Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-27T19:46:18.678Z Has data issue: false hasContentIssue false

Role of obesity in systemic low-grade inflammation and cognitive function in patients with bipolar I disorder or major depressive disorder

Published online by Cambridge University Press:  29 June 2020

Mu-Hong Chen
Affiliation:
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Ju-Wei Hsu*
Affiliation:
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Kai-Lin Huang
Affiliation:
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Shih-Jen Tsai
Affiliation:
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Tung-Ping Su
Affiliation:
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
Cheng-Ta Li
Affiliation:
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Wei-Chen Lin
Affiliation:
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Pei-Chi Tu
Affiliation:
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Philosophy of Mind and Cognition, National Yang-Ming University, Taipei, Taiwan
Ya-Mei Bai*
Affiliation:
Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
*
Ju-Wei Hsu, M.D. E-mail: [email protected]
Author for correspondence: Ya-Mei Bai, M.D., Ph.D. E-mail: [email protected]

Abstract

Background

Studies have suggested the detrimental effects of obesity and systemic inflammation on the cognitive function of patients with bipolar or major depressive disorder. However, the complex associations between affective disorder, obesity, systemic inflammation, and cognitive dysfunction remain unclear.

Methods

Overall, 110 patients with affective disorder (59 with bipolar I disorder and 51 with major depressive disorder) who scored ≥61 on the Global Assessment of Functioning and 51 age- and sex-matched controls were enrolled. Body mass index ≥25 kg/m2 was defined as obesity or overweight. Levels of proinflammatory cytokines—including interleukin-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP)—were measured, and cognitive function was assessed using various methods, including the Wisconsin Card Sorting Test (WCST) and go/no-go task.

Results

Patients with bipolar I disorder or major depressive disorder were more likely to be obese or overweight, had higher CRP and TNF-α levels, and had greater executive dysfunction in the WCST than the controls. TNF-α level (P < .05) but not affective disorder diagnosis or obesity/overweight was significantly associated with cognitive function deficits, although obesity/overweight and diagnosis were significantly associated with increased TNF-α level.

Conclusions

Our findings may indicate that proinflammatory cytokines, but not obesity or overweight, have crucial effects on cognitive function in patients with bipolar I disorder or major depressive disorder, although proinflammatory cytokines and obesity or overweight were found to be strongly associated. The complex relationships between affective disorder diagnosis, proinflammatory cytokine levels, obesity or overweight, and cognitive function require further investigation.

