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BACKGROUND Neurocognitive dysfunctions particularly executive functioning, attention, processing speed, verbal learning and declarative memory are key aspects of Bipolar disorder, as they occur in all the phases of the illness, across all neuropsychological domains, even during remission of symptoms. In our study, we compared the frequency and types of neurocognitive deficits and factors influencing them in individuals with Bipolar I disorder, their first-degree unaffected relatives and healthy controls. METHODS It was a cross sectional, case control, comparative, study with 50 samples in each of the three groups. Diagnosis of Bipolar disorder I was made following DSM IV TR criteria and current euthymic state was established by applying YMRS and HDRS scale. Neurocognitive performance was assessed on MMSE, frontal assessment battery, trail making test A and B. Statistical tests used were chi square test, ANOVA and Pearson's correlation using SPSS 20 software. RESULTS Age (early onset), duration of illness, total number of episodes and number of manic episodes worsen the neurocognitive performance. CONCLUSIONS First degree unaffected relatives of Bipolar I disorder patients had impairment in psychomotor speed and executive functioning with alternating attention suggesting, these may be valid endophenotypic traits of bipolar disorder. Euthymic Bipolar I patients had significant frontal dysfunction and impairment in psychomotor speed, visual conceptualization and visuomotor tracking. Neurocognitive deficits in the euthymic Bipolar I patients and their first-degree unaffected relatives may be of different nature, more global in patients while more specific in relatives. Neuropsychological deficits in remission period impair socio-occupational functions which lead to poor compliance and more relapses. This highlights the need of routine assessment and early interventions even in euthymic stage. Cognitive impairment in unaffected first-degree relatives warrants periodic neurocognitive testing, psycho education and early medical intervention if required.

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