Resonancia magnética funcional en pacientes adultos eutímicos con trastorno bipolar tipo I: una visión neuropsicológica y neurofuncional

Article information

Resumen

Introducción

En la última década se han realizado varios estudios de resonancia magnética funcional en la fase eutímica del trastorno bipolar tipo I; por lo tanto, es necesario hacer una revisión crítica de los hallazgos reportados.

Métodos

Revisión de la literatura, consistente en búsqueda, lectura y análisis de los estudios de resonancia magnética funcional en adultos eutímicos con trastorno bipolar tipo I en las bases de datos científicas PubMed, EMBASE, SciELO y Lilacs, sin límite cronológico.

Resultados

Los hallazgos neuroanatómicos y neuropsicológicos se presentan en dos bloques: primero, memoria de trabajo con paradigmas N Back y Stenberg y, segundo, función ejecutiva con interferencia en atención selectiva o pruebas tipo Stroop (palabra/color, numérico y emocional) y control inhibitorio con pruebas go/no go.

Conclusiones

Los resultados fueron contradictorios por diferencias en los paradigmas, criterios de inclusión, síntomas residuales, medicamentos e historia de psicoactivos. En pruebas Stroop y de memoria de trabajo se identificó una disfunción prefrontal en comparación con los controles (específicamente en la región dorsolateral), por lo que fue propuesta como un rasgo característico del trastorno. La región frontopolar (AB 10) parece ser clave en la disfunción frontal; por su parte, el cíngulo anterior, la corteza parietal y la prefrontal ventral necesitan ser replicadas en investigaciones posteriores en las que haya un mejor control de los factores de confusión.

Palabras clave:

Resonancia magnética funcional

trastorno bipolar

eutimia

Stroop

memoria

Abstract

Introduction

Several studies using functional magnetic resonance imaging during the euthymic phase of bipolar disorder type I have been performed in the last decade. A critical review of the findings is therefore required.

Methods

The major databases (Pubmed, EMBASE, Lilacs, and Scielo) were consulted searching studies of fMRI in euthymic adults with Bipolar disorder type I without timeframe limits.

Results

The neuroanatomical and neuropsychological findings are presented in two parts: 1) working memory with N_back and Stenberg paradigms, and 2) Executive function with interference in selective attention or Stroop test (word/color, counting and emotional) and inhibitory control with go/no go tasks.

Conclusions

The results were contradictory due to differences in paradigms, inclusion criteria, residual symptoms, and history of drugs. Prefrontal dysfunction was identified in the Stroop test and in working memory tasks compared with controls (specifically dorsolateral region) which has been proposed as a feature of the disorder. Frontopolar area (BA 10) appears to be important in frontal dysfunction. Findings in areas such as the anterior cingulate and parietal and ventral prefrontal cortex need to be replicated in subsequent research with a closer control of confounding factors.

Key words:

Functional magnetic resonance imaging

bipolar disorder

euthymia

Stroop

memory

Full text is only aviable in PDF

Referencias

[1]

A Olley, GS Malhi, PB Mitchell, et al.

When euthymia is just not good enough: the neuropsychology of bipolar disorder.

J Nerv Ment Dis, 193 (2005), pp. 323-330

Medline

[2]

L Altshuler, J Tekell, K Biswas, et al.

Executive function and employment status among veterans with bipolar disorder.

Psychiatr Serv, 58 (2007), pp. 1441-1447

http://dx.doi.org/10.1176/ps.2007.58.11.1441 | Medline

[3]

LL Altshuler, J Ventura, WG van Gorp, et al.

Neurocognitive function in clinically stable men with bipolar I disorder or schizophrenia and normal control subjects.

Biol Psychiatry, 56 (2004), pp. 560-569

http://dx.doi.org/10.1016/j.biopsych.2004.08.002 | Medline

[4]

LL Altshuler, CE Bearden, MF Green, et al.

A relationship between neurocognitive impairment and functional impairment in bipolar disorder: a pilot study.

Psychiatry Res, 157 (2008), pp. 289-293

http://dx.doi.org/10.1016/j.psychres.2007.01.001 | Medline

[5]

CE Bearden, KM Hoffman, TD Cannon.

The neuropsychology and neuroanatomy of bipolar affective disorder: a critical review.

Bipolar Disord, 3 (2001), pp. 106-150

Medline

[6]

LJ Robinson, JM Thompson, P Gallagher, et al.

A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder.

J Affect Disord, 93 (2006), pp. 105-115

http://dx.doi.org/10.1016/j.jad.2006.02.016 | Medline

[7]

B Arts, N Jabben, L Krabbendam, et al.

Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives.

Psychol Med, 38 (2008), pp. 771-785

http://dx.doi.org/10.1017/S0033291707001675 | Medline

[8]

T Deckersbach, CR Savage, N Reilly-Harrington, et al.

