changwei W Wu ², Chih-Mao Huang ³

¹National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan; Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
²Graduate Institute of Mind, Brain and Consciousness, Taipei Medical University, Taipei, Taiwan; Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan.
³Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
⁴Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan.
⁵College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
⁶Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
⁷State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong; Laboratory of Neuropsychology & Human Neuroscience, The University of Hong Kong, Hong Kong; Guangdong-Hong Kong-Macao Greater Bay Area Center for Brain Science and Brain-Inspired Intelligence, Guangzhou, China.
⁸Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.

⁰National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, Taiwan; Department of Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan; Department of Psychiatry, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.

Journal of Psychiatric Research +

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May 3, 2025

View abstract on PubMed

Summary

Functional magnetic resonance imaging (fMRI) reliably targets brain regions for late-life depression (LLD) treatment. The numerical Stroop task is effective for personalizing transcranial magnetic stimulation in LLD patients across suicidality levels.

Area Of Science

Neuroscience
Psychiatry
Medical Imaging

Background

Late-life depression (LLD) is a heterogeneous disorder associated with brain network abnormalities and high suicide risk.
Current treatments like transcranial magnetic stimulation (TMS) targeting the prefrontal cortex lack precision due to group-level targeting methods.
Personalized fMRI-based targeting exists but its reliability in LLD patients, especially with varying suicidality, remains unevaluated.

Purpose Of The Study

To evaluate the reliability of functional magnetic resonance imaging (fMRI) for personalizing the targeting of the dorsal and ventral lateral prefrontal cortex (DLPFC and VLPFC) in LLD patients.
To compare the efficacy of two tasks, numerical Stroop and face/shape matching, for reliable fMRI-based localization in LLD.
To assess localization reliability across LLD subgroups with different degrees of suicidality.

Main Methods

Task-based fMRI was conducted on 103 LLD patients, categorized into non-suicidal risk (NS), ideation/plans (IP), and past suicide attempts (SA) subgroups.
Voxel-wise statistical analyses and localization success rates for DLPFC and VLPFC were determined using numerical Stroop and face/shape matching tasks.
Localization reliability was assessed by detecting significant brain activity within predefined masks for each task and subgroup.

Main Results

The numerical Stroop task demonstrated high reliability, successfully localizing the bilateral DLPFC in all subgroups (98-100%) and the VLPFC in most cases (88-97%).
The face/shape matching task showed lower reliability, localizing the bilateral DLPFC in two-thirds of patients but failing to detect the VLPFC.
Localization success rates for DLPFC were 98% (NS), 100% (IP), and 100% (SA); VLPFC rates were 95% (NS), 97% (IP), and 88% (SA).

Conclusions

Task-based fMRI, particularly the numerical Stroop task, is a reliable method for the personalized localization of DLPFC and VLPFC in LLD patients.
This reliable targeting approach holds significant potential for improving the efficacy of TMS and other focal brain stimulation therapies for LLD.
The findings support the use of fMRI for tailored treatment strategies in LLD, considering individual differences in suicidality.

Keywords:

Functional MRI Functional localization Late-life depression Suicide Task-evoked fMRI

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