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Xu Y, Cheng X, Li Y, Shen H, Wan Y, Ping L, Yu H, Cheng Y, Xu X, Cui J, Zhou C. Shared and Distinct White Matter Alterations in Major Depression and Bipolar Disorder: A Systematic Review and Meta-Analysis. J Integr Neurosci 2024; 23:170. [PMID: 39344242 DOI: 10.31083/j.jin2309170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 07/22/2024] [Accepted: 07/31/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Identifying white matter (WM) microstructural similarities and differences between major depressive disorder (MDD) and bipolar disorder (BD) is an important way to understand the potential neuropathological mechanism in emotional disorders. Numerous diffusion tensor imaging (DTI) studies over recent decades have confirmed the presence of WM anomalies in these two affective disorders, but the results were inconsistent. This study aimed to determine the statistical consistency of DTI findings for BD and MDD by using the coordinate-based meta-analysis (CBMA) approach. METHODS We performed a systematic search of tract-based spatial statistics (TBSS) studies comparing MDD or BD with healthy controls (HC) as of June 30, 2024. The seed-based d-mapping (SDM) was applied to investigate fractional anisotropy (FA) changes. Meta-regression was then used to analyze the potential correlations between demographics and neuroimaging alterations. RESULTS Regional FA reductions in the body of the corpus callosum (CC) were identified in both of these two diseases. Besides, MDD patients also exhibited decreased FA in the genu and splenium of the CC, as well as the left anterior thalamic projections (ATP), while BD patients showed FA reduction in the left median network, and cingulum in addition to the CC. CONCLUSIONS The results highlighted that altered integrity in the body of CC served as the shared basis of MDD and BD, and distinct microstructural WM abnormalities also existed, which might induce the various clinical manifestations of these two affective disorders. The study was registered on PROSPERO (http://www.crd.york.ac.uk/PROSPERO), registration number: CRD42022301929.
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Affiliation(s)
- Yinghong Xu
- Department of Psychiatry, Shandong Daizhuang Hospital, 272075 Jining, Shandong, China
- School of Mental Health, Jining Medical University, 272002 Jining, Shandong, China
| | - Xiaodong Cheng
- Department of Psychiatry, Shandong Daizhuang Hospital, 272075 Jining, Shandong, China
| | - Ying Li
- School of Mental Health, Jining Medical University, 272002 Jining, Shandong, China
| | - Hailong Shen
- School of Mental Health, Jining Medical University, 272002 Jining, Shandong, China
| | - Yu Wan
- School of Mental Health, Jining Medical University, 272002 Jining, Shandong, China
| | - Liangliang Ping
- Department of Psychiatry, Xiamen Xianyue Hospital, 361012 Xiamen, Fujian, China
| | - Hao Yu
- School of Mental Health, Jining Medical University, 272002 Jining, Shandong, China
| | - Yuqi Cheng
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, 650032 Kunming, Yunnan, China
| | - Xiufeng Xu
- Department of Psychiatry, The First Affiliated Hospital of Kunming Medical University, 650032 Kunming, Yunnan, China
| | - Jian Cui
- Department of Psychiatry, Shandong Daizhuang Hospital, 272075 Jining, Shandong, China
| | - Cong Zhou
- School of Mental Health, Jining Medical University, 272002 Jining, Shandong, China
- Department of Psychology, Affiliated Hospital of Jining Medical University, 272067 Jining, Shandong, China
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Nabulsi L, Chandio BQ, McPhilemy G, Martyn FM, Roberts G, Hallahan B, Dannlowski U, Kircher T, Haarman B, Mitchell P, McDonald C, Cannon DM, Andreassen OA, Ching CRK, Thompson PM. Multi-Site Statistical Mapping of Along-Tract Microstructural Abnormalities in Bipolar Disorder with Diffusion MRI Tractometry. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.17.553762. [PMID: 37662230 PMCID: PMC10473593 DOI: 10.1101/2023.08.17.553762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Investigating alterations in brain circuitry associated with bipolar disorder (BD) may offer a valuable approach to discover brain biomarkers for genetic and interventional studies of the disorder and related mental illnesses. Some diffusion MRI studies report evidence of microstructural abnormalities in white matter regions of interest, but we lack a fine-scale spatial mapping of brain microstructural differences along tracts in BD. We also lack large-scale studies that integrate tractometry data from multiple sites, as larger datasets can greatly enhance power to detect subtle effects and assess whether effects replicate across larger international datasets. In this multisite diffusion MRI study, we used BUndle ANalytics (BUAN, Chandio 2020), a recently developed analytic approach for tractography, to extract, map, and visualize profiles of microstructural abnormalities on 3D models of fiber tracts in 148 participants with BD and 259 healthy controls from 6 independent scan sites. Modeling site differences as random effects, we investigated along-tract white matter (WM) microstructural differences between diagnostic groups. QQ plots showed that group differences were gradually enhanced as more sites were added. Using the BUAN pipeline, BD was associated with lower mean fractional anisotropy (FA) in fronto-limbic, interhemispheric, and posterior pathways; higher FA was also noted in posterior bundles, relative to controls. By integrating tractography and anatomical information, BUAN effectively captures unique effects along white matter (WM) tracts, providing valuable insights into anatomical variations that may assist in the classification of diseases.
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Affiliation(s)
- Leila Nabulsi
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, University of Southern California, Marina del Rey, CA 90292, USA
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - Bramsh Q Chandio
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, University of Southern California, Marina del Rey, CA 90292, USA
| | - Genevieve McPhilemy
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - Fiona M Martyn
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - Gloria Roberts
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Hallahan
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Benno Haarman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Philip Mitchell
- Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, Galway Neuroscience Centre, College of Medicine Nursing and Health Sciences, University of Galway, H91 TK33 Galway, Ireland
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Christopher R K Ching
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, University of Southern California, Marina del Rey, CA 90292, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging & Informatics Institute, University of Southern California, Marina del Rey, CA 90292, USA
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Nabulsi L, Chandio BQ, Dhinagar N, Laltoo E, McPhilemy G, Martyn FM, Hallahan B, McDonald C, Thompson PM, Cannon DM. Along-Tract Statistical Mapping of Microstructural Abnormalities in Bipolar Disorder: A Pilot Study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-7. [PMID: 38083303 DOI: 10.1109/embc40787.2023.10339964] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Investigating brain circuitry involved in bipolar disorder (BD) is key to discovering brain biomarkers for genetic and interventional studies of the disorder. Even so, prior research has not provided a fine-scale spatial mapping of brain microstructural differences in BD. In this pilot diffusion MRI dataset, we used BUndle ANalytics (BUAN)-a recently developed analytic approach for tractography-to extract, map, and visualize the profile of microstructural abnormalities on a 3D model of fiber tracts in people with BD (N=38) and healthy controls (N=49), and investigate along-tract white matter (WM) microstructural differences between these groups. Using the BUAN pipeline, BD was associated with lower mean fractional anisotropy (FA) in fronto-limbic and interhemispheric pathways and higher mean FA in posterior bundles relative to controls.Clinical Relevance- BUAN combines tractography and anatomical information to capture distinct along-tract effects on WM microstructure that may aid in classifying diseases based on anatomical differences.
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Yang J, Tao H, Sun F, Fan Z, Yang J, Liu Z, Xue Z, Chen X. The anatomical networks based on probabilistic structurally connectivity in bipolar disorder across mania, depression, and euthymic states. J Affect Disord 2023; 329:42-49. [PMID: 36842653 DOI: 10.1016/j.jad.2023.02.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUNDS There have pieces of evidence of the distinct aberrant functional network topology profile in bipolar disorder (BD) across mania, depression, and euthymic episodes. However, the underlying anatomical network topology pattern in BD across different episodes is unclear. METHODS We calculated the whole-brain probabilistic structurally connectivity across 143 subjects (72 with BD [34 depression; 13 mania; 25 euthymic] and 53 healthy controls), and used graph theory to examine the trait- and state-related topology alterations of the structural connectome in BD. The correlation analysis was further conducted to explore the relationship between detected network measures and clinical symptoms. RESULTS There no omnibus alteration of any global network metrics were observed across all diagnostic groups. In the regional network metrics level, bipolar depression showed increased clustering coefficient in the right lingual gyrus compared with all other groups, and the increased clustering coefficient in the right lingual gyrus positively correlated with depression, anxiety, and illness burden symptoms but negatively correlated with mania symptoms; manic and euthymic patients showed decreased clustering coefficient in the left inferior occipital gyrus compared with HCs. LIMITATIONS The moderate sample size of all patient groups (especially for subjects with mania) might have contributed to the negative findings of the trait feature in this study. CONCLUSIONS We demonstrated the altered regional connectivity pattern in the occipital lobe of the bipolar depression and mania episode, especially the lingual gyrus. The association of the clustering coefficient in the lingual gyrus with clinical symptoms helps monitor the state of BD.
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Affiliation(s)
- Jie Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Haojuan Tao
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Fuping Sun
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Zebin Fan
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Jun Yang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Zhening Liu
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Zhimin Xue
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China
| | - Xudong Chen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan, China.
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5
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Nabulsi L, Chandio BQ, Dhinagar N, Laltoo E, McPhilemy G, Martyn FM, Hallahan B, McDonald C, Thompson PM, Cannon DM. Along-Tract Statistical Mapping of Microstructural Abnormalities in Bipolar Disorder: A Pilot Study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.03.07.531585. [PMID: 36945403 PMCID: PMC10028925 DOI: 10.1101/2023.03.07.531585] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Investigating brain circuitry involved in bipolar disorder (BD) is key to discovering brain biomarkers for genetic and interventional studies of the disorder. Even so, prior research has not provided a fine-scale spatial mapping of brain microstructural differences in BD. In this pilot diffusion MRI dataset, we used BUndle ANalytics (BUAN), a recently developed analytic approach for tractography, to extract, map, and visualize the profile of microstructural abnormalities on a 3D model of fiber tracts in people with BD (N=38) and healthy controls (N=49), and investigate along-tract white matter (WM) microstructural differences between these groups. Using the BUAN pipeline, BD was associated with lower mean Fractional Anisotropy (FA) in fronto-limbic and interhemispheric pathways and higher mean FA in posterior bundles relative to controls. BUAN combines tractography and anatomical information to capture distinct along-tract effects on WM microstructure that may aid in classifying diseases based on anatomical differences.
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Affiliation(s)
- Leila Nabulsi
- Imaging Genetics Center, Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, 90292 USA
| | - Bramsh Q Chandio
- Imaging Genetics Center, Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, 90292 USA
| | - Nikhil Dhinagar
- Imaging Genetics Center, Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, 90292 USA
| | - Emily Laltoo
- Imaging Genetics Center, Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, 90292 USA
| | - Genevieve McPhilemy
- Clinical Neuroimaging Lab, Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
| | - Fiona M Martyn
- Clinical Neuroimaging Lab, Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
| | - Brian Hallahan
- Clinical Neuroimaging Lab, Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
| | - Colm McDonald
- Clinical Neuroimaging Lab, Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
| | - Paul M Thompson
- Imaging Genetics Center, Stevens Institute for Neuroimaging & Informatics, University of Southern California, Marina del Rey, CA, 90292 USA
| | - Dara M Cannon
- Clinical Neuroimaging Lab, Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, University of Galway, Galway, Ireland
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Argyropoulos GD, Christidi F, Karavasilis E, Velonakis G, Antoniou A, Bede P, Seimenis I, Kelekis N, Douzenis A, Papakonstantinou O, Efstathopoulos E, Ferentinos P. Cerebro-cerebellar white matter connectivity in bipolar disorder and associated polarity subphenotypes. Prog Neuropsychopharmacol Biol Psychiatry 2021; 104:110034. [PMID: 32710925 DOI: 10.1016/j.pnpbp.2020.110034] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/08/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND The cerebellum has a crucial role in mood regulation. While cerebellar grey matter (GM) alterations have been previously reported in bipolar disorder (BD), cerebro-cerebellar white matter (WM) connectivity alterations and cerebellar GM profiles have not been characterised in the context of predominant polarity (PP) and onset polarity (OP) subphenotypes of BD patients which is the aim of the present study. METHODS Forty-two euthymic BD patients stratified for PP and OP and 42 healthy controls (HC) were included in this quantitative neuroimaging study to evaluate cerebellar GM patterns and cerebro-cerebellar WM connections. Diffusion tensor tractography was used to characterise afferent and efferent cerebro-cerebellar tract integrity. False discovery rate corrections were applied in post-hoc comparisons. RESULTS BD patients exhibited higher fractional anisotropy (FA) in fronto-ponto-cerebellar tracts bilaterally compared to HC. Subphenotype-specific FA profiles were identified within the BD cohort. Regarding PP subgroups, we found FA changes in a) left contralateral fronto-ponto-cerebellar tract (depressive-PP > HC) and b) contralateral/ipsilateral fronto-ponto-cerebellar tracts bilaterally (manic-PP > HC). Regarding OP subgroups, we observed FA changes in a) left/right contralateral fronto-ponto-cerebellar tracts (depressive-OP > HC) and b) all fronto-ponto-cerebellar, most parieto-ponto-cerebellar and right contralateral occipito-ponto-cerebellar tracts (manic-OP>HC). In general, greater and more widespread cerebro-cerebellar changes were observed in manic-OP patients than in depressive-OP patients compared to HC. Manic-OP showed higher FA compared to depressive-OP patients in several afferent WM tracts. No GM differences were identified between BD and HC and across BD subgroups. CONCLUSIONS Our findings highlight fronto-ponto-cerebellar connectivity alterations in euthymic BD. Polarity-related subphenotypes have distinctive cerebro-cerebellar WM signatures with potential clinical and pathobiological implications.