Type
Original Research
Copyright
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Blanco, C, Compton, WM, Saha, TD, et al. Epidemiology of DSM-5 bipolar I disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. J Psychiatr Res. 2017;84:310317.CrossRefGoogle ScholarPubMed
Ferrari, AJ, Somerville, AJ, Baxter, AJ, et al. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychol Med. 2013;43(3):471481.CrossRefGoogle ScholarPubMed
Grande, I, Berk, M, Birmaher, B, Vieta, E. Bipolar disorder. Lancet. 2016;387(10027):15611572.10.1016/S0140-6736(15)00241-XCrossRefGoogle ScholarPubMed
Kupfer, DJ, Frank, E, Phillips, ML. Major depressive disorder: new clinical, neurobiological, and treatment perspectives. Lancet. 2012;379(9820):10451055.CrossRefGoogle ScholarPubMed
Fagiolini, A, Frank, E, Houck, PR, et al. Prevalence of obesity and weight change during treatment in patients with bipolar I disorder. J Clin Psychiatry. 2002;63(6):528533.CrossRefGoogle ScholarPubMed
Levitan, RD, Davis, C, Kaplan, AS, Arenovich, T, Phillips, DI, Ravindran, AV. Obesity comorbidity in unipolar major depressive disorder: refining the core phenotype. J Clin Psychiatry. 2012;73(8):11191124.CrossRefGoogle ScholarPubMed
Bai, YM, Su, TP, Li, CT, et al. Comparison of pro-inflammatory cytokines among patients with bipolar disorder and unipolar depression and normal controls. Bipolar Disord. 2015;17(3):269277.CrossRefGoogle ScholarPubMed
Bai, YM, Su, TP, Tsai, SJ, et al. Comparison of inflammatory cytokine levels among type I/type II and manic/hypomanic/euthymic/depressive states of bipolar disorder. J Affect Disord. 2014;166:187192.10.1016/j.jad.2014.05.009CrossRefGoogle ScholarPubMed
Bai, YM, Chiou, WF, Su, TP, Li, CT, Chen, MH. Pro-inflammatory cytokine associated with somatic and pain symptoms in depression. J Affect Disord. 2014;155:2834.CrossRefGoogle ScholarPubMed
Osimo, EF, Cardinal, RN, Jones, PB, Khandaker, GM. Prevalence and correlates of low-grade systemic inflammation in adult psychiatric inpatients: an electronic health record-based study. Psychoneuroendocrinology. 2018;91:226234.CrossRefGoogle ScholarPubMed
Berk, M, Williams, LJ, Jacka, FN, et al. So depression is an inflammatory disease, but where does the inflammation come from? BMC Med. 2013;11:200CrossRefGoogle Scholar
Millett, CE, Perez-Rodriguez, M, Shanahan, M, et al. C-reactive protein is associated with cognitive performance in a large cohort of euthymic patients with bipolar disorder. [published online ahead of print 19 November 2019] Mol Psychiatry. doi: 10.1038/s41380-019-0591-1CrossRefGoogle Scholar
Goldsmith, DR, Haroon, E, Woolwine, BJ, et al. Inflammatory markers are associated with decreased psychomotor speed in patients with major depressive disorder. Brain Behav Immun. 2016;56:281288.CrossRefGoogle ScholarPubMed
Bortolato, B, Carvalho, AF, Soczynska, JK, Perini, GI, McIntyre, RS. The involvement of TNF-alpha in cognitive dysfunction associated with major depressive disorder: an opportunity for domain specific treatments. Curr Neuropharmacol. 2015;13(5):558576.CrossRefGoogle ScholarPubMed
Dye, L, Boyle, NB, Champ, C, Lawton, C. The relationship between obesity and cognitive health and decline. Proc Nutr Soc. 2017;76(4):443454.10.1017/S0029665117002014CrossRefGoogle ScholarPubMed
Inoue, DS, Antunes, BM, Bin Maideen, MF, Lira, FS. Pathophysiological features of obesity and its impact on cognition: exercise training as a non-pharmacological approach. Curr Pharm Des. 2020;26:916931.CrossRefGoogle ScholarPubMed
Ribeiro, O, Carmo, I, Paiva, T, Figueira, ML. Neuropsychological profile, cognitive reserve and emotional distress in a portuguese sample of severely obese patients. Acta Med Port. 2020;33(1):3848.CrossRefGoogle Scholar
Yang, Y, Shields, GS, Wu, Q, Liu, Y, Chen, H, Guo, C. The association between obesity and lower working memory is mediated by inflammation: findings from a nationally representative dataset of U.S. adults. Brain Behav Immun. 2019;84:173179.CrossRefGoogle ScholarPubMed
Apovian, CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care. 2016;22(7 suppl):s176s185.Google ScholarPubMed
Berg, EA. A simple objective technique for measuring flexibility in thinking. J Gen Psychol. 1948;39:1522.CrossRefGoogle ScholarPubMed
Barcelo, F, Sanz, M, Molina, V, Rubia, FJ. The Wisconsin Card Sorting Test and the assessment of frontal function: a validation study with event-related potentials. Neuropsychologia. 1997;35(4):399408.CrossRefGoogle ScholarPubMed
Wright, L, Lipszyc, J, Dupuis, A, Thayapararajah, SW, Schachar, R. Response inhibition and psychopathology: a meta-analysis of go/no-go task performance. J Abnorm Psychol. 2014;123(2):429–439.CrossRefGoogle ScholarPubMed
Li, CT, Hsieh, JC, Wang, SJ, et al. Differential relations between fronto-limbic metabolism and executive function in patients with remitted bipolar I and bipolar II disorder. Bipolar Disord. 2012;14(8):831842.CrossRefGoogle ScholarPubMed
Cheng, CM, Juan, CH, Chen, MH, et al. Different forms of prefrontal theta burst stimulation for executive function of medication-resistant depression: evidence from a randomized sham-controlled study. Prog Neuropsychopharmacol Biol Psychiatry. 2016;66:3540.CrossRefGoogle ScholarPubMed
Chen, MH, Li, CT, Lin, WC, et al. Cognitive function of patients with treatment-resistant depression after a single low dose of ketamine infusion. J Affect Disord. 2018;241:17.CrossRefGoogle ScholarPubMed
Mora, E, Portella, MJ, Martinez-Alonso, M, et al. The impact of obesity on cognitive functioning in euthymic bipolar patients: a cross-sectional and longitudinal study. J Clin Psychiatry. 2017;78(8):e924–e932.CrossRefGoogle ScholarPubMed
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. 2012;27(3):223228.CrossRefGoogle ScholarPubMed
Mansur, RB, Subramaniapillai, M, Zuckerman, H, et al. Effort-based decision-making is affected by overweight/obesity in major depressive disorder. J Affect Disord. 2019;256:221227.CrossRefGoogle ScholarPubMed
Hidese, S, Ota, M, Matsuo, J, et al. Association of obesity with cognitive function and brain structure in patients with major depressive disorder. J Affect Disord. 2018;225:188194.CrossRefGoogle ScholarPubMed
Misiak, B, Beszlej, JA, Kotowicz, K, et al. Cytokine alterations and cognitive impairment in major depressive disorder: from putative mechanisms to novel treatment targets. Prog Neuropsychopharmacol Biol Psychiatry. 2018;80(Pt C):177188.10.1016/j.pnpbp.2017.04.021CrossRefGoogle ScholarPubMed
Charlton, RA, Lamar, M, Zhang, A, et al. Associations between pro-inflammatory cytokines, learning, and memory in late-life depression and healthy aging. Int J Geriatr Psychiatry. 2018;33(1):104112.CrossRefGoogle ScholarPubMed
Bobińska, K, Galecka, E, Szemraj, J, Galecki, P, Talarowska, M. Is there a link between TNF gene expression and cognitive deficits in depression? Acta Biochim Pol. 2017;64(1):6573.Google Scholar
Chakrabarty, T, Torres, IJ, Bond, DJ, Yatham, LN. Inflammatory cytokines and cognitive functioning in early-stage bipolar I disorder. J Affect Disord. 2019;245:679685.CrossRefGoogle ScholarPubMed
McIntyre, RS, Mansur, RB, Lee, Y, et al. Adverse effects of obesity on cognitive functions in individuals at ultra high risk for bipolar disorder: results from the global mood and brain science initiative. Bipolar Disord. 2017;19(2):128134.CrossRefGoogle ScholarPubMed
Keller, M, Mazuch, J, Abraham, U, et al. A circadian clock in macrophages controls inflammatory immune responses. Proc Natl Acad Sci U S A. 2009;106(50):2140721412.CrossRefGoogle ScholarPubMed
Naidu, KS, Morgan, LW, Bailey, MJ. Inflammation in the avian spleen: timing is everything. BMC Mol Biol. 2010;11:104CrossRefGoogle ScholarPubMed