Structural and Functional Brain Correlates of Neuroprogression in Bipolar Disorder
Neuroprogression is associated with structural and functional brain changes that occur in parallel with cognitive and functioning impairments. There is substantial evidence showing early white matter changes, as well as trajectory-related gray matter alte
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Contents 1 Introduction 2 Structural Aspects of Neuroprogression in Neuroimaging 2.1 Evidence from Cross-Sectional Studies 2.2 Evidence from Longitudinal Studies 3 Functional Aspects of Neuroprogression in Neuroimaging 4 Challenges (Limitations) and Perspectives References
Abstract Neuroprogression is associated with structural and functional brain changes that occur in parallel with cognitive and functioning impairments. There is substantial evidence showing early white matter changes, as well as trajectoryrelated gray matter alterations. Several structures, including prefrontal, parietal, temporal cortex, and limbic structures, seem to be altered over the course of bipolar
D. Librenza-Garcia Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada J. S. Suh, D. P. Watts, and P. L. Ballester Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada L. Minuzzi and B. N. Frey (*) Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada Mood Disorders Program and Women’s Health Concerns Clinic, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada e-mail: [email protected] F. Kapczinski Mood Disorders Program, St. Joseph’s Healthcare Hamilton, Hamilton, ON, Canada Neuroscience Graduate Program, McMaster University, Hamilton, ON, Canada Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada © Springer Nature Switzerland AG 2020 Curr Topics Behav Neurosci https://doi.org/10.1007/7854_2020_177
D. Librenza-Garcia et al.
disorder, especially associated with the number of episodes and length of the disease. An important limitation is that most of the studies used either a cross-sectional design or a short follow-up period, which may be insufficient to identify all neuroprogressive changes over time. In addition, the heterogeneity of patients with bipolar disorder is another challenge to determine which subjects will have a more pernicious trajectory. Larger studies and the use of new techniques, such as machine learning, may help to enable more discoveries and evidence on the role of neuroprogression in BD. Keywords Bipolar disorder · Functional MRI · Neuroprogression · Structural MRI
1 Introduction Bipolar disorder (BD) has heterogeneous trajectories, with some patients experiencing a more severe course, marked by progressive features and impairments in both cognition and functioning. The term neuroprogression has been proposed as a pathological rewiring of the brain that occurs in parallel with clinical, neurocognitive, and functioning deterioration in BD patients (Passos et al. 2016). In these cases, there is cumulative evidence that several structures and systems seem to be affected. Neuroprogression has been associated with poor clinical outcomes such as worse response to treatment (Ketter et al. 2006; Swann et al. 1999), increased comorbidity (Matza et al. 2005), functional and cognitive impairments (Kessing 2004; Rosa
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