Relationships Between Altered Functional Magnetic Resonance Imaging Activation and Cortical Thickness in Patients With Euthymic Bipolar I Disorder

Measuring Brain Temperature in Youth Bipolar Disorder Using a Novel Magnetic Resonance Imaging Approach: A Proof-of-concept Study

BACKGROUND

There is evidence of alterations in mitochondrial energy metabolism and cerebral blood flow (CBF) in adults and youth with bipolar disorder (BD). Brain thermoregulation is based on the balance of heat-producing metabolism and heat-dissipating mechanisms, including CBF.

OBJECTIVE

To examine brain temperature, and its relation to CBF, in relation to BD and mood symptom severity in youth.

METHODS

This study included 25 youth participants (age 17.4 ± 1.7 years; 13 BD, 12 control group (CG)). Magnetic resonance spectroscopy data were acquired to obtain brain temperature in the left anterior cingulate cortex (ACC) and the left precuneus. Regional estimates of CBF were provided by arterial spin labeling imaging. Analyses used general linear regression models, covarying for age, sex, and psychiatric medications.

RESULTS

Brain temperature was significantly higher in BD compared to CG in the precuneus. A higher ratio of brain temperature to CBF was significantly associated with greater depression symptom severity in both the ACC and precuneus within BD. Analyses examining the relationship of brain temperature or CBF with depression severity score did not reveal any significant finding in the ACC or the precuneus.

CONCLUSION

The current study provides preliminary evidence of increased brain temperature in youth with BD, in whom reduced thermoregulatory capacity is putatively associated with depression symptom severity. Evaluation of brain temperature and CBF in conjunction may provide valuable insight beyond what can be gleaned by either metric alone. Larger prospective studies are warranted to further evaluate brain temperature and its association with CBF concerning BD.

Reviewing applications of structural and functional MRI for bipolar disorder

Bipolar disorders (BDs) represent one of the leading causes of disability and morbidity globally. The use of functional magnetic resonance imaging (fMRI) is being increasingly studied as a tool to improve the diagnosis and treatment of BDs. While morphological biomarkers can be identified through the use of structural magnetic resonance imaging (sMRI), recent studies have demonstrated that varying degrees of both structural and functional impairments indicate differing bipolar subtypes. Within fMRI, resting-state fMRI has specifically drawn increased interest for its capability to detect different neuronal activation patterns compared to task-based fMRI. This study aims to review recently published literature regarding the use of fMRI to investigate structural-functional relationships in BD diagnosis and specifically resting-state fMRI to provide an opinion on fMRI's modern clinical application. All sources in this literature review were collected through searches on both PubMed and Google Scholar databases for terms such as 'resting-state fMRI' and 'functional neuroimaging biomarkers of bipolar disorder'. While there are promising results supporting the use of fMRI for improving differential accuracy and establishing clinically relevant biomarkers, additional evidence will be required before fMRI is considered a dependable component of the overall BD diagnostic process.

Common and Specific Characteristics of Adolescent Bipolar Disorder Types I and II: A Combined Cortical Thickness and Structural Covariance Analysis

BACKGROUND

By calculating cortical thickness (CT) and cortical structural covariance (SC), we aimed to investigate cortical morphology and cortical inter-regional correlation alterations in adolescent bipolar disorder type I (BD-I) and type II (BD-II) patients.

METHODS

T1-weighted images from 36 BD-I and 22 BD-II patients and 19 healthy controls (HCs) were processed to estimate CT. CT values of the whole brain were compared among three groups. Cortical regions showing CT differences in groups were regarded as seeds for analyzing cortical SC differences between groups. The relationship between CT and clinical indices was further assessed.

RESULTS

Both BD groups showed cortical thinning in several frontal and temporal areas vs. HCs, and CT showed no significant difference between two BD subtypes. Compared to HCs, both BD groups exhibited reduced SC connections between left superior frontal gyrus (SFG) and right postcentral gyrus (PCG), left superior temporal gyrus (STG) and right pars opercularis, and left STG and right PCG. Compared with HCs, decreased SC connections between left STG and right inferior parietal gyrus (IPG) and right pars opercularis and right STG were only observed in the BD-I group, and left PCG and left SFG only in the BD-II group. CT of right middle temporal gyrus was negatively correlated with number of episodes in BD-II patients.

CONCLUSIONS

Adolescent BD-I and BD-II showed commonly decreased CT while presenting commonly and distinctly declined SC connections. This study provides a better understanding of cortical morphology and cortical inter-regional correlation alterations in BD and crucial insights into neuroanatomical mechanisms and pathophysiology of different BD subtypes.

