Cognitive performance in patients with acute phase of bipolar disorder

Czech version

Authors: M. Sisrová ^1,2; L. Ustohal ²; I. Zikmundová ³
Authors‘ workplace: Psychologické oddělení Thomayerovy nemocnice, Praha ¹; Psychiatrická klinika LF MU a FN Brno ²; 1. neurologická klinika LF MU a FN u sv. Anny v Brně ³
Published in: Cesk Slov Neurol N 2018; 81(3): 320-329
Category: Original Paper
doi: https://doi.org/10.14735/amcsnn2018320

Overview

Aim:
The aim of this study was to evaluate the cognitive performance of bipolar disorder patients in the acute phase of the illness. The interest was in determining if the cognitive performance would vary, depending on the different acute phase and if the clinical characteristics were related to the clinical course and the cognitive performance level.

Patients and methods:
A total of 53 patients with bipolar disorder, of which 16 were in hypomania, 17 in mania, 20 in depression, and 23 healthy control group subjects were examined by complex neuropsychological assessment tools.

Results:
Patients with bipolar disorder exhibited cognitive impairment in the area of psychomotor speed, attention, verbal memory and, to a lesser extent, in executive functions and visual memory. Bipolar patients compared to the control group showed statistically significantly worse performance in all cognitive tests except the initiation time (TOL tit) (U = 480; p = 0.142). The healthy control group subjects performed all of the tests within normal standards. Comparison of cognitive performances in the different phases, reflected a statistically significant difference in all cognitive tests except for TOL tit (H = 6.464; p = 0.091), where the four groups did not differ statistically. Cognitive performance in acute phases did not show a statistically significant difference in either of the cognitive tests. After taking into account the clinical characteristics, the closest correlation was recorded between the onset of the illness and verbal memory AVLT 1 (r = – 0.452; p < 0.01), AVLT Sum (r = – 0.383; p < 0.01), and AVLT 30 (r = – 0.370; p < 0.01).

Conclusions:
In this study, patients in the acute phase of bipolar disorder showed significantly worse performance in all neuropsychological parameters than the healthy control group subjects. Cognitive impairment was recorded in the domain of psychomotor speed, attention, verbal memory and, to a lesser extent, executive functions and visual memory. Patients in hypomania, mania and depression did not differ significantly in cognitive performance. From the clinical characteristics, only the age of onset of the illness showed the most correlations with cognitive variables.

Key words:
bipolar disorder – cognitive performance – clinical course – neuropsychology

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Sources

1. Látalová K. Bipolární afektivní porucha. Praha: Grada 2010: 256.

2. Stehnová I, Sisrová M, Hublová V et al. Neuropsychologický výkon u pacientů s první epizodou schizofrenie. Cesk Slov Neurol N 2015; 111(3): 328–334.

3. Martínez-Arán A, Vieta E, Reinares M et al. Cognitive function across manic or hypomanic, depressed and euthymic states in bipolar disorder. Am J Psychiatry 2004; 161(2): 262–270. doi: 10.1176/ appi.ajp.161.2.262.

4. Buoli M, Caldiroli A, Caletti E et al. The impact of mood espisodes and duration of illness on cognition in bipolar disorder. Compr Psychiat 2014; 55(7): 1561–1566. doi: 10.1016/ j.comppsych.2014.06.001.

5. Martino DJ, Strejilevich SA, Scapola M et al. Heterogeneity in cognitive functioning among patients with bipolar disorder. J Affect Disord 2008; 109(1–2): 149–156. doi: 10.1016/ j.jad.2007.12.232.

6. Bora E, Yucel M, Pantelis C. Cognitive endophenotypes of bipolar disorder: A meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. J Affect Disord 2009; 113(1–2): 1–20. doi: 10.1016/ j.jad.2008.06.009.

7. Mann-Wrobel MC, Carreno JT, Dickinson D. Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disord 2011; 13(4): 334–342. doi: 10.1111/ j.1399-5618.2011.00935.x.

8. Rubinsztein JS, Michael A, Paykel ES et al. Cognitive impairment in remission in bipolar affective disorder. Psychol Med 2000; 30(5): 1025–1036.

9. Osuji IJ, Cullum CM. Cognition in bipolar disorder. Psychiat Clin North Am 2005; 28(2): 427–441.

10. van Gorp WG, Altshuler L, Theberge DC et al. Cognitive impairment in euthymic bipolar patients with and without prior alcohol dependence. Arch Gen Psychiatry 1998; 55(1): 41–46.

11. Kessing LV. Cognitive impairment in the euthymic phase of affective disorder. Psychol Med 1998; 28(5): 1027–1038.

12. Vrabie M, Marinescu V, Talaşman A et al. Cognitive impairment in manic bipolar patients: important, understated, significant aspects. Ann Gen Psychiatry 2015; 14: 41. doi: 10.1186/ s12991-015-0080-0.