Episodic memory impairment in bipolar disorder and obsessive-compulsive disorder: the role of memory strategies.

Bipolar Disord, 6 (2004), pp. 233-244

http://dx.doi.org/10.1111/j.1399-5618.2004.00118.x | Medline

[9]

IN Ferrier, BR Stanton, TP Kelly, et al.

Neuropsychological function in euthymic patients with bipolar disorder.

Br J Psychiatry, 175 (1999), pp. 246-251

Medline

[10]

A Martínez-Aran, E Vieta, M Reinares, et al.

Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder.

Am J Psychiatry, 161 (2004), pp. 262-270

http://dx.doi.org/10.1176/appi.ajp.161.2.262 | Medline

[11]

S Quraishi, S Frangou.

Neuropsychology of bipolar disorder: a review.

J Affect Disord, 72 (2002), pp. 209-226

Medline

[12]

JS Rubinsztein, BJ Sahakian.

Cognitive impairment in bipolar disorder.

Br J Psychiatry, 181 (2002), pp. 440

Medline

[13]

WG van Gorp, L Altshuler, DC Theberge, et al.

Cognitive impairment in euthymic bipolar patients with and without prior alcohol dependence. A preliminary study.

Arch Gen Psychiatry, 55 (1998), pp. 41-46

Medline

[14]

Y Lund, M Nissen, OJ Rafaelsen.

Long-term lithium treatment and psychological functions.

Acta Psychiatr Scand, 65 (1982), pp. 233-244

Medline

[15]

A Martínez-Rosas, M Alonso-Vanegas.

Aspectos neuropsicológicos de la resonancia magnética funcional.

Revista Ecuatoriana de Neurología, 16 (2007), pp. s

[16]

M Wessa, J Houenou, ML Paillere-Martinot, et al.

Fronto-striatal overactivation in euthymic bipolar patients during an emotional go/no go task.

Am J Psychiatry, 164 (2007), pp. 638-646

http://dx.doi.org/10.1176/ajp.2007.164.4.638 | Medline

[17]

PJ Monks, JM Thompson, ET Bullmore, et al.

A functional MRI study of working memory task in euthymic bipolar disorder: evidence for task-specific dysfunction.

Bipolar Disord, 6 (2004), pp. 550-564

http://dx.doi.org/10.1111/j.1399-5618.2004.00147.x | Medline

[18]

J Lagopoulos, B Ivanovski, GS Malhi.

An event-related functional MRI study of working memory in euthymic bipolar disorder.

J Psychiatry Neurosci, 32 (2007), pp. 174-184

Medline

[19]

CM Adler, SK Holland, S Enseleit, et al.

Age-related changes in regional activation during working memory in young adults: an fMRI study.

Synapse, 42 (2001), pp. 252-257

http://dx.doi.org/10.1002/syn.1111 | Medline

[20]

CM Adler, SK Holland, V Schmithorst, et al.

Changes in neuronal activation in patients with bipolar disorder during performance of a working memory task.

Bipolar Disord, 6 (2004), pp. 540-549

http://dx.doi.org/10.1111/j.1399-5618.2004.00117.x | Medline

[21]

HP Blumberg, A Martin, J Kaufman, et al.

Frontostriatal abnormalities in adolescents with bipolar disorder: preliminary observations from functional MRI.

Am J Psychiatry, 160 (2003), pp. 1345-1347

http://dx.doi.org/10.1176/appi.ajp.160.7.1345 | Medline

[22]

SA Gruber, J Rogowska, DA Yurgelun-Todd.

Decreased activation of the anterior cingulate in bipolar patients: an fMRI study.

J Affect Disord, 82 (2004), pp. 191-201

http://dx.doi.org/10.1016/j.jad.2003.10.010 | Medline

[23]

DM Kronhaus, NS Lawrence, AM Williams, et al.

Stroop performance in bipolar disorder: further evidence for abnormalities in the ventral prefrontal cortex.

Bipolar Disord, 8 (2006), pp. 28-39

http://dx.doi.org/10.1111/j.1399-5618.2006.00282.x | Medline

[24]

RM Roth, NS Koven, JJ Randolph, et al.

Functional magnetic resonance imaging of executive control in bipolar disorder.

Neuroreport, 17 (2006), pp. 1085-1089

http://dx.doi.org/10.1097/01.wnr.0000227979.06013.57 | Medline

[25]

MA Cerullo, CM Adler, MP Delbello, et al.

The functional neuroanatomy of bipolar disorder.

Int Rev Psychiatry, 21 (2009), pp. 314-322

http://dx.doi.org/10.1080/09540260902962107 | Medline

[26]

GD Pearlson.

Structural and functional brain changes in bipolar disorder: a selective review.

