Journal Article

Differences in biochemical metabolism and cognitive function between bipolar I and bipolar II disorder

Zhang, Rongxu, Wang, Ying, Huang, Dong, He, Jiali, Yan, Shuya, Chen, Guanmao, Lu, Xiaodan, Chen, Pan, Huang, Xiaosi, Zhong, Shuming, Lai, Shunkai, Zhang, Yiliang, Jia, Yanbin

2026

Overview

Background This study aimed to characterise neurometabolic differences between bipolar disorder I (BD-I) and bipolar disorder II (BD-II), and to examine their associations with cognitive function. Methods A total of 50 patients diagnosed with BD-I, 80 patients with BD-II, and 50 healthy controls (HCs) were recruited for this study. Metabolite concentrations—specifically N-acetylaspartate (NAA) and choline-containing compounds (Cho)—were measured in the prefrontal white matter (PWM), anterior cingulate cortex (ACC), and thalamus through proton magnetic resonance spectroscopy (¹H-MRS). Cognitive performance was evaluated using the MATRICS Consensus Cognitive Battery (MCCB). Results When compared to HCs, patients with BD-II showed significantly higher Cho/Cr ratios in the right PWM and left ACC, along with lower NAA/Cr ratios in the right thalamus; compared to BD-II patients, those with BD-I exhibited higher Cho/Cr ratios in the right PWM and lower NAA/Cr ratios in the right thalamus; among BD-I patients, the Cho/Cr ratio in the left ACC was negatively correlated with measures of information processing speed and attentional vigilance. Conclusions This study demonstrates that BD-II patients exhibit greater cholinergic dysregulation in the left ACC and the right PWM, whereas BD-I patients show more pronounced neuronal dysfunction in the right thalamus. Furthermore, the left ACC Cho/Cr ratio was specifically associated with cognitive impairments in information processing speed and attentional vigilance, but only among patients with BD-I. This suggests that subtype-specific mechanisms underlie the relationship between neurometabolic abnormalities and cognitive deficits. Clinical trial number Not applicable.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aspartic Acid - analogs & derivatives / Aspartic Acid - metabolism / Bipolar disorder / Bipolar Disorder - metabolism / Bipolar Disorder - physiopathology / Bipolar Disorder - psychology / Bipolar disorder I / Bipolar disorder II / Brain / Brain chemistry / Brain research / Case-Control Studies / Choline / Choline - metabolism / Cognition & reasoning / Cognition - physiology / Cognition disorders / Cognitive ability / Cognitive function / Comparative analysis / Complications and side effects / Cortex (cingulate) / Development and progression / Executive function / Female / Gyrus Cinguli - metabolism / Health aspects / Hospitals / Humans / Information processing / Magnetic resonance imaging / Magnetic resonance spectroscopy / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Memory / Mental depression / Mental disorders / Metabolism / Metabolites / Middle Aged / N-Acetylaspartate / Neurons / Neurophysiology / Neuropsychological Tests / Neuropsychology / Nuclear magnetic resonance spectroscopy / Physiological aspects / Prefrontal Cortex - metabolism / Proton Magnetic Resonance Spectroscopy / Psychiatry / Psychotherapy / Risk factors / Somatotropin / Spectrum analysis / Substantia alba / Thalamus / Thalamus - metabolism / Verbal learning / Vigilance / White Matter - metabolism