13. Ryan KA, Vederman AC, McFadden EM et al. Differential executive functioning performance by phase of bipolar disorder. Bipolar Disord 2012; 14(5): 527–536. doi: 10.1111/ j.1399-5618.2012.01032.x.

14. Robinson LJ, Ferrier IN. Evolution of cognitive impairment in bipolar disorder: a systematic review of crosssectional evidence. Bipolar Disord 2006; 8(2): 103–116. doi: 10.1111/ j.1399-5618.2006.00277.x.

15. Zubieta JK, Huguelet P, O’Neil RL et al. Cognitive function in euthymic bipolar I disorder. Psychiatry Res 2001; 102(1): 9–20.

16. Clark L, Iversen SD, Goodwin GM. Sustained attention deﬁcit in bipolar disorder. Br J Psychiatry 2002; 180: 313–319.

17. Thompson JM, Gallagher P, Hughes JH et al. Neurocognitive impairment in euthymic patients with bipolar disorder. Br J Psychiatry 2005; 186: 32–40. doi: 10.1192/ bjp.186.1.32.

18. El-Badri S, Ashton C, Moore P et al. Electrophysiological and cognitive function in young euthymic patients with bipolar affective disorder. Bipolar Disord 2001; 3(2): 79–87.

19. Martínez-Arán A, Vieta E, Colom F et al. Cognitive impairment in euthymic bipolar patients: implication for clinical and functional outcome. Bipolar Disord 2004; 6(3): 224–232. doi: 10.1111/ j.1399-5618.2004.00111.x.

20. Schouws SN, Comijs HC, Stek ML et al. Cognitive impairment in early and late bipolar disorder. Am J Geriatr Psychiatry 2009; 17(6): 508–515. doi: 10.1097/ JGP.0b013e31819e2d50.

21. Robinson LJ, Thompson JM, Gallagher P et al. A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. J Affect Disord 2006; 93(1–3): 105–115. doi: 10.1016/ j.jad.2006.02.016.

22. Torres IJ, Boudreau VG, Yatham LN. Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatr Scand Suppl 2007; 116(s434): 17–26. doi: 10.1111/ j.1600-0447.2007.01055.x.

23. Camelo E, Velasques B, Ribeiro P et al. Attention impairment in bipolar disorder: a systematic review. Psychol Neurosci 2013; 6(3): 299–309. doi: 10.3922/ j.psns.2013.3.08.

24. Glahn DC, Bearden CE, Barguil M et al. The neurocognitive signature of psychotic bipolar disorder. Biol Psychiatry 2007; 62(8): 910–916. doi: 10.1016/ j.biopsych.2007.02.001.

25. Basso MR, Lowery N, Neel J et al. Neuropsychological impairment among manic, depressed, and mixed episode inpatients with bipolar disorder. Neuropsychology 2002; 16(1): 84–91.

26. Mahli GS, Ivanovski B, Hadzi-Pavlovic D et al. Neuropsychological deficits and functional impairment in bipolar depression, hypomania and euthymia. Bipolar Disord 2007; 9(1–2): 114–125. doi: 10.1111/ j.1399-5618.2007.00324.x.

27. van der Werf-Eldering MJ, Burger H, Holthausen EAE, et al. Cognitive functioning in patients with bipolar disorder: association with depressive symptoms and alcohol use. PLoS One 2010; 5(9): e13032. doi: 10.1371/ journal.pone.0013032.

28. Clark L, Iversen SD, Goodwin GM. A neuropsychological investigation of prefrontal cortex involvement in acute mania. Am J Psychiatry 2001; 158(10): 1605–1611.

29. Deckersbach T, McMurrich S, Oqutha J. Characteristics of non verbal memory impairment in bipolar disorder: the role of encoding strategies. Psychol Med 2004; 34(5): 823–832.

30. Torrent C, Martínez-Arán A, Bonnin CM et al. Long-term outcome of cognitive impairment in bipolar disorder. J Clin Psychiatry 2012; 73(7): e899–e905. doi: 10.4088/ JCP.11m07471.

31. Bora E, Yucel M, Pantelis C et al. Meta-analytic review of neurocognition in bipolar II disorder. Acta Psychiatr Scand 2011; 123(3): 165–174. doi: 10.1111/ j.1600-0447.2010.01638.x.

32. Aminoff SR, Hellvin T, Lagerberg TV et al. Neurocognitive features in subgroups of bipolar disorder. Bipolar Disord 2013; 15(3): 272–283. doi: 10.1111/ bdi.12061.

33. Rheenena TE, Rossella SL. An empirical evaluation of the MATRICS Consensus Cognitive Battery in bipolar disorder. Bipolar Disord 2014; 16(3): 318–325. doi: 10.1111/ bdi.12134.