Meta-analysis of longitudinal studies of cognition in bipolar disorder: comparison with healthy controls and schizophrenia

Bora, Emre; Özerdem, Ayşegül

doi:10.1017/s0033291717001490

Cited by 140 publications

(108 citation statements)

References 80 publications

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“…Importantly, a recent meta‐analysis of the few published longitudinal studies of BD samples found no good evidence of decline in cognition over short (~1.5 years) or longer term (~5.5 years) periods . There was also no evidence for an effect of age, gender, education or changes in mood symptoms on cognitive change . Cognitive changes in BD patients also did not differ from healthy controls or SZ patients, and were largely consistent with an earlier meta‐analysis on the topic .…”

Section: Trajectory Of Cognitive Functioning In Bdsupporting

confidence: 72%

Section: Trajectory Of Cognitive Functioning In Bdmentioning

confidence: 95%

“…In the context of an absence of age differences between single and multi‐episode groups, this has been taken by some to indicate progressive cognitive dysfunction that may directly owe to the cumulative biological toxicity associated with repeated mood episodes—a key notion of the clinical staging framework . However, given evidence of cognitive dysfunction in adult first degree relatives of BD that frames cognitive impairment as the outcome of genetic liability, it is also plausible that more severe cognitive impairment in those with repeated episodes represents a marker of a more severe illness phenotype rather than a function of illness progression . Indeed, available evidence shows that multi‐manic episode patients with worse cognitive functioning manifested the illness between 2 to 5 years earlier than single episode patients .…”

Section: Trajectory Of Cognitive Functioning In Bdmentioning

confidence: 99%

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Current understandings of the trajectory and emerging correlates of cognitive impairment in bipolar disorder: An overview of evidence

et al. 2019

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Objectives Cognitive dysfunction affects a significant proportion of people with bipolar disorder (BD), but the cause, trajectory and correlates of such dysfunction remains unclear. Increased understanding of these factors is required to progress treatment development for this symptom dimension. Methods This paper provides a critical overview of the literature concerning the trajectories and emerging correlates of cognitive functioning in BD. It is a narrative review in which we provide a qualitative synthesis of current evidence concerning clinical, molecular, neural and lifestyle correlates of cognitive impairment in BD across the lifespan (in premorbid, prodromal, early onset, post‐onset, elderly cohorts). Results There is emerging evidence of empirical links between cognitive impairment and an increased inflammatory state, brain structural abnormalities and reduced neuroprotection in BD. However, evidence regarding the progressive nature of cognitive impairment is mixed, since consensus between different cross‐sectional data is lacking and does not align to the outcomes of the limited longitudinal studies available. Increased recognition of cognitive heterogeneity in BD may help to explain some inconsistencies in the extant literature. Conclusions Large, longitudinally focussed studies of cognition and its covariation alongside biological and lifestyle factors are required to better define cognitive trajectories in BD, and eventually pave the way for the application of a precision medicine approach for individual patients in clinical practice.

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Section: Trajectory Of Cognitive Functioning In Bdsupporting

confidence: 72%

Section: Trajectory Of Cognitive Functioning In Bdmentioning

confidence: 95%

Section: Trajectory Of Cognitive Functioning In Bdmentioning

confidence: 99%

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Current understandings of the trajectory and emerging correlates of cognitive impairment in bipolar disorder: An overview of evidence

et al. 2019

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“…Conversely, most longitudinal studies have reported stability in neurocognitive deficits during a follow‐up period that ranged between 1 and 5 years . In fact, two meta‐analyses conducted on this subject have reported stability in neurocognitive performance among middle‐life BD subjects . Nonetheless, it remains plausible that deterioration in neurocognitive performance might occur in very early or late stages of the course of this disease, and meta‐analyses conducted on middle‐life patients (or averaging over patients across all stages) were unable to detect these processes.…”

Section: Introductionmentioning

confidence: 85%

Longitudinal analysis of cognitive performances in recent‐onset and late‐life Bipolar Disorder: A systematic review and meta‐analysis