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Affiliation(s)
- Georgios D Argyropoulos
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Foteini Christidi
- 2nd Department of Psychiatry, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| | - Efstratios Karavasilis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Velonakis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Antoniou
- 2nd Department of Psychiatry, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Bede
- Biomedical Imaging Laboratory, Sorbonne University, CNRS, INSERM, Paris, France; Computational Neuroimaging Group, Trinity College Dublin, Ireland
| | - Ioannis Seimenis
- Medical Physics Laboratory, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Douzenis
- 2nd Department of Psychiatry, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Olympia Papakonstantinou
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Efstathopoulos
- Research Unit of Radiology and Medical Imaging, 2nd Department of Radiology, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Ferentinos
- 2nd Department of Psychiatry, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Yamada S, Takahashi S, Ohoshi Y, Ishida T, Tsuji T, Shinosaki K, Terada M, Ukai S. Widespread white matter microstructural abnormalities and cognitive impairment in schizophrenia, bipolar disorder, and major depressive disorder: Tract-based spatial statistics study. Psychiatry Res Neuroimaging 2020; 298:111045. [PMID: 32087457 DOI: 10.1016/j.pscychresns.2020.111045] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/01/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Shinichi Yamada
- Department of Neuropsychiatry, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-0012 Japan.
| | - Shun Takahashi
- Department of Neuropsychiatry, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-0012 Japan
| | - Yuji Ohoshi
- Department of Neuropsychiatry, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-0012 Japan
| | - Takuya Ishida
- Department of Neuropsychiatry, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-0012 Japan
| | - Tomikimi Tsuji
- Department of Neuropsychiatry, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-0012 Japan
| | | | | | - Satoshi Ukai
- Department of Neuropsychiatry, Wakayama Medical University, 811-1, Kimiidera, Wakayama 641-0012 Japan
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Delvecchio G, Maggioni E, Squarcina L, Arighi A, Galimberti D, Scarpini E, Bellani M, Brambilla P. A Critical Review on Structural Neuroimaging Studies in BD: a Transdiagnostic Perspective from Psychosis to Fronto-Temporal Dementia. Curr Behav Neurosci Rep 2020. [DOI: 10.1007/s40473-020-00204-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhang S, Wang W, Su X, Li L, Yang X, Su J, Tan Q, Zhao Y, Sun H, Kemp GJ, Gong Q, Yue Q. White Matter Abnormalities in Anorexia Nervosa: Psychoradiologic Evidence From Meta-Analysis of Diffusion Tensor Imaging Studies Using Tract Based Spatial Statistics. Front Neurosci 2020; 14:159. [PMID: 32194371 PMCID: PMC7063983 DOI: 10.3389/fnins.2020.00159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 02/11/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Anorexia nervosa (AN) is a debilitating illness whose neural basis remains unclear. Studies using tract-based spatial statistics (TBSS) with diffusion tensor imaging (DTI) have demonstrated differences in white matter (WM) microarchitecture in AN, but the findings are inconclusive and controversial. Objectives: To identify the most consistent WM abnormalities among previous TBSS studies of differences in WM microarchitecture in AN. Methods: By systematically searching online databases, a total of 11 datasets were identified, including 245 patients with AN and 246 healthy controls (HC). We used Seed-based d Mapping to analyze fractional anisotropy (FA) differences between AN patients and HC, and performed meta-regression analysis to explore the effects of clinical characteristics on WM abnormalities in AN. Results: The pooled results of all AN patients showed robustly lower FA in the corpus callosum (CC) and the cingulum compared to HC. These two regions preserved significance in the sensitivity analysis as well as in all subgroup analyses. Fiber tracking showed that the WM tracts primarily involved were the body of the CC and the cingulum bundle. Meta-regression analysis revealed that the body mass index and mean age were not linearly correlated with the lower FA. Conclusions: The most consistent WM microstructural differences in AN were in the interhemispheric connections and limbic association fibers. These common “targets” advance our understanding of the complex neural mechanisms underlying the puzzling symptoms of AN, and may help in developing early treatment approaches.
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Affiliation(s)
- Simin Zhang
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Weina Wang
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Xiaorui Su
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Lei Li
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Xibiao Yang
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Jingkai Su
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
| | - Qiaoyue Tan
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Youjin Zhao
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Huaiqiang Sun
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
| | - Qiyong Gong
- Department of Radiology, Huaxi MR Research Center (HMRRC), West China Hospital of Sichuan University, Chengdu, China
| | - Qiang Yue
- Department of Radiology, West China Hospital of Sichuan University, Chengdu, China
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10
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Nabulsi L, McPhilemy G, Kilmartin L, O'Hora D, O'Donoghue S, Forcellini G, Najt P, Ambati S, Costello L, Byrne F, McLoughlin J, Hallahan B, McDonald C, Cannon DM. Bipolar Disorder and Gender Are Associated with Frontolimbic and Basal Ganglia Dysconnectivity: A Study of Topological Variance Using Network Analysis. Brain Connect 2019; 9:745-759. [PMID: 31591898 DOI: 10.1089/brain.2019.0667] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Well-established structural abnormalities, mostly involving the limbic system, have been associated with disorders of emotion regulation. Understanding the arrangement and connections of these regions with other functionally specialized cortico-subcortical subnetworks is key to understanding how the human brain's architecture underpins abnormalities of mood and emotion. We investigated topological patterns in bipolar disorder (BD) with the anatomically improved precision conferred by combining subject-specific parcellation/segmentation with nontensor-based tractograms derived using a high-angular resolution diffusion-weighted approach. Connectivity matrices were constructed using 34 cortical and 9 subcortical bilateral nodes (Desikan-Killiany), and edges that were weighted by fractional anisotropy and streamline count derived from deterministic tractography using constrained spherical deconvolution. Whole-brain and rich-club connectivity alongside a permutation-based statistical approach was used to investigate topological variance in predominantly euthymic BD relative to healthy volunteers. BP patients (n = 40) demonstrated impairments across whole-brain topological arrangements (density, degree, and efficiency), and a dysconnected subnetwork involving limbic and basal ganglia relative to controls (n = 45). Increased rich-club connectivity was most evident in females with BD, with frontolimbic and parieto-occipital nodes not members of BD rich-club. Increased centrality in females relative to males was driven by basal ganglia and fronto-temporo-limbic nodes. Our subject-specific cortico-subcortical nontensor-based connectome map presents a neuroanatomical model of BD dysconnectivity that differentially involves communication within and between emotion-regulatory and reward-related subsystems. Moreover, the female brain positions more dependence on nodes belonging to these two differently specialized subsystems for communication relative to males, which may confer increased susceptibility to processes dependent on integration of emotion and reward-related information.
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Affiliation(s)
- Leila Nabulsi
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Genevieve McPhilemy
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Liam Kilmartin
- College of Engineering and Informatics, National University of Ireland Galway, Galway, Ireland
| | - Denis O'Hora
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Stefani O'Donoghue
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Giulia Forcellini
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland.,Center for Neuroscience and Cognitive Systems, Istituto Italiano di Tecnologia, Rovereto, Italy
| | - Pablo Najt
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Srinath Ambati
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Laura Costello
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Fintan Byrne
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - James McLoughlin
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Brian Hallahan
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Colm McDonald
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Dara M Cannon
- Centre for Neuroimaging & Cognitive Genomics (NICOG), Clinical Neuroimaging Laboratory, NCBES Galway Neuroscience Centre, College of Medicine, Nursing, and Health Sciences, National University of Ireland Galway, Galway, Ireland
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11
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Zhang R, Shao R, Xu G, Lu W, Zheng W, Miao Q, Chen K, Gao Y, Bi Y, Guan L, McIntyre RS, Deng Y, Huang X, So KF, Lin K. Aberrant brain structural-functional connectivity coupling in euthymic bipolar disorder. Hum Brain Mapp 2019; 40:3452-3463. [PMID: 31282606 DOI: 10.1002/hbm.24608] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022] Open
Abstract
Aberrant structural (diffusion tensor imaging [DTI]) and resting-state functional magnetic resonance imagining connectivity are core features of bipolar disorder. However, few studies have explored the integrity agreement between structural and functional connectivity (SC-FC) in bipolar disorder. We examine SC connectivity coupling index whether could potentially provide additional clinical predictive value for bipolar disorder spectrum disorders besides the intramodality network measures. By examining the structural (DTI) and resting-state functional network properties, as well as their coupling index, among 57 euthymic bipolar disorder patients (age 13-28 years, 18 females) and 42 age- and gender-matched healthy controls (age 13-28 years, 16 females), we found that compared to controls, bipolar disorder patients showed increased structural rich-club connectivity as well as decreased functional modularity. Importantly, the coupling strength between structural and functional connectome was decreased in patients compared to controls, which emerged as the most powerful feature discriminating the two groups. Our findings suggest that structural-functional coupling strength could serve as a valuable biological trait-like feature for bipolar disorder over and above the intramodality network measures. Such measure can have important clinical implications for early identification of bipolar disorder individuals, and inform strategies for prevention of bipolar disorder onset and relapse.
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Affiliation(s)
- Ruibin Zhang
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Laboratory of Neuropsychology, Laboratory of Social Cognitive Affective Neuroscience, Department of Psychology, The University of Hong Kong, Hong Kong, China.,Department of Psychology, School of Public Health, Southern Medical University (Guangdong Provincial Key Laboratory of Tropical Disease Research), Guangzhou, China
| | - Robin Shao
- Laboratory of Neuropsychology, Laboratory of Social Cognitive Affective Neuroscience, Department of Psychology, The University of Hong Kong, Hong Kong, China
| | - Guiyun Xu
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Academician workstation of Mood and Brain Sciences, Guangzhou Medical University, Guangzhou, China.,Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Weicong Lu
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wenjing Zheng
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qingzhe Miao
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Kun Chen
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanling Gao
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yanan Bi
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China
| | - Lijie Guan
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Roger S McIntyre
- Academician workstation of Mood and Brain Sciences, Guangzhou Medical University, Guangzhou, China.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Yue Deng
- Department of Psychology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuejun Huang
- Department of Psychology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kwok-Fai So
- Academician workstation of Mood and Brain Sciences, Guangzhou Medical University, Guangzhou, China.,GMH Institute of CNS Regeneration, Jinan University, Guangzhou, China.,The State Key Laboratory of Brain and Cognitive Sciences and Department of Ophthalmology, University of Hong Kong, Hong Kong, China
| | - Kangguang Lin
- Department of Affective Disorders, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Laboratory of Neuropsychology, Laboratory of Social Cognitive Affective Neuroscience, Department of Psychology, The University of Hong Kong, Hong Kong, China.,Academician workstation of Mood and Brain Sciences, Guangzhou Medical University, Guangzhou, China.,Laboratory of Emotion and Cognition, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China.,GMH Institute of CNS Regeneration, Jinan University, Guangzhou, China
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12
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Yang C, Li L, Hu X, Luo Q, Kuang W, Lui S, Huang X, Dai J, He M, Kemp GJ, Sweeney JA, Gong Q. Psychoradiologic abnormalities of white matter in patients with bipolar disorder: diffusion tensor imaging studies using tract-based spatial statistics. J Psychiatry Neurosci 2019; 44:32-44. [PMID: 30565904 PMCID: PMC6306286 DOI: 10.1503/jpn.170221] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND An increasing number of psychoradiology studies that use tract-based spatial statistics (TBSS) of diffusion tensor imaging have reported abnormalities of white matter in patients with bipolar disorder; however, robust conclusions have proven elusive, especially considering some important clinical and demographic factors. In the present study, we performed a quantitative meta-analysis of TBSS studies to elucidate the most consistent white-matter abnormalities in patients with bipolar disorder. METHODS We conducted a systematic search up to May 2017 for all TBSS studies comparing fractional anisotropy (FA) between patients with bipolar disorder and healthy controls. We performed anisotropic effect size–signed differential mapping meta-analysis. RESULTS We identified a total of 22 data sets including 556 patients with bipolar disorder and 623 healthy controls. We found significant FA reductions in the genu and body of the corpus callosum in patients with bipolar disorder relative to healthy controls. No regions of increased FA were reported. In subgroup analyses, the FA reduction in the genu of the corpus callosum retained significance in patients with bipolar disorder type I, and the FA reduction in the body of the corpus callosum retained significance in euthymic patients with bipolar disorder. Meta-regression analysis revealed that the percentage of female patients was negatively correlated with reduced FA in the body of the corpus callosum. LIMITATIONS Data acquisition, patient characteristics and clinical variables in the included studies were heterogeneous. The small number of diffusion tensor imaging studies using TBSS in patients with bipolar disorder type II, as well as the lack of other clinical information, hindered the application of subgroup meta-analyses. CONCLUSION Our study consistently identified decreased FA in the genu and body of the corpus callosum, suggesting that interhemispheric communication may be the connectivity most affected in patients with bipolar disorder.
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Affiliation(s)
- Cheng Yang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Lei Li
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Xinyu Hu
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Qiang Luo
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Weihong Kuang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Su Lui
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Xiaoqi Huang
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Jing Dai
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Manxi He
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Graham J. Kemp
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - John A Sweeney
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
| | - Qiyong Gong
- From the Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, China (Yang, Li, Hu, Luo, Lui, Huang, Sweeney, Gong); the Department of Psychiatry, West China Hospital of Sichuan University, China (Kuang); the Department of Psychoradiology, Chengdu Mental Health Center, China (Kuang, Dai, He); the Liverpool Magnetic Resonance Imaging Centre (LiMRIC) and Institute of Ageing and Chronic Disease, University of Liverpool, United Kingdom (Kemp); the Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, Ohio, United States (Sweeney); and the Department of Psychology, School of Public Administration, Sichuan University, China (Gong)
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13
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Vai B, Bertocchi C, Benedetti F. Cortico-limbic connectivity as a possible biomarker for bipolar disorder: where are we now? Expert Rev Neurother 2019; 19:159-172. [PMID: 30599797 DOI: 10.1080/14737175.2019.1562338] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The fronto-limbic network has been suggested as a key circuitry in the pathophysiology and maintenance of bipolar disorder. In the past decade, a disrupted connectivity within prefrontal-limbic structures was identified as a promising candidate biomarker for the disorder. Areas Covered: In this review, the authors examine current literature in terms of the structural, functional and effective connectivity in bipolar disorder, integrating recent findings of imaging genetics and machine learning. This paper profiles the current knowledge and identifies future perspectives to provide reliable and usable neuroimaging biomarkers for bipolar psychopathology in clinical practice. Expert Opinion: The replication and the translation of acquired knowledge into useful and usable tools represents one of the current greatest challenges in biomarker research applied to psychiatry.
