J Psychiatry Neurosci 2011;36(6):391-401
Sven Haller, MD, MSc; Aikaterini Xekardaki, MRPsychol; Christophe Delaloye, PhD; Alessandra Canuto, MD; Karl Olof Lövblad, MD; Gabriel Gold, MD; Panteleimon Giannakopoulos, MD
Haller, Lövblad — Service neuro-diagnostique et neuro-interventionnel DISIM, University Hospitals of Geneva; Xekardaki, Delaloye, Canuto, Giannakopoulos — Division of General Psychiatry, Department of Psychiatry, University Hospitals of Geneva; Gold — Department of Rehabilitation and Geriatrics, University Hospitals of Geneva; Giannakopoulos — Division of Old Age Psychiatry, University of Lausanne School of Medicine, Lausanne, Switzerland
Background: Previous magnetic resonance imaging (MRI) studies in young patients with bipolar disorder indicated the presence of grey matter concentration changes as well as microstructural alterations in white matter in various neocortical areas and the corpus callosum. Whether these structural changes are also present in elderly patients with bipolar disorder with long-lasting clinical evolution remains unclear.
Methods: We performed a prospective MRI study of consecutive elderly, euthymic patients with bipolar disorder and healthy, elderly controls. We conducted a voxel-based morphometry (VBM) analysis and a tract-based spatial statistics (TBSS) analysis to assess fractional anisotropy and longitudinal, radial and mean diffusivity derived by diffusion tensor imaging (DTI).
Results: We included 19 patients with bipolar disorder and 47 controls in our study. Fractional anisotropy was the most sensitive DTI marker and decreased significantly in the ventral part of the corpus callosum in patients with bipolar disorder. Longitudinal, radial and mean diffusivity showed no significant between-group differences. Grey matter concentration was reduced in patients with bipolar disorder in the right anterior insula, head of the caudate nucleus, nucleus accumbens, ventral putamen and frontal orbital cortex. Conversely, there was no grey matter concentration or fractional anisotropy increase in any brain region in patients with bipolar disorder compared with controls.
Limitations: The major limitation of our study is the small number of patients with bipolar disorder.
Conclusion: Our data document the concomitant presence of grey matter concentration decreases in the anterior limbic areas and the reduced fibre tract coherence in the corpus callosum of elderly patients with long-lasting bipolar disorder.
Submitted Sept. 7, 2010; Revised Nov. 3, 2010; Accepted Nov. 29, 2010.
Acknowledgments: We thank all patients and controls for participating in this study.
Competing interests: None declared for Ms. Xekardaki and Drs. Canuto, Lövblad and Giannakopoulos. Drs. Haller and Delaloye reported grants to their institutions from the Swiss National Science Foundation. Dr. Gold declares serving on the boards of Lundbeck, Pfizer and AC Immune, receiving payment for lectures from Lundbeck and Vifor, and receiving payment of meeting expenses from Merz.
Contributors: Drs. Haller, Delaloye, Lövblad, Gold and Giannakopoulos designed the study. Drs. Delaloye, Canuto and Lövblad acquired the data, which Drs. Haller, Delaloye and Giannakopoulos and Ms. Xekardaki analyzed. Drs. Haller, Lövblad and Giannakopoulos and Ms. Xekardaki wrote the article, which all authors reviewed and approved for publication.
Correspondence to: Dr. S. Haller, Service neuro-diagnostique et neuro-interventionnel DISIM, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, 1211 Genève 14, Switzerland; firstname.lastname@example.org