Differences Between Hot And Cool Executive Function And Frontal Lobe Blood Flow In Unipolar And Bipolar Disorder

Objective: Bipolar depression and unipolar depression have always been the focus and difficulty of clinical differential diagnosis,and both diseases show impairment of executive function,but there is still a lack of empirical studies on the different impairments of cool and hot executive function.In this study,the differences between the two diseases were explored from the perspectives of cool execution and hot execution,as well as the difference in the activation level of brain regions under the corresponding hot and cool execution tasks,and the executive function mechanism of the two diseases was explored,in order to provide a basis and reference for the differential diagnosis of the two diseases,shorten the diagnosis cycle,and reduce the disease burden of patients.Methods: From September 2021 to December 2022,74 patients with depressive episodes were recruited in the outpatient clinic of the Sixth People’s Hospital of Hebei Province,including 35 patients in the unipolar depression group,39 patients in the bipolar depression group,and 39 patients in the healthy control group recruited in the community.The self-made general demographic scale was used to collect demographic information,the Hamilton Depression 17 Scale was used to assess the severity of depression,and the Adult Executive Function Scale was used to assess the degree of overall executive function impairment.The classic cool execution task and the hot execution task were used to explore the differences in cool and hot executive functions,and the functional near-infrared imager was used to measure the changes of cerebral blood flow in each group under the two tasks,and then reflect the difference in brain region activationResults: 1 The number of years of education in the unipolar depression group was significantly less than that of the healthy control group(H=24.792,P=0.02),and there was a significant difference in the age of onset between the unipolar depression group and the bipolar depression group,and the bipolar depression group was significantly smaller than that in the unipolar depression group(?2=-3.797,P=0.000).2 There were significant differences between the healthy control group and the unipolar depression group in the factors and total scores of the adult executive function scale(P<0.05).There were significant differences between the healthy control group and the bipolar depression group in the factors and total scores of the adult executive function scale(P<0.05).There were significant differences in self-monitoring between the unipolar depression group and the bipolar depression group(H=42.586,P<0.05).3 In the cold execution task,the main effect of the participant type was not significant(F(2,110)=2.081,P=0.130),the main effect of the stimulus condition was significant(F(2,110)=28.605,P<0.05),and the interaction between the participant type and the stimulus condition was not significant.In the hot execution task,the main effect of the participant type was significant(F(2,110)=3.764,P<0.05),the main effect of the emotion type was significant(F(2,110)=27.863,P<0.05),and the interaction between the subject type and the emotion type was not significant.4 The total executive function score factor of patients in the unipolar depr ession group was significantly positively correlated with the total score of cog nitive impairment,blockade and depression(P<0.05),and the behavior manage ment index factor was significantly positively correlated with the total score ofcognitive impairment,blockade and depression(r=0.401,P<0.05;r=0.542,r=0.558,P<0.001);The metacognitive index factor was positively correlated with the to tal scores of cognitive impairment,blockade and depression(r=0.438,r=0.633,r=0.508,P<0.001).5 The total executive function score factor of patients in the bipolar depression group was significantly positively correlated with sleep disorder and depression total score(P<0.05),and the behavior management index factor was significantly positively correlated with cognitive impairment and depression total score(r=0.319,P<0.05;r=0.438,P<0.001);Metacognitive index factors were significantly positively correlated with the total scores of somatization of anxiety,sleep disorder and depression(r=0.376,P<0.05;r=0.411,r=0.534,P<0.001).6 Under cool execution tasks X conditions,there were no significant differences between the unipolar depression group and the bipolar depression group under each channel.Under consistent conditions,there were significant differences between the two groups in channels 21 and 42(t=2.56,P=0.012;t= 2.43,P=0.018),the degree of activation was significantly higher in the unipolar depression group than in the bipolar depression group;Under the inconsistent conditions,there were significant differences between the two groups in channels 1,12,34,and channels 42(t=-2.36,P=0.021;t=-2.40,P=0.018;t=-2.78,P=0.007;t=2.163,P=0.034).7 Under positive emotional conditions,there were significant differences between the unipolar depression group and the bipolar depression group in channels10 and 21(t=2.029,P=0.046;t=2.776,P=0.007);Under the neutral condition,there was no significant difference in each channel between the two groups.Under the negative mood condition,there was a significant difference in channel 26 between the two groups(t=-2.32,P =0.023).Conclusion: 1 Both the unipolar depression group and the bipolar depression group showed impaired executive function,and the bipolar depression group may be more severe,especially self-monitoring factors.2 Patients with unipolar depression have separation of hot and cool executive function,and impaired executive function in patients with unipolar and bipolar depression is associated with disease severity.3 In the cool executive function task,the brain regions with different activation differences between unipolar depression and bipolar depression were the left dorsolateral prefrontal lobe,the right posterior central gyrus,and the right triangular inferior frontal gyrus region.In the thermal executive function task,the brain regions with different activation in patients with the two diseases are the left frontal pole,the left superior marginal gyrus,and the right medial superior frontal gyrus,mainly concentrated in the frontal lobe.