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Affiliation(s)
- Benedetta Vai
- a Psychiatry & Clinical Psychobiology , Division of Neuroscience, Scientific Institute Ospedale San Raffaele , Milano , Italy.,b University Vita-Salute San Raffaele , Milano , Italy
| | - Carlotta Bertocchi
- a Psychiatry & Clinical Psychobiology , Division of Neuroscience, Scientific Institute Ospedale San Raffaele , Milano , Italy
| | - Francesco Benedetti
- a Psychiatry & Clinical Psychobiology , Division of Neuroscience, Scientific Institute Ospedale San Raffaele , Milano , Italy.,b University Vita-Salute San Raffaele , Milano , Italy
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14
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Mamah D, Ji A, Rutlin J, Shimony JS. White matter integrity in schizophrenia and bipolar disorder: Tract- and voxel-based analyses of diffusion data from the Connectom scanner. NEUROIMAGE-CLINICAL 2018; 21:101649. [PMID: 30639179 PMCID: PMC6411967 DOI: 10.1016/j.nicl.2018.101649] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/06/2018] [Accepted: 12/26/2018] [Indexed: 11/22/2022]
Abstract
Background Diffusion imaging abnormalities have been associated with schizophrenia (SZ) and bipolar disorder (BD), indicating impaired structural connectivity. Newer methods permit the automated reconstruction of major white matter tracts from diffusion-weighted MR images in each individual's native space. Using high-definition diffusion data from SZ and BP subjects, we investigated brain white matter integrity using both an automated tract-based and voxel-based methods. Methods Using a protocol matched to the NIH (Young-Adult) Human Connectome Project (and collected on the same customized ‘Connectom’ scanner), diffusion scans were acquired from 87 total participants (aged 18–30), grouped as SZ (n = 24), BD (n = 33) and healthy controls (n = 30). Fractional anisotropy (FA) of eighteen white matter tracks were analyzed using the TRACULA software. Voxel-wise statistical analyses of diffusion data was carried out using the tract-based spatial statistics (TBSS) software. TRACULA group effects and clinical correlations were investigated using analyses of variance and multiple regression. Results TRACULA analysis identified a trend towards lower tract FA in SZ patients, most significantly in the left anterior thalamic radiation (ATR; p = .04). TBSS results showed significantly lower FA voxels bilaterally within the cerebellum and unilaterally within the left ATR, posterior thalamic radiation, corticospinal tract, and superior longitudinal fasciculus in SZ patients compared to controls (FDR corrected p < .05). FA in BD patients did not significantly differ from controls using either TRACULA or TBSS. Multiple regression showed FA of the ATR as predicting chronic mania (p = .0005) and the cingulum-angular bundle as predicting recent mania (p = .02) in patients. TBSS showed chronic mania correlating with FA voxels within the left ATR and corpus callosum. Conclusions White matter abnormality in SZ varies in severity across different white matter tract regions. Our results indicate that voxel-based analysis of diffusion data is more sensitive than tract-based analysis in identifying such abnormalities. Absence of white matter abnormality in BD may be related to medication effects and age. Our study investigated white matter integrity in 87 young schizophrenia, bipolar disorder and control subjects with a tract-based (TRACULA) and a voxel-based (TBSS) approach, using high-definition diffusion imaging data obtained from the Human Connectome Project ‘Connectom’ scanner. TRACULA evaluated fractional anisotropy (FA) from 18 white matter tracts. TBSS evaluated regional white matter FA. TRACULA identified a trend towards lower tract FA in schizophrenia subjects across multiple tracts. TBSS results showed mainly unilaterally decreased FA voxels in schizophrenia subjects. FA in bipolar patients did not significantly differ from controls with either method. With TRACULA, multiple regression showed that anterior thalamic radiation FA predicted chronic affectivity and cingulum-angular bundle FA predicted recent mania in patients. With TBSS, chronic mania correlated with FA voxels within the left anterior thalamic radiation and corpus callosum.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States.
| | - Andrew Ji
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Jerrel Rutlin
- Department Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - Joshua S Shimony
- Department Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
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15
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Duarte JA, Massuda R, Goi PD, Vianna-Sulzbach M, Colombo R, Kapczinski F, Gama CS. White matter volume is decreased in bipolar disorder at early and late stages. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2018; 40:277-284. [DOI: 10.1590/2237-6089-2017-0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 01/11/2018] [Indexed: 11/21/2022]
Abstract
Abstract Introduction: Bipolar disorder (BD) is a debilitating mood condition that affects approximately 1.3% of people worldwide, although some studies report up to 3.9% lifetime prevalence and 4-6% in adults when broad diagnostic criteria are applied. Objective: To compare differences in total white matter (WM), corpus callosum (CC) and total gray matter (GM) volumes in patients with type I BD at early and late stages compared with controls. Methods: Fifty-five subjects were enrolled in this study protocol. The double case-control design included 14 patients with BD at early stage; 15 patients at late stage; and their respective matched controls (14 and 12 subjects). Results: CC and total WM volumes were significantly smaller in patients with BD at early and late stages vs. controls. There was no difference for total GM volume in the early stage group, but in patients at late stage total GM volume was significantly smaller than in controls. The total GM volume reduction in patients at late stage is in agreement with the neuroprogression theory of BD. The reduction of WM volumes in total WM and in the CC at early and late stages supports the possibility that an early demyelination process could occur underlying the clinical manifestation of BD. Conclusion: Our findings may direct to the investigation of WM abnormalities in populations at high risk to develop BD, perhaps as early biomarkers before the overt syndrome.
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Affiliation(s)
- Juliana A. Duarte
- Hospital de Clínicas de Porto Alegre, Brazil; Tomoclínica, Brazil; Universidade Federal do Rio Grande do Sul, Brazil
| | - Raffael Massuda
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Paraná, Brazil
| | - Pedro D. Goi
- Universidade Federal do Rio Grande do Sul, Brazil
| | | | - Rafael Colombo
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Paraná, Brazil; Universidade de Caxias do Sul, Brazil
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16
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Wang B, Li T, Zhou M, Zhao S, Niu Y, Wang X, Yan T, Cao R, Xiang J, Li D. The Abnormality of Topological Asymmetry in Hemispheric Brain Anatomical Networks in Bipolar Disorder. Front Neurosci 2018; 12:618. [PMID: 30233301 PMCID: PMC6129594 DOI: 10.3389/fnins.2018.00618] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/14/2018] [Indexed: 12/24/2022] Open
Abstract
Convergent evidences have demonstrated a variety of regional abnormalities of asymmetry in bipolar disorder (BD). However, little is known about the alterations in hemispheric topological asymmetries. In this study, we used diffusion tensor imaging to construct the hemispheric brain anatomical network of 49 patients with BD and 61 matched normal controls. Graph theory was then applied to quantify topological properties of the hemispheric networks. Although small-world properties were preserved in the hemispheric networks of BD, the degrees of the asymmetry in global efficiency, characteristic path length, and small-world property were significantly decreased. More changes in topological properties of the right hemisphere than those of left hemisphere were found in patients compared with normal controls. Consistent with such changes, the nodal efficiency in patients with BD also showed less rightward asymmetry mainly in the frontal, occipital, parietal, and temporal lobes. In contrast to leftward asymmetry, significant rightward asymmetry was found in supplementary motor area of BD, and attributed to more deficits in nodal efficiency of the left hemisphere. Finally, these asymmetry score of nodal efficiency in the inferior parietal lobule and rolandic operculum were significantly associated with symptom severity of BD. Our results suggested that abnormal hemispheric asymmetries in brain anatomical networks were associated with aberrant neurodevelopment, and providing insights into the potential neural biomarkers of BD by measuring the topological asymmetry in hemispheric brain anatomical networks.
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Affiliation(s)
- Bin Wang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Ting Li
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Mengni Zhou
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Shuo Zhao
- Faculty of Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yan Niu
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Xin Wang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Ting Yan
- Translational Medicine Research Center, Shanxi Medical University, Taiyuan, China
| | - Rui Cao
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Jie Xiang
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
| | - Dandan Li
- College of Information and Computer, Taiyuan University of Technology, Taiyuan, China
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Sartori JM, Reckziegel R, Passos IC, Czepielewski LS, Fijtman A, Sodré LA, Massuda R, Goi PD, Vianna-Sulzbach M, Cardoso TDA, Kapczinski F, Mwangi B, Gama CS. Volumetric brain magnetic resonance imaging predicts functioning in bipolar disorder: A machine learning approach. J Psychiatr Res 2018; 103:237-243. [PMID: 29894922 DOI: 10.1016/j.jpsychires.2018.05.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/30/2018] [Accepted: 05/24/2018] [Indexed: 12/14/2022]
Abstract
Neuroimaging studies have been steadily explored in Bipolar Disorder (BD) in the last decades. Neuroanatomical changes tend to be more pronounced in patients with repeated episodes. Although the role of such changes in cognition and memory is well established, daily-life functioning impairments bulge among the consequences of the proposed progression. The objective of this study was to analyze MRI volumetric modifications in BD and healthy controls (HC) as possible predictors of daily-life functioning through a machine learning approach. Ninety-four participants (35 DSM-IV BD type I and 59 HC) underwent clinical and functioning assessments, and structural MRI. Functioning was assessed using the Functioning Assessment Short Test (FAST). The machine learning analysis was used to identify possible candidates of regional brain volumes that could predict functioning status, through a support vector regression algorithm. Patients with BD and HC did not differ in age, education and marital status. There were significant differences between groups in gender, BMI, FAST score, and employment status. There was significant correlation between observed and predicted FAST score for patients with BD, but not for controls. According to the model, the brain structures volumes that could predict FAST scores were: left superior frontal cortex, left rostral medial frontal cortex, right white matter total volume and right lateral ventricle volume. The machine learning approach demonstrated that brain volume changes in MRI were predictors of FAST score in patients with BD and could identify specific brain areas related to functioning impairment.
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Affiliation(s)
- Juliana M Sartori
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Ramiro Reckziegel
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Leticia S Czepielewski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Adam Fijtman
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Leonardo A Sodré
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Raffael Massuda
- Departamento de Psiquiatria, Universidade Federal do Paraná, Rua Padre Camargo, 280 - 6º andar, 80060-240, Curitiba, Brazil
| | - Pedro D Goi
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Miréia Vianna-Sulzbach
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Taiane de Azevedo Cardoso
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil
| | - Flávio Kapczinski
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil; Department of Psychiatry and Behavioural Neurosciences, McMaster University, West 5th Campus, Administration - B3, 100 West 5th, Hamilton, ON L8N 3K7, Canada
| | - Benson Mwangi
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center, Houston, 1941 East Road, Houston, TX 77054, USA
| | - Clarissa S Gama
- Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Avenida Ramiro Barcelos, 2350, 90035-903, Porto Alegre, Brazil; Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2° andar, 90035-003, Porto Alegre, Brazil.
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18
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Ganzola R, McIntosh AM, Nickson T, Sprooten E, Bastin ME, Giles S, Macdonald A, Sussmann J, Duchesne S, Whalley HC. Diffusion tensor imaging correlates of early markers of depression in youth at high-familial risk for bipolar disorder. J Child Psychol Psychiatry 2018; 59:917-927. [PMID: 29488219 DOI: 10.1111/jcpp.12879] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Mood disorders are familial psychiatric diseases, in which patients show reduced white matter (WM) integrity. We sought to determine whether WM integrity was affected in young offspring at high-familial risk of mood disorder before they go on to develop major depressive disorder (MDD). METHODS The Bipolar Family study is a prospective longitudinal study examining young individuals (age 16-25 years) at familial risk of mood disorder on three occasions 2 years apart. This study used baseline imaging data, categorizing groups according to clinical outcome at follow-up. Diffusion tensor MRI data were acquired for 61 controls and 106 high-risk individuals, the latter divided into 78 high-risk subjects who remained well throughout the study ('high-risk well') and 28 individuals who subsequently developed MDD ('high-risk MDD'). Voxel-wise between-group comparison of fractional anisotropy (FA) based on diagnostic status was performed using tract-based spatial statistics (TBSS). RESULTS Compared to controls, both high-risk groups showed widespread decreases in FA (pcorr < .05) at baseline. Although FA in the high-risk MDD group negatively correlated with subthreshold depressive symptoms at the time of scanning (pcorr < .05), there were no statistically significant differences at p-corrected levels between the two high-risk groups. CONCLUSIONS These results suggest that decreased FA is related to the presence of familial risk for mood disorder along with subdiagnostic symptoms at the time of scanning rather than predictive of subsequent diagnosis. Due to the difficulties performing such longitudinal prospective studies, we note, however, that this latter analysis may be underpowered due to sample size within the high-risk MDD group. Further clinical follow-up may clarify these findings.
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Affiliation(s)
- Rossana Ganzola
- Centre de Recherche CERVO, Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
| | | | - Thomas Nickson
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Emma Sprooten
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mark E Bastin
- Centre for Clinical Brain Sciences, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - Stephen Giles
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | - Alix Macdonald
- Division of Psychiatry, University of Edinburgh, Edinburgh, UK
| | | | - Simon Duchesne
- Centre de Recherche CERVO, Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada.,Départment de Radiologie, Faculté de Médecine, Université Laval, Québec, QC, Canada
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19
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Weathers J, Lippard ETC, Spencer L, Pittman B, Wang F, Blumberg HP. Longitudinal Diffusion Tensor Imaging Study of Adolescents and Young Adults With Bipolar Disorder. J Am Acad Child Adolesc Psychiatry 2018; 57:111-117. [PMID: 29413143 PMCID: PMC5806147 DOI: 10.1016/j.jaac.2017.11.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/04/2017] [Accepted: 11/21/2017] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Longitudinal neuroimaging during adolescence/young adulthood, when bipolar disorder (BD) commonly emerges, can help elucidate the neurodevelopmental pathophysiology of BD. Adults with BD have shown reduced structural integrity in the uncinate fasciculus (UF), a white matter (WM) tract providing major connections between the amygdala and ventral prefrontal cortex (vPFC), important in emotion regulation. In this longitudinal diffusion tensor imaging (DTI) study of adolescents/young adults, we hypothesized differences in age- and time-related changes in UF integrity in BD compared to healthy controls (HC). METHOD Two DTI scans were obtained in 27 adolescents/young adults with BD and 37 HC adolescents/young adults, on average approximately 2.5 years apart. Interactions between diagnosis with age and with time for UF fractional anisotropy (FA) were assessed. Exploratory analyses were performed including euthymic-only participants with BD, and for potential influences of demographic and clinical factors. Whole-brain analyses were performed to explore for interactions in other regions. RESULTS There were significant interactions between diagnosis with age and with time for UF FA (p < .05). Healthy control adolescents/young adults showed significant UF FA increases with age and over time (p < .05), whereas no significant changes with age or over time were observed in the adolescents/young adults with BD. Significant interactions with age and time were also observed in analyses including euthymic-only participants with BD (p < .05). CONCLUSION These findings provide neuroimaging evidence supporting differences in UF WM structural development during adolescence/young adulthood, suggesting that differences in the development of an amygdala-vPFC system subserving emotion regulation may be a trait feature of BD neurodevelopment.
