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- Title
Association Between the Fronto-Limbic Network and Cognitive and Emotional Functioning in Individuals With Bipolar Disorder: A Systematic Review and Meta-analysis.
- Authors
Mesbah, Rahele; Koenders, Manja A.; van der Wee, Nic J. A.; Giltay, Erik J.; van Hemert, Albert M.; de Leeuw, Max
- Abstract
Key Points: Question: Do individuals with bipolar disorder show aberrant brain activities in regions of the fronto-limbic network compared with healthy control individuals? Findings: This systematic review and meta-analysis consisting of 49 functional magnetic resonance imaging studies (999 individuals with bipolar disorder and 1027 healthy control individuals) examining brain activity in 3 domains (emotion processing, reward processing, and working memory) found robust activity disturbances in brain regions, mostly within the fronto-limbic network. Meaning: Aberrations in the fronto-limbic network may underlie cognitive and emotional dysfunctions in individuals with BD. This systematic review and meta-analysis investigates the emotion processing, reward processing, and working memory brain domains of individuals with bipolar disorder vs those of healthy control individuals. Importance: Individuals with bipolar disorder (BD) experience cognitive and emotional dysfunctions. Various brain circuits are implicated in BD but have not been investigated in a meta-analysis of functional magnetic resonance imaging (fMRI) studies. Objective: To investigate the brain functioning of individuals with BD compared with healthy control individuals in the domains of emotion processing, reward processing, and working memory. Data Sources: All fMRI experiments on BD published before March 2020, as identified in a literature search of PubMed, Embase, Web of Science, Cochrane Library, PsycInfo, Emcare, Academic Search Premier, and ScienceDirect. The literature search was conducted on February 21, 2017, and March 2, 2020, and data were analyzed from January 2021 to January 2022. Study Selection: fMRI experiments comparing adult individuals with BD and healthy control individuals were selected if they reported whole-brain results, including a task assessing at least 1 of the domains. In total, 2320 studies were screened, and 253 full-text articles were evaluated. Data Extraction and Synthesis: A total of 49 studies were included after selection procedure. Coordinates reporting significant activation differences between individuals with BD and healthy control individuals were extracted. Differences in brain region activity were tested using the activation likelihood estimation method. Main Outcomes and Measures: A whole-brain meta-analysis evaluated whether reported differences in brain activation in response to stimuli in 3 cognitive domains between individuals with BD and healthy control individuals were different. Results: The study population included 999 individuals with BD (551 [55.2%] female) and 1027 healthy control individuals (532 [51.8%] female). Compared with healthy control individuals, individuals with BD showed amygdala and hippocampal hyperactivity and hypoactivation in the inferior frontal gyrus during emotion processing (20 studies; 324 individuals with BD and 369 healthy control individuals), hyperactivation in the orbitofrontal cortex during reward processing (9 studies; 195 individuals with BD and 213 healthy control individuals), and hyperactivation in the ventromedial prefrontal cortex and subgenual anterior cingulate cortex during working memory (20 studies; 530 individuals with BD and 417 healthy control individuals). Limbic hyperactivation was only found during euthymia in the emotion and reward processing domains; abnormalities in frontal cortex activity were also found in individuals with BD with mania and depression. Conclusions and Relevance: This systematic review and meta-analysis revealed evidence for activity disturbances in key brain areas involved in cognitive and emotion processing in individuals with BD. Most of the regions are part of the fronto-limbic network. The results suggest that aberrations in the fronto-limbic network, present in both euthymic and symptomatic individuals, may be underlying cognitive and emotional dysfunctions in BD.
- Subjects
BIPOLAR disorder; COGNITIVE ability; FUNCTIONAL magnetic resonance imaging; REWARD (Psychology); PREFRONTAL cortex; MIND-wandering
- Publication
JAMA Psychiatry, 2023, Vol 80, Issue 5, p432
- ISSN
2168-622X
- Publication type
Article
- DOI
10.1001/jamapsychiatry.2023.0131