2019

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Objectives Neurocognitive deficits have been widely reported in euthymic Bipolar Disorder (BD) patients and contribute to functional disability. However, the longitudinal trajectory of these deficits remains a subject of debate. Although most research to this date shows that neurocognitive deficits tend to be stable among middle‐age BD patients, it remains plausible that deterioration occurs at either early or late stages of this condition. Methods We conducted a comprehensive meta‐analysis of studies that reported longitudinal neurocognitive performance among individuals with BD either within the year of their diagnosis or among late‐life BD patients. Pooled effects of standardized mean differences (SMDs) for changes in neuropsychological scores over follow‐up were estimated using random effects model. We also examined effect moderators, such as length of follow‐up, mood state, or pharmacological load. Results Eight studies met inclusion criteria for recent‐onset and four studies for late‐life BD analysis. No evidence for a deterioration in neurocognitive functioning was observed among recent‐onset BD patients (8 studies, 284 patients, SMD: 0.12, 95% CI −0.06 to 0.30, mean follow‐up: 17 months) nor for late‐life BD patients (4 studies, 153 patients, SMD: −0.35, 95% CI −0.84 to 0.15, mean follow‐up: 33 months). None of the moderators were shown to be significant. Conclusions These results, when appraised together with the findings in middle‐life BD patients and individuals at genetic risk for BD, suggest that neurodevelopmental factors might play a significant role in cognitive deficits in BD and do not support the notion of progressive cognitive decline in most patients with BD.

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“…However, not all longitudinal studies of cognitive functioning in bipolar disorder support the notion of deteriorating cognitive functioning over the course of the disorder. Several studies have observed static cognitive deficit trajectories in the bipolar disorder (Samame et al 2014; Bora and Ozerdem 2017; Martino et al 2018), and several studies demonstrate cognitive improvements after the first manic episode (Torres et al 2014; Torrent et al 2018). It is also plausible that premorbid cognitive functioning impairments in bipolar disorder are associated with specific genetic variants (Arts et al 2013; Bryzgalov et al 2018; Flowers et al 2016) that may be associated with neural development (Tabares-Seisdedos et al 2008) and thus may not be present in all individuals premorbidly.…”

Section: Introductionmentioning

confidence: 99%

Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective

Karcher²,

2018

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Individuals with disorders that include psychotic symptoms (i.e. psychotic disorders) experience broad cognitive impairments in the chronic state, indicating a dimension of abnormality associated with the experience of psychosis. These impairments negatively impact functional outcome, contributing to the disabling nature of schizophrenia, bipolar disorder, and psychotic depression. The robust and reliable nature of cognitive deficits has led researchers to explore the timing and profile of impairments, as this may elucidate different neurodevelopmental patterns in individuals who experience psychosis. Here, we review the literature on cognitive deficits across the life span of individuals with psychotic disorder and psychotic-like experiences, highlighting the dimensional nature of both psychosis and cognitive ability. We identify premorbid generalized cognitive impairment in schizophrenia that worsens throughout development, and stabilizes by the first-episode of psychosis, suggesting a neurodevelopmental course. Research in affective psychosis is less clear, with mixed evidence regarding premorbid deficits, but a fairly reliable generalized deficit at first-episode, which appears to worsen into the chronic state. In general, cognitive impairments are most severe in schizophrenia, intermediate in bipolar disorder, and the least severe in psychotic depression. In all groups, cognitive deficits are associated with functional outcome. Finally, while the generalized deficit is the clearest and most reliable signal, data suggests specific deficits in verbal memory across all groups, specific processing speed impairments in schizophrenia and executive functioning impairments in bipolar disorder. Cognitive deficits are a core feature of psychotic disorders that provide a window into understanding developmental course and risk for psychosis.

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Meta-analysis of longitudinal studies of cognition in bipolar disorder: comparison with healthy controls and schizophrenia

Abstract: Together with the findings in early BP and individuals at genetic risk for BP, current findings suggest that neurodevelopmental factors might play a significant role in cognitive deficits in BP and do not support the notion of progressive cognitive decline in most patients with BP.

Cited by 140 publications

References 80 publications

Current understandings of the trajectory and emerging correlates of cognitive impairment in bipolar disorder: An overview of evidence

Current understandings of the trajectory and emerging correlates of cognitive impairment in bipolar disorder: An overview of evidence

Longitudinal analysis of cognitive performances in recent‐onset and late‐life Bipolar Disorder: A systematic review and meta‐analysis

Cognitive Deficits in Psychotic Disorders: A Lifespan Perspective

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