Disturbances of Dynamic Function in Patients With Bipolar Disorder I and Its Relationship With Executive-Function Deficit

Abnormity in brain regional function and inter-regional cooperation have been linked with the dysfunction during cognitive and emotional processing in bipolar disorder (BD) patients. Recent evidences have suggested that brain function is not static but temporal dynamic. In present study, we aimed to characterize the temporal dynamics of regional function and inter-regional cooperation in BD and its relationship with executive dysfunction, an important deficit in BD. Resting-state functional MRI was performed in patients with bipolar I disorder (BDI) (n = 18) and healthy controls (HCs, n = 19). We first assessed local-function temporal variety with dynamic amplitude of low-frequency fluctuation (dALFF). Region with significant inter-groups difference in dALFF was chosen as a seed to calculate inter-regions connective temporal variety with dynamic functional connectivity (dFC). The executive function was measured by Verbal Fluency Test (VFT). The relationship between executive function and brain dynamics were examined. Compared with HC, the BDI group showed decreased dALFF (less temporal variability) in the posterior cingulate cortex (PCC) and decreased dFC between PCC and medial prefrontal cortex (mPFC). The PCC-mPFC dFC was positively associated with VFT in BDI patients, but not in HC. These findings implicated the reduced temporal variability in local region and inter-regions cooperation in BDI, which may be a neural substrate of executive-function deficit in BDI.

Failure of activation of striatum during the performance of executive function tasks in adult patients with bipolar disorder

BACKGROUND

Although numerous studies have used functional neuroimaging to identify executive dysfunction in patients with bipolar disorder (BD), the findings are not consistent. The aim of this meta-analysis is to identify the most reliable functional anomalies in BD patients during performance of Executive Function (EF) tasks.

METHODS

A web-based search was performed on publication databases to identify functional magnetic resonance imaging studies of BD patients performing EF tasks and a voxel-based meta-analytic method known as anisotropic Effect Size Signed Differential Mapping (ES-SDM) was used to identify brain regions which showed anomalous activity in BD patients compared with healthy controls (HC).

RESULTS

Twenty datasets consisting of 463 BD patients and 484 HC were included. Compared with HC, BD patients showed significant hypo-activation or failure of activation in the left striatum (p = 0.00007), supplementary motor area (BA 6, p = 0.00037), precentral gyrus (BA 6, p = 0.0014) and cerebellum (BA 37, p = 0.0019), and hyper-activation in the left gyrus rectus (BA 11, p ≈ 0) and right middle temporal gyrus (BA 22, p = 0.00031) during performance of EF tasks. Sensitivity and subgroup analyses showed that the anomaly of left striatum is consistent across studies and present in both euthymic and BD I patients.

CONCLUSIONS

Patients with BD consistently showed abnormal activation in the cortico-striatal system during performance of EF tasks compared with HC. Failure of activation of the striatum may be a reliable marker for impairment in performance of especially inhibition tasks by patients with BD.

Longitudinal Cortical Thickness Changes in Bipolar Disorder and the Relationship to Genetic Risk, Mania, and Lithium Use

BACKGROUND

Bipolar disorder (BD) is a highly heritable psychiatric disorder characterized by episodes of manic and depressed mood states and associated with cortical brain abnormalities. Although the course of BD is often progressive, longitudinal brain imaging studies are scarce. It remains unknown whether brain abnormalities are static traits of BD or result from pathological changes over time. Moreover, the genetic effect on implicated brain regions remains unknown.

METHODS

Patients with BD and healthy control (HC) subjects underwent structural magnetic resonance imaging at baseline (123 patients, 83 HC subjects) and after 6 years (90 patients, 61 HC subjects). Cortical thickness maps were generated using FreeSurfer. Using linear mixed effects models, we compared longitudinal changes in cortical thickness between patients with BD and HC subjects across the whole brain. We related our findings to genetic risk for BD and tested for effects of demographic and clinical variables.

RESULTS

Patients showed abnormal cortical thinning of temporal cortices and thickness increases in visual/somatosensory brain areas. Thickness increases were related to genetic risk and lithium use. Patients who experienced hypomanic or manic episodes between time points showed abnormal thinning in inferior frontal cortices. Cortical changes did not differ between diagnostic BD subtypes I and II.

