Decreased Cingulate Cortex activation during cognitive control processing in bipolar disorder

Staci A Gruber; M Kathryn Dahlgren; Kelly A Sagar; Atilla Gonenc; Lesley Norris; Bruce M Cohen; Dost Ongur; Kathryn E Lewandowski

doi:10.1016/j.jad.2017.02.003

Decreased Cingulate Cortex activation during cognitive control processing in bipolar disorder

J Affect Disord. 2017 Apr 15:213:86-95. doi: 10.1016/j.jad.2017.02.003. Epub 2017 Feb 7.

Authors

Staci A Gruber¹, M Kathryn Dahlgren², Kelly A Sagar³, Atilla Gonenc³, Lesley Norris⁴, Bruce M Cohen⁵, Dost Ongur⁶, Kathryn E Lewandowski⁷

Affiliations

¹ Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States. Electronic address: gruber@mclean.harvard.edu.
² Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychology, Tufts University, Medford, MA 02155, United States.
³ Cognitive and Clinical Neuroimaging Core, McLean Imaging Center, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States.
⁴ Schizophrenia and Bipolar Disorders Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States.
⁵ Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States; Program for Neuropsychiatric Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States.
⁶ Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States; Schizophrenia and Bipolar Disorders Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Program for Neuropsychiatric Research, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States.
⁷ Department of Psychiatry, Harvard Medical School, Boston, MA 02215, United States; Schizophrenia and Bipolar Disorders Research Program, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States.

PMID: 28199893
DOI: 10.1016/j.jad.2017.02.003

Abstract

Background: Cognitive deficits are well-documented in patients with bipolar disorder (BPD) and may impact the efficacy of psychotherapy. Cognitive control, a form of executive functioning, is often used therapeutically to shift patients' thoughts and behaviors from automatic, maladaptive responses to adaptive coping strategies. This study examined cognitive control processing in patients with BPD using the Multi-Source Interference Task (MSIT).

Method: Twenty-nine patients diagnosed with BPD and 21 healthy control (HC) subjects completed the MSIT with concurrent functional magnetic resonance imaging (fMRI).

Results: Patients with BPD generally performed worse on the MSIT relative to HC participants; the BPD group had significantly lower performance accuracy and made more omission errors. Further, fMRI analyses revealed differential patterns of activation between the groups during the MSIT. Region of interest (ROI) analyses revealed that relative to HC participants, patients with BPD activated significantly fewer voxels within the cingulate cortex (CC) and more voxels within prefrontal cortex (PFC), although the PFC findings did not survive more stringent significance thresholds.

Limitations: Patients and HCs were not matched for age, sex, and premorbid verbal IQ, however, these variables were controlled for statistically. Medication usage in the BPD group may have possibly impacted the results. Given a priori hypotheses, ROI analyses were utilized.

Conclusions: Decreased CC activation and increased PFC activation may be associated with impaired cognitive control, demonstrated by BPD patients when completing the MSIT. Identifying the neural mechanisms which underlie key cognitive abnormalities in BPD may aid in clarifying the pathophysiology of this disorder and inform selection of potential targets for cognition remediation in BPD.

Keywords: Bipolar disorder; Cognitive control; Executive function; MSIT; Multi-Source Interference Task; fMRI.

MeSH terms

Adolescent
Adult
Bipolar Disorder / complications
Bipolar Disorder / physiopathology*
Bipolar Disorder / psychology
Cognition Disorders / complications
Cognition Disorders / physiopathology*
Female
Functional Neuroimaging
Gyrus Cinguli / physiopathology*
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Prefrontal Cortex / physiopathology
Young Adult