Several studies have demonstrated altered brain functional connectivity in the resting state in depression. However, no study investigated interregional networking in patients with persistent depressive disorder (PDD). The aim of this study was to assess differences in brain perfusion distribution and connectivity between large groups of patients and healthy controls. Participants comprised 91 patients with PDD and 65 age- and sex-matched healthy controls. Resting-state perfusion was investigated by single photon emission computed tomography and group differences were assessed by Statistical Parametric Mapping. Brain connectivity was explored through a voxel-wise interregional correlation analysis using as covariate of interest the normalized values of clusters of voxels in which perfusion differences were found at group analysis. Significantly increased regional brain perfusion distribution covering a large part of the cerebellum was observed in patients as compared to controls. Patients showed significantly negative functional connectivity between the cerebellar cluster and caudate, bilaterally. This study demonstrated inverse relative perfusion between cerebellum and caudate in PDD. Functional uncoupling may be associated with a dysregulation between the role of cerebellum in action control and of the caudate action selection, initiation and decision making in the patients. The possible impact of the resting-state condition and of mitochondrial impairment are discussed.
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