| PurposePediatric bipolar disorder(PBD)is a common psychiatric disorder with high prevalence,recurrence,and suicide rates,and is the fourth most disabling disorder among adolescents.It is often accompanied by cognitive impairments such as memory,language learning,and executive control.This study attempted to explore the differences of brain structure and function in adolescent patients with bipolar disorder by using multimodal magnetic resonance imaging analysis technology,and preliminarily explore the differentiation characteristics of cerebral structure and function in adolescent patients with bipolar disorder,and introduce a mediation model to analyze the role of core brain regions on executive control function in PBD patients.MethodIn this study,38 PBD patients from the Child Psychiatric Outpatient Department were recruited,including 17 patients with depressive phase and 21 patients with remission phase.The healthy control group was recruited from a middle school at the same time,and a total of 19 subjects were eligible for inclusion in the experiment.In terms of behavior,a self-designed questionnaire was conducted for all subjects to collect general demographic information,and Stroop color word interference test was used to assess the cognitive executive control function of participants.Multimodal magnetic resonance imaging was used to capture the brain structure and function.Research based on voxel morphology analysis(VBM)and center degrees(DC)analysis method,respectively,to explore PBD group and health control group two groups of patients with brain structure and brain function of the connection between abnormal,and to further explore the group of patients with depression phase PBD,remission PBD group and healthy control group between the three groups of patients with abnormal brain structure and brain function connection,Finally,a mediating model was established to explore the mediating effect of the volume of gray matter in the superior frontal gyrus of the core brain region on cognitive function in different groups of PBD patients.Results(1)The cognitive score results showed that there were significant differences in the Stroop color word test scores among the three groups.Further pairable comparison showed that,compared with the healthy control group,the Stroop color word test scores of the depressed and the remission PBD patients were significantly reduced,and there was no significant difference in the cognitive score between the depressed and the remission PBD patients.This study found significant deficits in some cognitive functions in PBD patients compared with healthy controls.(2)Morphological results showed that the gray matter volume of the left superior frontal gyrus,left hippocampus and left posterior central gyrus in PBD patients was significantly reduced compared with the healthy control group by t-test analysis.The results of variance analysis showed that there were significant differences in the gray matter volume of the left middle frontal gyrus,right posterior central gyrus,right precentral gyrus,left insula and hippocampus among the three groups of subjects.Based on the results of variance analysis results show that after further compare two patients with depression phase PBD after back,on the right side of the central in the left frontal back,on the right side of the central front back,left insula,the hippocampus area of gray matter volume were significantly less than healthy controls,the patients with remission PBD in the left hippocampal area of gray matter volume less than healthy controls,The gray matter volume in the left middle frontal gyrus,right posterior central gyrus,and right anterior central gyrus decreased in depressed PBD patients compared with those in remission PBD patients.Correlation analysis between cognitive score and gray matter volume showed that the left superior frontal gyrus,right lingual gyrus and left insula were significantly positively correlated with cognitive score in PBD patients.(3)The results of the resting state data showed that the default mode network of the three groups showed positive connection after analysis by using the single sample t-test.The T-test of two samples was used to analyze the results.Compared with the healthy control group,the left superior frontal gyrus and bilateral hippocampus DC values of PBD patients were significantly increased,showing a strong brain functional connection.The DC value of bilateral lenticulate nucleus was significantly decreased,and the functional connectivity of brain was decreased.Variance analysis was used to analyze the differences among the three groups of subjects.The results showed that there were significant differences in DC values in the right superior frontal gyrus and bilateral lenticulate gyrus.Based on the results of variance analysis,pairwise comparison showed that the DC values in the right superior frontal gyrus and bilateral lentiform nucleus of PBD patients with depression phase and PBD patients in remission phase were significantly lower than those of healthy control group.The DC values in the right superior frontal gyrus of PBD patients with depression phase were significantly lower than those of PBD patients in remission phase.Correlation analysis between cognitive score and functional connectivity showed that the left superior frontal gyrus and the left lentiform nucleus were positively correlated with cognitive function in PBD patients.(4)The results of mediating analysis showed that the left superior frontal gyrus had a significant mediating effect on the correlation between cognitive function and PBD patients,and it was a partial mediating effectConclusion(1)Both PBD patients with depression and PBD patients in remission had deficits in cognitive function,but no difference in cognitive function was found between them.(2)Brain structural abnormalities in PBD patients involve a wide range of brain regions,including frontal lobe,parietoccipital lobe,insula,etc.,which may be related to the pathogenesis of bipolar disorder.(3)In patients with PBD,abnormal functional connectivity in resting state involves the default mode network,frontal lobe,lentiform nucleus,hippocampus and other brain regions,and the brain structure and abnormal functional connectivity in depressed and remission PBD patients are not completely consistent.(4)The structural abnormalities of superior frontal gyrus may be related to the pathogenesis of bipolar disorder and cognitive impairment in PBD patients. |
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