Correlation Between Cognitive Performance and Structural Neuroanatomy in Patients with Type I Bipolar Affective Disorder Treated with and Without Lithium

Andrés Camilo Díaz Ortiz; Cristian Vargas Upeguí; Juan Pablo Zapata Ospina; Daniel Camilo Aguirre Acevedo; Julián Alberto Pineda Zapata; Carlos Alberto López Jaramillo

doi:10.1016/j.rcp.2020.10.003

Correlation Between Cognitive Performance and Structural Neuroanatomy in Patients with Type I Bipolar Affective Disorder Treated with and Without Lithium

Rev Colomb Psiquiatr (Engl Ed). 2021 Jan 1:S0034-7450(20)30094-9. doi: 10.1016/j.rcp.2020.10.003. Online ahead of print.

[Article in English, Spanish]

Authors

Andrés Camilo Díaz Ortiz¹, Cristian Vargas Upeguí², Juan Pablo Zapata Ospina³, Daniel Camilo Aguirre Acevedo³, Julián Alberto Pineda Zapata⁴, Carlos Alberto López Jaramillo²

Affiliations

¹ Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia. Electronic address: camilodiazo.md@gmail.com.
² Grupo de Investigación en Psiquiatría (GIPSI), Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
³ Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
⁴ Ayudas Diagnósticas SURA, Grupo de Investigación del Instituto de Alta Tecnología Médica (IATM).

PMID: 33735049
DOI: 10.1016/j.rcp.2020.10.003

Abstract

Introduction: Lithium treatment of bipolar disorder (BD) has been associated with less cognitive impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium.

Methods: Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propensity score, and the Spearman correlation coefficient (ρ) was used to assess the relationship between cognitive performance and neuroanatomical regions.

Results: Compared to the group without lithium, the group with lithium had fewer perseverative errors in the Wisconsin test (SMD = -0.69) and greater left and right cortical areas (SMD = 0.85; SMD = 0.92); greater surface area in the left anterior cingulate (SMD = 1.32), right medial orbitofrontal cortex (SMD = 1.17), right superior frontal gyrus (SMD = 0.82), and right and left precentral gyrus (SMD = 1.33; SMD = 0.98); greater volume of the right amygdala (SMD = 0.57), right hippocampus (SMD = 0.66), right putamen (SMD = 0.87) and right thalamus (SMD=.67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (ρ = -0.78), the volume of the right thalamus (ρ =-0.44), and the right amygdala (ρ = 0.6).

Conclusions: The lithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium.

Keywords: Bipolar disorder; Cognición; Cognition; Executive function; Función ejecutiva; Lithium; Litio; Neuroanatomy; Neuroanatomía; Neuropsychological tests; Pruebas neuropsicológicas; Trastorno afectivo bipolar.