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Peu d’études comparent les adultes plus jeunes aux aînés quant aux séquelles cognitives et affectives après un traumatisme craniocérébral léger (TCCl). Celles qui l’ont fait présentent des résultats très variables concernant les symptômes anxio-dépressifs et les études sur le fonctionnement cognitif sont rares chez les aînés. Cette étude compare les symptômes dépressifs, anxieux et cognitifs perçus 12 mois après un TCCl chez des aînés et des adultes plus jeunes. 113 adultes de 18 à 64 ans et 57 personnes âgées de 65 ans et plus ont été évalués avec le Medical Outcomes Study Cognitive Functioning Scale (MOS-Cog) et le Hospital Anxiety and Depression Scale (HADS). Les résultats suggèrent que les adultes plus jeunes ont davantage de symptômes anxieux (t(146,658) = 4,591, p < 0,001, d = 0,071) et des difficultés cognitives perçues plus importantes (t(168) = -2,491, p = 0,014, d = 0,445), mais aucune différence significative n’a été trouvée concernant les symptômes dépressifs (t(168) = 1,631, p = 0,105, d = 0,028). Les pressions plus grandes chez l’adulte plus jeune liées aux responsabilités familiales et occupationnelles pourraient expliquer partiellement ces symptômes. Ces résultats permettent de mieux cibler les particularités et les interventions spécifiques pour chaque groupe d’âge post-TCCl.

Highlights • A sub-group of bipolar patients have extensive blood-brain barrier leakage • These patients have a more chronic form of illness, greater depression and anxiety • All patients with extensive blood-brain barrier leakage are also insulin resistant, Bipolar disorder affects approximately 2% of the population and is typically characterized by recurrent episodes of mania and depression. While some patients achieve remission using mood-stabilizing treatments, a significant proportion of patients show progressive changes in symptomatology over time. Bipolar progression is diverse in nature and may include a treatment-resistant increase in the frequency and severity of episodes, worse psychiatric and functional outcomes, and a greater risk of suicide. The mechanisms underlying bipolar disorder progression remain poorly understood and there are currently no biomarkers for identifying patients at risk. The objective of this study was to explore the potential of blood-brain barrier (BBB) imaging as such a biomarker, by acquiring the first imaging data of BBB leakage in bipolar patients, and evaluating the potential association between BBB dysfunction and bipolar symptoms. To this end, a cohort of 36 bipolar patients was recruited through the Mood Disorders Clinic (Nova Scotia Health Authority, Canada). All patients, along with 14 control subjects (matched for sex, age and metabolic status), underwent contrast-enhanced dynamic MRI scanning for quantitative assessment of BBB leakage as well as clinical and psychiatric evaluations. Outlier analysis has identified a group of 10 subjects with significantly higher percentages of brain volume with BBB leakage (labeled the “extensive BBB leakage” group). This group consisted exclusively of bipolar patients, while the “normal BBB leakage” group included the entire control cohort and the remaining 26 bipolar subjects. Among the bipolar cohort, patients with extensive BBB leakage were found to have more severe depression and anxiety, and a more chronic course of illness. Furthermore, all bipolar patients within this group were also found to have co-morbid insulin resistance, suggesting that insulin resistance may increase the risk of BBB dysfunction in bipolar patients. Our findings demonstrate a clear link between BBB leakage and greater psychiatric morbidity in bipolar patients and highlight the potential of BBB imaging as a mechanism-based biomarker for bipolar disorder progression.

Cross-sectional studies indicate that comorbid insulin resistance (IR) and type 2 diabetes are associated with a more severe course of bipolar disorder (BD); however, this relationship has not previously been assessed longitudinally. To address this, we reviewed health records of a case series of six patients with BD and comorbid IR. Severity and length of affective episodes (both mania and depression) over the lifetime were recorded using the Affective Morbidity Index; these data were obtained from ongoing prospective follow-up and from detailed retrospective chart reviews. All six patients with a previously episodic, relapsing-remitting course of illness experienced a worsening of morbidity after the onset of laboratory-demonstrated IR. These results suggest that IR may be a potential testable, modifiable factor in the progression of BD from a treatment responsive (episodic) to a non-responsive (chronic) course of illness.