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Affiliation(s)
- Judah Weathers
- Yale School of Medicine, New Haven, CT; Yale Child Study Center, New Haven
| | - Elizabeth T C Lippard
- Yale School of Medicine, New Haven, CT; Dell Medical School, University of Texas at Austin, TX
| | | | | | - Fei Wang
- Yale School of Medicine, New Haven, CT; First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hilary P Blumberg
- Yale School of Medicine, New Haven, CT; Yale Child Study Center, New Haven.
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20
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Tendolkar I, Mårtensson J, Kühn S, Klumpers F, Fernández G. Physical neglect during childhood alters white matter connectivity in healthy young males. Hum Brain Mapp 2017; 39:1283-1290. [PMID: 29250891 DOI: 10.1002/hbm.23916] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Childhood adversity (CA) leads to greater vulnerability for psychopathology by causing structural as well as functional brain abnormalities. Recent findings on gray matter effects point towards the importance of identifying CA outcome as a function of different CA types, varying in the dimensions of threat and deprivation. Using diffusion tensor imaging, we investigate whether different forms of CA impact differently on white matter connectivity in a healthy cohort not confounded by other aspects of disease. METHODS In 120 healthy young males, we assessed different forms of maltreatment during childhood with the Childhood Trauma Questionnaire (CTQ). Fractional anisotropy (FA) and mean diffusivity (MD) images were generated and projected onto a white matter skeleton using tract-based spatial statistics. Correlational analysis between FA, MD, and CTQ subscores was then performed using voxelwise statistics. RESULTS Of all CTQ-subscores, only physical neglect (PN) predicted a decrease of FA but not MD in the bilateral anterior thalamic radiation around the middle frontal gyrus and the right inferior fronto-occipital fasciculus, the inferior longitudinal fasciculus, the cingulum and precuneus. Reduced FA in the posterior cingulum was related to the effects of PN during childhood on anxiety levels at trend level. CONCLUSIONS PN may have severe consequences and should be considered equally important to more active forms of abuse. FA changes, particularly in the cingulum, actually appear to a functional consequence and are linked to trait anxiety, a personality dimension that is suggested to be a transdiagnostic risk factor of affective disorders. Potentially this reveals a mechanistic chain that forms one pathyway from CA to disease.
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Affiliation(s)
- Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Simone Kühn
- Max-Planck Institute for Human Development, Berlin, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Floris Klumpers
- Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands.,Experimental Psychopathology and Treatment Section, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Guillén Fernández
- Donders Institute for Brain Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Dong D, Wang Y, Chang X, Jiang Y, Klugah-Brown B, Luo C, Yao D. Shared abnormality of white matter integrity in schizophrenia and bipolar disorder: A comparative voxel-based meta-analysis. Schizophr Res 2017; 185:41-50. [PMID: 28082140 DOI: 10.1016/j.schres.2017.01.005] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/06/2016] [Accepted: 01/03/2017] [Indexed: 01/04/2023]
Abstract
Patients with schizophrenia and bipolar disorder (BD) shared a significant overlap in genetic susceptibility, pharmacological treatment responses, neuropsychological deficits, and epidemiological features. However, it remains unknown whether these clinical overlaps are mediated by shared or disorder-specific abnormalities of white matter integrity. In this voxel-based meta-analytic comparison of whole-brain white matter integrity, we aimed to identify the shared or disorder-specific structural abnormalities between schizophrenia and BD. A comprehensive literature search was conducted up to February 2016 to identify studies that compared between patients and healthy controls (HC) by using whole-brain diffusion approach (schizophrenia: 24 datasets with 754 patients vs. 775 HC; BD: 23 datasets with 705 patients vs. 679 HC). Voxel-wise meta-analyses were conducted and restricted to unified template using seed-based d-Mapping. Abnormal white matter integrity was calculated within each condition and a direct comparison of effect size was performed of alterations between two conditions. Two regions with significant reductions of fractional anisotropy (FA) characterized abnormal water diffusion in both disorders: the genu of the corpus callosum (CC) and posterior cingulum fibers. There was no significant difference found between the two disorders. Our results highlighted shared impairments of FA at genu of the CC and left posterior cingulum fibers, which suggests that, phenotypic overlap between schizophrenia and BD could be related to common brain circuit dysfunction.
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Affiliation(s)
- Debo Dong
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Yulin Wang
- Faculty of Psychological and Educational Sciences, Department of Experimental and Applied Psychology, Research Group of Biological Psychology, Vrije Universiteit Brussel, Brussels 1040, Belgium; Faculty of Psychology and Educational Sciences, Department of Data Analysis, Ghent University, Henri Dunantlaan 2, Ghent B-9000, Belgium.
| | - Xuebin Chang
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Yuchao Jiang
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Benjamin Klugah-Brown
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Cheng Luo
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.
| | - Dezhong Yao
- Key Laboratory for NeuroInformation of Ministry of Education, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, Center for Information in Medicine, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 611731, China.
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22
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Dev SI, Nguyen TT, McKenna BS, Sutherland AN, Bartsch H, Theilmann RJ, Eyler LT. Steeper Slope of Age-Related Changes in White Matter Microstructure and Processing Speed in Bipolar Disorder. Am J Geriatr Psychiatry 2017; 25:744-752. [PMID: 28342644 PMCID: PMC5479871 DOI: 10.1016/j.jagp.2017.02.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Bipolar disorder (BD) is associated with compromised white matter (WM) integrity and deficits in processing speed (PS). Few studies, however, have investigated age relationships with WM structure and cognition to understand possible changes in brain health over the lifespan. This investigation explored whether BD and healthy counterpart (HC) participants exhibited differential age-related associations with WM and cognition, which may be suggestive of accelerated brain and cognitive aging. DESIGN Cross-sectional study. SETTING University of California San Diego and the Veterans Administration San Diego Healthcare System. PARTICIPANTS 33 euthymic BD and 38 HC participants. MEASUREMENTS Diffusion tensor imaging was acquired as a measure of WM integrity, and tract-specific fractional anisotropy (FA) was extracted utilizing the Johns Hopkins University probability atlas. PS was assessed with the Number and Letter Sequencing conditions of the Delis-Kaplan Executive Function System Trail Making Test. RESULTS BD participants demonstrated slower PS compared with the HC group, but no group differences were found in FA across tracts. Multiple linear regressions revealed a significant group-by-age interaction for the right uncinate fasciculus, the left hippocampal portion of the cingulum, and for PS, such that older age was associated with lower FA values and slower PS in the BD group only. The relationship between age and PS did not significantly change after accounting for uncinate FA, suggesting that the observed age associations occur independently. CONCLUSIONS Results provide support for future study of the accelerated aging hypothesis by identifying markers of brain health that demonstrate a differential age association in BD.
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Affiliation(s)
- Sheena I. Dev
- Research Service, Veterans Affairs San Diego Healthcare system, San Diego, California,Department of Psychiatry, University of California, San Diego,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Tanya T. Nguyen
- Department of Psychiatry, University of California, San Diego,VA San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center (MIRECC), San Diego, California
| | | | - Ashley N. Sutherland
- Research Service, Veterans Affairs San Diego Healthcare system, San Diego, California,Department of Psychiatry, University of California, San Diego
| | - Hauke Bartsch
- Department of Radiology, University of California, San Diego
| | | | - Lisa T. Eyler
- Research Service, Veterans Affairs San Diego Healthcare system, San Diego, California,Department of Psychiatry, University of California, San Diego,San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
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23
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Mazza E, Poletti S, Bollettini I, Locatelli C, Falini A, Colombo C, Benedetti F. Body mass index associates with white matter microstructure in bipolar depression. Bipolar Disord 2017; 19:116-127. [PMID: 28418197 DOI: 10.1111/bdi.12484] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Obesity has been reported in over 60% of bipolar disorder (BD) patients. It worsens the severity of illness, and influences cognition and functional outcomes. White matter (WM) abnormalities are one of the most consistently reported findings in neuroimaging studies of BD. We hypothesized that body mass index (BMI) could correlate with WM integrity in bipolar patients. METHODS We evaluated BMI in a sample of 164 depressed patients affected by BD. We performed whole-brain tract-based spatial statistics with threshold-free cluster enhancement for the diffusion tensor imaging (DTI) measures of WM integrity: fractional anisotropy; axial, radial, and mean diffusivity. RESULTS We observed that BMI was associated with DTI measures of WM integrity in several fiber tracts: anterior corona radiata, anterior thalamic radiation, inferior fronto-occipital fasciculus and corpus callosum. CONCLUSIONS The association of BMI in key WM tracts that are crucial to mood regulation and neurocognitive functioning suggests that BMI might contribute to the pathophysiology of BD through a detrimental action on structural connectivity in critical cortico-limbic networks.
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Affiliation(s)
- Elena Mazza
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Sara Poletti
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Irene Bollettini
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Clara Locatelli
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Falini
- C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy.,Department of Neuroradiology, Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Cristina Colombo
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Department of Clinical Neurosciences, Scientific Institute Ospedale San Raffaele, Milan, Italy.,C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
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24
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Haarman BCM'B, Riemersma-Van der Lek RF, Burger H, de Groot JC, Drexhage HA, Nolen WA, Cerliani L. Diffusion tensor imaging in euthymic bipolar disorder - A tract-based spatial statistics study. J Affect Disord 2016; 203:281-291. [PMID: 27317921 DOI: 10.1016/j.jad.2016.05.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/22/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In the current DTI study we compared euthymic bipolar I disorder (BD-I) patients and healthy controls (HC). We subsequently divided the total patient group into lithium-users and non-lithium-users and estimated differences across the three groups. METHODS Twenty-one euthymic BD-I patients and twenty-two HC participants were included in psychiatric interviews and MRI image acquisition (diffusion-weighted (DW) and T1-weighted scans). Fractional anisotropy (FA), radial, mean and axial diffusivity (RD, MD, AD) were estimated from the DW data, using DTI. These measures were then compared between groups using FSL Tract Based Spatial Statistics (TBSS). Correlations with age at onset, number of episodes and depression score were analyzed. RESULTS A difference in FA, MD, RD and AD between the whole sample of euthymic BD-I patients and healthy controls could not be detected. Amongst others, lithium-using patients demonstrated a higher FA and lower RD when compared to non-lithium-using BD-I patients in the corpus callosum and left anterior corona radiata. Widespread clusters demonstrated negative FA associations and positive RD and MD associations with minor depressive symptoms. LIMITATIONS Patients were naturalistically treated. Although the sample size is comparable to several other DTI studies, a larger sample size would have been benificial. TBSS and DTI have their own limitations. CONCLUSION Our findings support the theory that previously described DTI-based microstructural differences between HC and BD patients could be less pronounced in euthymic BD patients. Differences in FA between patients using and not using lithium suggest a counteracting effect of lithium on white matter microstructural disturbances.
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Affiliation(s)
- Bartholomeus C M 'Benno' Haarman
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands; Radiology Morphological Solutions, Berkel en Rodenrijs, The Netherlands.
| | - Rixt F Riemersma-Van der Lek
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Huibert Burger
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, The Netherlands
| | - Jan Cees de Groot
- University of Groningen, University Medical Center Groningen, Department of Radiology, Groningen, The Netherlands
| | - Hemmo A Drexhage
- Erasmus MC, Department of Immunology, Rotterdam, The Netherlands
| | - Willem A Nolen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands
| | - Leonardo Cerliani
- University of Groningen, Neuroimaging Center, Groningen, The Netherlands; Institute du Cerveau et de la Moelle épinière, Paris, France
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25
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Jenkins LM, Barba A, Campbell M, Lamar M, Shankman SA, Leow AD, Ajilore O, Langenecker SA. Shared white matter alterations across emotional disorders: A voxel-based meta-analysis of fractional anisotropy. NEUROIMAGE-CLINICAL 2016; 12:1022-1034. [PMID: 27995068 PMCID: PMC5153602 DOI: 10.1016/j.nicl.2016.09.001] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 02/02/2023]
Abstract
Background White matter (WM) integrity may represent a shared biomarker for emotional disorders (ED). Aims: To identify transdiagnostic biomarkers of reduced WM by meta-analysis of findings across multiple EDs. Method Web of Science was searched systematically for studies of whole brain analysis of fractional anisotropy (FA) in adults with major depressive disorder, bipolar disorder, social anxiety disorder, obsessive-compulsive disorder or posttraumatic stress disorder compared with a healthy control (HC) group. Peak MNI coordinates were extracted from 37 studies of voxel-based analysis (892 HC and 962 with ED) and meta-analyzed using seed-based d Mapping (SDM) Version 4.31. Separate meta-analyses were also conducted for each disorder. Results In the transdiagnostic meta-analysis, reduced FA was identified in ED studies compared to HCs in the left inferior fronto-occipital fasciculus, forceps minor, uncinate fasciculus, anterior thalamic radiation, superior corona radiata, bilateral superior longitudinal fasciculi, and cerebellum. Disorder-specific meta-analyses revealed the OCD group had the most similarities in reduced FA to other EDs, with every cluster of reduced FA overlapping with at least one other diagnosis. The PTSD group was the most distinct, with no clusters of reduced FA overlapping with any other diagnosis. The BD group were the only disorder to show increased FA in any region, and showed a more bilateral pattern of WM changes, compared to the other groups which tended to demonstrate a left lateralized pattern of FA reductions. Conclusions Distinct diagnostic categories of ED show commonalities in WM tracts with reduced FA when compared to HC, which links brain networks involved in cognitive and affective processing. This meta-analysis facilitates an increased understanding of the biological markers that are shared by these ED. A meta-analysis of FA in MDD, bipolar, social anxiety disorder, OCD and PTSD Reduced FA in left superior longitudinal and inferior fronto-occipital fasciculi Distinct diagnostic categories show commonalities of white matter changes. Differences among diagnostic categories also found, PTSD most distinct White matter integrity may be a shared biomarker for emotional disorders.