Schizophr Res, 39 (1999), pp. 133-140

Medline

[27]

K Jamrozinski.

Do euthymic bipolar patients have normal cognitive functioning?.

Curr Opin Psychiatry, 23 (2010), pp. 255-260

http://dx.doi.org/10.1097/YCO.0b013e328338620a | Medline

[28]

J Townsend, SY Bookheimer, LC Foland-Ross, et al.

fMRI abnormalities in dorsolateral prefrontal cortex during a working memory task in manic, euthymic and depressed bipolar subjects.

Psychiatry Res, 182 (2010), pp. 22-29

http://dx.doi.org/10.1016/j.pscychresns.2009.11.010 | Medline

[29]

HW Thermenos, JM Goldstein, SM Milanovic, et al.

An fMRI study of working memory in persons with bipolar disorder or at genetic risk for bipolar disorder.

Am J Med Genet B Neuropsychiatr Genet, 153B (2010), pp. 120-131

http://dx.doi.org/10.1002/ajmg.b.30964 | Medline

[30]

DS Manoach.

Prefrontal cortex dysfunction during working memory performance in schizophrenia: reconciling discrepant findings.

Schizophr Res, 60 (2003), pp. 285-298

Medline

[31]

C López-Jaramillo, J Lopera-Vásquez, J Ospina-Duque, et al.

Lithium treatment effects on the neuropsychological functioning of patients with bipolar I disorder.

J Clin Psychiatry, 71 (2010), pp. 1055-1060

http://dx.doi.org/10.4088/JCP.08m04673yel | Medline

[32]

LS Hamilton, LL Altshuler, J Townsend, et al.

Alterations in functional activation in euthymic bipolar disorder and schizophrenia during a working memory task.

Hum Brain Mapp, 30 (2009), pp. 3958-3969

http://dx.doi.org/10.1002/hbm.20820 | Medline

[33]

M Haldane, J Jogia, A Cobb, et al.

Changes in brain activation during working memory and facial recognition tasks in patients with bipolar disorder with Lamotrigine monotherapy.

Eur Neuropsychopharmacol, 18 (2008), pp. 48-54

http://dx.doi.org/10.1016/j.euroneuro.2007.05.009 | Medline

[34]

O Gruber, H Tost, I Henseler, et al.

Pathological amygdala activation during working memory performance: Evidence for a pathophysiological trait marker in bipolar affective disorder.

Hum Brain Mapp, 31 (2010), pp. 115-125

http://dx.doi.org/10.1002/hbm.20849 | Medline

[35]

S Frangou, J Kington, V Raymont, et al.

Examining ventral and dorsal prefrontal function in bipolar disorder: a functional magnetic resonance imaging study.

Eur Psychiatry, 23 (2008), pp. 300-308

http://dx.doi.org/10.1016/j.eurpsy.2007.05.002 | Medline

[36]

D Drapier, S Surguladze, N Marshall, et al.

Genetic liability for bipolar disorder is characterized by excess frontal activation in response to a working memory task.

Biol Psychiatry, 64 (2008), pp. 513-520

http://dx.doi.org/10.1016/j.biopsych.2008.04.038 | Medline

[37]

K Chang, NE Adleman, K Dienes, et al.

Anomalous prefrontal-subcortical activation in familial pediatric bipolar disorder: a functional magnetic resonance imaging investigation.

Arch Gen Psychiatry, 61 (2004), pp. 781-792

http://dx.doi.org/10.1001/archpsyc.61.8.781 | Medline

[38]

A Kaladjian, R Jeanningros, JM Azorin, et al.

Reduced brain activation in euthymic bipolar patients during response inhibition: an event-related fMRI study.

Psychiatry Res, 173 (2009), pp. 45-51

http://dx.doi.org/10.1016/j.pscychresns.2008.08.003 | Medline

[39]

A Baddeley.

Working memory: looking back and looking forward.

Nat Rev Neurosci, 4 (2003), pp. 829-839

http://dx.doi.org/10.1038/nrn1201 | Medline

[40]

M Mur, MJ Portella, A Martínez-Aran, et al.

Persistent neuropsychological deficit in euthymic bipolar patients: executive function as a core deficit.

J Clin Psychiatry, 68 (2007), pp. 1078-1086

Medline

[41]

DC Glahn, CE Bearden, TA Niendam, et al.

The feasibility of neuropsychological endophenotypes in the search for genes associated with bipolar affective disorder.

Bipolar Disord, 6 (2004), pp. 171-182

http://dx.doi.org/10.1111/j.1399-5618.2004.00113.x | Medline

[42]

J Tirapu-Ustárroz, JM Muñoz-Céspedes, C Pelegrín-Valero, et al.

Propuesta de un protocolo para la evaluación de las funciones ejecutivas.

