Association of cognitive deficits with elevated homocysteine levels in euthymic bipolar patients and its impact on psychosocial functioning: preliminary results

Dittmann, Sandra; Seemüller, Florian; Schwarz, Markus J.; Kleindienst, Nikolaus; Stampfer, Robert; Zach, J.; Born, Christoph; Bernhard, Britta; Fast, Kristina; Grunze, Heinz; Engel, Rolf R.; Severus, Emanuel

doi:10.1111/j.1399-5618.2007.00412.x

Cited by 58 publications

(47 citation statements)

References 61 publications

(80 reference statements)

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“…Of the 13 remaining reports, one was excluded for not exploring correlations between cognitive and functional domains, yielding 12 studies suitable for further analysis (1,3,4,23,(28)(29)(30)(31)(32)(33)(34)(35). These 12 studies provided 13 sets of correlations between cognitive and functional status, including eight studies involving euthymic BPD patients (3,4,(29)(30)(31)(32)(33)(34) and five involving BPD patients in non-euthymic or uncertain mood states (1,3,23,28,35). The latter five studies included BPD patients either recently hospitalized (23,28) or still in major depression, mania, or hypomania (1, 3), or in unspecified mood states (35).…”

Section: Resultsmentioning

confidence: 99%

“…Euthymic BPD patients performed less well than matched healthy controls in these cognitive measures in 7 ⁄ 8 studies. Their impaired domains involved verbal learning and memory in four studies (4,29,32,34), executive functioning in three (4,33,34), and attention, concentration, mental tracking, and information processing speed in three (31)(32)(33).…”

Section: Neurocognitive Performancementioning

confidence: 99%

“…Of studies reporting functional status separately from its correlation with cognitive status, mean GAF scores for euthymic BPD patients ranged from 68 to 86 (3,4,30) for a pooled average of 74.6 ± 11.4, or 19% lower than the value of 92 ± 2.9 in healthy controls (3). In one study where the Social Adjustment Scale (39) was used, 61% of euthymic BPD patients were considered as having good-tovery-good psychosocial functioning, 25% moderate, and 14% poor-to-very-poor functioning, compared to good-to-very-good psychosocial functioning in 100% of healthy controls (31).…”

Section: Neurocognitive Performancementioning

confidence: 99%

“…c Participants had cognitive testing when Ôsufficiently stableÕ after hospitalization; at one-year follow-up they were rated for functional status [Multidimensional Scale for Independent Living To assess functional status in euthymic BPD patients, 5 ⁄ 8 studies (3,4,30,32,34) used the Global Assessment of Functioning (GAF) Scale (38); three of these (4, 32, 34) reported explicitly that only social and occupational functioning, and not mood symptoms, were considered, two relied on patient self-assessment on psychosocial functioning rating scales (29,31), and only one used performance-based measures to assess the instrumental activities of daily living [IADL (33)]. Functional domains considered were vocational and educational activities, household maintenance, level of independent living, and quality of family and social relationships.…”

Section: Neurocognitive Performancementioning

confidence: 99%

“…Specifically, in studies of euthymic BPD patients (Table 2A), estimated premorbid IQ was assessed in 6 ⁄ 8 studies (3,4,(29)(30)(31)(32), executive function in six (3,4,30,(32)(33)(34), verbal learning and memory in six (3,4,29,(32)(33)(34), attention, concentration, mental tracking, information processing speed, and immediate memory in five (3,4,30,31,33), verbal fluency or language in four (4,30,31,33), visuospatial performance in three (29,31,33), and psychomotor speed in two studies (3,31). Euthymic BPD patients performed less well than matched healthy controls in these cognitive measures in 7 ⁄ 8 studies.…”

Section: Neurocognitive Performancementioning

confidence: 99%

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Neurocognitive impairment in bipolar disorder patients: functional implications

