Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis.

OBJECTIVE: An association between bipolar disorder and cognitive impairment has repeatedly been described, even for euthymic patients. Findings are inconsistent both across primary studies and previous meta-analyses. This study reanalysed 31 primary data sets as a single large sample (N = 2876) to provide a more definitive view. METHOD: Individual patient and control data were obtained from original authors for 11 measures from four common neuropsychological tests: California or Rey Verbal Learning Task (VLT), Trail Making Test (TMT), Digit Span and/or Wisconsin Card Sorting Task. RESULTS: Impairments were found for all 11 test-measures in the bipolar group after controlling for age, IQ and gender (Ps ≤ 0.001, E.S. = 0.26-0.63). Residual mood symptoms confound this result but cannot account for the effect sizes found. Impairments also seem unrelated to drug treatment. Some test-measures were weakly correlated with illness severity measures suggesting that some impairments may track illness progression. CONCLUSION: This reanalysis supports VLT, Digit Span and TMT as robust measures of cognitive impairments in bipolar disorder patients. The heterogeneity of some test results explains previous differences in meta-analyses. Better controlling for confounds suggests deficits may be smaller than previously reported but should be tracked longitudinally across illness progression and treatment.

Impulsivity modulates performance under response uncertainty in a reaching task.

We sought to explore the interaction of the impulsivity trait with response uncertainty. To this end, we used a reaching task (Pellizzer and Hedges in Exp Brain Res 150:276-289, 2003) where a motor response direction was cued at different levels of uncertainty (1 cue, i.e., no uncertainty, 2 cues or 3 cues). Data from 95 healthy adults (54 F, 41 M) were analysed. Impulsivity was measured using the Barratt Impulsiveness Scale version 11 (BIS-11). Behavioral variables recorded were reaction time (RT), errors of commission (referred to as 'early errors') and errors of precision. Data analysis employed generalised linear mixed models and generalised additive mixed models. For the early errors, there was an interaction of impulsivity with uncertainty and gender, with increased errors for high impulsivity in the one-cue condition for women and the three-cue condition for men. There was no effect of impulsivity on precision errors or RT. However, the analysis of the effect of RT and impulsivity on precision errors showed a different pattern for high versus low impulsives in the high uncertainty (3 cue) condition. In addition, there was a significant early error speed-accuracy trade-off for women, primarily in low uncertainty and a 'reverse' speed-accuracy trade-off for men in high uncertainty. These results extend those of past studies of impulsivity which help define it as a behavioural trait that modulates speed versus accuracy response styles depending on environmental constraints and highlight once more the importance of gender in the interplay of personality and behaviour.

Partial cloning of the M subunit of laminin from adult rat lipocytes: expression of the M subunit by cells isolated from normal and injured liver.

Laminin is a heterotrimeric glycoprotein found in the perisinusoidal space of adult rat liver. The principal cellular source of laminin in liver is the lipocyte, with its three subunits measuring 324, 200 and 200 kD. The large subunit of lipocyte-derived laminin is distinct from the A subunit of murine laminin (440 kD); its size suggests that it represents a peptide, called M, recently cloned from human placenta. Using oligonucleotide primers derived from the human M-subunit cDNA, we amplified a 445-bp sequence encoding a fragment of M-laminin from adult rat lipocytes. The rat cDNA is 90% homologous to the human M-subunit cDNA and recognizes an mRNA in lipocytes measuring about 10 kb. M-subunit transcripts were identified only in lipocytes from normal adult liver; they could not be identified in hepatocytes, endothelial cells or Kupffer cells. Lipocytes were screened for M-subunit protein with a polyclonal M antiserum. Cells stained specifically for the M-subunit after 36 hr in primary culture; the protein was also identified in freshly isolated cells by means of immunoblotting. To determine whether lipocytes alter their expression of the laminin M subunit during liver injury, we monitored M-subunit mRNA in these cells at various intervals after carbon tetrachloride administration. M-subunit transcripts increased twofold within 12 hr of toxin exposure, returning to below baseline by 48 hr. The results indicate that lipocytes produce the M subunit of laminin in place of A. Production of this subunit by lipocytes may facilitate cell growth and reorganization during liver regeneration.

Acetaldehyde-induced stimulation of collagen synthesis and gene expression is dependent on conditions of cell culture: studies with rat lipocytes and fibroblasts.

Acetaldehyde has been proposed as a mediator of fibrogenesis in alcoholic liver disease, based in part on its ability to stimulate collagen synthesis by hepatic lipocytes in late primary or passaged culture. In this study, we examined the effect of acetaldehyde on rat lipocytes and fibroblasts at various stages of culture, in an effort to determine whether culture-related events influence responsiveness to this compound. Lipocytes from normal rat liver were studied in primary culture at 3 and 7 days after plating; fibroblasts were studied in subculture, at subconfluent and confluent densities. Both cell types were incubated with 100 microM acetaldehyde for 24 hr followed by measurement of collagen synthesis and type I collagen gene expression. Acetaldehyde had no effect on lipocytes at either 3 or 7 days in primary culture. The inability of acetaldehyde to stimulate collagen synthesis in primary culture was not attributable to toxicity, because cell morphology and total protein synthesis were identical in both treated and untreated cultures. Fibroblasts exhibited a variable response to acetaldehyde that was dependent on cell density: subconfluent cells contained similar amounts of type I collagen mRNA in both the presence and absence of acetaldehyde, whereas confluent cells exhibited a 2- to 3-fold increase in collagen mRNA levels upon acetaldehyde exposure. To determine whether quiescent lipocytes would respond to acetaldehyde in a culture system that mimics the hepatic environment in vivo, lipocytes were plated in coculture with hepatocytes on a basement membrane gel and incubated with 20 mM ethanol for 72 hr. Direct communication between these two cell types did not provoke lipocyte activation, even in the setting of ethanol oxidation.(ABSTRACT TRUNCATED AT 250 WORDS)

Malondialdehyde stimulates collagen production by hepatic lipocytes only upon activation in primary culture.

Lipid aldehydes have been proposed as mediators of hepatic fibrosis in alcoholics. In this study we examined whether hepatic lipocytes, the principal matrix-producing cells in liver, exhibit enhanced collagen synthesis in response to the lipid aldehyde malondialdehyde. Lipocytes isolated from normal rat liver and plated in primary culture for 3 days were not affected by malondialdehyde in concentrations ranging from 2 to 200 microM. Cells cultured for 7 days displayed a modest increase in collagen synthesis (137% of control levels) in response to malondialdehyde, but only at a concentration of 200 microM. The malondialdehyde-induced increase in collagen synthesis was paralleled by a rise in type I procollagen mRNA. Subcultured rat fibroblasts at confluent density responded better to malondialdehyde than did 7-day lipocytes. The results indicate that lipocytes respond to the fibrogenic effects of malondialdehyde only after activation in primary culture. This delayed response suggests that lipid aldehydes may enhance, but do not initiate, alcoholic liver fibrosis in vivo.