Brain Morphometrics

Differences in White Matter Abnormalities between bipolar I and II Disorders


Background: Although patients with bipolar I and II disorders exhibit heterogeneous clinical presentations and cognitive functions, it remains unclear whether these two subtypes have distinct neural substrates. This study aimed to differentiate the fiber abnormalities between bipolar I and II patients using diffusion tensor images.

Method: Fourteen bipolar I patients, thirteen bipolar II patients, and twenty-one healthy subjects were recruited. Fractional anisotropy (FA) values calculated from diffusion tensor images were compared among groups using two-sample t-test analysis in a voxel-wise manner. Correlations between the mean FA value of each survived area and the clinical characteristics as well as the scores of neuropsychological tests were further analyzed.

Results: Patients of both subtypes manifested fiber impairments in the thalamus, anterior cingulate, and inferior frontal areas, whereas the bipolar II patients showed more fiber alterations in the temporal and inferior prefrontal regions. The FA values of the subgenual anterior cingulate cortices for both subtypes correlated with the performance of working memory. The FA values of the right inferior frontal area of bipolar I and the left middle temporal area of bipolar II both correlated with executive function. For bipolar II patients, the left middle temporal and inferior prefrontal FA values correlated with the scores of YMRS and hypomanic episodes, respectively.

Conclusions: Our findings suggest distinct neuropathological substrates between bipolar I and II subtypes. The fiber alterations observed in the bipolar I patients were majorly associated with cognitive dysfunction, whereas those in the bipolar II patients were related to both cognitive and emotional processing.


Figure : Regions with significantly decreased FA values found in the (a) combined bipolar, (b) bipolar I, and (c) bipolar II groups compared to the controls; and (d) bipolar II group compared to the bipolar I group. The t-values of these areas are shown with “hot” color map (black–red–yellow–white) whereas the spatial probability maps of major fiber tracts covering these areas are shown in “winter” color map (blue–green), overlaid on the MNI-152 brain template.