Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.
Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada.
Curr Top Behav Neurosci. 2021;48:197-213. doi: 10.1007/7854_2020_177.
Neuroprogression is associated with structural and functional brain changes that occur in parallel with cognitive and functioning impairments. There is substantial evidence showing early white matter changes, as well as trajectory-related gray matter alterations. Several structures, including prefrontal, parietal, temporal cortex, and limbic structures, seem to be altered over the course of bipolar disorder, especially associated with the number of episodes and length of the disease. An important limitation is that most of the studies used either a cross-sectional design or a short follow-up period, which may be insufficient to identify all neuroprogressive changes over time. In addition, the heterogeneity of patients with bipolar disorder is another challenge to determine which subjects will have a more pernicious trajectory. Larger studies and the use of new techniques, such as machine learning, may help to enable more discoveries and evidence on the role of neuroprogression in BD.
神经进展与认知和功能障碍同时发生的结构和功能脑变化有关。有大量证据表明早期的白质变化，以及与轨迹相关的灰质改变。几个结构，包括前额叶、顶叶、颞叶皮层和边缘结构，似乎在双相情感障碍的过程中发生了改变，特别是与发作次数和疾病持续时间有关。一个重要的局限性是，大多数研究要么采用横断面设计，要么随访时间短，这可能不足以确定随着时间的推移所有神经进展性变化。此外，双相情感障碍患者的异质性是另一个挑战，无法确定哪些患者会有更严重的病程。更大的研究和使用新的技术，如机器学习，可能有助于发现更多关于神经进展在 BD 中的作用的发现和证据。