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Affiliation(s)
| | - Alyssa Barba
- The University of Illinois at Chicago, Department of Psychiatry
| | | | - Melissa Lamar
- The University of Illinois at Chicago, Department of Psychiatry
| | | | - Alex D Leow
- The University of Illinois at Chicago, Department of Psychiatry
| | - Olusola Ajilore
- The University of Illinois at Chicago, Department of Psychiatry
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Knöchel C, Schmied C, Linden DEJ, Stäblein M, Prvulovic D, de A de Carvalho L, Harrison O, Barros PO, Carvalho AF, Reif A, Alves GS, Oertel-Knöchel V. White matter abnormalities in the fornix are linked to cognitive performance in SZ but not in BD disorder: An exploratory analysis with DTI deterministic tractography. J Affect Disord 2016; 201:64-78. [PMID: 27177298 DOI: 10.1016/j.jad.2016.03.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND In psychosis, white matter (WM) microstructural changes have been detected previously; however, direct comparisons of findings between bipolar (BD) and schizophrenia (SZ) patients are scarce. In this study, we employed deterministic tractography to reconstruct WM tracts in BD and SZ patients. METHODS Diffusion tensor imaging (DTI) data was carried out with n=32 euthymic BD type I patients, n=26 SZ patients and 30 matched healthy controls. Deterministic tractography using multiple indices of diffusion (fractional anisotropy (FA), tract volume (Vol), tract length (Le) and number of tracts (NofT)) were obtained from the fornix, the cingulum, the anterior thalamic radiation, and the corpus callosum bilaterally. RESULTS We showed widespread WM microstructural changes in SZ, and changes in the corpus callosum, the left cingulum and the fornix in BD. Fornix fiber tracking scores were associated with cognitive performance in SZ, and with age and age at disease onset in the BD patient group. LIMITATIONS Although the influence of psychopharmacological drugs as biasing variables on morphological alterations has been discussed for SZ and BD, we did not observe a clear influence of drug exposure on our findings. CONCLUSIONS These results confirm the assumption that SZ patients have more severe WM changes than BD patients. The findings also suggest a major role of WM changes in the fornix as important fronto-limbic connections in the etiology of cognitive symptoms in SZ, but not in BD.
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Affiliation(s)
- Christian Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany.
| | - Claudia Schmied
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - David E J Linden
- MRC Centre for Neuropsychiatric Genetics & Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, United Kingdom
| | - Michael Stäblein
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - David Prvulovic
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Luiza de A de Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Octavia Harrison
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany; Brain Imaging Center, Goethe Univ., Frankfurt/Main, Germany
| | - Paulo O Barros
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - André F Carvalho
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Andreas Reif
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
| | - Gilberto S Alves
- Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Viola Oertel-Knöchel
- Laboratory for Neuroimaging, Dept. of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe Univ., Frankfurt/Main, Germany
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Souza-Queiroz J, Boisgontier J, Etain B, Poupon C, Duclap D, d'Albis MA, Daban C, Hamdani N, Le Corvoisier P, Delavest M, Bellivier F, Guevara P, Leboyer M, Henry C, Houenou J. Childhood trauma and the limbic network: a multimodal MRI study in patients with bipolar disorder and controls. J Affect Disord 2016; 200:159-64. [PMID: 27136413 DOI: 10.1016/j.jad.2016.04.038] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/16/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Childhood trauma (CT) is a major risk factor for psychiatric conditions. It is hypothesized that CT effects are mediated by the limbic system. Few multimodal neuroimaging studies allow an integrated perspective of this impact. Our goal was thus to study the effects of CT on the limbic network. METHODS We acquired multimodal MRI (T1, diffusion weighted, and resting state fMRI) data from 79 subjects (47 healthy controls and 32 patients with bipolar disorder, BD). We performed correlational analyses between Childhood Trauma Questionnaire (sub)scores (physical and emotional abuse/neglect and sexual abuse) and anatomo-functional measurements of the limbic network (hippocampal and amygdala volumes, prefronto-limbic functional connectivity, uncinate fractional anisotropy). RESULTS We found CTQ total scores to be negatively correlated with amygdala volume, prefronto-limbic functional connectivity (FC) and uncinate fractional anisotropy in our sample. Considering subscores, neglects (physical and emotional) were the only to affect neural parameters. The patients with BD drove most of the results. LIMITATIONS Small sample size and low level of trauma in controls. CONCLUSIONS Our multimodal approach enabled an integrated view of the long-term effects of CT on the limbic system.
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Affiliation(s)
- Julia Souza-Queiroz
- CAPES Foundation, Ministry of Education of Brazil, Brasília/DF 70040-020, Brazil; Fondation FondaMental, Créteil, France; INSERM, U955, équipe 15 "Psychiatrie Translationnelle", IMRB, Créteil, France
| | - Jennifer Boisgontier
- AP-HP, Hôpitaux H. Mondor, DHU PePsy, Pôle de Psychiatrie, Créteil, France; Faculté de Médecine, Université Paris Est, Créteil, France; Fondation FondaMental, Créteil, France; INSERM, U955, équipe 15 "Psychiatrie Translationnelle", IMRB, Créteil, France; Neurospin, UNIACT Lab, Psychiatry Team, CEA Saclay, Gif sur Yvette, France
| | - Bruno Etain
- AP-HP, Hôpitaux H. Mondor, DHU PePsy, Pôle de Psychiatrie, Créteil, France; Faculté de Médecine, Université Paris Est, Créteil, France; Fondation FondaMental, Créteil, France; INSERM, U955, équipe 15 "Psychiatrie Translationnelle", IMRB, Créteil, France
| | - Cyril Poupon
- Neurospin, UNIRS Lab, CEA Saclay, Gif Sur Yvette, France
| | | | - Marc-Antoine d'Albis
- AP-HP, Hôpitaux H. Mondor, DHU PePsy, Pôle de Psychiatrie, Créteil, France; Faculté de Médecine, Université Paris Est, Créteil, France; Fondation FondaMental, Créteil, France; INSERM, U955, équipe 15 "Psychiatrie Translationnelle", IMRB, Créteil, France; Neurospin, UNIACT Lab, Psychiatry Team, CEA Saclay, Gif sur Yvette, France
| | - Claire Daban
- AP-HP, Hôpitaux H. Mondor, DHU PePsy, Pôle de Psychiatrie, Créteil, France; Faculté de Médecine, Université Paris Est, Créteil, France; Fondation FondaMental, Créteil, France; INSERM, U955, équipe 15 "Psychiatrie Translationnelle", IMRB, Créteil, France
| | - Nora Hamdani
- AP-HP, Hôpitaux H. Mondor, DHU PePsy, Pôle de Psychiatrie, Créteil, France; Faculté de Médecine, Université Paris Est, Créteil, France; Fondation FondaMental, Créteil, France; INSERM, U955, équipe 15 "Psychiatrie Translationnelle", IMRB, Créteil, France
| | | | - Marine Delavest
- Fondation FondaMental, Créteil, France; Inserm, Université Paris Diderot, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France
| | - Frank Bellivier
- Fondation FondaMental, Créteil, France; Inserm, Université Paris Diderot, UMR-S 1144, Paris, France; AP-HP, GH Saint-Louis - Lariboisière - Fernand Widal, Pôle Neurosciences, Paris, France
| | - Pamela Guevara
- Faculty of Engineering, University of Concepción, Concepción, Chile
| | - Marion Leboyer
- AP-HP, Hôpitaux H. Mondor, DHU PePsy, Pôle de Psychiatrie, Créteil, France; Faculté de Médecine, Université Paris Est, Créteil, France; Fondation FondaMental, Créteil, France; INSERM, U955, équipe 15 "Psychiatrie Translationnelle", IMRB, Créteil, France
| | - Chantal Henry
- AP-HP, Hôpitaux H. Mondor, DHU PePsy, Pôle de Psychiatrie, Créteil, France; Faculté de Médecine, Université Paris Est, Créteil, France; Fondation FondaMental, Créteil, France; INSERM, U955, équipe 15 "Psychiatrie Translationnelle", IMRB, Créteil, France; Institut Pasteur, Unité Perception et Mémoire, F-75015 Paris, France
| | - Josselin Houenou
- AP-HP, Hôpitaux H. Mondor, DHU PePsy, Pôle de Psychiatrie, Créteil, France; Faculté de Médecine, Université Paris Est, Créteil, France; Fondation FondaMental, Créteil, France; INSERM, U955, équipe 15 "Psychiatrie Translationnelle", IMRB, Créteil, France; Neurospin, UNIACT Lab, Psychiatry Team, CEA Saclay, Gif sur Yvette, France.
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Sarıçiçek A, Zorlu N, Yalın N, Hıdıroğlu C, Çavuşoğlu B, Ceylan D, Ada E, Tunca Z, Özerdem A. Abnormal white matter integrity as a structural endophenotype for bipolar disorder. Psychol Med 2016; 46:1547-1558. [PMID: 26947335 DOI: 10.1017/s0033291716000180] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several lines of evidence suggest that bipolar disorder (BD) is associated with white matter (WM) pathology. Investigation of unaffected first-degree relatives of BD patients may help to distinguish structural biomarkers of genetic risk without the confounding effects of burden of illness, medication or clinical state. In the present study, we applied tract-based spatial statistics to study WM changes in patients with BD, unaffected siblings and controls. METHOD A total of 27 euthymic patients with BD type I, 20 unaffected siblings of bipolar patients and 29 healthy controls who did not have any current or past diagnosis of Axis I psychiatric disorders were enrolled in the study. RESULTS Fractional anisotropy (FA) was significantly lower in BD patients than in the control group in the corpus callosum, fornix, bilateral superior longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, anterior thalamic radiation, posterior thalamic radiation, cingulum, uncinate fasciculus, superior corona radiata, anterior corona radiata and left external capsule. In region-of-interest (ROI) analyses, we found that both unaffected siblings and bipolar patients had significantly reduced FA in the left posterior thalamic radiation, the left sagittal stratum, and the fornix compared with healthy controls. Average FA for unaffected siblings was intermediate between the healthy controls and bipolar patients within these ROIs. CONCLUSIONS Decreased FA in the fornix, left posterior thalamic radiation and left sagittal stratum in both bipolar patients and unaffected siblings may represent a potential structural endophenotype or a trait-based marker for BD.
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Affiliation(s)
- A Sarıçiçek
- Department of Psychiatry,Faculty of Medicine,Izmir Katip Celebi University,Ataturk Training and Research Hospital,Izmir,Turkey
| | - N Zorlu
- Department of Psychiatry,Faculty of Medicine,Izmir Katip Celebi University,Ataturk Training and Research Hospital,Izmir,Turkey
| | - N Yalın
- Department of Neuroscience,Health Sciences Institute,Dokuz Eylul University,Izmir,Turkey
| | - C Hıdıroğlu
- Department of Neuroscience,Health Sciences Institute,Dokuz Eylul University,Izmir,Turkey
| | - B Çavuşoğlu
- Department of Neuroscience,Health Sciences Institute,Dokuz Eylul University,Izmir,Turkey
| | - D Ceylan
- Department of Neuroscience,Health Sciences Institute,Dokuz Eylul University,Izmir,Turkey
| | - E Ada
- Department of Radiology,Faculty of Medicine,Dokuz Eylul University,Izmir,Turkey
| | - Z Tunca
- Department of Neuroscience,Health Sciences Institute,Dokuz Eylul University,Izmir,Turkey
| | - A Özerdem
- Department of Neuroscience,Health Sciences Institute,Dokuz Eylul University,Izmir,Turkey
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29
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Scholz V, Houenou J, Kollmann B, Duclap D, Poupon C, Wessa M. Dysfunctional decision-making related to white matter alterations in bipolar I disorder. J Affect Disord 2016; 194:72-9. [PMID: 26803778 DOI: 10.1016/j.jad.2015.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 10/31/2015] [Accepted: 12/12/2015] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study investigated how frontal white matter (WM) alterations in patients with bipolar I disorder (BD-I) are linked to motivational dysregulation, often reported in the form of risk-taking and impulsivity, and whether structure-function relations in patients might differ from healthy subjects (HC). METHOD We acquired diffusion data from 24 euthymic BD-I patients and 24 controls, to evaluate WM integrity of selected frontal tracts. Risk-taking was assessed by the Cambridge Gambling Task and impulsivity by self-report with the Barratt-Impulsiveness Scale. RESULTS BD-I patients displayed significantly lower integrity in the right cingulum compared to HC. They also showed more risk-taking behavior and reported increased trait-impulsivity. Risk-taking was negatively associated with WM integrity in the right cingulum. Impulsivity was not related to WM integrity in investigated tracts. Together with age and sex, FA in the cingulum explained 25% of variance in risk-taking scores in all study participants. The left inferior fronto-occipital fasciculus (IFOF) was specifically predictive of risk-taking behavior in BD-I patients, but not in HC. LIMITATIONS The employed parameters did not allow us to specify the exact origin of WM changes, nor did the method allow the analysis of specific brain subregions. Also, sample size was moderate and the sample included patients with lifetime alcohol dependence/abuse, hence effects found need replication and have to be interpreted with caution. CONCLUSION Our results further strengthen recent models linking structural changes in frontal networks to behavioral markers of BD-I. They extend recent findings by showing that risk-taking is also linked to the cingulum in BD-I and HC, while other prefrontal tracts (IFOF) are specifically implicated in risk-taking behavior in BD-I patients. Meanwhile, self-reported impulsivity was not associated with WM integrity of the tracts investigated in our study.
