Nanjing Brain Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, China; Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 249 Guangzhou Road, Nanjing, 210029, China.
Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 249 Guangzhou Road, Nanjing, 210029, China.
J Psychiatr Res. 2024 Mar;171:60-68. doi: 10.1016/j.jpsychires.2024.01.028. Epub 2024 Jan 16.
Bipolar disorder (BD) is often misdiagnosed as major depressive disorder (MDD) in the early stage, which may lead to inappropriate treatment. This study aimed to characterize the alterations of spontaneous neuronal activity in patients with depressive episodes whose diagnosis transferred from MDD to BD.
532 patients with MDD and 132 healthy controls (HCs) were recruited over 10 years. During the follow-up period, 75 participants with MDD transferred to BD (tBD), and 157 participants remained with the diagnosis of unipolar depression (UD). After excluding participants with poor image quality and excessive head movement, 68 participants with the diagnosis of tBD, 150 participants with the diagnosis of UD, and 130 HCs were finally included in the analysis. The dynamic amplitude of low-frequency fluctuations (dALFF) of spontaneous neuronal activity was evaluated in tBD, UD and HC using functional magnetic resonance imaging at study inclusion. Receiver operating characteristic (ROC) analysis was performed to evaluate sensitivity and specificity of the conversion prediction from MDD to BD based on dALFF.
Compared to HC, tBD exhibited elevated dALFF at left premotor cortex (PMC_L), right lateral temporal cortex (LTC_R) and right early auditory cortex (EAC_R), and UD showed reduced dALFF at PMC_L, left paracentral lobule (PCL_L), bilateral medial prefrontal cortex (mPFC), right orbital frontal cortex (OFC_R), right dorsolateral prefrontal cortex (DLPFC_R), right posterior cingulate cortex (PCC_R) and elevated dALFF at LTC_R. Furthermore, tBD exhibited elevated dALFF at PMC_L, PCL_L, bilateral mPFC, bilateral OFC, DLPFC_R, PCC_R and LTC_R than UD. In addition, ROC analysis based on dALFF in differential areas obtained an area under the curve (AUC) of 72.7%.
The study demonstrated the temporal dynamic abnormalities of tBD and UD in the critical regions of the somatomotor network (SMN), default mode network (DMN), and central executive network (CEN). The differential abnormal patterns of temporal dynamics between the two diseases have the potential to predict the diagnosis transition from MDD to BD.
双相障碍（BD）在早期常被误诊为重度抑郁症（MDD），可能导致治疗不当。本研究旨在描述从 MDD 转为 BD 的抑郁发作患者自发神经元活动变化的特点。
10 年间共招募了 532 例 MDD 患者和 132 例健康对照者（HCs）。在随访期间，75 例 MDD 患者转为 BD（tBD），157 例患者仍诊断为单相抑郁（UD）。排除图像质量差和过度头部运动的参与者后，最终纳入 68 例 tBD 患者、150 例 UD 患者和 130 例 HCs 进行分析。在研究纳入时使用功能磁共振成像评估 tBD、UD 和 HCs 的自发神经元活动的低频波动（dALFF）的动态幅度。通过 ROC 分析评估基于 dALFF 从 MDD 到 BD 转换的预测的灵敏度和特异性。
与 HCs 相比，tBD 在左侧运动前皮质（PMC_L）、右侧外侧颞叶皮质（LTC_R）和右侧早期听觉皮质（EAC_R）显示出升高的 dALFF，而 UD 在 PMC_L、左侧旁中央小叶（PCL_L）、双侧内侧前额叶皮质（mPFC）、右侧眶额皮质（OFC_R）、右侧背外侧前额叶皮质（DLPFC_R）、右侧后扣带皮质（PCC_R）显示出降低的 dALFF和 LTC_R 升高的 dALFF。此外，tBD 在 PMC_L、PCL_L、双侧 mPFC、双侧 OFC、DLPFC_R、PCC_R 和 LTC_R 的 dALFF 高于 UD。此外，基于差异区域的 dALFF 的 ROC 分析获得了 72.7%的曲线下面积（AUC）。
本研究表明 tBD 和 UD 在躯体运动网络（SMN）、默认模式网络（DMN）和中央执行网络（CEN）的关键区域存在时间动态异常。两种疾病之间时间动态差异的异常模式有可能预测从 MDD 到 BD 的诊断转变。
