Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
Bipolar Disord. 2022 Feb;24(1):69-81. doi: 10.1111/bdi.13100. Epub 2021 Jun 18.
Cognitive impairment occurs in approximately 50% of remitted patients with bipolar disorder (BD). However, there exists no treatment with replicated and robust efficacy on cognition in BD. This is partially due to limited insight into the neuronal underpinnings of cognitive impairment in these patients. This is the first study to investigate neuronal underpinnings of cognitive impairment in a large functional magnetic resonance imaging (fMRI) dataset comparing neural activity patterns between distinct neurocognitive subgroups of partially or fully remitted patients with BD.
Patients (n = 153) and healthy controls (HC) (n = 52) underwent neuropsychological assessment and fMRI, during which they performed a verbal N-back working memory (WM) task. Based on hierarchical cluster analysis of neuropsychological test performance, patients were grouped into one of two neurocognitive subgroups (cognitively impaired, n = 91; cognitively normal compared to HC, n = 62) that were compared on WM-related neural activity.
Cognitively impaired patients displayed WM-related hypo-activity in left dorsolateral prefrontal cortex and frontal and parietal regions within a cognitive control network (CCN) as well as hyper-activity in the default mode network (DMN) compared to cognitively normal patients. In contrast, cognitively normal patients only exhibited hypo-activity within a small cluster in the superior frontal gyrus relative to HC.
Cognitive impairment in BD seems to originate from a failure to recruit key regions in the CCN and to suppress task-irrelevant DMN activity during cognitive performance. These results highlight modulation of aberrant dorsal prefrontal and DMN activity as a putative target for pro-cognitive treatment in BD.
约 50%缓解期双相情感障碍（BD）患者存在认知障碍。然而，目前尚无针对 BD 认知障碍具有复制性和稳健疗效的治疗方法。部分原因是对这些患者认知障碍的神经基础了解有限。这是第一项研究，旨在通过比较部分或完全缓解的 BD 患者的不同神经认知亚组之间的神经活动模式，来探究认知障碍的神经基础。
患者（n=153）和健康对照者（HC）（n=52）接受神经心理学评估和 fMRI，在此期间他们执行言语 N-back 工作记忆（WM）任务。基于神经心理学测试表现的层次聚类分析，将患者分为两个神经认知亚组之一（认知障碍，n=91；认知正常与 HC 相比，n=62），并对 WM 相关的神经活动进行比较。
与认知正常的患者相比，认知障碍的患者在左背外侧前额叶皮质和认知控制网络（CCN）内的额顶叶区域以及默认模式网络（DMN）中显示出 WM 相关的活动不足，而认知正常的患者仅在额上回的一个小簇中显示出相对于 HC 的活动不足。
BD 的认知障碍似乎源于在认知表现过程中无法募集 CCN 中的关键区域和抑制与任务无关的 DMN 活动。这些结果强调了调节异常的背外侧前额叶和 DMN 活动作为 BD 认知治疗的潜在靶点。