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Affiliation(s)
- Vanessa Scholz
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Josselin Houenou
- UNIACT, Psychiatry Team, NeuroSpin, I2BM, CEA Saclay, Gif-Sur-Yvette, France; Inserm U955, Equipe 15 "Psychiatrie translationnelle", APHP, CHU Mondor, DHU PePsy, Université Paris Est, Fondamental Foundation, Créteil, France
| | - Bianca Kollmann
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | | | - Cyril Poupon
- Neurospin, UNIRS Lab, CEA Saclay, Gif Sur Yvette, France
| | - Michèle Wessa
- Department of Clinical Psychology and Neuropsychology, Institute for Psychology, Johannes Gutenberg-University of Mainz, Mainz, Germany; Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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30
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Duarte JA, de Araújo e Silva JQ, Goldani AA, Massuda R, Gama CS. Neurobiological underpinnings of bipolar disorder focusing on findings of diffusion tensor imaging: a systematic review. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2016; 38:167-75. [PMID: 27007148 PMCID: PMC7111360 DOI: 10.1590/1516-4446-2015-1793] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 09/02/2015] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To review the available data on diffusion tensor imaging (DTI) of subjects with bipolar disorder (BD), with a particular focus on fractional anisotropy (FA) in white matter (WM) tracts. METHODS The PubMed/MEDLINE database was searched for relevant articles, which were included in a systematic review of the literature. FA reductions and WM abnormalities were divided anatomically into three groups: commissural tracts, association tracts, and projection tracts. RESULTS Eighteen studies met the inclusion criteria. The corpus callosum was the main impaired commissural tract as demonstrated by FA reductions. Five studies reported FA reductions in the cingulum. Two studies reported decreased FA in the anterior thalamic radiation, and one in the corticospinal tract. Conversely, three studies found increased FA values in WM tracts involved in BD pathophysiology. CONCLUSION Despite considerable heterogeneity, these results indicate a direct link between executive cognitive functioning and abnormal WM microstructural integrity of fronto-limbic tracts in patients with remitted BD, providing further evidence of the neuronal disruption that underlies BD symptomatology.
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Affiliation(s)
- Juliana A. Duarte
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia – Medicina Translacional (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- Departamento de Radiologia e Ressonância Magnética, HCPA, Porto Alegre, RS, Brazil
- Tomoclínica, Canoas, RS, Brazil
| | | | - André A. Goldani
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia – Medicina Translacional (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Raffael Massuda
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia – Medicina Translacional (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
- UFRGS, Porto Alegre, RS, Brazil
- Departamento de Psiquiatria, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Clarissa S. Gama
- Laboratório de Psiquiatria Molecular, Instituto Nacional de Ciência e Tecnologia – Medicina Translacional (INCT-TM), Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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31
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Magioncalda P, Martino M, Conio B, Piaggio N, Teodorescu R, Escelsior A, Marozzi V, Rocchi G, Roccatagliata L, Northoff G, Inglese M, Amore M. Patterns of microstructural white matter abnormalities and their impact on cognitive dysfunction in the various phases of type I bipolar disorder. J Affect Disord 2016; 193:39-50. [PMID: 26766032 DOI: 10.1016/j.jad.2015.12.050] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/30/2015] [Accepted: 12/24/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND In recent years, diffusion tensor imaging (DTI) studies have detected subtle microstructural abnormalities of white matter (WM) in type I bipolar disorder (BD). However, WM alterations in the different phases of BD remain to be explored. The aims of this study is to investigate the WM alterations in the various phases of illness and their correlations with clinical and neurocognitive features. METHODS We investigated the DTI-derived fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) in patients with type I BD (n=61) subdivided in manic (n=21), depressive (n=20) and euthymic phases (n=20) vs. healthy controls (n=42), using a tract-based spatial statistics (TBSS) approach. Then, we investigated whether the subgroups of patients in the various phases of illness present different patterns of WM abnormalities. Finally we studied the correlations between WM alterations and clinical-cognitive parameters. RESULTS We found a widespread alteration in WM microstructure (decrease in FA and increase in MD and RD) in BD when compared to controls. The various subgroups of BD showed different spatial patterns of WM alterations. A gradient of increasing WM abnormalities from the euthymic (low degree and localized WM alterations mainly in the midline structures) to the manic (more diffuse WM alterations affecting both midline and lateral structures) and, finally, to the depressive phase (high degree and widespread WM alterations), was found. Furthermore, the WM diffuse alterations correlated with cognitive deficits in BD, such as decreased fluency prompted by letter and decreased hits and increased omission errors at the continuous performance test. LIMITATIONS Patients under treatment. CONCLUSIONS The WM alterations in type I BD showed different spatial patterns in the various phases of illness, mainly affecting the active phases, and correlated with some cognitive deficits. This suggests a complex trait- and state-dependent pathogenesis of WM abnormalities in BD.
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Affiliation(s)
- Paola Magioncalda
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Matteo Martino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Benedetta Conio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Niccolò Piaggio
- Department of Radiology, Section of Neuroradiology, University of Genoa, Genoa, Italy.
| | - Roxana Teodorescu
- Department of Neurology, Radiology and Neuroscience, Mount Sinai School of Medicine, New York, USA.
| | - Andrea Escelsior
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Valentina Marozzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Giulio Rocchi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
| | - Luca Roccatagliata
- Magnetic Resonance Research Center on Nervous System Diseases, University of Genoa, Genoa, Italy.
| | - Georg Northoff
- Institute of Mental Health Research, University of Ottawa, Ottawa, Canada; Taipei Medical University, Graduate Institute of Humanities in Medicine, Taipei, Taiwan; Taipei Medical University-Shuang Ho Hospital, Brain and Consciousness Research Center, New Taipei City, Taiwan; National Chengchi University, Research Center for Mind, Brain and Learning, Taipei, Taiwan; Centre for Cognition and Brain Disorders (CCBD), Normal University Hangzhou, Hangzhou, China.
| | - Matilde Inglese
- Department of Neurology, Radiology and Neuroscience, Mount Sinai School of Medicine, New York, USA; Magnetic Resonance Research Center on Nervous System Diseases, University of Genoa, Genoa, Italy.
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy.
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32
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Wise T, Radua J, Nortje G, Cleare AJ, Young AH, Arnone D. Voxel-Based Meta-Analytical Evidence of Structural Disconnectivity in Major Depression and Bipolar Disorder. Biol Psychiatry 2016; 79:293-302. [PMID: 25891219 DOI: 10.1016/j.biopsych.2015.03.004] [Citation(s) in RCA: 213] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 02/03/2015] [Accepted: 03/02/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Identification of white matter microstructure differences and similarities between major depression and bipolar disorder is a necessary step to better understand the underlying brain abnormalities in affective disorders and target more effective treatments. However, research has not yet yielded robust conclusions. We report here a meta-analysis of diffusion tensor imaging studies in these conditions. METHODS A comprehensive literature search was conducted up to 2014 to identify studies comparing fractional anisotropy (FA) between patients and control subjects. Results were combined to identify white matter abnormalities in major depression (736 patients vs. 668 control subjects) and bipolar disorder (536 patients vs. 489 control subjects). Effect size comparison and conjunction analysis allowed identification of similarities and differences between the disorders. RESULTS A significant decrease in FA in the genu of the corpus callosum characterized both conditions. The comparison between unipolar and bipolar disorders revealed a greater decrease in FA in the left posterior cingulum in bipolar disorder. Studies that adopted tract-based spatial statistics methodology showed more pronounced reductions in these regions compared with voxel-based analyses. CONCLUSIONS Major depression and bipolar disorder are characterized by abnormalities in white matter tracts of the genu of the corpus callosum that connect the two hemispheres of the prefrontal cortex implicated in mood regulation. Bipolar disorder was associated with reduced white matter integrity in the left posterior cingulum, which may contribute to cognitive impairment described in this condition. Tract-based spatial statistics may be a more sensitive technique to detect white matter abnormalities in these regions compared with voxel-based analyses.
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Affiliation(s)
- Toby Wise
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom.
| | - Joaquim Radua
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom; Research Unit, FIDMAG Germanes Hospitalàries-Centro de Investigación Biomédica en Red de Salud Mental, Sant Boi de Llobregat, Barcelona, Spain
| | - Gareth Nortje
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Anthony J Cleare
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Allan H Young
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Danilo Arnone
- Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom
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Ambrosi E, Chiapponi C, Sani G, Manfredi G, Piras F, Caltagirone C, Spalletta G. White matter microstructural characteristics in Bipolar I and Bipolar II Disorder: A diffusion tensor imaging study. J Affect Disord 2016; 189:176-83. [PMID: 26437232 DOI: 10.1016/j.jad.2015.09.035] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/08/2015] [Accepted: 09/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) studies of bipolar disorder (BD) report contrasting results and are mainly focused on bipolar I (BD-I) samples. We aimed at investigating how and where DTI parameters differ between BD-I and bipolar II (BD-II) and between BD and healthy control subjects (HC). METHODS We conducted a tract-based spatial statistics analysis of DTI derived parameters, namely fractional anisotropy (FA), axial diffusivity (AD) and radial diffusivity (RD) in a matched sample of 50 BD (25 BD-I and 25 BD-II) during the chronic course of the illness and 50 HC. RESULTS Compared to BD-I and HC, BD-II showed lower FA but no significant AD or RD differences in the right inferior longitudinal fasciculus (ILF). Both patient groups showed lower AD and RD in the left internal capsule and lower AD across the left ILF, the cortico-spinal tract within the right hemisphere and bilaterally in the cerebellum with respect to HC. LIMITATIONS Patients were medicated at the time of scanning; the BD-II group had higher Hamilton Rating Scale for Depression scores than the BD-I group. CONCLUSIONS BD-II patients differ from BD-I in the ILF. Both BD subtypes showed widespread white matter (WM) changes in the internal capsule, cortico-spinal tract and cerebellum. The loss of WM integrity in BD-II might be due to demyelination whereas WM changes common to both subgroups could be attributable to axonal damage.
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Affiliation(s)
- Elisa Ambrosi
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy; NESMOS Department, Sapienza University of Rome, Italy
| | - Chiara Chiapponi
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Systems Medicine, "Tor Vergata" University, Rome, Italy
| | - Gabriele Sani
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy; NESMOS Department, Sapienza University of Rome, Italy; Centro Lucio Bini, Rome, Italy
| | - Giovanni Manfredi
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy; NESMOS Department, Sapienza University of Rome, Italy; Centro Lucio Bini, Rome, Italy
| | - Fabrizio Piras
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Carlo Caltagirone
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy; Department of Neuroscience, "Tor Vergata" University, Rome, Italy
| | - Gianfranco Spalletta
- Neuropsychiatry Laboratory, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome, Italy; Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
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Correction for Eddy Current-Induced Echo-Shifting Effect in Partial-Fourier Diffusion Tensor Imaging. BIOMED RESEARCH INTERNATIONAL 2015; 2015:185026. [PMID: 26413505 PMCID: PMC4568076 DOI: 10.1155/2015/185026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 10/13/2014] [Indexed: 01/09/2023]
Abstract
In most diffusion tensor imaging (DTI) studies, images are acquired with either a partial-Fourier or a parallel partial-Fourier echo-planar imaging (EPI) sequence, in order to shorten the echo time and increase the signal-to-noise ratio (SNR). However, eddy currents induced by the diffusion-sensitizing gradients can often lead to a shift of the echo in k-space, resulting in three distinct types of artifacts in partial-Fourier DTI. Here, we present an improved DTI acquisition and reconstruction scheme, capable of generating high-quality and high-SNR DTI data without eddy current-induced artifacts. This new scheme consists of three components, respectively, addressing the three distinct types of artifacts. First, a k-space energy-anchored DTI sequence is designed to recover eddy current-induced signal loss (i.e., Type 1 artifact). Second, a multischeme partial-Fourier reconstruction is used to eliminate artificial signal elevation (i.e., Type 2 artifact) associated with the conventional partial-Fourier reconstruction. Third, a signal intensity correction is applied to remove artificial signal modulations due to eddy current-induced erroneous T2∗-weighting (i.e., Type 3 artifact). These systematic improvements will greatly increase the consistency and accuracy of DTI measurements, expanding the utility of DTI in translational applications where quantitative robustness is much needed.
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Versace A, Acuff H, Bertocci MA, Bebko G, Almeida JRC, Perlman SB, Leemans A, Schirda C, Aslam H, Dwojak A, Bonar L, Travis M, Gill MK, Demeter C, Diwadkar VA, Sunshine JL, Holland SK, Kowatch RA, Birmaher B, Axelson D, Horwitz SM, Frazier TW, Arnold LE, Fristad MA, Youngstrom EA, Findling RL, Phillips ML. White matter structure in youth with behavioral and emotional dysregulation disorders: a probabilistic tractographic study. JAMA Psychiatry 2015; 72:367-76. [PMID: 25715064 PMCID: PMC4415624 DOI: 10.1001/jamapsychiatry.2014.2170] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Psychiatric disorders in youth characterized by behavioral and emotional dysregulation are often comorbid and difficult to distinguish. An alternative approach to conceptualizing these disorders is to move toward a diagnostic system based on underlying pathophysiologic processes that may cut across conventionally defined diagnoses. Neuroimaging techniques have potentials for the identification of these processes. OBJECTIVE To determine whether diffusion imaging, a neuroimaging technique examining white matter (WM) structure, can identify neural correlates of emotional dysregulation in a sample of youth with different psychiatric disorders characterized by behavioral and emotional dysregulation. DESIGN, SETTING, AND PARTICIPANTS Using global probabilistic tractography, we examined relationships between WM structure in key tracts in emotional regulation circuitry (ie, cingulum, uncinate fasciculus, and forceps minor) and (1) broader diagnostic categories of behavioral and emotional dysregulation disorders (DDs) and (2) symptom dimensions cutting across conventional diagnoses in 120 youth with behavioral and/or emotional DDs, a referred sample of the Longitudinal Assessment of Manic Symptoms (LAM) study. Thirty age- and sex-matched typically developing youth (control participants) were included. Multivariate multiple regression models were used. The study was conducted from July 1, 2010, to February 28, 2014. MAIN OUTCOMES AND MEASURES Fractional anisotropy as well as axial and radial diffusivity were estimated and imported into a well-established statistical package. We hypothesized that (1) youth with emotional DDs and those with both behavioral and emotional DDs would show significantly lower fractional anisotropy compared with youth with behavioral DDs in these WM tracts and (2) that there would be significant inverse relationships between dimensional measures of affective symptom severity and fractional anisotropy in these tracts across all participants. RESULTS Multivariate multiple regression analyses revealed decreased fractional anisotropy and decreased axial diffusivity within the uncinate fasciculus in youth with emotional DDs vs those with behavioral DDs, those with both DDs, and the controls (F6,160 = 2.4; P = .032; all pairwise comparisons, P < .002). In the same model, greater severity of manic symptoms was positively associated with higher fractional anisotropy across all affected youth (F3,85 = 2.8; P = .044). CONCLUSIONS AND RELEVANCE These findings suggest that abnormal uncinate fasciculus and cingulum WM structure may underlie emotional, but not behavioral, dysregulation in pediatric psychiatric disorders and that a different neural mechanism may exist for comorbid emotional and behavioral DDs.