2009

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Growing evidence suggests that bipolar disorder (BPD) patients experience prominent neurocognitive impairment not only during acute mood episodes (1-3) but also during euthymia (1,(4)(5)(6)(7)(8)(9)(10)(11)(12). A recent meta-analytic review of 39 studies comparing neurocognitive functioning in 948 euthymic BPD patients and 1,128 normal controls, matched for age, sex, education, and estimated premorbid IQ, found medium-to-large effect sizes (ES, as group differences ⁄ variance) for impaired attention and processing speed (ES = 0.60-0.79), episodic memory (ES = 0.43-0.81), and executive functioning (ES = 0.47-0.71) in the BPD patients (11). Another meta-analytic review of 20 studies, also comparing neurocognitive performance in euthymic BPD patients to matched normal controls, found deficits of similar magnitude in measures of executive functions, verbal learning, immediate Background: Functional recovery among treated bipolar disorder (BPD) patients is far less likely than syndromal and even symptomatic recovery. We hypothesized that increasingly well-documented aspects of cognitive impairment may contribute to poor functional outcomes in BPD patients, and reviewed the available research on the topic.Methods: Computerized literature searching identified 12 studies with 13 comparisons that simultaneously evaluated cognitive and functional status in euthymic (n = 8) or non-euthymic (n = 5 comparisons) adult BPD patients versus otherwise similar healthy controls.Results: In 6 ⁄ 8 studies of euthymic BPD patients and 5 ⁄ 5 studies of non-euthymic BPD patients, neurocognitive impairment was significantly associated with impaired psychosocial functioning, even after adjusting for residual mood symptoms and relevant demographic and clinical variables. Cognitive status was consistently assessed with standardized, performance-based neuropsychological tests, but functional status usually was based on subjective self-appraisals. Approximately 55% of BPD patients were unemployed.Conclusions: Available studies are limited by subjective assessments of functional status rather than objective, performance-based measures. Nevertheless, they support the hypothesis that enduring aspects of cognitive impairment found even in euthymic BPD patients are associated with inferior functioning. These findings encourage further studies with better assessment methods and greater rehabilitative efforts in BPD patients.

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Section: Resultsmentioning

confidence: 99%

Section: Neurocognitive Performancementioning

confidence: 99%

Section: Neurocognitive Performancementioning

confidence: 99%

Section: Neurocognitive Performancementioning

confidence: 99%

Section: Neurocognitive Performancementioning

confidence: 99%

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Neurocognitive impairment in bipolar disorder patients: functional implications

2009

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Sex differences in the prevalence and clinical correlates of hyperhomocysteinemia in patients with bipolar disorder

Lin

Huang

et al. 2020

Human Psychopharmacology

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Objective Sex differences in bipolar disorder are well recognized but little attention has been paid to sex differences in homocysteine or hyperhomocysteinemia in bipolar patients. This study compared gender differences in homocysteine levels and rates of hyperhomocysteinemia in Chinese inpatients with bipolar disorder. Methods A total of 198 BD patients and 84 healthy controls were enrolled. The Young Mania Rating Scale, Hamilton Depression Rating Scale, and the Clinical Global Impressions–Severity scale were used to assess the affective symptomatology. Fasting plasma Hcy levels were measured by high‐performance liquid chromatography. Results Men had higher homocysteine levels than women and the prevalence of hyperhomocysteinemia in male patients was approximately twice that in female patients. Logistic regression analyses showed that HHcy was associated with less frequent use of valproate in males and being overweight in females. Further correlation analysis and multivariate regression analysis demonstrated that Hcy levels were inversely correlated with valproate treatment in men and positively associated with overweight in women. Conclusions In bipolar patients, there are significant differences between sexes in the levels of homocysteine and prevalence of hyperhomocysteinemia. This appears to be associated with lower prevalence of valproate prescribing in men and with being overweight in women.

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Repeatable battery for assessment of neuropsychological status in early Parkinson's disease

et al. 2009

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Adequate reliability and valid factor structure are prerequisites for appropriate use of a measure in a population. Although the Repeatable Battery for Assessment of Neuropsychological Status (RBANS) has been used to examine cognition in Parkinson’s disease (PD), its reliability and factor structure have not been examined in this population. This study examined the reliability and factor structure of the RBANS in participants with de novo PD recruited for two NIH Exploratory Trials in Parkinson’s Disease (NET-PD), using Cronbach’s α and factor analysis. Confirmatory factor analysis (CFA) was implemented on the factor structure proposed in the RBANS manual, and exploratory factor analysis (EFA) was conducted to identify a valid factor structure given the proposed one was not supported. The RBANS exhibited poor reliability in participants with NET-PD. Cronbach’s α ranged from 0.03 to 0.74 for the five domains and the full scale. CFA results indicated that the proposed factor structure in the RBANS manual was not supported in this sample. EFA identified a two-factor structure for six of the 12 RBANS items. Six items were eliminated due to low correlation with other items or severe ceiling effects. This new factor structure was validated by another CFA. The two domains have fair reliability. Cronbach’s α ranged from 0.65 to 0.74 for the two factors in the two datasets. These results suggest that the current RBANS domain and total scores may not provide valid measurement of the neuropsychological status for patients with early PD.

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Association of cognitive deficits with elevated homocysteine levels in euthymic bipolar patients and its impact on psychosocial functioning: preliminary results

Abstract: Elevated Hcy levels seem to be associated with cognitive impairment in euthymic bipolar patients, but not with psychosocial functioning. More studies are needed to clarify the role of Hcy in cognition in bipolar disorder.

Cited by 58 publications

References 61 publications

Neurocognitive impairment in bipolar disorder patients: functional implications

Neurocognitive impairment in bipolar disorder patients: functional implications

Sex differences in the prevalence and clinical correlates of hyperhomocysteinemia in patients with bipolar disorder

Repeatable battery for assessment of neuropsychological status in early Parkinson's disease

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