Miskowiak Kamilla W, Macoveanu Julian, Ozenne Brice, Beaman Emily E, Dam Vibeke H, Fisher Patrick M, Knudsen Gitte M, Kessing Lars V, Jørgensen Martin B, Frokjaer Vibe G, Sankar Anjali
Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Mental Health Services, Capital Region of Denmark, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
Psychiatric Centre Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.
Acta Psychiatr Scand. 2025 Feb 20;151(6):689-97. doi: 10.1111/acps.13790.
Patients with mood disorders, especially, major depressive disorder (MDD) and bipolar disorder (BD), are at heightened risk of relapse and psychiatric rehospitalizations. Therefore, there is an urgent need to identify modifiable biomarkers to inform personalized and intensified prevention strategies for those at the greatest risk of relapse and hospital readmissions. Brain structural measures subserving cognitive function hold particular promise among potential predictive biomarkers.
In the present study, structural magnetic resonance imaging scans were obtained from 319 patients with MDD (n = 241) or BD (n = 78). Longitudinal data on psychiatric hospitalization for up to 10 years were available from the Danish National population-based registers. Interhemispheric hippocampal asymmetry, a putative marker of cognitive function and brain reserve, was calculated for each patient. The association between hippocampal asymmetry and future psychiatric hospitalization was assessed using a cause-specific Cox regression model. Exploratory analyses, also using a cause-specific Cox model, assessed the association of prefrontal and hippocampal gray matter volume and whole-brain white matter volume with hospitalizations.
The results indicated a negative association between rightward hippocampal asymmetry (i.e., left<right) and risk of future hospitalizations (HR = 0.90, corresponding to a 10-year risk reduction of 0.018 for a 1% increase in asymmetry, p = 0.040). Exploratory analysis indicated that a larger right hippocampus volume was associated with a reduced risk of hospitalization (HR = 0.18, p = 0.004) while a larger bilateral dorsolateral prefrontal volume (HR = 1.06, p = 0.01) was associated with an increased risk of hospitalization.
The findings suggest a role for hippocampal and, additionally, prefrontal morphological features in the risk of future psychiatric hospitalizations in mood disorders.
患有情绪障碍的患者，尤其是重度抑郁症（MDD）和双相情感障碍（BD）患者，复发和再次住院的风险更高。因此，迫切需要确定可改变的生物标志物，为复发和再次入院风险最高的患者制定个性化和强化的预防策略。在潜在的预测生物标志物中，有助于认知功能的脑结构测量具有特别的前景。
在本研究中，对319例MDD患者（n = 241）或BD患者（n = 78）进行了结构磁共振成像扫描。丹麦国家人口登记处提供了长达10年的精神科住院纵向数据。计算了每位患者的半球间海马不对称性，这是一种认知功能和脑储备的假定标志物。使用病因特异性Cox回归模型评估海马不对称性与未来精神科住院之间的关联。探索性分析也使用病因特异性Cox模型，评估前额叶和海马灰质体积以及全脑白质体积与住院之间的关联。
结果表明，右侧海马不对称性（即左侧<右侧）与未来住院风险呈负相关（HR = 0.90，不对称性每增加1%，10年风险降低0.018，p = 0.040）。探索性分析表明，右侧海马体积较大与住院风险降低相关（HR = 0.18，p = 0.004），而双侧背外侧前额叶体积较大（HR = 1.06，p = 0.01）与住院风险增加相关。
研究结果表明，海马以及前额叶形态特征在情绪障碍患者未来精神科住院风险中起作用。
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