Neurocognitive Functioning in Overweight and Obese Patients with Bipolar Disorder: Data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM)

Abstract

Objective: Obesity is frequent in people with bipolar I disorder (BD I) and has a major impact on the course of the illness. Although obesity negatively influences cognitive function in patients with BD, its impact in the early phase of the disorder is unknown. We investigated the impact of overweight and obesity on cognitive functioning in clinically stable patients with BD recently recovered from their first manic episode. Method: Sixty-five patients with BD (25 overweight or obese and 40 normal weight) recently remitted from a first episode of mania and 37 age- and sex-matched healthy control subjects (9 overweight or obese and 28 normal weight) were included in this analysis from the Systematic Treatment Optimization Program for Early Mania (commonly referred to as STOP-EM). All subjects had their cognitive function assessed using a standard neurocognitive battery. We compared cognitive function between normal weight patients, overweight-obese patients, and normal weight healthy control subjects. Results: There was a negative affect of BD diagnosis on the domains of attention, verbal memory, nonverbal memory, working memory, and executive function, but we were unable to find an additional effect of weight on cognitive functioning in patients. There was a trend for a negative correlation between body mass index and nonverbal memory in the patient group. Conclusions: These data suggest that overweight-obesity does not negatively influence cognitive function early in the course of BD. Given that there is evidence for a negative impact of obesity later in the course of illness, there may be an opportunity to address obesity early in the course of BD.

Greater body mass index is associated with reduced frontal cortical volumes among adolescents with bipolar disorder

“…11 In addition to its adverse physical health correlates, obesity has been associated with a more pernicious course of BD in adults, including increased frequency of mood episodes, increased treatment resistance, poor cognitive function and increased suicidality. 2,[12][13][14] Similar to findings in adults with BD, overweight/obesity in adolescents with BD has been associated with greater prevalence of substance use disorder, self-injurious behaviour, suicidality, neurocognitive dysfunction and greater number of psychiatric hospital admissions. 2,6,15,16 Recent general population data from the United States indicated that although overweight/ obesity was not more common among adolescents with BD than in other adolescents, in this largely untreated sample it was nonetheless associated with indicators of BD severity, such as suicide attempts and psychiatric hospital admission.…”

Impact of metabolic syndrome and clinical features on functioning in patients with bipolar disorder: a cross-sectional study

“…In a study evaluating neurocognitive functions in overweight and obese bipolar patients, there was a weak negative correlation between BMI and nonverbal memory, and no correlation between BMI and other cognitive domains. 39 Another study showed a correlation between hypertension and global cognitive dysfunction in remitted BD. 40 The negative correlation between waist circumference and participation in social activities can be explained by the fact that people with abdominal obesity refrain from participating in social activities due to social attitudes toward obese bodies, but further studies are needed in this regard.…”

Call to action regarding the vascular‐bipolar link: A report from the Vascular Task Force of the International Society for Bipolar Disorders

“…CVRFs are also associated with reduced neurocognitive function, particularly in frontal‐executive tasks 49‐57 . The strength of this association may depend in part on the symptomatic status and on the illness duration/stage 58,59 . Prospective studies indicate that the association among CVRFs, particularly obesity, and impaired cognition is bidirectional 53,59 .…”