Revista de Neurología, 41 (2005), pp. 177-186

Medline

[43]

JD Cohen, WM Perlstein, TS Braver, et al.

Temporal dynamics of brain activation during a working memory task.

Nature, 386 (1997), pp. 604-608

http://dx.doi.org/10.1038/386604a0 | Medline

[44]

C López-Jaramillo, A Correa-Palacio, J Delgado, et al.

Diferencias en la resonancia magnética funcional en pacientes con trastorno afectivo bipolar usando un paradigma de memoria de trabajo.

Rev. Colomb. Psiquiat, 39 (2010), pp. 481-492

[45]

CM Macleod.

Ridley Stroop, creator of a landmark cognitive task.

Canadian Psychology, 32 (1999), pp. 521-524

[46]

HP Blumberg, HC Leung, P Skudlarski, et al.

A functional magnetic resonance imaging study of bipolar disorder: state- and trait-related dysfunction in ventral prefrontal cortices.

Arch Gen Psychiatry, 60 (2003), pp. 601-609

http://dx.doi.org/10.1001/archpsyc.60.6.601 | Medline

[47]

J Lagopoulos, GS Malhi.

A functional magnetic resonance imaging study of emotional Stroop in euthymic bipolar disorder.

Neuroreport, 18 (2007), pp. 1583-1587

http://dx.doi.org/10.1097/WNR.0b013e3282efa07a | Medline

[48]

GS Malhi, J Lagopoulos, PS Sachdev, et al.

An emotional Stroop functional MRI study of euthymic bipolar disorder.

Bipolar Disord, 7 (2005), pp. 58-69

http://dx.doi.org/10.1111/j.1399-5618.2005.00255.x | Medline

[49]

SM Strakowski, CM Adler, SK Holland, et al.

Abnormal FMRI brain activation in euthymic bipolar disorder patients during a counting Stroop interference task.

Am J Psychiatry, 162 (2005), pp. 1697-1705

http://dx.doi.org/10.1176/appi.ajp.162.9.1697 | Medline

[50]

G Bush, PJ Whalen, LM Shin, et al.

The counting Stroop: a cognitive interference task.

Nat Protoc, 1 (2006), pp. 230-233

http://dx.doi.org/10.1038/nprot.2006.35 | Medline

[51]

G Bush, PJ Whalen, BR Rosen, et al.

The counting Stroop: an interference task specialized for functional neuroimaging-validation study with functional MRI.

Hum Brain Mapp, 6 (1998), pp. 270-282

Medline

[52]

AS Welander-Vatn, J Jensen, C Lycke, et al.

No altered dorsal anterior cingulate activation in bipolar II disorder patients during a Go/No-go task: an fMRI study.

Bipolar Disord, 11 (2009), pp. 270-279

http://dx.doi.org/10.1111/j.1399-5618.2009.00680.x | Medline

[53]

AM Passarotti, JA Sweeney, MN Pavuluri.

Neural correlates of response inhibition in pediatric bipolar disorder and attention deficit hyperactivity disorder.

Psychiatry Res, 181 (2010), pp. 36-43

http://dx.doi.org/10.1016/j.pscychresns.2009.07.002 | Medline

[54]

P Mazzola-Pomietto, A Kaladjian, JM Azorin, et al.

Bilateral decrease in ventrolateral prefrontal cortex activation during motor response inhibition in mania.

J Psychiatr Res, 43 (2009), pp. 432-441

http://dx.doi.org/10.1016/j.jpsychires.2008.05.004 | Medline

[55]

LL Altshuler, SY Bookheimer, J Townsend, et al.

Blunted activation in orbitofrontal cortex during mania: a functional magnetic resonance imaging study.

Biol Psychiatry, 58 (2005), pp. 763-769

http://dx.doi.org/10.1016/j.biopsych.2005.09.012 | Medline

[56]

T Dixon, E Kravariti, C Frith, et al.

Effect of symptoms on executive function in bipolar illness.

Psychol Med, 34 (2004), pp. 811-821

Medline

[57]

S Frangou, M Haldane, D Roddy, et al.

Evidence for deficit in tasks of ventral, but not dorsal, prefrontal executive function as an endophenotypic marker for bipolar disorder.

Biol Psychiatry, 58 (2005), pp. 838-839

http://dx.doi.org/10.1016/j.biopsych.2005.05.020 | Medline

[58]

WC Drevets, JL Price, JR Simpson Jr, et al.

Subgenual prefrontal cortex abnormalities in mood disorders.

Nature, 386 (1997), pp. 824-827

http://dx.doi.org/10.1038/386824a0 | Medline

Conflictos de interés: Los autores manifiestan que no tienen conflictos de interés en este artículo.

Indexed in:

Follow us:

Indexed in:

Follow us:

Subscribe to our newsletter