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Affiliation(s)
- Amelia Versace
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Heather Acuff
- Medical Science Training Program, University of Pittsburgh School of Medicine
| | - Michele A. Bertocci
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Genna Bebko
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Jorge R. C. Almeida
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Susan B. Perlman
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Claudiu Schirda
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Haris Aslam
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Amanda Dwojak
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Lisa Bonar
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Michael Travis
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Mary Kay Gill
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | - Christine Demeter
- University Hospitals Case Medical Center/Case Western Reserve University
| | - Vaibhav A. Diwadkar
- Department of Psychiatry and Behavioral Neuroscience, Wayne State University
| | | | - Scott K Holland
- Cincinnati Children's Hospital Medical Center, University of Cincinnati
| | | | - Boris Birmaher
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
| | | | - Sarah M. Horwitz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine
| | | | | | | | | | - Robert L. Findling
- University Hospitals Case Medical Center/Case Western Reserve University.,Department of Psychiatry, Johns Hopkins University
| | - Mary L. Phillips
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, University of Pittsburgh
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Bollettini I, Poletti S, Locatelli C, Vai B, Smeraldi E, Colombo C, Benedetti F. Disruption of white matter integrity marks poor antidepressant response in bipolar disorder. J Affect Disord 2015; 174:233-40. [PMID: 25527993 DOI: 10.1016/j.jad.2014.11.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/07/2014] [Accepted: 11/10/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Changes of white matter (WM) microstructure have been proposed as structural biomarkers of bipolar disorder (BD). The chronotherapeutic combination of repeated total sleep deprivation and morning light therapy (TSD+LT) can acutely reverse depressive symptoms in approximately 60% of patients, and it has been proposed as a model antidepressant treatment to investigate the neurobiological correlates of rapid antidepressant response. METHODS We tested if baseline DTI measures can predict response to treatment in 70 in-patients affected by a major depressive episode in the course of BD, treated with chronotherapeutics for one week. We performed whole-brain tract-based spatial statistics with threshold-free cluster enhancement for the DTI measures of WM microstructure integrity: fractional anisotropy, axial, radial, and mean diffusivity. RESULTS Increased mean and radial water diffusivity correlated with poor antidepressant response to TSD+LT in core WM tracts which are crucial for the functional integrity of the brain, including corpus callosum, corona radiata, cingulum bundle, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, and thalamic radiation. LIMITATIONS Limitations include issues such as generalizability, possible population stratification, medications and their effects on DTI measures, and no placebo control for chronotherapeutics. We could not consider other factors such as gene-environment interactions. CONCLUSIONS The association of increased radial and mean diffusivity with poor response to chronotherapeutic treatment warrants interest for the study of DTI measures of WM microstructure as markers for treatment response in bipolar depression.
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Affiliation(s)
- Irene Bollettini
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy; PhD Program in Philosophy and Sciences of Mind; University Vita-Salute San Raffaele, Milan, Italy
| | - Sara Poletti
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Clara Locatelli
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Benedetta Vai
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy; PhD Program in Evolutionary Psychopathology; Libera Università Maria SS. Assunta, Rome, Italy
| | - Enrico Smeraldi
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy
| | - Cristina Colombo
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Benedetti
- Department of Clinical Neurosciences, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy; C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo), University Vita-Salute San Raffaele, Milan, Italy.
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Yamada S, Takahashi S, Ukai S, Tsuji T, Iwatani J, Tsuda K, Kita A, Sakamoto Y, Yamamoto M, Terada M, Shinosaki K. Microstructural abnormalities in anterior callosal fibers and their relationship with cognitive function in major depressive disorder and bipolar disorder: a tract-specific analysis study. J Affect Disord 2015; 174:542-8. [PMID: 25556672 DOI: 10.1016/j.jad.2014.12.022] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 12/04/2014] [Indexed: 01/23/2023]
Abstract
BACKGROUND The corpus callosum modulates interhemispheric communication and cognitive processes. It has been suggested that white matter abnormalities in the corpus callosum are related to the pathophysiology of major depressive disorder (MDD) and bipolar disorder (BD). The aim of this study was to examine microstructural abnormalities in callosal fibers separated by their connection to functional brain regions and determine the relationship of these abnormalities with cognitive function in MDD and BD. METHODS The subjects were 18 patients with MDD, 20 patients with BD, and 21 healthy controls. The callosal fibers were divided into 6 segments based on their cortical projection using tract-specific analysis of diffusion tensor imaging. We examined differences in the fractional anisotropy (FA) of callosal fibers in six segments among the three subject groups and examined the correlation between the FA in each segment and cognitive performance in the 3 groups. RESULTS The FA of anterior callosal fibers were reduced significantly in the MDD and BD groups compared to those in the HC group, and the FA of anterior callosal fibers correlated significantly with the raw scores of the digit sequencing task and symbol coding in the MDD group. LIMITATIONS The patients were medicated at the time of scanning, and the MDD and BD groups were not matched for symptom severity. CONCLUSIONS Our results suggest that MDD and BD have similar microstructural abnormalities in anterior callosal fibers connecting bilateral frontal cortices, and these abnormalities may be related to impairment of working memory and attention in MDD.
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Affiliation(s)
- Shinichi Yamada
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan.
| | - Shun Takahashi
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Satoshi Ukai
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Tomikimi Tsuji
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Jun Iwatani
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Kumi Tsuda
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Akira Kita
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Yuka Sakamoto
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Yamamoto
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | | | - Kazuhiro Shinosaki
- Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
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Wang C, Xu X, Qian W, Shen Z, Zhang M. Altered human brain anatomy in chronic smokers: a review of magnetic resonance imaging studies. Neurol Sci 2015; 36:497-504. [PMID: 25577510 DOI: 10.1007/s10072-015-2065-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/05/2015] [Indexed: 01/23/2023]
Abstract
Cigarette smoking is becoming more prevalent in developing countries, such as China, and is the largest single cause of preventable death worldwide. New emerging reports are highlighting how chronic cigarette smoking plays a role in neural dysfunctions, such as cognitive decline. Basic animal experimental studies have shown that rats undergo persistent pathological brain changes after being given chronic levels of nicotine. What is perhaps less appreciated is the fact that chronic cigarette smoking induces subtle anatomical changes in the human brain. Consequently, this chapter aims to summarize and integrate the existing magnetic resonance imaging studies on both gray- and white-matter marcostructural and microstructural changes. The reviewed studies demonstrate that chronic cigarette smoking results in discrete and localized alterations in brain region tissue (both the gray and white matter of different brain regions), which may, in part, be responsible for different neural dysfunctions. In addition, we further discuss the possible pathological and neurobiological mechanisms of these nicotinic effects on the brain tissue. We will also address the limitations of the current studies on this issue and identify opportunities for future research.
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Affiliation(s)
- Chao Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Hangzhou, 310009, China
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Wang X, Tao J, Li L, Zhong Z, Liu S, Jiang T, Zhang J. Alterations in white matter fractional anisotropy in subsyndromal perimenopausal depression. BMC Psychiatry 2014; 14:367. [PMID: 25539808 PMCID: PMC4355552 DOI: 10.1186/s12888-014-0367-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 12/17/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Subsyndromal depression (SSD) is considered as a predictor for future depressive disorders, however whether white matter abnormalities are involved in the high-susceptibility of women to depressive disorders during perimenopause is unknown. The purpose of this study was to investigate fractional anisotropy (FA) in the white matter of the whole brain in perimenopausal women with SSD using diffusion tensor imaging (DTI). METHODS In a cross-sectional study, 24 perimenopausal women with SSD and 24 other age-, education-, and body mass index-matched healthy women underwent DTI. A voxel-based analysis was used to elucidate regional FA changes at a voxel threshold of p < 0.001 with an extent threshold of k > 127 voxels (p < 0.05, AlphaSim correction). Subsequently, correlation analyses were performed between mean FA values in significant brain regions and plasma estradiol level. RESULTS Compared to healthy controls, women with SSD exhibited significantly lower FA values in the left insula, while higher FA values were observed in the left ventral lateral thalamus and left and right brainstem in the midbrain. In subjects with SSD, the mean FA value in the left insula was positively correlated to plasma estradiol levels (r = 0.453, p = 0.026) (uncorrected). CONCLUSIONS Our findings indicate altered microstructures in white matter of the insula and subcortical regions may be associated with the high susceptibility of perimenopausal women to depressive disorders. Estrogen may modulate the white matter microstructure of the insula.
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Affiliation(s)
- Xianglan Wang
- Mental Health Institute of the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, 410011, China. .,Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
| | - Jiong Tao
- Mental Health Institute of the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, 410011, China. .,Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, 410011, China. .,Shenzhen Kangning Hospital of Guangdong Province, Shenzhen, 518003, China.
| | - Zhiyong Zhong
- Mental Health Institute of the Second Xiangya Hospital, National Technology Institute of Psychiatry, Key Laboratory of Psychiatry and Mental Health of Hunan Province, Central South University, Changsha, 410011, China. .,Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
| | - Sha Liu
- Department of Radiology, Guangzhou Brain Hospital, Guangzhou, 510370, China.
| | - Tianzi Jiang
- Brainnetome Center, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,Queensland Brain Institute, University of Queensland, Brisbane, Queensland, 4072, Australia. .,Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China.
| | - Jinbei Zhang
- Department of Psychiatry, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510630, China.
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Abstract
Patients with bipolar disorder (BD) experience difficulties in information processing and in the cognitive control of emotions. Mood-congruent biases, which parallel illness episodes, find a neural correlate in abnormal reactivity to stimuli in specific brain regions, and in disrupted functional connectivity among brain areas pertaining to corticolimbic circuitries. It is suggested that a reduced integrity of white matter tracts could underpin dysfunctions in networks implicated in the generation and control of affect. Recent studies using diffusion tensor imaging techniques found that (1) independent of drug treatment, patients with BD show widespread signs of disrupted white matter microstructure, suggesting significant demyelination/dysmyelination without axonal loss, and (2) effective long-term treatment with lithium is associated with increased axial connectivity, proportional to the duration of treatment. These findings suggest that changes of white matter microstructure in specific brain networks could parallel disrupted neural connectivity during illness episodes in BD and that these changes might play a major role in the mechanistic explanation of the biological underpinnings of BD psychopathology.
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Benedetti F, Bollettini I, Radaelli D, Poletti S, Locatelli C, Falini A, Smeraldi E, Colombo C. Adverse childhood experiences influence white matter microstructure in patients with bipolar disorder. Psychol Med 2014; 44:3069-3082. [PMID: 25065766 DOI: 10.1017/s0033291714000506] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with adverse childhood experiences (ACE), which worsen the lifetime course of illness, and with signs of widespread disruption of white matter (WM) integrity in adult life. ACE are associated with changes in WM microstructure in healthy humans. METHOD We tested the effects of ACE on diffusion-tensor imaging (DTI) measures of WM integrity in 80 in-patients affected by a major depressive episode in the course of BD. We used whole-brain tract-based spatial statistics in the WM skeleton with threshold-free cluster enhancement of DTI measures of WM microstructure: axial, radial and mean diffusivity, and fractional anisotropy. RESULTS ACE hastened the onset of illness. We observed an inverse correlation between the severity of ACE and DTI measures of axial diffusivity in several WM fibre tracts contributing to the functional integrity of the brain and including the corona radiata, thalamic radiations, corpus callosum, cingulum bundle, superior longitudinal fasciculus, inferior fronto-occipital fasciculus and uncinate fasciculus. CONCLUSIONS Axial diffusivity reflects the integrity of axons and myelin sheaths, and correlates with functional connectivity and with higher-order abilities such as reasoning and experience of emotions. In patients with BD axial diffusivity is increased by lithium treatment. ACE might contribute to BD pathophysiology by hampering structural connectivity in critical cortico-limbic networks.
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Affiliation(s)
- F Benedetti
- Department of Clinical Neurosciences,Scientific Institute Ospedale San Raffaele,Milan,Italy
| | - I Bollettini
- Department of Clinical Neurosciences,Scientific Institute Ospedale San Raffaele,Milan,Italy
| | - D Radaelli
- Department of Clinical Neurosciences,Scientific Institute Ospedale San Raffaele,Milan,Italy
| | - S Poletti
- Department of Clinical Neurosciences,Scientific Institute Ospedale San Raffaele,Milan,Italy
| | - C Locatelli
- Department of Clinical Neurosciences,Scientific Institute Ospedale San Raffaele,Milan,Italy
| | - A Falini
- C.E.R.M.A.C. (Centro di Eccellenza Risonanza Magnetica ad Alto Campo),University Vita-Salute San Raffaele,Milan,Italy
| | - E Smeraldi
- Department of Clinical Neurosciences,Scientific Institute Ospedale San Raffaele,Milan,Italy
| | - C Colombo
- Department of Clinical Neurosciences,Scientific Institute Ospedale San Raffaele,Milan,Italy
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fMRI evidence for abnormal resting-state functional connectivity in euthymic bipolar patients. J Affect Disord 2014; 165:182-9. [PMID: 24882198 DOI: 10.1016/j.jad.2014.04.054] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 01/15/2023]
Abstract
BACKGROUND Neural substrates of bipolar disorder (BD) have frequently been characterized by dysregulation of fronto-limbic networks that may persist during euthymic periods. Only a few studies have investigated euthymic bipolar patients (BP) functional connectivity at rest. The current study aims to assess resting-state functional connectivity in euthymic BP in order to identify trait abnormalities responsible for enduring mood dysregulation in these patients. METHODS Medial prefrontal cortex (mPFC) functional connectivity was investigated in 20 euthymic BP and 20 healthy subjects (HS). The functional connectivity maps were compared across groups using a between-group random effect analysis. Additional region of interest (ROI) analysis focused on mPFC-amygdala functional connectivity as well as correlations between the clinical features in euthymic BP was also conducted. RESULTS A significant difference between euthymic BP and HS was observed in terms of connectivity between the mPFC and the right dorsolateral prefrontal cortex (dlPFC). A significant negative correlation between the activity of these regions was found in HS but not in euthymic BP. In addition, euthymic BP showed greater connectivity between mPFC and right amygdala compared to HS, which was also correlated with the duration of the disease. LIMITATIONS The BP group was heterogeneous with respect to the bipolarity subtype and the medication. The robustness of results could be improved with an increased sample size. CONCLUSIONS Compared to HS, the euthymic BP showed abnormal decoupling (decreased functional connectivity) activity between mPFC-dlPFC and hyperconnectivity (increased functional connectivity) and between mPFC and amygdala. These abnormalities could underlie the pathophysiology of BD, and may deteriorate further in accordance with disease duration.
