Montejo Laura, Sole Brisa, Fortea Lydia, Jimenez Esther, Martinez-Aran Anabel, Martinez-Heras Eloy, Sanchez-Moreno Jose, Ortuño Maria, Pariente Jose, Solanes Aleix, Torrent Carla, Vilajosana Enric, De Prisco Michele, Vieta Eduard, Radua Joaquim
Bipolar and Depressive Disorders Unit, Hospital Clinic de Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Front Psychiatry. 2024 Jan 17;14:1302255. doi: 10.3389/fpsyt.2023.1302255. eCollection 2023.
Beyond mood abnormalities, bipolar disorder (BD) includes cognitive impairments that worsen psychosocial functioning and quality of life. These deficits are especially severe in older adults with BD (OABD), a condition expected to represent most individuals with BD in the upcoming years. Restoring the psychosocial functioning of this population will thus soon represent a public health priority. To help tackle the problem, the Bipolar and Depressive Disorders Unit at the Hospital Clínic of Barcelona has recently adapted its Functional Remediation (FR) program to that population, calling it FROA-BD. However, while scarce previous studies localize the neural mechanisms of cognitive remediation interventions in the dorsal prefrontal cortex, the specific mechanisms are seldom unknown. In the present project, we will investigate the neural correlates of FR-OABD to understand its mechanisms better and inform for potential optimization. The aim is to investigate the brain features and changes associated with FROA-BD efficacy.
Thirty-two individuals with OABD in full or partial remission will undergo a magnetic resonance imaging (MRI) session before receiving FR-OABD. After completing the FR-OABD intervention, they will undergo another MRI session. The MRI sessions will include structural, diffusion-weighted imaging (DWI), functional MRI (fMRI) with working memory (n-back) and verbal learning tasks, and frontal spectroscopy. We will correlate the pre-post change in dorsolateral and dorsomedial prefrontal cortices activation during the n-back task with the change in psychosocial functioning [measured with the Functioning Assessment Short Test (FAST)]. We will also conduct exploratory whole-brain correlation analyses between baseline or pre-post changes in MRI data and other clinical and cognitive outcomes to provide more insights into the mechanisms and explore potential brain markers that may predict a better treatment response. We will also conduct separate analyses by sex.
The results of this study may provide insights into how FROA-BD and other cognitive remediations modulate brain function and thus could optimize these interventions.
双相情感障碍（BD）除了存在情绪异常外，还包括认知障碍，这些障碍会使心理社会功能和生活质量恶化。这些缺陷在老年双相情感障碍患者（OABD）中尤为严重，预计在未来几年，该群体将占双相情感障碍患者的大多数。因此，恢复这一人群的心理社会功能很快将成为公共卫生的优先事项。为了帮助解决这一问题，巴塞罗那临床医院的双相情感障碍和抑郁症治疗单元最近针对该人群调整了其功能修复（FR）计划，将其称为FROA-BD。然而，尽管先前的研究很少将认知修复干预的神经机制定位在背侧前额叶皮层，但具体机制却鲜为人知。在本项目中，我们将研究FR-OABD的神经相关性，以更好地理解其机制，并为潜在的优化提供依据。目的是研究与FROA-BD疗效相关的大脑特征和变化。
32名处于完全或部分缓解期的OABD患者将在接受FR-OABD之前进行一次磁共振成像（MRI）检查。完成FR-OABD干预后，他们将再进行一次MRI检查。MRI检查将包括结构成像、扩散加权成像（DWI）、带有工作记忆（n-back）和言语学习任务的功能磁共振成像（fMRI）以及额叶光谱分析。我们将把n-back任务期间背外侧和背内侧前额叶皮层激活的前后变化与心理社会功能的变化[用功能评估简短测试（FAST）测量]进行关联。我们还将对MRI数据的基线或前后变化与其他临床和认知结果进行探索性全脑相关性分析，以更深入地了解其机制，并探索可能预测更好治疗反应的潜在脑标志物。我们还将按性别进行单独分析。
本研究结果可能有助于深入了解FROA-BD和其他认知修复如何调节脑功能，从而优化这些干预措施。
