IN BRIEF

Can Brain Imaging Help Predict Bipolar Disorder in High Risk Children?

April 19, 2019
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Patterns in connectivity in a portion of the frontal lobe called the inferior frontal gyrus appears to be an early biomarker in children of parents with bipolar disorder.

Researchers report a potential neural marker of individual risk in those with a family history of bipolar disorder. The study, published in the journal Neuropsychopharmacology, points to particular patterns of brain connectivity as future potential targets for early intervention.

Children of parents with bipolar disorder (BD) are at increased risk of developing the condition themselves. To distinguish children that are likely to develop BD from those who will not, Danella Hafeman, MD, PhD, assistant professor of Psychiatry at the University of Pittsburgh, helped devise a risk calculator. Using diagnostic and dimensional predictors from the literature, Dr. Hafeman and her colleagues can predict the risk of a particular child developing BD within the next five years with high accuracy.

In the new study, Dr. Hafeman and her colleagues examined how individual risk scores correlate with changes in neural circuitry. The researchers set out to replicate and extend the findings of a recent study that found reduced resting state functional connectivity between the inferior frontal gyrus (IFG) and three target regions in young adult children of parents with BD. These brain areas are involved in subjective reward value encoding, cognitive control and emotion regulation, behavioral processes that are abnormal in individuals with BD and their first-degree relatives.

“We looked at how these parts of the brain fluctuate together in terms of blood flow while people are at rest with their minds wandering,” says Dr. Hafeman. “It turns out that even when you’re doing nothing, your brain is very active.”

Contrary to their predictions, the researchers did not find any group differences in resting state functional connectivity between children of individuals with BD and healthy controls. They speculate that it could be because their sample is smaller and younger (7-17 years old versus 16-30 years old) than that of the earlier study. However, the researchers did find correlations between resting state functional connectivity and risk score (in children of parents with BD) and mood lability (across the sample).

“We found that the higher the risk score, the lower the connectivity between the IFG and the left insula,” says Dr. Hafeman. “Mood lability is an important predictor of BD and that was also negatively correlated with connectivity between those two regions.”

This study supports the hypothesis that IFG resting state functional connectivity is an important risk marker for the development of BD, at least partially through effects on mood lability. If confirmed, this pattern could represent a marker of individual risk in those with a family history of BD and a potential neural target of treatments aiming to decrease emotion-related impulsivity and mood lability.

“This work is significant because it links brain activity with a clinical profile that is associated with a higher risk of developing bipolar disorder” says David Axelson, MD, section chief of Psychiatry and Behavioral Health at Nationwide Children’s Hospital and a collaborator on the new study. “If replicated, it could help us develop better ways to combine brain imaging with clinical assessment to improve our ability to predict whether a child may have bipolar disorder in the future.”

 

Citation:

Hafeman DM. Chase HW, Monk K, Bonar L, Hickey MB, McCaffrey A, Graur S, Manelis A, Ladouceur CD, Merranko J, Axelson DA, Goldstein BI, Goldstein TR, Birmaher B, Phillips ML. Intrinsic functional connectivity correlates of person-level risk for bipolar disorder in offspring of affected parents. Neuropsychopharmacology. 2018;44:629-634.

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