Department of Clinical Neuroscience, Osher Center, Karolinska Institutet, Stockholm, Sweden.
Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, University of Southern California, Los Angeles, California.
Biol Psychiatry. 2022 Mar 15;91(6):582-592. doi: 10.1016/j.biopsych.2021.09.008. Epub 2021 Sep 16.
Bipolar disorder (BD) is associated with cortical and subcortical structural brain abnormalities. It is unclear whether such alterations progressively change over time, and how this is related to the number of mood episodes. To address this question, we analyzed a large and diverse international sample with longitudinal magnetic resonance imaging (MRI) and clinical data to examine structural brain changes over time in BD.
Longitudinal structural MRI and clinical data from the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) BD Working Group, including 307 patients with BD and 925 healthy control subjects, were collected from 14 sites worldwide. Male and female participants, aged 40 ± 17 years, underwent MRI at 2 time points. Cortical thickness, surface area, and subcortical volumes were estimated using FreeSurfer. Annualized change rates for each imaging phenotype were compared between patients with BD and healthy control subjects. Within patients, we related brain change rates to the number of mood episodes between time points and tested for effects of demographic and clinical variables.
Compared with healthy control subjects, patients with BD showed faster enlargement of ventricular volumes and slower thinning of the fusiform and parahippocampal cortex (0.18 <d < 0.22). More (hypo)manic episodes were associated with faster cortical thinning, primarily in the prefrontal cortex.
In the hitherto largest longitudinal MRI study on BD, we did not detect accelerated cortical thinning but noted faster ventricular enlargements in BD. However, abnormal frontocortical thinning was observed in association with frequent manic episodes. Our study yields insights into disease progression in BD and highlights the importance of mania prevention in BD treatment.
双相障碍（BD）与皮质和皮质下结构脑异常有关。目前尚不清楚这些改变是否会随时间逐渐变化，以及这与情绪发作次数有何关系。为了解决这个问题，我们分析了一个具有纵向磁共振成像（MRI）和临床数据的大型国际样本，以检查 BD 患者的大脑结构随时间的变化。
来自 ENIGMA（通过荟萃分析增强神经影像学遗传学）BD 工作组的纵向结构 MRI 和临床数据，包括来自全球 14 个地点的 307 名 BD 患者和 925 名健康对照者，包括男性和女性参与者，年龄 40 ± 17 岁，在 2 个时间点进行 MRI 检查。使用 FreeSurfer 估计皮质厚度、表面积和皮质下体积。比较 BD 患者和健康对照者之间每个成像表型的年化变化率。在患者中，我们将大脑变化率与时间点之间的情绪发作次数相关联，并测试人口统计学和临床变量的影响。
与健康对照组相比，BD 患者的脑室容积增大速度更快，梭形和海马旁皮质变薄速度更慢（0.18 <d < 0.22）。更多（低）躁狂发作与额皮质变薄速度更快有关，主要在前额叶皮质。
在迄今为止最大的 BD 纵向 MRI 研究中，我们没有发现皮质变薄加速，但注意到 BD 患者的脑室扩大速度更快。然而，在前额皮质中观察到异常的皮质变薄与频繁的躁狂发作有关。我们的研究为 BD 的疾病进展提供了深入的了解，并强调了预防躁狂发作在 BD 治疗中的重要性。
