Longitudinal relationships between cognition and functioning over 2 years in euthymic patients with bipolar disorder: a cross-lagged panel model approach with the FACE-BD cohort

Abstract

Background Longitudinal studies of the relationship between cognition and functioning in bipolar disorder are scarce, although cognition is thought to be a key determinant of functioning. The causal structure between cognition and psychosocial functioning in bipolar disorder is unknown. Aims We sought to examine the direction of causality between cognitive performance and functional outcome over 2 years in a large cohort of euthymic patients with bipolar disorder. Method The sample consisted of 272 adults diagnosed with bipolar disorder who were euthymic at baseline, 12 and 24 months. All participants were recruited via the FondaMental Advanced Centers of Expertise in Bipolar Disorders. We used a battery of tests, assessing six domains of cognition at baseline and 24 months. Residual depressive symptoms and psychosocial functioning were measured at baseline and 12 and 24 months. The possible causal structure between cognition and psychosocial functioning was investigated with cross-lagged panel models with residual depressive symptoms as a covariate. Results The analyses support a causal model in which cognition moderately predicts and is causally primary to functional outcome 1 year later, whereas psychosocial functioning does not predict later cognitive performance. Subthreshold depressive symptoms concurrently affected functioning at each time of measure. Conclusions Our results are compatible with an upward causal effect of cognition on functional outcome in euthymic patients with bipolar disorder. Neuropsychological assessment may help specify individual prognoses. Further studies are warranted to confirm this causal link and evaluate cognitive remediation, before or simultaneously with functional remediation, as an intervention to improve functional outcome. Declaration of interest None.

Long-term outcome predictors after functional remediation in patients with bipolar disorder

“…Nowadays, there is no doubt about the marked impact of neurocognitive impairment on psychosocial functioning in BD (Depp & Mausbach, 2012;Iosifescu, 2012;Sanchez-Moreno, Martinez-Aran, & Vieta, 2017b). Recently Ehrminger and colleagues published a cross-lagged panel model supporting an upward causal effect of cognition on functioning in euthymic patients (Ehrminger et al, 2019). Different cognitive domains have been found to have an effect on overall functioning (Sanchez-Moreno et al, 2018).…”

Not in education, employment and training status in the early stages of bipolar I disorder with psychotic features

“…Fifth, we did not assess key factors such as cognitive functioning—which can be predictive of social and occupational functioning in BD (Ehrminger et al, 2019; Kapczinski et al, 2016; Van Rheenen et al, 2020). Indeed, substance use and cognitive functioning can both impact vocational engagements (de Azevedo et al, 2015).…”

Minimum clinically important differences for the Functioning Assessment Short Test and a battery of neuropsychological tests in bipolar disorders: results from the FACE-BD cohort

“…This may have led to an overestimation of the s.e.m. , increasing the probability of a change to occur during the follow-up period, especially since previous reports showed an improvement in psychosocial functioning and cognition in this cohort (Ehrminger et al ., 2019). However, we believe that such an overestimation bias may have been controlled by the fact that the distribution-based estimates were computed on a sample of patients with stable functioning.…”