| Objective:The Cognitive function of patients with bipolar depressive disorder comorbidity borderline personality disorder(BPD)was assessed by MATRICS Consensus Cognitive Battery(MCCB),the biochemical metabolism in the frontal lobe,putamen and anterior cingulate gyrus was examined by ~1H-magnetic resonance spectroscopy(~1H-MRS),and the Minnesota multiphasic personality inventory(MMPI)was completed,to explore the characteristics of psychological,cognitive and biochemical metabolism in patients with bipolar depression comorbidity BPD,and to identify the risk factors of bipolar depressive disorder comorbidity BPD.Methods:According to the diagnostic criteria of DSM-5,41patients with bipolar depression comorbidity BPD(comorbidity group)and 51 patients with bipolar depression without comorbidity BPD(non-comorbidity group)were enrolled in the study,and 30 normal subjects were recruited as healthy control group(control group)..The levels of N-Acetylasparte(NAA),Choline Compounds(Cho)and Creatine(Cr)in frontal lobe,putamen and anterior cingulate gyrus of three groups were measured by ~1H-MRS,the ratio of NAA/Cr and Cho/Cr indicate the level of metabolites in each brain region.In the meantime,MMPI was used to assess the subjects’personality traits,MCCB was used to assess the cognitive functions of all subjects in seven cognitive domains:information processing speed,attentiveness/alertness,working memory,word learning,visual learning,reasoning and problem solving,and social cognition,the correlation of cerebral biochemical metabolism,cognitive function and clinical psychological characteristics in patients with comorbidity was analyzed,and the risk prediction model was established.Results:(1)the scores of cognitive dimension of comorbidity group were lower than those of non-comorbidity group and HC group.In the comorbidity group,7 cognitive dimensions were severe impaired,including information speed of processing,attention/vigilance,word learning,visual learning and social cognition(d=1.341,0.807,1.325,0.991,0.956).Except reasoning and problem solving ability(P=0.18),the scores of cognitive dimension of Comorbidity group were significantly different from those of non-comorbidity Group and HC group(P<0.05)There were significant differences in information processing speed,word learning and general cognitive scores between comorbidity group and non-comorbidity group(P<0.001).(2)The speed of information processing in the comorbidity group was significantly correlated with the course of the attack and the age of the first attack(r=-0.459,0.396;P=0.009,0.015),the working memory was negatively correlated with the course of the attack(r=-0.351,P=0.033),visual learning was positively correlated with the number of attacks and the total course of disease(r=0.333,0.476;P=0.014,0.003).The other cognitive domains were not correlated with clinical features(all P>0.05)(3)NAA/Cr ratio in the frontal lobe and the putamen of the comorbidity group were slightly higher than those of the control group,and the ratio of NAA/Cr in the anterior cingulate gyrus were lower than those of the control group,however,there was no significant difference between non-comorbidity group and non-comorbidity group(P>0.05),the Cho/Cr ratio of right putamen in non-comorbidity group was significantly higher than that in control group(P=0.029),and there was no significant difference between non-comorbidity group and control group(P>0.05).(4)The right anterior cingulate gyrus and right frontal lobe Cho/Cr ratio were positively correlated with the severity of depression(r=0.514,0.358;P=0.003,0.048)..(5)NAA/Cr ratio in left frontal lobe and right lenticular nucleus were positively correlated with information processing speed(r=0.469,0.430;P=0.010,0.030),and NAA/Cr ratio in left frontal lobe and left lenticular nucleus were positively correlated with word learning(r=0.386,0.378,P=0.038,0.043),attention was negatively correlated with bilateral NAA/Cr in frontal lobe(r=-0.396,-0.386;P=0.033,0.039).Word learning was positively correlated with left frontal lobe and left anterior cingulate gyrus(r=0.386,0.378;P=0.038,0.043),there was a positive correlation between visual learning and NAA/Cr in the right putamen(r=0.504;P=0.005).There was no significant correlation between~1H-MRS and MCCB in other brain regions(P>0.05).(6)There were significant differences in MMPI between the two groups in cheat score,hypochondria,hysteria,delusion,mental weakness and schizophrenia,and the score of comorbidity group was higher than that of non-comorbidity group(P=0.009,0.008,0.038,0.019,0.007,0.004).(7)Multivariate logistic regression analysis showed that non-suicidal self-injury behavior was associated with bipolar depressive disorder comorbidity BPD(OR=3.350;P=0.036).Conclusion:(1)Comorbidity borderline personality disorder can aggravate the cognitive impairment in patients with bipolar depression,who was significant impairment in several cognitive dimensions.Including the additive impairment in information processing speed,word learning and general cognitive function,it may be related to the function of neurons in left frontal lobe and right anterior cingulate gyrus.(2)The younger the first onset age and the longer the course of the disease,the faster the information processing speed and the more severe the impairment of working memory in patients with borderline personality disorder.(3)patients with borderline personality disorder of bipolar depression have higher anxiety,inferiority complex,sensitivity,somatic and psychotic symptoms.(4)Non-suicidal self-injury behavior may be the potential risk factors of bipolar depression Comorbidity borderline personality disorder,among which general cognition is the protective factor. |
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