| In today’s society,the growing pressure of life has created many mental problems.The prevalence of common diseases in psychiatric disorder is increasing year by year,showing a trend of becoming younger.Bipolar disorder(BD)is one of the common psychological disorders.It has a young age of onset and a high risk of suicide,so it has a serious impact on the patient’s learning,work,and life.The comorbidity rate of BD and Attention Deficit Hyperactivity Disorder(ADHD)is high.However,diagnosis and treatment of adult ADHD are often neglected clinically,and the rate of misdiagnosis is high,which is not conducive to the prognosis of patients and the recovery of social functions.This study focused on patients of bipolar disorder comorbid ADHD.MATRICS Consensus Cognitive Battery(MCCB)and facial emotion processing test were used to evaluate the patients’comprehensive cognitive function.,and the ~1H-MRS was used to detect the brain biochemical metabolism in patients.Though the biochemical metabolism of brain,this study tended to investigate the pathological mechanism of cognitive impairment in patients with BD comorbid ADHD.According to the DSM-V diagnostic criteria,29 patients were enrolled as BD comorbided with ADHD group,26 patients with BD were enrolled as BD without ADHD group,and35 normal subjects were recruited as healthy control group(HC group).MCCB and facial emotion processing procedure were used to evaluate the information processing speed,attention/alertness,working memory,word learning,visual learning,reasoning and problem solving ability and social cognition in these three groups.Meanwhile,the study used ~1H-MRS to examine the levels of N-acetylasparte(NAA),choline compounds(Cho)and creatine(Cr)of all the subjects’frontal lobe,bilaterally lenticular nucleus and Cerebellar,and the levels of cerebral metabolism were calculated by NAA/Cr and Cho/Cr.The correlations among brain biochemical metabolism,cognitive function and clinical symptoms of these three groups was conducted to examine the mediating effect of depression between the brain metabolism and cognitive function.Results:(1)The BD comorbided with ADHD group had significant difference in overall cognition with HC group(p<0.05).There was no significant effect on the correct rate,response time and assigned values of the three groups in the facial emotion processing test.(2)For the Cho/Cr values of the right basal ganglia,the comorbid ADHD group was significantly lower than the normal control group(p<0.05).(3)There was a significant positive correlation between visual learning and NAA/Cr values in the frontal lobe and Cho/Cr in the right basal ganglion in all three groups(p<0.05).HAMD scores were negatively correlated with Cho/Cr values in the right basal ganglion(p<0.05).There was a significant negative correlation between the cognitive functions and the HAMD scores(p<0.01).The degree of depression had the mediating effect in the Cho/Cr of the right basal ganglion and visual learning.(4)Simple slope analysis result showed that in visual learning and overall comprehensive score,the severity of comorbid ADHD had a significant moderating effect on the degree of depression(p<0.05).Conclusion:(1)BD comorbid ADHD patients have Cognitive deficits,of which visual learning is most severely impaired.(2)Abnormalities in the biochemical metabolism of the right basal ganglia in BD comorbid ADHD patients may affect their mood and cognitive function.(3)The degree of depression plays a complete mediating role in the relationship between biochemical metabolism of the right basal ganglia and visual learning.The biochemical metabolism of the right basal ganglia affects the visual learning function by affecting depression.(4)Visual learning in BD patients is extrinsic and affected by depressive symptoms.The degree of comorbid ADHD plays a moderating role in the relationship between depressive symptoms and visual learning. |
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