Effects of proinflammatory cytokines and programmed cell death on cognitive domains in older age patients with bipolar disorder

Abstract Objectives Proinflammatory cytokines are linked to cognitive deficits in bipolar disorder (BD). The programmed cell death (PD) pathway, involved in immune regulation, may impact mood disorders and dementia. Older age BD (OABD) patients face a heightened risk of cognitive decline, yet studie...

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Main Authors: Pei-Ying Lee, Chih Chiang Chiu, Po-Hsiu Kuo, Cho-Yin Huang, Shang-Ying Tsai, Chian-Jue Kuo, Wen-Yin Chen
Format: Article
Language:English
Published: BMC 2025-08-01
Series:Annals of General Psychiatry
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Online Access:https://doi.org/10.1186/s12991-025-00591-9
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author Pei-Ying Lee
Chih Chiang Chiu
Po-Hsiu Kuo
Cho-Yin Huang
Shang-Ying Tsai
Chian-Jue Kuo
Wen-Yin Chen
author_facet Pei-Ying Lee
Chih Chiang Chiu
Po-Hsiu Kuo
Cho-Yin Huang
Shang-Ying Tsai
Chian-Jue Kuo
Wen-Yin Chen
author_sort Pei-Ying Lee
collection DOAJ
description Abstract Objectives Proinflammatory cytokines are linked to cognitive deficits in bipolar disorder (BD). The programmed cell death (PD) pathway, involved in immune regulation, may impact mood disorders and dementia. Older age BD (OABD) patients face a heightened risk of cognitive decline, yet studies exploring the underlying mechanisms in this population are scarce. Aim of this study is to investigate proinflammatory cytokines and the PD pathway in OABD, for their correlation with clinical features and neuroaxonal integrity, and the impact on cognitive domains. Methods Eighty-seven euthymic OABD patients were assessed using the Brief Assessment of Cognition in Affective Disorders. We measured CRP, IL-6, TNF-α, TNF-R1, TNF-R2, PD-1, and PD-L1. Neurofilament light chain (NfL) was used to gauge neuroaxonal integrity. Associations between cytokines, PD-1/PD-L1, and cognition were examined using linear regression models. Results The average age of the OABD patients was 59.64 with a mean illness duration of 27.19 years. NfL levels positively correlated with TNF-R2 levels. Regression analysis revealed a negative association between TNF-R1 and motor speed and verbal fluency, while TNF-R2 showed positive associations with these cognitive domains. PD-1 was negatively associated with composite score, especially in motor speed and working memory, while PD-L1 was positively associated with executive function. Conclusion This is the first study to simultaneously examine the proinflammatory system and the PD-1/PD-L1 pathway in a clinical OABD sample, with findings suggesting that both systems impact cognitive function in OABD patients. Further research is needed to explore the neuroinflammatory mechanisms underlying BD’s neurodegenerative course.
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spelling doaj-art-86b64ade587c4357b30c9c3911f46a952025-08-20T03:43:20ZengBMCAnnals of General Psychiatry1744-859X2025-08-0124111010.1186/s12991-025-00591-9Effects of proinflammatory cytokines and programmed cell death on cognitive domains in older age patients with bipolar disorderPei-Ying Lee0Chih Chiang Chiu1Po-Hsiu Kuo2Cho-Yin Huang3Shang-Ying Tsai4Chian-Jue Kuo5Wen-Yin Chen6Department of Psychiatry, Taipei City Psychiatric Center, Taipei City HospitalDepartment of Psychiatry, Taipei City Psychiatric Center, Taipei City HospitalInstitute of Health Policy and Management, College of Public Health,, National Taiwan UniversityDepartment of Psychiatry, Taipei City Psychiatric Center, Taipei City HospitalDepartment of Psychiatry, School of Medicine, College of Medicine, Taipei Medical UniversityDepartment of Psychiatry, Taipei City Psychiatric Center, Taipei City HospitalDepartment of Psychiatry, Taipei City Psychiatric Center, Taipei City HospitalAbstract Objectives Proinflammatory cytokines are linked to cognitive deficits in bipolar disorder (BD). The programmed cell death (PD) pathway, involved in immune regulation, may impact mood disorders and dementia. Older age BD (OABD) patients face a heightened risk of cognitive decline, yet studies exploring the underlying mechanisms in this population are scarce. Aim of this study is to investigate proinflammatory cytokines and the PD pathway in OABD, for their correlation with clinical features and neuroaxonal integrity, and the impact on cognitive domains. Methods Eighty-seven euthymic OABD patients were assessed using the Brief Assessment of Cognition in Affective Disorders. We measured CRP, IL-6, TNF-α, TNF-R1, TNF-R2, PD-1, and PD-L1. Neurofilament light chain (NfL) was used to gauge neuroaxonal integrity. Associations between cytokines, PD-1/PD-L1, and cognition were examined using linear regression models. Results The average age of the OABD patients was 59.64 with a mean illness duration of 27.19 years. NfL levels positively correlated with TNF-R2 levels. Regression analysis revealed a negative association between TNF-R1 and motor speed and verbal fluency, while TNF-R2 showed positive associations with these cognitive domains. PD-1 was negatively associated with composite score, especially in motor speed and working memory, while PD-L1 was positively associated with executive function. Conclusion This is the first study to simultaneously examine the proinflammatory system and the PD-1/PD-L1 pathway in a clinical OABD sample, with findings suggesting that both systems impact cognitive function in OABD patients. Further research is needed to explore the neuroinflammatory mechanisms underlying BD’s neurodegenerative course.https://doi.org/10.1186/s12991-025-00591-9Older age bipolar disorders (OABD)Neuroaxonal integrityProgrammed cell deathNeuroinflammatoryCytokines
spellingShingle Pei-Ying Lee
Chih Chiang Chiu
Po-Hsiu Kuo
Cho-Yin Huang
Shang-Ying Tsai
Chian-Jue Kuo
Wen-Yin Chen
Effects of proinflammatory cytokines and programmed cell death on cognitive domains in older age patients with bipolar disorder
Annals of General Psychiatry
Older age bipolar disorders (OABD)
Neuroaxonal integrity
Programmed cell death
Neuroinflammatory
Cytokines
title Effects of proinflammatory cytokines and programmed cell death on cognitive domains in older age patients with bipolar disorder
title_full Effects of proinflammatory cytokines and programmed cell death on cognitive domains in older age patients with bipolar disorder
title_fullStr Effects of proinflammatory cytokines and programmed cell death on cognitive domains in older age patients with bipolar disorder
title_full_unstemmed Effects of proinflammatory cytokines and programmed cell death on cognitive domains in older age patients with bipolar disorder
title_short Effects of proinflammatory cytokines and programmed cell death on cognitive domains in older age patients with bipolar disorder
title_sort effects of proinflammatory cytokines and programmed cell death on cognitive domains in older age patients with bipolar disorder
topic Older age bipolar disorders (OABD)
Neuroaxonal integrity
Programmed cell death
Neuroinflammatory
Cytokines
url https://doi.org/10.1186/s12991-025-00591-9
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