CONCLUSIONS

In the largest longitudinal BD study to date, we detected abnormal cortical changes with high anatomical resolution. We delineated regional effects of clinical symptoms, genetic factors, and medication that may explain progressive brain changes in BD. Our study yields important insights into disease mechanisms and suggests that neuroprogression plays a role in BD.

The Lifespan Trajectory of the Encoding-Retrieval Flip: A Multimodal Examination of Medial Parietal Cortex Contributions to Episodic Memory

The formation of episodic memories is associated with deactivation during encoding and activation during retrieval in the posteromedial cortex (PMC). We hypothesized that the encoding/retrieval (E/R) flip is a critical component of episodic memory across the lifespan because structural and metabolic changes in the PMC coincide with the fine tuning of the episodic memory system in development and the reductions of memory performance in aging. The aims of the present study were, first, to describe lifespan trajectories of PMC encoding and retrieval activity in 270 human participants (167 females) from 6 to 80 years of age. Our second goal was to construct a model for episodic memory development in which contributions from brain activity, cortical thickness (CT), and structural connectivity are accounted for. We found that modulation of neural activity in response to memory encoding and retrieval demands was not fully developed until adolescence and decreased from adulthood through old age. The magnitude of the E/R flip was related to source memory and 55% of the age-related variance in source memory performance during childhood and adolescence could be accounted for by the E/R flip, CT, and mean diffusivity together. However, only CT and the E/R flip provided unique contributions with which to explain memory performance. The results suggest that neural dynamics in the PMC is related to the development of episodic memory during childhood and adolescence. The similar trajectories of the E/R flip and episodic memory emergence and decline through development and aging further suggests that a lifelong relationship exists.SIGNIFICANCE STATEMENT Modulation of neural activity in the posteromedial cortex (PMC) in response to memory encoding/retrieval (E/R) demands (E/R flip) does not reach its peak until adolescence and decreases from adulthood through old age. The magnitude of the E/R flip is related to source memory and 55% of the age-related variance in source memory performance during childhood and adolescence can be accounted for by the E/R flip and brain structure together. The results suggest that neural dynamics in the PMC is related to the development of episodic memory function during childhood and adolescence and the similar trajectories of the E/R flip and episodic memory performance through development and aging suggests that a lifelong relationship exists.

Bipolar disorder type I and II show distinct relationships between cortical thickness and executive function

OBJECTIVE

Frontal cortical abnormalities and executive function impairment co-occur in bipolar disorder. Recent studies have shown that bipolar subtypes differ in the degree of structural and functional impairments. The relationships between cognitive performance and cortical integrity have not been clarified and might differ across patients with bipolar disorder type I, II, and healthy subjects.

METHOD

Using a vertex-wise whole-brain analysis, we investigated how cortical integrity, as measured by cortical thickness, correlates with executive performance in patients with bipolar disorder type I, II, and controls (N = 160).

RESULTS

We found focal associations between executive function and cortical thickness in the medial prefrontal cortex in bipolar II patients and controls, but not in bipolar I disorder. In bipolar II patients, we observed additional correlations in lateral prefrontal and occipital regions.

CONCLUSIONS

Our findings suggest that bipolar disorder patients show altered structure-function relationships, and importantly that those relationships may differ between bipolar subtypes. The findings are line with studies suggesting subtype-specific neurobiological and cognitive profiles. This study contributes to a better understanding of brain structure-function relationships in bipolar disorder and gives important insights into the neuropathophysiology of diagnostic subtypes.

Function of Selective Neuromodulatory Projections in the Mammalian Cerebral Cortex: Comparison Between Cholinergic and Noradrenergic Systems

Cortical processing is dynamically modulated by different neuromodulators. Neuromodulation of the cerebral cortex is crucial for maintaining cognitive brain functions such as perception, attention and learning. However, we do not fully understand how neuromodulatory projections are organized in the cerebral cortex to exert various functions. The basal forebrain (BF) cholinergic projection and the locus coeruleus (LC) noradrenergic projection are well-known neuromodulatory projections to the cortex. Decades of studies have identified anatomical and physiological characteristics of these circuits. While both cholinergic and noradrenergic neurons widely project to the cortex, they exhibit different levels of selectivity. Here, we summarize their anatomical and physiological features, highlighting selectivity and specificity of these circuits to different cortical regions. We discuss the importance of selective modulation by comparing their functions in the cortex. We highlight key features in the input-output circuits and target selectivity of these neuromodulatory projections and their roles in controlling four major brain functions: attention, reinforcement, learning and memory, sleep and wakefulness.