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Although executive impairment has been reported in mania, its brain functional correlates have been relatively little studied. This study examined goal management, believed to be more closely related to executive impairment in daily life than other executive tasks, using a novel functional magnetic resonance imaging (fMRI) paradigm in patients in this illness phase.
Twenty-one currently manic patients with bipolar disorder and 30 matched healthy controls were scanned while performing the Computerized Multiple Elements Test (CMET). This requires participants to sequentially play four simple games, with transition between games being made either voluntarily (executive condition) or automatically (control condition).
CMET performance was impaired in the manic patients compared to the healthy controls. Manic patients failed to increase activation in the lateral frontal, cingulate and inferior parietal cortex when the executive demands of the task increased, while this increase was observed in the healthy controls. Activity in these regions was associated with task performance.
Manic patients show evidence of impaired goal management, which is associated with a pattern of reduced medial and lateral frontal and parietal activity.
Little is known about how functional imaging changes in bipolar disorder
relate to different phases of the illness.
To compare cognitive task activation in participants with bipolar
disorder examined in different phases of illness.
Participants with bipolar disorder in mania (n = 38),
depression (n = 38) and euthymia (n =
38), as well as healthy controls (n = 38), underwent
functional magnetic resonance imaging during performance of the n-back
working memory task. Activations and de-activations were compared between
the bipolar subgroups and the controls, and among the bipolar subgroups.
All participants were also entered into a linear mixed-effects model.
Compared with the controls, the mania and depression subgroups, but not
the euthymia subgroup, showed reduced activation in the dorsolateral
prefrontal cortex, the parietal cortex and other areas. Compared with the
euthymia subgroup, the mania and depression subgroups showed
hypoactivation in the parietal cortex. All three bipolar subgroups showed
failure of de-activation in the ventromedial frontal cortex. Linear
mixed-effects modelling revealed a further cluster of reduced activation
in the left dorsolateral prefrontal cortex in the patients; this was
significantly more marked in the mania than in the euthymia subgroup.
Bipolar disorder is characterised by mood state-dependent hypoactivation
in the parietal cortex. Reduced dorsolateral prefrontal activation is a
further feature of mania and depression, which may improve partially in
euthymia. Failure of de-activation in the medial frontal cortex shows
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