Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome

Martínez‐Arán, Anabel; Vieta, Eduard; Colom, Francesc; Torrent, Carla; Sánchez-Moreno, José; Reinares, María; Benabarre, Antonio; Goikolea, J. M.; Brugue, Esteve; Daban, Claire; Salamero, Manel

doi:10.1111/j.1399-5618.2004.00111.x

Cited by 522 publications

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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%

“…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%

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mentioning

confidence: 99%

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Neurocognitive impairment in bipolar disorder patients: functional implications

2009

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“…By contrast, there were main effects of group in the executive domain (TMT-B and digit span backward), in the inhibition domain (Stroop inhibition), in the processing speed domain (TMT-A and hit reaction time of CPT-II), and finally in the verbal memory domain (immediate and delayed recall). Since previous studies (Clark et al 2002 ;Martínez-Arán et al 2004a ;Savitz et al 2005 ;Kurtz & Gerraty, 2009) have already established the impact of residual mood symptoms, a repeated-measures MANCOVA was also performed, controlling for pre-morbid IQ and by YMRS and HAMD score. Even including these covariates, the results showed again the same effects, except for the interaction in the hit reaction time of CPT-II (although it depicted a similar trend), which did not reach the significance threshold.…”

Section: Neuropsychological Performancementioning

confidence: 99%

Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

et al. 2012

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BackgroundPrevious cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome.MethodA total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test.ResultsRepeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05).ConclusionsExecutive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

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Association Between the Fronto-Limbic Network and Cognitive and Emotional Functioning in Individuals With Bipolar Disorder

et al. 2023

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ImportanceIndividuals with bipolar disorder (BD) experience cognitive and emotional dysfunctions. Various brain circuits are implicated in BD but have not been investigated in a meta-analysis of functional magnetic resonance imaging (fMRI) studies.ObjectiveTo investigate the brain functioning of individuals with BD compared with healthy control individuals in the domains of emotion processing, reward processing, and working memory.Data SourcesAll fMRI experiments on BD published before March 2020, as identified in a literature search of PubMed, Embase, Web of Science, Cochrane Library, PsycInfo, Emcare, Academic Search Premier, and ScienceDirect. The literature search was conducted on February 21, 2017, and March 2, 2020, and data were analyzed from January 2021 to January 2022.Study SelectionfMRI experiments comparing adult individuals with BD and healthy control individuals were selected if they reported whole-brain results, including a task assessing at least 1 of the domains. In total, 2320 studies were screened, and 253 full-text articles were evaluated.Data Extraction and SynthesisA total of 49 studies were included after selection procedure. Coordinates reporting significant activation differences between individuals with BD and healthy control individuals were extracted. Differences in brain region activity were tested using the activation likelihood estimation method.Main Outcomes and MeasuresA whole-brain meta-analysis evaluated whether reported differences in brain activation in response to stimuli in 3 cognitive domains between individuals with BD and healthy control individuals were different.ResultsThe study population included 999 individuals with BD (551 [55.2%] female) and 1027 healthy control individuals (532 [51.8%] female). Compared with healthy control individuals, individuals with BD showed amygdala and hippocampal hyperactivity and hypoactivation in the inferior frontal gyrus during emotion processing (20 studies; 324 individuals with BD and 369 healthy control individuals), hyperactivation in the orbitofrontal cortex during reward processing (9 studies; 195 individuals with BD and 213 healthy control individuals), and hyperactivation in the ventromedial prefrontal cortex and subgenual anterior cingulate cortex during working memory (20 studies; 530 individuals with BD and 417 healthy control individuals). Limbic hyperactivation was only found during euthymia in the emotion and reward processing domains; abnormalities in frontal cortex activity were also found in individuals with BD with mania and depression.Conclusions and RelevanceThis systematic review and meta-analysis revealed evidence for activity disturbances in key brain areas involved in cognitive and emotion processing in individuals with BD. Most of the regions are part of the fronto-limbic network. The results suggest that aberrations in the fronto-limbic network, present in both euthymic and symptomatic individuals, may be underlying cognitive and emotional dysfunctions in BD.

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Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome

Cited by 522 publications

References 45 publications

Neurocognitive impairment in bipolar disorder patients: functional implications

Neurocognitive impairment in bipolar disorder patients: functional implications

Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

Association Between the Fronto-Limbic Network and Cognitive and Emotional Functioning in Individuals With Bipolar Disorder

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