Jagiellonian University Medical College, Department of Adult Psychiatry, Kopernika St. 21a, 31-501 Cracow, Poland.
Jagiellonian University, Institute of Zoology and Biomedical Research, Laboratory of Experimental Neuropathology, Gronostajowa 9, 30-387 Cracow, Poland.
Prog Neuropsychopharmacol Biol Psychiatry. 2023 Mar 8;121:110673. doi: 10.1016/j.pnpbp.2022.110673. Epub 2022 Oct 29.
Bipolar disorder (BD) patients show neurological abnormalities in form of neurological and cerebellar soft signs (NSS and CSS). NSS represents heterogeneous group of symptoms representing i.a. deficits of motor coordination, sequencing of complex motor acts and sensory integration. CSS were introduced as group of the neurological deficits of posture, gait, kinetic functions, eye movements and speech, associated more specifically to cerebellar abnormalities than NSS. Studies show significant effect size variability of those symptoms in BD group suggesting the existence of differing subpopulations. The aim of our study was to evaluate the effect of BD type, stage and the history of psychotic symptoms (HoPS) on the severity of CSS and NSS as none of the previous studies had verified the role of those categories.
This study involved 181 participants: 116 euthymic BD patients (66 BD I, 50 BD II) and 65 healthy controls (HC). CSS was assessed with the International Cooperative Ataxia Rating Scale and NSS with Neurological Evaluation Scale. Patients were divided into early and late stage of the disorder according to Kapczinski's criteria. Rater was blind to patients' stage, type and HoPS.
Staging was related to vast majority of CSS and NSS scores. HoPS was related to oculomotor deficits. The effect of BD type was the least significant. Late stage BD showed more severe CSS and NSS than HC in every measure. There were no differences between early stage BD and HC, apart of posture and gait disturbances. Except of sensory integration scores, late stage BD showed higher CSS and NSS rates than early stage patients.
In this hitherto the largest study of neurological abnormalities in BD we have shown significant role of staging in CSS and NSS severity. Progression criteria based on inter-episode psychosocial functioning may stand as unrecognised factor responsible for variability observed in previous studies evaluating neurological abnormalities in BD. Our study suggests that in clinical practice NSS and CSS may be potentially used as easy-to-assess biological marker of BD staging. Observed severity of neurological impairments of BD patients may more likely correspond to the disease progression than to BD type and HoPS.
双相障碍（BD）患者在神经和小脑软体征（NSS 和 CSS）方面表现出神经异常。NSS 代表了一组异质的症状，包括运动协调、复杂运动行为的顺序和感觉综合方面的缺陷。CSS 是一组与姿势、步态、运动功能、眼球运动和言语相关的神经缺陷，与 NSS 相比，它们更具体地与小脑异常有关。研究表明，BD 组中这些症状的效应大小变异性很大，提示存在不同的亚群。我们研究的目的是评估 BD 类型、阶段和精神病症状史（HoPS）对 CSS 和 NSS 严重程度的影响，因为以前的研究都没有验证这些类别的作用。
本研究共纳入 181 名参与者：116 名缓解期 BD 患者（66 名 BD I，50 名 BD II）和 65 名健康对照（HC）。CSS 采用国际合作共济失调评定量表评估，NSS 采用神经功能评定量表评估。根据 Kapczinski 的标准，患者被分为疾病的早期和晚期。评估者对患者的阶段、类型和 HoPS 情况不了解。
分期与绝大多数 CSS 和 NSS 评分相关。HoPS 与眼球运动缺陷相关。BD 类型的影响最小。晚期 BD 在每一项测量中都比 HC 有更严重的 CSS 和 NSS。早期 BD 与 HC 之间没有差异，除了姿势和步态紊乱。除了感觉整合评分外，晚期 BD 的 CSS 和 NSS 评分均高于早期患者。
在迄今为止最大的 BD 神经异常研究中，我们已经表明分期在 CSS 和 NSS 严重程度中起重要作用。基于发作间社会心理功能的进展标准可能是以前评估 BD 神经异常的研究中观察到的变异性的未被识别的因素。我们的研究表明，在临床实践中，NSS 和 CSS 可能可作为 BD 分期的潜在易于评估的生物学标志物。BD 患者神经损伤的严重程度可能更符合疾病进展，而不是 BD 类型和 HoPS。
