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Study Highlights Mania Prevention Importance in Bipolar Disorder Treatment
In this Q&A, Christophe Abé, PhD, Quantify Research, Stockholm, Sweden, shares insights on his study that examined structural brain changes over time in bipolar disorder using longitudinal magnetic resonance imaging (MRI) and clinical data and also highlighted the importance of mania prevention in treatment.
In the upcoming part 2, Dr Abé is joined by co-author Mikael Landén, MD, PhD, Department of Medical Epidemiology and Biostatistics and the Karolinska Institute, Stockholm, Sweden, to discuss the study's unexpected outcomes, clinical implications, and current gaps in existing literature.
Q: What led you and your colleagues to analyze longitudinal magnetic resonance imaging (MRI) and clinical data?
Dr Christoph Abé: Previous studies had indicated relationships between mania and reduced brain volume. However, these studies were cross-sectional, meaning just a snap-shot in time. Hence, questions [of] whether or not an individual’s brain structure changes when experiencing mania could not be answered. To investigate if the occurrence of mania is related to actual brain changes, longitudinal studies were required, ie, the same individual needs to be investigated over multiple time points.
Q: Please briefly describe the study method and participants.
Dr Abé: The ENIGMA consortium is a large-scale international collaboration bringing together many researchers and clinicians from all over the world. While ENIGMA has various disease focuses, this project was performed within the ENIGMA Bipolar Disorder Working Group, where numerous research centers contributed with longitudinal structural brain imaging (T1-weighted MRI) and clinical data. The data were acquired at 2 points in time, which were, depending on [the] individual, 6 months to 9 years apart.
Data stem from patients diagnosed with bipolar disorder and healthy individuals without this diagnosis (controls). The data were shared with our research team at Karolinska Institutet and were analyzed using a so-called mega-analytic approach. The outcome measures were regional brain change rates and were compared between patients and controls. The results were then presented to, interpreted by, and discussed with all contributing members before publication.
Q: Please briefly describe the most significant finding(s).
Dr Abé: There were 3 main findings. First, we found that the brain’s ventricles, cavities that produce cerebrospinal fluid important for the brain’s protection, showed a faster enlargement over time in patients with bipolar disorder compared with healthy individuals. While ventricular enlargements over time occur in healthy individuals, the enlargement in bipolar patients was significantly faster.
Second, with respect to the cortex, the brain’s outermost layer, which usually shows age-related thinning over time in adults, we observed that patients showed slower thinning than healthy individuals. This was observed in the fusiform and the parahippocampal cortex, brain areas linked to recognition and memory.
However, third, another striking finding was that the cortex thinned over time to a greater extent in people who experienced more frequent manic episodes. Those who did not have mania showed no cortical thinning or even cortical thickening. These changes were most evident in the prefrontal cortex, which is associated with executive function (eg, cognitive control) and emotion regulation.
Christoph Abé, PhD, obtained his PhD in biophysics from the University of Osnabrueck, Germany, in 2010. From 2011 to 2012, he was employed as postdoc at the University of California San Francsico (UCSF) at the Department of Radiology and Biomedical Imaging, where he conducted research in substance use disorders using neuroimaging. From 2013 to 2017, he was postdoc at Karolinska Institutet (KI), Stockholm, Sweden (Dept. of Clinical Neuroscience, CNS), where he performed neuroimaging research in psychiatric disorders with a focus on bipolar disorder. From 2017 tp 2021, he was employed as assistant professor in neuroimaging psychiatric disorders at KI, CNS. Currently, he is the lead analysist at Quantify Research, Stockholm, and affiliated to research at Karolinska Institutet (CNS).
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