Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
Bipolar Disord. 2012 Dec;14(8):831-42. doi: 10.1111/bdi.12017.
The aim of this study was to investigate the relationship between resting brain glucose metabolism and cognitive profiles in patients with remitted bipolar I disorder (BD-I) and bipolar II disorder (BD-II). We hypothesized that BD-I patients (compared to BD-II patients) would perform worse on tests of cognitive function because of abnormal metabolism in the prefrontal cortex and other mood-related brain areas.
Thirty-four patients with remitted bipolar disorder (BD) (BD-I = 17, BD-II = 17) under treatment and 17 well-matched healthy controls received both fluorodeoxyglucose ((18) F-FDG) positron emission tomography (PET) and neuropsychological tests of attention, memory, and executive function.
Clinical features in patients with BD-I and BD-II were comparable. Executive function, as indicated by performance on the Wisconsin Card Sorting Test, was significantly worse (i.e., higher percentage of errors, lower percentage of conceptual level responses, and fewer categories completed) in BD-I patients than in BD-II patients and healthy subjects. No difference in attention and memory tests was found among these three groups. Brain PET analysis showed that BD-I patients (compared to BD-II patients) had significantly lower glucose uptake in the bilateral anterior cingulum, insula, striatum, and part of the prefrontal cortex, and higher glucose uptake in the left parahippocampus. Further analyses revealed significant correlations between poor executive function and abnormal glucose uptake in other brain areas in BD-I patients.
There are neurobiological differences between subtypes of BD. BD-I is associated with more impaired fronto-limbic circuitry, which might account for reduced executive function in BD-I patients during remission.
本研究旨在探讨缓解期单相双相障碍 I 型（BD-I）和双相障碍 II 型（BD-II）患者静息脑葡萄糖代谢与认知特征之间的关系。我们假设，由于前额叶皮层和其他与情绪相关的脑区代谢异常，BD-I 患者（与 BD-II 患者相比）在认知功能测试中的表现会更差。
34 名接受治疗的缓解期双相障碍患者（BD）（BD-I=17，BD-II=17）和 17 名匹配良好的健康对照者接受了氟脱氧葡萄糖（（18）F-FDG）正电子发射断层扫描（PET）和注意力、记忆和执行功能的神经心理学测试。
BD-I 型和 BD-II 型患者的临床特征相当。执行功能（威斯康星卡片分类测试的表现）在 BD-I 患者中明显更差（即错误率更高、概念水平反应比例更低、完成的分类更少），而在 BD-II 患者和健康受试者中则无差异。这三组在注意力和记忆测试中无差异。脑 PET 分析显示，BD-I 患者（与 BD-II 患者相比）双侧前扣带回、岛叶、纹状体和部分前额叶的葡萄糖摄取明显较低，而左侧海马旁回的葡萄糖摄取较高。进一步分析显示，BD-I 患者中执行功能差与其他脑区葡萄糖摄取异常之间存在显著相关性。
BD 的亚型存在神经生物学差异。BD-I 与更受损的额-边缘回路有关，这可能是 BD-I 患者在缓解期执行功能下降的原因。
