McIntyre Roger S, Mansur Rodrigo B, Lee Yena, Japiassú Letícia, Chen Kun, Lu Rui, Lu Weicong, Chen Xiaodong, Li Ting, Xu Guiyun, Lin Kangguang
Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Bipolar Disord. 2017 Mar;19(2):128-134. doi: 10.1111/bdi.12491. Epub 2017 May 11.
The burden of illness associated with bipolar disorder (BD) warrants early pre-emption/prevention. Prediction models limited to psychiatric phenomenology have insufficient predictive power. Herein, we aimed to evaluate whether the presence of overweight/obesity is associated with greater cognitive decline in individuals at high risk (HR) or ultra high risk (UHR) for BD.
We conducted a retrospective analysis to investigate the moderational role of body mass index (BMI) on measures of cognitive function. Subjects between the ages of 8 and 28 years with a positive family history of BD were compared to age-matched controls with a negative family history of BD. Subjects with at least one biological parent with bipolar I/II disorder were further stratified into UHR or HR status by the presence or absence, respectively, of subthreshold hypomanic, major depressive, attenuated psychotic, and/or attention-deficit/hyperactivity disorder symptoms.
A total of 36 individuals at HR for BD, 33 individuals at UHR for BD, and 48 age-matched controls were included in the analysis. Higher BMI was significantly associated with lower performance on measures of processing speed (i.e. Brief Assessment of Cognition in Schizophrenia-symbol coding: r=-.186, P=.047) and attention/vigilance (i.e. Continuous Performance Test-Identical Pairs: r=-.257, P=.006). There were trends for negative correlations between BMI and measures of working memory (i.e. Wechsler Memory Scale-III Spatial Span: r=-0.177, P=.059) and overall cognitive function (i.e. Measurement and Treatment Research to Improve Cognition in Schizophrenia composite score: r=-.157, P=.097). Negative associations between BMI and cognitive performance were significantly stronger in the UHR group than in the HR group, when compared to controls.
Individuals at varying degrees of risk for BD exhibit greater cognitive impairment as a function of co-existing overweight/obesity. Prediction models for BD may be substantively informed by including information related to overweight/obesity and, perhaps, other general medical conditions that share pathology with BD. Our findings herein, as well as the salutary effects of bariatric surgery on measures of cognitive function in obese populations, provide the rationale for hypothesizing that mitigating excess weight in individuals at elevated risk for BD may forestall or prevent declaration of illness.
双相情感障碍（BD）相关的疾病负担需要早期干预/预防。限于精神症状学的预测模型预测能力不足。在此，我们旨在评估超重/肥胖的存在是否与BD高风险（HR）或超高风险（UHR）个体的认知功能衰退加剧相关。
我们进行了一项回顾性分析，以研究体重指数（BMI）对认知功能测量指标的调节作用。将8至28岁有BD家族史阳性的受试者与年龄匹配的BD家族史阴性的对照组进行比较。至少有一位生物学父母患有双相I/II型障碍的受试者，根据是否存在阈下轻躁狂、重度抑郁、精神病性症状减弱和/或注意力缺陷/多动障碍症状，进一步分别分层为UHR或HR状态。
分析共纳入36名BD的HR个体、33名BD的UHR个体和48名年龄匹配的对照组。较高的BMI与处理速度测量指标（即精神分裂症认知简短评估-符号编码：r = -0.186，P = 0.047）和注意力/警觉性测量指标（即连续操作测试-相同配对：r = -0.257，P = 0.006）的较低表现显著相关。BMI与工作记忆测量指标（即韦氏记忆量表第三版空间广度：r = -0.177，P = 0.059）和总体认知功能测量指标（即改善精神分裂症认知的测量与治疗研究综合评分：r = -0.157，P = 0.097）之间存在负相关趋势。与对照组相比，UHR组中BMI与认知表现之间的负相关在UHR组中比在HR组中显著更强。
不同程度BD风险的个体表现出因并存的超重/肥胖而导致的更大认知损害。BD的预测模型可能通过纳入与超重/肥胖以及可能与BD有共同病理的其他一般医学状况相关的信息而得到实质性的完善。我们在此的发现，以及减肥手术对肥胖人群认知功能测量指标的有益影响，为假设减轻BD高风险个体的超重可能预防或防止疾病发作提供了理论依据。
