Reduced Prefrontal Activation During the Tower of London and Verbal Fluency Task in Patients With Bipolar Depression: A Multi-Channel NIRS Study

Q: What is the clinical evidence from this study?

Study design: Case-Control. Population: Bipolar depression (n=75). Intervention: Bipolar depression vs. Healthy controls. Primary outcome: Changes in oxygenated hemoglobin (oxy-Hb) levels in frontal areas during the Tower of London (TOL) task and verbal fluency task (VFT) (p=<0.05).

Linyan Fu; Dan Xiang; Jiawei Xiao; Lihua Yao; Ying Wang; Ling Xiao; Huiling Wang; Gaohua Wang; Zhongchun Liu

doi:10.3389/fpsyt.2018.00214

May 28, 2018Frontiers in PsychiatryOpen Access

Reduced Prefrontal Activation During the Tower of London and Verbal Fluency Task in Patients With Bipolar Depression: A Multi-Channel NIRS Study

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Key result

Patients with bipolar depression exhibited significantly smaller changes in oxygenated hemoglobin in the prefrontal cortex during the Tower of London and verbal fluency tasks compared to healthy controls.

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Why the study?

Does bipolar depression alter prefrontal activation during executive function tasks compared to healthy controls?

Key Points

To assess frontocortical hemodynamic changes in patients with bipolar depression during the Tower of London and verbal fluency tasks using near-infrared spectroscopy.
Enrolled 43 patients with bipolar depression and 32 matched healthy controls.
Measured frontal changes in oxygenated and deoxygenated hemoglobin using a 41-channel near-infrared spectroscopy system during the Tower of London task and verbal fluency task.
Patients with bipolar depression exhibited significantly lower activation levels in the bilateral dorsolateral prefrontal cortex during the Tower of London task compared to healthy controls.
During the verbal fluency task, patients displayed lower activation across the right ventrolateral prefrontal cortex, right dorsolateral prefrontal cortex, and bilateral prefrontal cortex relative to controls.

Study Design

Type

Case-Control (n=75)

Multicenter

No

Structured PICO

Does bipolar depression alter prefrontal activation during executive function tasks compared to healthy controls?

P

Population

75 participants, comprising 43 patients with bipolar depression and 32 matched healthy controls aged 16 to 50, assessed for prefrontal hemodynamic changes during cognitive tasks.

E

Exposure

Tower of London (TOL) task and verbal fluency task (VFT) while undergoing 41-channel near-infrared spectroscopy (NIRS)

C

Comparator

Healthy controls undergoing the same tasks

O

Outcome

Hemodynamic changes (oxygenated and deoxygenated hemoglobin levels) in frontal areas during the TOL task and VFTsurrogate

Main Result

p-value: p=<0.05

Patients with bipolar depression exhibit reduced prefrontal cortex activation during planning and problem-solving tasks, suggesting that executive dysfunction in this population is linked to prefrontal impairment.

Limitations

NIRS can only measure cortical regions rather than the deep structures of the brain
The sample size used was relatively small
All patients were taking medications at the time of measurement, so medication effects cannot be excluded
Cross-sectional study design
Small sample size
Effects of medication cannot be excluded
Only evaluated patients with bipolar depression

Implication

Reduced prefrontal oxy-Hb changes during TOL/VFT in bipolar depression may signal executive impairment; leaves open NIRS diagnostic or monitoring utility.

Abstract

Background: The Tower of London (TOL) task is one of the most commonly used tests for evaluating executive functions, and can indicate planning and problem-solving abilities. The aim of this study was to evaluate hemodynamic changes in patients with bipolar depression during the TOL task and the verbal fluency task (VFT) using near-infrared spectroscopy. Methods: Forty-three patients with bipolar depression and 32 healthy controls (HCs) matched for sex, age, handedness, and years of education were enrolled in this study. Changes in oxygenated and deoxygenated hemoglobin (oxy-Hb and deoxy-Hb) levels in frontal areas during the TOL task and VFT were evaluated using a 41-channel NIRS system. Results: During the TOL task, the patients with bipolar depression had lower activation levels in the bilateral dorsal-lateral prefrontal cortex (DLPFC) than the HCs. During the VFT task, the patients with bipolar depression had lower activation levels in the right ventrolateral prefrontal cortex (VLPFC), the right DLPFC and both the right and left prefrontal cortex (PFC) than the HCs. Limitations: Our sample size was small, and the effects of medication cannot be excluded. Conclusions: These results indicate that planning and problem solving dysfunction is related to the impairment of the prefrontal cortex in patients with bipolar depression, and NIRS can be used to assess planning and problem solving abilities, which are essential to daily life in patients with bipolar disorder.

Discussion

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Cite This Study

Fu et al. (2018) conducted a case-control in Bipolar depression (n=75). Bipolar depression vs. Healthy controls was evaluated on Changes in oxygenated hemoglobin (oxy-Hb) levels in frontal areas during the Tower of London (TOL) task and verbal fluency task (VFT) (p=<0.05). Patients with bipolar depression exhibited significantly smaller changes in oxygenated hemoglobin in the prefrontal cortex during the Tower of London and verbal fluency tasks compared to healthy controls.

synapsesocial.com/papers/6a9ea612523ea69b6e6a7da1 https://doi.org/10.3389/fpsyt.2018.00214

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Reduced Prefrontal Activation During the Tower of London and Verbal Fluency Task in Patients With Bipolar Depression: A Multi-Channel NIRS Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Reduced Prefrontal Activation During the Tower of London and Verbal Fluency Task in Patients With Bipolar Depression: A Multi-Channel NIRS Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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