The Study Of Cognitive Impairments And Cerebral Metabolism Abnormalities In Bipolar Depressive Disorder Patients With Suicidal Ideation

ObjectiveThe objective of this study is to investigate the cognitive function and levels of cerebralmetabolism in bipolar depressive disorder (BDD) patients with suicidal ideation (SI), usingmagnetic resonance spectroscopy (MRS), then compared with BDD patients without suicidalideation and healthy controls, found the cognitive impairments and cerebral metabolismabnormalities in BDD patients with suicidal ideation, to provide basis for early identification andintervention of suicide.Methods44BDD patients were studied by Beck Scale for Suicide Ideation-Chinese Version (BSI-CV),divided the patients into two groups: patients with suicidal ideation (SI, n=23) and patientswithout suicidal ideation (NSI, n=21), according to the result of BSI-CV. We evaluated the speedof information processing, attention, memory, executive function, and language in the group SI,group NSI and21healthy controls by using Symbol Digital Modalities Test (SDMT), digitalspan, Trail Making Test (TMT), visual reproduction, Wisconisin Card Sorting Test-modified(WCST) and verbal fluency, and performed by magnetic resonance spectroscopy (MRS) at thebilaterally lenticular nucleus and thalamus in the two patient groups and healthy controls to studythe levels of N-acetylasparte (NAA), choline compounds (Cho), myo-inositol (mI) and creatine(Cr). We analyzed the data to find the cognitive impairments and cerebral metabolismabnormalities in BDD patients.Results1. When compared with healthy controls, group SI has a significantly worse performance onscore of SDMT, digital span (forward, backword, forward+backword) and visual reproduction,and TMT-B(errors) were more than healthy controls. When compared with healthy controls,group NSI has significantly worse performance on score of SDMT, digital span (forward+backword), visual reproduction and verbal fluency. There was no significant differencebetween the group SI and NSI.2. When compared with the healthy controls, group NSI has a significantly decreased NAA/Crratio in the left lenticular nucleus and Cho/Cr ratio in the left thalamus, there was no significantdifference in the ratios in the bilaterally lenticular nucleus and thalamus in group SI.3. Correlation analysis:â‘ In group SI, the verbal fluency (repeating number) was positively correlated with the mI/Crratio in the right lenticular nucleus, the TMT-B(uptakes) was negatively correlated with theNAA/Cr ratio in the left thalamus, and the TMT-B(errors) was positively correlated with theCho/Cr ratio in the left thalamus.â‘¡In group SI, the score of SDMT, digital span(backword, forward+backword), visualreproduction and types of WCST were negatively correlated with the number of episodes, andthe TMT-B(time, uptakes) and WCST(total errors, perseverative errors, non-perseverative errors)were positively correlated with the number of episodes; the TMT-B(time, errors) was positivelycorrelated with the duration; the score of SDMT, digital span(forward, backword,forward+backword) and visual reproduction were positively correlated with the years ofeducation, the TMT-A(time) and TMT-B(time, uptakes) were negatively correlated with theyears of education.â‘¢In group SI, the Cho/Cr ratio in the right lenticular nucleus was positively correlated with theage and age of onset, and the NAA/Cr ratio in the left thalamus was negatively correlated withthe score of HAMD-24.Conclusion1. The speed of information processing, attention and memory in both BDD patients with orwithout suicidal ideation may be impaired, and BDD patients without suicidal ideation may havelanguage impairment.2. The metabolism of mI in the right lenticular nucleus in BDD patients with suicidal ideationmay relate to the impairment of language function, the neuronal dysfunction and theabnormalities of membrane hospholipids in the left thalamus in BDD patients with suicidalideation were more significant, the attention function may be more serious impaired. 3. The more episodes in BDD patients with suicidal ideation, the speed of information processing,attention, memory and executive function may be more serious impaired, and the impairments ofattention and executive function may relate to the long course of disease.4. The ages or the ages of onset of BDD patients with suicidal ideation were older, theabnormalities of membrane hospholipids in the right lenticular nucleus may be more significant,and the aggravation of depression may relate to the neuronal dysfunction in the left thalamus.