Neurocognitive impairment in middle-aged and older adults with bipolar disorder: Comparison to schizophrenia and normal comparison subjects

Depp, Colin A.; Moore, David J.; Sitzer, David; Palmer, Barton W.; Eyler, Lisa T.; Roesch, Scott; Lebowitz, Barry D.; Jeste, Dilip V.

doi:10.1016/j.jad.2006.11.022

Cited by 112 publications

(93 citation statements)

References 31 publications

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“…In other words, the relative severity of impairments across different cognitive domains tends to be very similar in bipolar disorder, psychotic major depression and schizoaffective disorders as compared to schizophrenia (e.g., 104,105,109,114).…”

Section: Cognition Across Psychotic Disordersmentioning

confidence: 99%

Cognitive impairments in psychotic disorders: common mechanisms and measurement

2014

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Decades of research have provided robust evidence of cognitive impairments in psychotic disorders. Individuals with schizophrenia appear to be impaired on the majority of neuropsychological tasks, leading some researchers to argue for a "generalized deficit", in which the multitude of cognitive impairments are the result of a common neurobiological source. One such common mechanism may be an inability to actively represent goal information in working memory as a means to guide behavior, with the associated neurobiological impairment being a disturbance in the function of the dorsolateral prefrontal cortex. Here, we provide a discussion of the evidence for such impairment in schizophrenia, and how it manifests in domains typically referred to as cognitive control, working memory and episodic memory. We also briefly discuss cognitive impairment in affective psychoses, reporting that the degree of impairment is worse in schizophrenia than in bipolar disorder and psychotic major depression, but the profile of impairment is similar, possibly reflecting common mechanisms at the neural level. Given the recent release of the DSM-5, we end with a brief discussion on assessing cognition in the context of diagnosis and treatment planning in psychotic disorders.

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Section: Cognition Across Psychotic Disordersmentioning

confidence: 99%

Cognitive impairments in psychotic disorders: common mechanisms and measurement

2014

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“…Neurocognitive impairment has been found to limit creativity, work performance, quality of life, selfesteem, and psychosocial functioning substantially in patients with other severe mental illnesses, especially schizophrenia (16)(17)(18)(19)(20)(21). In BPD, there has been increasing recognition of more functional impairment than had been realized formerly, particularly with regard to independent living, personal relationships, and vocational success (22).…”

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confidence: 99%

“…However, in a recent review of 15 studies, Bauer and colleagues (26) found that, except for ongoing depressive symptoms, few of these factors were consistently associated with poor functional outcomes across studies. Neurocognitive functioning, remarkably, was not examined in most of the preceding studies of BPD patients, despite having been explored extensively in relation to functional disability in patients with schizophrenia and other neuropsychiatric conditions (17)(18)(19)(20)(21)27).…”

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confidence: 99%

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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“…Cognitive impairment is a common clinical problem associated with BD patients, even in euthymic periods. In spite of a presumed stability of the cognitive impairment among the majority of patients through their life span, these deficits seems clinically important interfering negatively in functional capacity and exerting a negative effect on the global prognosis of these patients 15 . Additionally, the characterization and follow-up of these cognitive deficits are relevant since the risk to develop dementia among BD patients is almost three times higher especially among older patients, when compared to non-BD age-matched population 11,12,30 .…”

Section: Discussionmentioning

confidence: 99%

“…Both neuropsychological and biological markers of cognitive impairment are required for the early or better identification of those BD patients that will present a higher risk for worsening or converting this cognitive dysfunction to dementia 2 . In the absence of these markers, the prompt identification and follow-up knowledge of the neuropsychological deficits presented by these patients are fundamental as long as cognitive impairment negatively affects functional capacity and global prognosis, facilitating the evolution to dementia 15 . In the matter of the most significant cognitive impairments presented by BD patients, the largest effect sizes observed by two meta-analyses indicated that executive function and verbal memory are the most relevant domains 3,4 .…”

mentioning

confidence: 99%

The use of the Clock Drawing Test in bipolar disorder with or without dementia of Alzheimer’s type

Aprahamian

Radanovic

Nunes

et al. 2014

Arq. Neuro-Psiquiatr.

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There is limited data regarding the cognitive profile from screening tests of older adults with bipolar disorder (BD) with dementia. Objective: To investigate the Clock Drawing Test (CDT) among older adults with BD with and without Alzheimer's disease (AD). Method: 209 older adults (79 with BD without dementia and 70 controls; 60 with AD, being 27 with BD) were included to evaluate the performance of three CDT scoring scales, beyond the Mini-Mental State Examination (MMSE) and verbal fluency (VFT). Results: Patients with BD without dementia presented with lower scores in MMSE, VF and one CDT scoring scale than controls. Patients with BD and AD presented with lower scores in VF and CDT scoring scales than patients with only AD. All CDT scales presented similar sensitivity and specificity for BD and non-BD groups. Conclusion: Elderly subjects with BD showed greater impairment in CDT in both groups of normal cognition and AD.Keywords: Clock Drawing Test, Alzheimer's disease, bipolar disorder. RESUMOHá dados limitados sobre o perfil cognitivo de idosos com transtorno bipolar (TAB) e demência. Previamente, testes de rastreio cognitivo comuns foram pouco estudados. Objetivo: Investigar o Teste do Desenho do Relógio (CDT) entre idosos com TAB com e sem doença de Alzheimer (DA). Método: Foram incluídos 209 idosos (79 pacientes com TAB sem demência e 70 controles; 60 indivíduos com DA leve, sendo 27 com TAB) para avaliar três escalas de pontuação do TDR, além do Mini-Mental State Examination (MMSE) e fluência verbal (FV). Resultados: Pacientes com TAB sem demência apresentaram menores escores no MMSE, FV e uma escala de TDR que controles. Pacientes com TAB e DA apresentaram escores mais baixos na FV e em todos os TDR comparados aos apenas com DA. As escalas de CDT apresentaram sensibilidade e especificidade semelhantes para os grupos com e sem TAB. Conclusão: Idosos com TAB apresentaram maior comprometimento no TDR em ambos grupos com cognição normal e DA.Palavras-chave: Teste do Desenho do Relógio, doença de Alzheimer, transtorno bipolar.

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Neurocognitive impairment in middle-aged and older adults with bipolar disorder: Comparison to schizophrenia and normal comparison subjects

Cited by 112 publications

References 31 publications

Cognitive impairments in psychotic disorders: common mechanisms and measurement

Cognitive impairments in psychotic disorders: common mechanisms and measurement

Neurocognitive impairment in bipolar disorder patients: functional implications

The use of the Clock Drawing Test in bipolar disorder with or without dementia of Alzheimer’s type

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