Jones Brett D M, Gallucci Julia, Jones On Yee, Zhukovsky Peter, Wong Stanley, Lakhani Karina, Farooqui Rayyan, Stirpe Lauren, Eltom Mohamed Ahmed K, Love Paramveer, Voineskos Aristotle N, Hawco Colin, Ortiz Abigail, Mulsant Benoit H, Ishrat Husain M
University of Toronto, Department of Psychiatry, Toronto, ON, Canada.
Centre for Addiction and Mental Health, Toronto, ON, Canada.
Neuropsychopharmacology. 2025 Apr 24. doi: 10.1038/s41386-025-02096-1.
Bipolar disorder (BD) is a chronic condition characterized by recurrent mood episodes and persistent cognitive deficits that span multiple domains, ultimately impacting daily functioning. Understanding the neural underpinnings of these impairments is crucial. In a systematic review and meta-analysis examining 80 studies (with 50 meeting criteria for meta-analysis) of adults with BD, relationships between structural brain measures and cognitive performance were evaluated. Participants were diagnosed according to standard criteria, underwent structural and diffusion-weighted MRI, and completed standardized cognitive assessments. The meta-analyses indicated significant associations between both grey matter and white matter indices and cognitive functioning, reflected in moderate effect sizes. Notably, these associations exhibited substantial heterogeneity. Meta-regression revealed that bipolar subtype and current mood state moderated the observed brain-cognition relationships, with bipolar I and euthymic individuals showing higher associations with grey matter metrics. Cognitive domain differences also played a key role, indicating that certain cognitive functions are more strongly linked to structural brain measures than others. Brain networks emerged as a global influence on cognition, with limited differences in pairwise comparisons. Age, sex, psychosis, and mania were not found to significantly moderate these relationships. Overall, this work suggests that structural alterations in grey and white matter in individuals with BD may contribute meaningfully to cognitive difficulties, while brain networks may provide a broad integrative framework for these associations. These findings underscore the importance of considering both global and specific neural factors when exploring the pathophysiology of cognitive impairment in BD.
双相情感障碍（BD）是一种慢性疾病，其特征为反复出现的情绪发作以及跨越多个领域的持续性认知缺陷，最终影响日常功能。了解这些损伤的神经基础至关重要。在一项系统综述和荟萃分析中，研究人员对80项关于双相情感障碍成人患者的研究（其中50项符合荟萃分析标准）进行了考察，评估了脑结构测量与认知表现之间的关系。参与者根据标准标准进行诊断，接受了结构和扩散加权磁共振成像检查，并完成了标准化认知评估。荟萃分析表明，灰质和白质指数与认知功能之间存在显著关联，中等效应量反映了这一点。值得注意的是，这些关联表现出很大的异质性。元回归显示，双相情感障碍亚型和当前情绪状态调节了观察到的脑-认知关系，双相I型患者和心境正常者与灰质指标的关联更高。认知领域差异也起到了关键作用，表明某些认知功能与脑结构测量的联系比其他功能更强。脑网络成为对认知的一种全局性影响，在成对比较中差异有限。未发现年龄、性别、精神病和躁狂对这些关系有显著调节作用。总体而言，这项研究表明，双相情感障碍患者灰质和白质的结构改变可能对认知困难有重要影响，而脑网络可能为这些关联提供一个广泛的综合框架。这些发现强调了在探索双相情感障碍认知障碍的病理生理学过程中，考虑全局和特定神经因素的重要性。
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