双相I型与双相II型障碍的工作记忆网络功能障碍：任务功能磁共振成像证据的系统综述

摘要(中文译文)

工作记忆损伤是双相障碍的核心认知表型之一。然而，双相障碍Ⅰ型（BD-I）与Ⅱ型（BD-II）在工作记忆加工背后的任务态功能磁共振成像机制是否一致仍不清楚。本系统综述总结了任务态fMRI证据，重点刻画BD-II工作记忆的神经相关物，并与BD-I进行比较。遵循PRISMA 2020指南，系统检索了PubMed、Embase和Web of Science中2011年1月至2025年6月发表的研究。纳入标准为采用工作记忆范式、分别报告BD-I和BD-II结果的成人任务态fMRI研究。共纳入22项研究进行定性综合。在22项任务态fMRI研究中，定性证据提示BD-I与BD-II在工作记忆网络参与模式上可能存在差异；然而，亚型特异性推断受限于BD-II文献极为有限，仅有三项研究纳入BD-II样本（一项仅含BD-II的研究和两项BD-I与BD-II直接比较）。在BD-I中，研究更常报告执行控制区域/网络招募改变或效率降低，以及在高认知负荷和/或情绪干扰下默认模式区域的任务相关抑制减弱。在BD-II中（基于稀疏证据），缓解期样本通常报告招募和表现相对保留，而抑郁状态或更高需求条件下与负荷相关的上调减弱。在单一情绪干扰范式中，BD-II显示更强的DLPFC-杏仁核反向耦合，这可能反映额-边缘相互作用的背景特异性调节。当前任务态fMRI文献提供了初步的、产生假设的提示，即BD-I与BD-II可能无法被简单的严重程度连续谱解释完全涵盖，但鉴于BD-II研究稀缺且BD-I/BD-II直接比较数量有限，尚不能得出确切的亚型特异性结论。总体而言，BD-I的发现更多在神经低效/有限可扩展性解释和任务相关DMN抑制减弱框架下被解读，而BD-II的发现——基于稀疏证据——被报告为更具状态和背景依赖性。需要更大规模、协调一致的研究，进行BD-I/BD-II直接比较并分层心境状态，以检验这些暂定模式。

Abstract

Working memory impairment is one of the core cognitive phenotypes in bipolar disorder. However, whether the task-based functional magnetic resonance imaging mechanisms underlying working memory processing are consistent between bipolar disorder type I (BD-I) and type II (BD-II) remains unclear. This systematic review summarizes task-based fMRI evidence, with a focus on characterizing the neural correlates of working memory in BD-II and comparing them with BD-I. Following the PRISMA 2020 guidelines, PubMed, Embase, and Web of Science were systematically searched for studies published between January 2011 and June 2025. Eligible studies included task-based fMRI investigations in adults using working memory paradigms that separately reported results for BD-I and BD-II. A total of 22 studies were included for qualitative synthesis. Across 22 task-based fMRI studies, the qualitative evidence suggests potentially different patterns of working-memory network engagement in BD-I and BD-II; however, subtype-specific inference is constrained by the very limited BD-II literature, with only three studies including BD-II samples (one BD-II-only study and two direct BD-I vs BD-II comparisons). In BD-I, studies more often reported altered or less efficient recruitment of executive-control regions/networks and reduced task-related suppression of default-mode regions under higher cognitive load and/or emotional distraction. In BD-II (based on sparse evidence), euthymic samples were generally reported to show relatively preserved recruitment and performance, whereas depressive-state or higher-demand conditions were associated with attenuated load-related upregulation. In a single emotional-interference paradigm, BD-II showed stronger inverse DLPFC-amygdala coupling, which may reflect context-specific modulation of fronto-limbic interactions. The current task-fMRI literature provides preliminary, hypothesis-generating indications that BD-I and BD-II may not be fully captured by a simple severity-continuum account, but firm subtype-specific conclusions are not yet warranted given the scarcity of BD-II studies and the limited number of direct BD-I/BD-II comparisons. Across studies, BD-I findings have more often been interpreted within neural inefficiency/limited-scalability accounts and reduced task-related DMN suppression, whereas BD-II findings-based on sparse evidence-have been reported as more state- and context-dependent. Larger, harmonized studies with direct BD-I/BD-II comparisons and mood-state stratification are needed to test these provisional patterns.

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