Neurococognitive and neuroimaging correlates of obesity and components of metabolic syndrome in bipolar disorder: a systematic review

Abstract

BackgroundIndividuals with bipolar disorder (BD) have a higher prevalence of obesity and metabolic syndrome (MetS) compared with the general population. Obesity and MetS are associated with cognitive deficits and brain imaging abnormalities in the general population. Obesity and components of MetS might potentially associate with neuroimaging and neurocognitive findings in BD.MethodsA literature search of studies investigating the association between obesity (and other components of MetS) and neurocognitive and neuroimaging findings in BD was conducted. In addition to a systematic review, a random-effects meta-analysis was conducted when sufficient data were available.ResultsTwenty-three studies were included in the current systematic review. Overweight/obese patients were significantly associated with impaired neurocognition compared normal weight individuals with BD (d = 0.37). The most robust association between obesity and cognitive deficits in BD was observed in the cognitive subdomain of executive functions (d = 0.61). There was also evidence for a significant relationship between cognitive impairment in BD and other components of MetS including hypertension, dyslipidemia, and diabetes. Overweight/obese individuals with BD had more pronounced brain imaging abnormalities than normal weight individuals with BD.ConclusionsObesity and related cardiovascular risk factors significantly are associated with more severe cognitive and brain imaging abnormalities in BD. Medical co-morbidities can potentially contribute to functional decline observed in some patients throughout the course of BD.

Metabolic Syndrome Impairs Executive Function in Bipolar Disorder

“…MetS was associated with an increased risk of developing cognitive impairment during a 4-year period in women without psychiatric disorders (OR, 1.66; 95% CI, 1.14–2.41; Yaffe et al, 2009 ), and MetS was found to increase the risk of progression from mild cognitive impairment to dementia (hazard ratio (HR), 2.69; 95% CI, 1.16–6.27; Atti et al, 2019 ). In individuals with BD, however, the relationship between MetS and neurocognition has received limited attention ( Bora et al, 2019 ; Restrepo Moreno et al, 2019 ). A recent systematic review by Bora et al (2019) reported on three studies comparing cognitive performances of bipolar individuals with and without MetS.…”

“…In individuals with BD, however, the relationship between MetS and neurocognition has received limited attention ( Bora et al, 2019 ; Restrepo Moreno et al, 2019 ). A recent systematic review by Bora et al (2019) reported on three studies comparing cognitive performances of bipolar individuals with and without MetS. Hubenak et al (2015) found impairments in bipolar patients with MetS in global cognition using a cognitive composite score including values of the Rey Auditory Verbal Learning Test, the Spatial Span and Digit Span from the Wechsler Memory Scale–III, the Continuous Performance Test II, the Tower of London DX, and the Wisconsin Card Sorting Test.…”

Call to action regarding the vascular‐bipolar link: A report from the Vascular Task Force of the International Society for Bipolar Disorders

“…CVRFs are also associated with reduced neurocognitive function, particularly in frontal‐executive tasks 49‐57 . The strength of this association may depend in part on the symptomatic status and on the illness duration/stage 58,59 .…”

“…Thus far, there is a gap with regard to the link between neuroimaging phenotypes and hypertension/blood pressure or lipids levels, 55 and related studies are warranted. There are opportunities to capitalize on the advantages of ASL, which magnetically tags blood as a non‐invasive endogenous tracer.…”

Imágenes en obesidad: contribuyendo a un entendimiento más profundo de la enfermedad

“…Desde la aproximación neurocientífica, existe evidencia de que las personas con obesidad o sobrepeso manifiestan más alteraciones en el dominio de las funciones ejecutivas, hallazgo que a su vez se ha visto asociado a la aparición de diferencias en estudios de neuroimágenes, en comparación con sujetos sanos (4) . Así también, conductas poco saludables como el consumo excesivo de azúcar se ha relacionado con el compromiso de vías de retroalimentación cerebro-metabólicas, sensibles al efecto de situaciones como estrés (4,5) .…”