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Phillips ML, Swartz HA. A critical appraisal of neuroimaging studies of bipolar disorder: toward a new conceptualization of underlying neural circuitry and a road map for future research. Am J Psychiatry 2014; 171:829-43. [PMID: 24626773 PMCID: PMC4119497 DOI: 10.1176/appi.ajp.2014.13081008] [Citation(s) in RCA: 396] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE In this critical review, the authors appraise neuroimaging findings in bipolar disorder in emotion-processing, emotion-regulation, and reward-processing neural circuitry in order to synthesize the current knowledge of the neural underpinnings of bipolar disorder and provide a neuroimaging research road map for future studies. METHOD The authors examined findings from all major studies in bipolar disorder that used functional MRI, volumetric analysis, diffusion imaging, and resting-state techniques, integrating findings to provide a better understanding of larger-scale neural circuitry abnormalities in bipolar disorder. RESULTS Bipolar disorder can be conceptualized, in neural circuitry terms, as parallel dysfunction in prefrontal cortical (especially ventrolateral prefrontal cortical)-hippocampal-amygdala emotion-processing and emotion-regulation circuits bilaterally, together with an "overactive" left-sided ventral striatal-ventrolateral and orbitofrontal cortical reward-processing circuitry, resulting in characteristic behavioral abnormalities associated with bipolar disorder: emotional lability, emotional dysregulation, and heightened reward sensitivity. A potential structural basis for these functional abnormalities is gray matter volume decreases in the prefrontal and temporal cortices, the amygdala, and the hippocampus and fractional anisotropy decreases in white matter tracts connecting prefrontal and subcortical regions. CONCLUSIONS Neuroimaging studies of bipolar disorder clearly demonstrate abnormalities in neural circuits supporting emotion processing, emotion regulation, and reward processing, although there are several limitations to these studies. Future neuroimaging research in bipolar disorder should include studies adopting dimensional approaches; larger studies examining neurodevelopmental trajectories in youths with bipolar disorder or at risk for bipolar disorder; multimodal neuroimaging studies using integrated systems approaches; and studies using pattern recognition approaches to provide clinically useful individual-level data. Such studies will help identify clinically relevant biomarkers to guide diagnosis and treatment decision making for individuals with bipolar disorder.
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Vai B, Bollettini I, Benedetti F. Corticolimbic connectivity as a possible biomarker for bipolar disorder. Expert Rev Neurother 2014; 14:631-50. [DOI: 10.1586/14737175.2014.915744] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Marlinge E, Bellivier F, Houenou J. White matter alterations in bipolar disorder: potential for drug discovery and development. Bipolar Disord 2014; 16:97-112. [PMID: 24571279 DOI: 10.1111/bdi.12135] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 05/24/2013] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Brain white matter (WM) alterations have recently emerged as potentially relevant in bipolar disorder. New techniques such as diffusion tensor imaging allow precise exploration of these WM microstructural alterations in bipolar disorder. Our objective was to critically review WM alterations in bipolar disorder, using neuroimaging and neuropathological studies, in the context of neural models and the potential for drug discovery and development. METHODS We conducted a systematic PubMed and Google Scholar search of the WM and bipolar disorder literature up to and including January 2013. RESULTS Findings relating to WM alterations are consistent in neuroimaging and neuropathology studies of bipolar disorder, especially in regions involved in emotional processing such as the anterior frontal lobe, corpus callosum, cingulate cortex, and in fronto-limbic connections. Some of the structural alterations are related to genetic risk factors for bipolar disorder and may underlie the dysfunctional emotional processing described in recent neurobiological models of bipolar disorder. Medication effects in bipolar disorder, from lithium and other mood stabilizers, might impact myelinating processes, particularly by inhibition of glycogen synthase kinase-3 beta. CONCLUSIONS Pathways leading to WM alterations in bipolar disorder represent potential targets for the development and discovery of new drugs. Myelin damage in bipolar disorder suggests that the effects of existing pro-myelinating drugs should also be evaluated to improve our understanding and treatment of this disease.
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Affiliation(s)
- Emeline Marlinge
- AP-HP, Groupe Henri Mondor-Albert Chenevier, Pôle de Psychiatrie, Paris, France; Inserm, U955, Equipe 15 (Psychiatrie Génétique), Paris, France; Fondation Fondamental, Créteil, France; Neurospin, I2BM, CEA, Gif-Sur-Yvette, France
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Oertel-Knöchel V, Reinke B, Alves G, Jurcoane A, Wenzler S, Prvulovic D, Linden D, Knöchel C. Frontal white matter alterations are associated with executive cognitive function in euthymic bipolar patients. J Affect Disord 2014; 155:223-33. [PMID: 24295601 DOI: 10.1016/j.jad.2013.11.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Bipolar affective disorder (BD) is often associated with cognitive dysfunction in executive domains. However the biological underpinnings of cognitive deficits in BD are not sufficiently understood. A growing body of evidence indicates a loss of microstructural integrity in various white matter (WM) fiber tracts in BD. The aim of the current study was to assess potential links between WM structural abnormalities and cognitive performance in euthymic middle-aged BD patients (n=30) and matched healthy controls (n=32). METHODS Diffusion tensor imaging (DTI) data was carried out with both voxelwise (tract based spatial statistics, TBSS) and region-of-interest (ROI) based analysis. We compared multiple indices of diffusion including fractional anisotropy (FA), radial (DR), axial (DA) and mean diffusivities (MD). RESULTS Increased mean diffusivity was found in the fornix, anterior thalamic radiation, splenium and the truncus of the corpus callosum in BD patients compared with controls. These diffusion changes were significantly associated with poorer performance in executive tasks in BD patients. CONCLUSIONS Our results indicate a direct link between executive cognitive functioning and abnormal WM microstructural integrity of fronto-limbic tracts in remitted BD patients, and add evidence to the neuronal disruption that underlies the residual symptomatology of BD.
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Affiliation(s)
- Viola Oertel-Knöchel
- Laboratory of Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main 60528, Germany.
| | - Britta Reinke
- Laboratory of Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main 60528, Germany
| | - Gilberto Alves
- Center for Alzheimer's Disease and Related Disorders, Universidade Federal, do Rio de Janeiro, Brazil
| | - Alina Jurcoane
- Institute for Neuroradiology, Goethe University, Frankfurt/Main, Germany; Center for Individual Development and Adaptive Education of Children at Risk, Frankfurt, Germany
| | - Sofia Wenzler
- Laboratory of Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main 60528, Germany
| | - David Prvulovic
- Laboratory of Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main 60528, Germany
| | - David Linden
- MRC Centre for Neuropsychiatric Genetics & Genomics, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, CF, United Kingdom
| | - Christian Knöchel
- Laboratory of Neurophysiology and Neuroimaging, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt/Main 60528, Germany
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GRIN2B gene and associated brain cortical white matter changes in bipolar disorder: a preliminary combined platform investigation. BIOMED RESEARCH INTERNATIONAL 2013; 2013:635131. [PMID: 24490167 PMCID: PMC3893811 DOI: 10.1155/2013/635131] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/04/2013] [Accepted: 12/05/2013] [Indexed: 11/29/2022]
Abstract
Abnormalities in glutamate signaling and glutamate toxicity are thought to be important in the pathophysiology of bipolar disorder (BD). Whilst previous studies have found brain white matter changes in BD, there is paucity of data about how glutamatergic genes affect brain white matter integrity in BD. Based on extant neuroimaging data, we hypothesized that GRIN2B risk allele is associated with reductions of brain white matter integrity in the frontal, parietal, temporal, and occipital regions and cingulate gyrus in BD. Fourteen patients with BD and 22 healthy controls matched in terms of age, gender and handedness were genotyped using blood samples and underwent diffusion tensor imaging. Compared to G allele, brain FA values were significantly lower in BD patients with risk T allele in left frontal region (P = 0.001), right frontal region (P = 0.002), left parietal region (P = 0.001), left occipital region (P = 0.001), right occipital region (P < 0.001), and left cingulate gyrus (P = 0.001). Further elucidation of the interactions between different glutamate genes and their relationships with such structural, functional brain substrates will enhance our understanding of the link between dysregulated glutamatergic neurotransmission and neuroimaging endophenotypes in BD.
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Liu CS, Carvalho AF, Mansur RB, McIntyre RS. Obesity and bipolar disorder: synergistic neurotoxic effects? Adv Ther 2013; 30:987-1006. [PMID: 24194362 DOI: 10.1007/s12325-013-0067-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2013] [Indexed: 12/11/2022]
Abstract
Bipolar disorder (BD) is a disabling and chronic neuropsychiatric disorder that is typified by a complex illness presentation, episode recurrence and by its frequent association with psychiatric and medical comorbidities. Over the past decade, obesity has emerged as one of many comorbidities generating substantial concern in the BD population due to important prognostic implications. This comprehensive review details the bidirectional relationship between obesity and BD as evidenced by alterations in the structure and function of the central nervous system, in addition to greater depressive recurrence, cognitive dysfunction and risk of suicidality. Drawing on current research results, this article presents several putative mechanisms underlying the synergistic toxic effects and provides a framework for future treatment options for the obesity-BD comorbidity. There is a need for more large-scale prospective studies to investigate the bidirectional relationships between obesity and BD.
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Affiliation(s)
- Celina S Liu
- Department of Human Biology, University of Toronto, Toronto, ON, Canada
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Nortje G, Stein DJ, Radua J, Mataix-Cols D, Horn N. Systematic review and voxel-based meta-analysis of diffusion tensor imaging studies in bipolar disorder. J Affect Disord 2013; 150:192-200. [PMID: 23810479 DOI: 10.1016/j.jad.2013.05.034] [Citation(s) in RCA: 173] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 05/10/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diffusion tensor imaging (DTI) studies have shown changes in the microstructure of white matter in bipolar disorder. Studies suggest both localised, predominantly fronto-limbic, as well as more widespread changes in white matter, but with some apparent inconsistency. A meta-analysis of white matter alterations in adults with bipolar disorder was undertaken. METHOD Whole-brain DTI studies comparing adults with bipolar disorder to healthy controls on fractional anisotropy (FA) were retrieved using searches of MEDLINE and EMBASE from between 2003 and December 2012. White-matter tract involvement was collated and quantified. Clusters of significantly altered FA were meta-analysed using effect-size signed differential mapping (ES-SDM). RESULTS Ten VBA studies (252 patients and 256 controls) and five TBSS studies (138 patients and 98 controls) met inclusion criteria. Sixty-one clusters of significantly different FA between bipolar disorder and healthy controls were identified. Analysis of white-matter tracts indicated that all major classes of tracts are implicated. ES-SDM meta-analysis of VBA studies revealed three significant clusters of decreased FA in bipolar disorder (a right posterior temporoparietal cluster and two left cingulate clusters). Findings limited to the Bipolar Type I papers were more robust. LIMITATIONS Voxel-based studies do not accurately identify tracts, and our ES-SDM analysis used only published peak voxels rather than raw DTI data. CONCLUSIONS There is consistent data indicating widespread white matter involvement with decreased white matter FA demonstrated in three disparate areas in bipolar disorder. White matter alterations are not limited to anterior fronto-limbic pathways in bipolar disorder.
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Affiliation(s)
- Gareth Nortje
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, South Africa.
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Anderson D, Ardekani BA, Burdick KE, Robinson DG, John M, Malhotra AK, Szeszko PR. Overlapping and distinct gray and white matter abnormalities in schizophrenia and bipolar I disorder. Bipolar Disord 2013; 15:680-93. [PMID: 23796123 PMCID: PMC3762889 DOI: 10.1111/bdi.12096] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 01/13/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Schizophrenia and bipolar disorder may share common neurobiological mechanisms, but few studies have directly compared gray and white matter structure in these disorders. We used diffusion-weighted magnetic resonance imaging and a region of interest based analysis to identify overlapping and distinct gray and white matter abnormalities in 35 patients with schizophrenia and 20 patients with bipolar I disorder in comparison to 56 healthy volunteers. METHODS We examined fractional anisotropy within the white matter and mean diffusivity within the gray matter in 42 regions of interest defined on a probabilistic atlas following non-linear registration of the images to atlas space. RESULTS Patients with schizophrenia had significantly lower fractional anisotropy in temporal (superior temporal and parahippocampal) and occipital (superior and middle occipital) white matter compared to patients with bipolar disorder and healthy volunteers. By contrast, both patient groups demonstrated significantly higher mean diffusivity in frontal (inferior frontal and lateral orbitofrontal) and temporal (superior temporal and parahippocampal) gray matter compared to healthy volunteers, but did not differ from each other. CONCLUSIONS Our study implicates overlapping gray matter frontal and temporal lobe structural alterations in the neurobiology of schizophrenia and bipolar I disorder, but suggests that temporal and occipital lobe white matter deficits may be an additional risk factor for schizophrenia. Our findings may have relevance for future diagnostic classification systems and the identification of susceptibility genes for these disorders.
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Affiliation(s)
- Dana Anderson
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Babak A. Ardekani
- The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
| | - Katherine E. Burdick
- Departments of Psychiatry and Neuroscience, Mount Sinai School of Medicine, NY, NY
| | - Delbert G. Robinson
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Hofstra North Shore – LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Majnu John
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY
| | - Anil K. Malhotra
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Hofstra North Shore – LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
| | - Philip R. Szeszko
- The Feinstein Institute for Medical Research, North Shore-LIJ Health System, Manhasset, NY,The Zucker Hillside Hospital, North Shore-LIJ Health System, Glen Oaks, NY,Hofstra North Shore – LIJ School of Medicine, Departments of Psychiatry and Molecular Medicine, Hempstead, NY, USA
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