Assessing Serum Brain Derived Neurotrophic Factor and Matrix MetalloProteinase-9 Levels and Their Correlation With Neurocognitive and Psychosocial Functioning in Bipolar Disorder-I in Remission: A Case-Control Study

AIMS: 1. To determine the association between serum BDNF, serum MMP-9 and cognitive function test in BD-1 patients in remission and to compare with controls. 2. To assess the current psychosocial functioning of BD-I patients in remission and their correlates. METHODS: Single center case control study. Cases were BD-I patients in Remission (n = 60) and controls (n = 60) were age and gender matched healthy persons. The diagnosis of BD-1 was confirmed using Structured Clinical Interview For DSM-IV-Tr Axis I Disorders –Research Version along with clinical record. Age group between18–60 years, in remission for at least 2 months [scoring ≤ 8 on the Hamilton Depression Rating Scale, and ≤ 6 on Young Mania Rating Scale] were included. Those with significant head injury, neurological disorder, substance use disorder, Diabetes/Hypertension and premorbid IQ < 70 were excluded. Control group were excluded if their first degree relative had any psychiatric illness as elicited using Family Interview for Genetic Studies scale (FIGS). Cognitive functioning was assessed using Addenbrooke's Cognitive Examination version III (ACE-III) and Trail making test A and B (TMT A and TMT B). Current psychosocial functioning was assessed with Functioning assessment short test (FAST). Five ml blood sample was taken for estimation of serum BDNF and MMP-9 levels by ELISA. Chi-square test used to compare categorical variables. Mann-Whitney U test for continuous variables. Spearman's correlation - evaluate the relationship between scores on the cognitive function tests and serum levels of BDNF and MMP-9, within the group of patients with BD-I. RESULTS: With regards to cognitive functioning, compared to controls, cases performed significantly poor in domains of Memory (Z = −3.435, p = 0.001), Processing speed (z=−2.667, p = 0.008), and Executive functioning (Z= −4.084, p = 0.000). No statistical difference in levels of serum BDNF and MMP-9 between patients and controls were found. While BDNF serum levels were not associated with cognitive or psychosocial functioning, there were significant relation between serum MMP-9 and the various domains of FAST scale and total FAST score (rho = 0.447, p < 0.001). BD-I patients exhibited poor psychosocial functioning compared to controls even in euthymic state (U = 702.00, p < 0.000). CONCLUSION: Patients with BD-I display poor performance in memory, executive function and psychosocial functioning even during euthymic state compared to controls. Serum BDNF and MMP-9 levels comparable to the healthy controls during remission- pointing towards them as state markers rather than trait. Need for routine evaluation of cognitive function during follow-up visits and focus on target deficits for rehabilitation for better recovery and improving the quality of life of BD patients.