Psychiatric Times.
CLINICAL Q&A
Obesity and Bipolar Disorder
By Roger S. McIntyre, MD, FRCPC |
January 26, 2012
Dr McIntyre is associate professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit at the University Health Network, Toronto, Canada. Dr McIntyre is involved in multiple research endeavors, which primarily aim to characterize the association between mood disorders and medical comorbidity. This research involves elucidating metabolic adverse events associated with the use of psychotropic medications, the impact of medical comorbidity on the course of mood disorders, and the effect of glucose homeostasis on neurocognition.
Answer: All of the above.
Discussion
Bipolar disorder (BD) has been highly associated with disparate cognitive deficits, including attention, psychomotor performance, executive function, verbal fluency, learning, memory, and global neurocognitive functioning.1-4 The pertinacity of cognitive deficits in BD is underscored by reports that document an association between cognitive deficits and psychosocial functioning, workforce performance, and interpersonal adjustment.5-7
Emerging evidence also indicate that obesity is associated with reduced cognitive function in otherwise healthy individuals.8-15 The association between anthropometrics and cognitive deficits is detectable in individuals without obesity-associated comorbidities (eg, type 2 diabetes mellitus, hypertension) known to independently affect brain function.13,15.16 Most cognitive domains are reported to be adversely affected by excess weight with replicated abnormalities in measures of learning, memory, and executive function.9
It has been amply documented that individuals with BD are differentially associated with overweight/obesity and abdominal obesity and excess weight adversely effects illness presentation, course, and outcome. Available evidence is beginning to suggest that excess weight is negatively associated with cognitive function in BD.17
It is well established that impairments in executive function are apparent in mixed populations of individuals with BD as well as obese individuals without psychiatric disorders.3,4,9,12,13,18-22 It could be hypothesized that obesity and BD are associated with common CNS structural and/or functional changes in brain regions that subserve cognitive functioning. For example, frontal cortical regions that mediate executive function are hypometabolic in depressed individuals; similarly, overweight/obese individuals manifest reduced metabolic activity, as well as atrophy, in several cortical and subcortical structures.21,23,24
Moreover, the interrelationship between obesity and mood disorders may be due to a pathophysiological nexus that includes abnormalities in hypothalamus-pituitary-adrenal axis function, inflammatory and metabolic systems, disruption of brain circuitry, all of which are potential mediators of cognitive function.9,20,25,26 Further structural and functional investigations, as well as the establishment of mechanisms that mediate cognitive deficits in obesity and BD, are required before a firm conclusion can be drawn.
More like this
More like this
References
1. Bearden CE, Hoffman KM, Cannon TD. The neuropsychology and neuroanatomy of bipolar affective disorder: a critical review. Bipolar Disord. 2001;3:106-150.
2. Malhi GS, Ivanovski B, Hadzi-Pavlovic D. Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia. Bipolar Disord. 2007;9:114-125.
3. Martinez-Aran A, Vieta E, Colom F, et al. Cognitive dysfunctions in bipolar disorder: evidence of neuropsychological disturbances. Psychother Psychosom. 2000;69:2-18.
4. Martinez-Aran A, Vieta E, Reinares M, et al. Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry. 2004;161:262-270.
5. Wingo AP, Harvey PD, Baldessarini RJ. Neurocognitive impairment in bipolar disorder patients: functional implications. Bipolar Disord. 2009;11:113-125.
6. Friedman ES. Cognitive deficits in bipolar individuals: implications for clinical practice. CNS Neurosci Ther. 2009;15:305-306.
7. McIntyre RS, Konarski JZ. Bipolar disorder: a national health concern. CNS Spectr. 2004;9(Suppl 12):6-15.
8. Brook JS, Zhang C, Saar NS, Brook DW. Psychosocial predictors, higher body mass index, and aspects of neurocognitive dysfunction. Percept Mot Skills. 2009;108:181-195.
9. Cohen RA. Obesity-associated cognitive decline: excess weight affects more than the waistline. Neuroepidemiol. 2010;34:230-231.
10. Cournot M, Marquie JC, Ansiau D, et al. Relation between body mass index and cognitive function in healthy middle-aged men and women. Neurology. 2006;67:1208-1214.
11. Elias MF, Elias PK, Sullivan LM, et al. Obesity, diabetes and cognitive deficit: The Framingham Heart Study. Neurobiol Aging. 2005;26(Suppl 1):11-16.
12. Fergenbaum JH, Bruce S, Lou W, Hanley AJ, Greenwood C, Young TK. Obesity and lowered cognitive performance in a Canadian First Nations population. Obesity (Silver Spring). 2009;17:1957-1963.
13. Gunstad J, Paul RH, Cohen RA, et al. Elevated body mass index is associated with executive dysfunction in otherwise healthy adults. Compr Psychiatry. 2007;48:57-61.
14. Jeong SK, Nam HS, Son MH, et al. Interactive effect of obesity indexes on cognition. Dement Geriatr Cogn Disord. 2005;19:91-96.
15. Nilsson LG, Nilsson E. Overweight and cognition. Scand J Psychol. 2009;50:660-667.
16. Gunstad J, Spitznagel MB, Paul RH, et al. Body mass index and neuropsychological function in healthy children and adolescents. Appetite. 2008;50:246-251.
17. Yim CY, Soczynska JK, Kennedy SH, Woldeyohannes HO, Brietzke E, McIntyre RS. The effect of overweight/obesity on cognitive function in euthymic individuals with bipolar disorder. Eur Psychiatry. 2011 May 11 (Epub ahead of print].
18. Bruce-Keller AJ, Keller JN, Morrison CD. Obesity and vulnerability of the CNS. Biochim Biophys Acta. 2009;1792:395-400.
19. Jamrozinski K. Do euthymic bipolar patients have normal cognitive functioning? Curr Opin Psychiatry. 2010;23:255-260.
20. Martinez-Aran A, Vieta E, Colom F, et al. Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord. 2004;6:224-232.
21. Robinson LJ, Thompson JM, Gallagher P, et al. A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord. 2006;93:105-115.
22. Walther K, Birdsill AC, Glisky EL, Ryan L. Structural brain differences and cognitive functioning related to body mass index in older females. Hum Brain Mapp. 2010;31:1052-1064.
23. Drevets WC, Price JL, Furey ML. Brain structural and functional abnormalities in mood disorders: implications for neurocircuitry models of depression. Brain Struct Funct. 2008;213:93-118.
24. Volkow ND, Wang GJ, Telang F, et al. Inverse association between BMI and prefrontal metabolic activity in healthy adults. Obesity (Silver Spring). 2009;17:60-65.
25. Capuron L, Miller AH. Cytokines and psychopathology: lessons from interferon-alpha. Biol Psychiatry. 2004;56:819-824.
26. Thompson JM, Gallagher P, Hughes JH, et al. Neurocognitive impairment in euthymic patients with bipolar affective disorder. Br J Psychiatry. 2005;186:32-40.
