Multivariate brain-cognition associations in euthymic bipolar disorder

Background: People with bipolar disorder (BD) tend to show widespread cognitive impairment compared to healthy controls. Impairments in processing speed (PS), attention, and executive function (EF) may represent 'core' impairments that have a role in wider cognitive dysfunction. Cognitive impairments appear to relate to structural brain abnormalities in BD, but whether core deficits are related to particular brain regions is unclear and much of the research on brain-cognition associations is limited by univariate analysis and small samples. Methods: Euthymic BD patients (n=56) and matched healthy controls (n=26) underwent T1-weighted MRI scans and completed neuropsychological tests of PS, attention, and EF. We utilised public datasets to develop a normative model of cortical thickness (n=5,977) to generate robust estimations of cortical abnormalities in patients. Canonical correlation analysis was used to assess multivariate brain-cognition associations in BD, controlling for age, sex, and premorbid IQ. Results: BD showed impairments on tests of PS, attention, and EF, and abnormal cortical thickness in several brain regions compared to healthy controls. Impairments in tests of PS and EF were most strongly associated with cortical thickness in left inferior temporal, right entorhinal, and right temporal pole areas. Conclusion: Impairments in PS, attention, and EF can be observed in euthymic BD and may be related to abnormal cortical thickness in temporal regions. Future research should continue to leverage multivariate methods to examine complex brain-cognition associations in BD. Future research may benefit from exploring covariance between traditional brain structural morphological metrics such as cortical thickness, cortical volume, and surface area.