Relationship between frontostriatal morphology and executive function deficits in bipolar I disorder following a first manic episode: data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM)
Article first published online: 6 AUG 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd
Volume 15, Issue 6, pages 657–668, September 2013
How to Cite
Relationship between frontostriatal morphology and executive function deficits in bipolar I disorder following a first manic episode: data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM). Bipolar Disord 2013: 15: 657–668. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., , , , , , .
- Issue published online: 3 SEP 2013
- Article first published online: 6 AUG 2013
- Manuscript Accepted: 24 FEB 2013
- Manuscript Received: 8 MAY 2012
- Systematic Treatment Optimization Program for Early Mania
- basal ganglia;
- bipolar disorder;
- CANTAB ;
- dorsolateral prefrontal cortex;
- executive function;
- magnetic resonance imaging;
- voxel-based morphometry
Executive function impairments are a core feature of bipolar I disorder (BD-I), not only present during acute episodes but also persisting following remission of mood symptoms. Despite advances in knowledge regarding the neural basis of executive functions in healthy subjects, research into morphological abnormalities underlying the deficits in BD-I is lacking.
Patients with BD-I within three months of sustained remission from their first manic episode (n = 41) underwent neuropsychological testing and a 3T magnetic resonance imaging scan and were compared to healthy subjects matched for age, sex, and premorbid IQ (n = 30). Group dorsolateral prefrontal cortex (DLPFC; Brodmann areas 9 and 46) and caudate volumes were examined and analyzed for relationships with the average score from three computerized tests of executive function: Spatial Working Memory, Stockings of Cambridge, and Intradimensional/Extradimensional Shift.
Right caudate volumes were enlarged in patients (z = 3.57, p < 0.05 corrected). No differences in DLPFC volumes were found. Patients showed large deficits in executive function relative to healthy subjects (d = −0.92, p < 0.001). While in healthy subjects, a larger right (r = +0.39, p < 0.05) and left (r = +0.44, p < 0.05) caudate was associated with better executive function score, in patients, larger right (r = −0.36, p < 0.05) and left (r = −0.34, p < 0.05) volumes correlated with poorer performance.
Although the etiology of gray matter changes is unknown, volume increases in the right caudate may be an important factor underlying executive function impairments during remission in patients with BD-I.