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Advancing Brain and Body Vascular Imaging in Bipolar Disorder: A Report From the International Society for Bipolar
Megan Mio1, Pao-Huan Chen2,3, Kody G Kennedy1
1Centre for Youth Bipolar Disorder, Centre for Addiction and Mental Health, Toronto, Canada.
Insights
Vascular imaging reveals structural and functional differences in the brain and body of individuals with bipolar disorder (BD). This highlights the importance of the heart-brain connection for mental health research and treatment.
Area of Science:
- Cardiovascular and Neurological Sciences
- Psychiatric Research
- Medical Imaging
Background:
- The heart-brain nexus is crucial for overall health, yet its integration into psychiatric research and treatment, especially for bipolar disorder (BD), is limited.
- Multisystem vascular imaging offers a potential pathway to understand the intricate links between cardiovascular and brain health in BD.
Purpose of the Study:
- To review and synthesize the existing literature on vascular imaging in bipolar disorder.
- To identify limitations and future directions for integrating vascular imaging into BD research.
- To inspire broader adoption of vascular imaging techniques in the study of BD.
Main Methods:
- An international expert group conducted a comprehensive review of vascular imaging studies in BD.
- Findings were systematically organized by organ system: brain, eye, heart, and body.
- Novel imaging methods from other psychiatric and neurological disorders were considered for their potential application in BD.
Main Results:
- Structural and functional vascular differences, indicative of macro- and microvascular health, are present throughout the lifespan in individuals with BD.
- Functional vascular metrics showed more pronounced state effects compared to structural metrics.
- BD-related vascular differences were sometimes independent of traditional vascular risk factors, with varying accessibility of imaging techniques.
Conclusions:
- Vascular imaging demonstrates clear differences within and beyond the brain in individuals with BD, underscoring the heart-brain connection.
- Further research with larger sample sizes, subgroup analyses, and prospective designs is needed to fully realize the implications for brain, heart, and mental health.
- Integrating fluid biomarkers and lived-experience perspectives will enhance the clinical relevance of vascular imaging for BD patients.
Objectives:
The heart-brain nexus is increasingly recognized as important for human health. Nonetheless, integration of this perspective in research and treatment remains limited in psychiatry, particularly in bipolar disorder (BD). Multisystem vascular imaging may help elucidate mechanisms linking heart and brain health in BD. The ultimate purpose of this review is to inspire and guide integration of vascular imaging more broadly in BD research.
Methods:
An international group of experts reviewed the vascular imaging literature in BD, synthesizing key studies, limitations, and future directions. Findings were organized by organ system (brain, eye, heart, body), including novel methods reported in other psychiatric or neurological disorders that are understudied in BD.
Results:
Structural and functional vascular differences, reflecting macro- and microvascular health, are reported across the lifespan in BD. State effects are more apparent for functional than structural metrics. BD-related differences in vascular metrics were independent of traditional vascular risk factors in some but not all studies. Accessibility ranged from widespread (e.g., tonometry, retinal imaging) to specialized (e.g., cardiac magnetic resonance imaging [MRI], arterial-spin labeling MRI). Although small BD samples were common, general population cohorts demonstrate feasibility for broader use.
Conclusions:
BD-related differences in vascular imaging metrics are evident within and beyond the brain. Continued progress is warranted to realize potential implications for brain, heart, and mental health. Larger studies, powered for subgroup analyses and robust covariate modeling, are warranted. Future studies including prospective designs, fluid biomarkers, and lived-experience perspectives would further enhance the relevance of vascular imaging for those with BD.
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