Neurocognitive test performance predicts functional recovery from acute exacerbation leading to hospitalization in bipolar disorder

Abstract

Objective: Bipolar disorder (BPD) is associated with significant functional morbidity at a rate which is particularly elevated among patients discharged from hospital. The aim of this study was to examine the degree to which neurocognitive test performance, measured following hospitalization for an acute affective episode, is predictive of functional recovery 1 year later. Methods: Seventy‐eight Zucker Hillside Hospital patients aged 18–59 years and having Structured Clinical Interview for DSM‐IV diagnosis of bipolar I disorder (BPD I), bipolar II disorder (BPD II) or BPD not otherwise specified (NOS) confirmed through a rigorous diagnosis consensus procedure, underwent a comprehensive neurocognitive test battery after initial stabilization (baseline) and were followed for at least 12 months (follow‐up). Hamilton Depression Rating Scale (HAM‐D) and Clinician‐Administered Rating Scale for Mania (CARS‐M) ratings were made at baseline and follow‐up. At follow‐up, functionality was assessed using the Multidimensional Scale for Independent Functioning (MSIF). Logistic regression was used to examine the predictive value of each of six validated neurocognitive domains for determining functionality (MSIF) at follow‐up. Baseline and follow‐up HAM‐D and CARS‐M were entered as covariates as was number of days between baseline and follow‐up. Results: Attention and Ideational Fluency were significantly predictive of functional recovery 12 months later. Residual mania but not depression was associated with 12‐month MSIF rating. Lithium and benzodiazepine treatment at the time of neurocognitive testing did not affect the results. Conclusions: This is the first study examining the predictive value of neurocognitive deficits, independent of residual mania or depression, for long‐term functional recovery following hospitalization. Selective neurocognitive deficits are predictive of long‐term functional recovery and, as such, should be candidate targets in treatment and rehabilitation programs.

Neurocognitive impairment in bipolar disorder patients: functional implications

“…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). One of the 12 studies (3) involved longitudinal follow-up through episodes of major depression, hypomania, and euthymia, and thus provided data involving both euthymia and non-euthymia.…”

“…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).…”

“…Mood states of BPD participants were described variously as sufficiently stable for hospital discharge, involving ongoing recovery from recent major depression, mania, or hypomania, or were not specified. Most patients had type I or II BPD, and only a small proportion in one study (28) had an unspecified (not otherwise specified) type. Patients of non-euthymic or uncertain mood states were prescribed psychotropic medications similar to those prescribed to euthymic subjects (Table 1A,B).…”

“…In the five studies of non-euthymic or uncertain mood-state patients (1,3,23,28,35), there were 497 BPD patients and 55 healthy controls; 61% were men; age averaged 41 ± 9 years; education averaged at least 12.9 ± 2.8 years; and illness began at 20.8 ± 8.5 years (weighted by study sample size; Table 1B). Mood states of BPD participants were described variously as sufficiently stable for hospital discharge, involving ongoing recovery from recent major depression, mania, or hypomania, or were not specified.…”

Cognitive impairments in psychotic disorders: common mechanisms and measurement

“…Nonetheless, it remains clear that cognitive function is important for understanding functional status in schizophrenia (121,123,124), as well as other psychotic disorders, including bipolar disorder (125)(126)(127)(128), and that cognitive deficits are not well treated by current antipsychotic medications (e.g., 129). Thus, the DSM-5 psychosis committee included a dimensional assessment of cognition, in order to highlight the potential need for additional treatments specifically targeting cognitive remediation in schizophrenia and other psychotic disorders (e.g., 130,131).…”