Alteration of prefrontal cortex and its associations with emotional and cognitive dysfunctions in adolescent borderline personality disorder

Abstract

Abstract Background The neurobiological mechanism of borderline personality disorder (BPD) in adolescents remains unclear. The study aimed to assess the alterations in neural activity within prefrontal cortex in adolescents with BPD and investigate the relationship of prefrontal activity with cognitive function and emotional regulation. Methods This study enrolled 50 adolescents aged 12–17 years with BPD and 21 gender and age-matched healthy control (HC) participants. Study assessment for each participant included a brain resting-state functional MRI (rs-fMRI), cognitive testing with Stroop Color-Word Test (SCWT) and clinical assessment questionnaires such as Borderline Personality Features Scale (BPFS), Difficulties in Emotion Regulation Scale (DERS), Ottawa Self-Injury Inventory and Childhood Trauma Questionnaire (CTQ). Fractional amplitude of low-frequency fluctuations (fALFF) and seed-based functional connectivity (FC) were obtained from rs-fMRI analysis. Correlative analysis was also performed to evaluate the associations of the neuroimaging metrics such as fALFF and FC with cognitive testing scores and clinical assessment questionnaire scores. Results Adolescents with BPD showed increased fALFF values in the right inferior frontal gyrus and decreased activity in the left middle frontal gyrus as compared to the HC group (p < 0.05, cluster size ≥ 100, FWE correction). In adolescents with BPD, the reduced fALFF in the left middle frontal gyrus was associated with SCWT-A (reading characters) and SCWT-B (reading color). Increased fALFF in the right inferior frontal gyrus was related to BPFS, DERS-F and Ottawa Self-Injury Inventory-4C. Additionally, both the fALFF values in the left middle frontal gyrus and the right inferior frontal gyrus were related to the CTQ-D (emotional neglect) (p < 0.05). The left middle frontal gyrus exhibited increased FC with the right hippocampus, left inferior temporal gyrus and right inferior frontal gyrus (voxel p < 0.001, cluster p < 0.05, FWE correction). The increased FC between the left middle frontal gyrus and the right hippocampus was related to SCWT-C (cognitive flexibility). Conclusions We observed diverging changes in intrinsic brain activity in prefrontal cortex, and neural compensatory FC changes to maintain function in adolescents with BPD. In addition, increased neural function as indicated by brain activity and FC was associated with cognitive dysfunction, while decreased neural function was closely associated with emotional dysregulation. These results indicated that alterations of intrinsic brain activity may be one of the underlying neurobiological markers for clinical symptoms in adolescents with BPD.