Abstract Objective Persistent cognitive deficits in bipolar disorder represent a major impediment to functional adjustment, but their static or progressive nature remains to be ascertained. The aim ...of this study was to synthesize findings from longitudinal research in order to examine the trajectory of cognitive impairment in bipolar disorder. Method A literature search was conducted through online databases covering the period between January 1990 and February 2014. Two approaches were undertaken. First, the results of longitudinal studies including neuropsychological assessment of stable bipolar patients at baseline and after a follow-up period of at least one year were meta-analyzed so as to obtain overall test–retest effect sizes for neurocognitive domains. Second, meta-analysis was restricted to longitudinal studies of bipolar patients including a control group. Patients’ and controls’ overall test–retest effect sizes were compared. Results Bipolar patients’ performance on 14 cognitive measures remained stable after a mean follow-up period of 4.62 years. When meta-analysis was restricted to controlled studies, no patient-control differences were found regarding longitudinal cognitive outcomes. Limitations Test–retest differences for medication variables and mood state could not be controlled. Sufficient data were not available to investigate a wider array of neuropsychological domains. Furthermore, most primary studies included relatively short test–restest intervals. Conclusion To date, the available evidence from longitudinal studies is not in accordance with the hypothesis of a progressive nature of cognitive deficits in BD. The implications of this finding for further research are discussed.
Abstract Objective Social cognition has been shown to be affected in bipolar disorders, even during euthymia. However, the social cognitive profile of this group of disorders remains to be ...ascertained, given that such a broad neuropsychological construct has not been systematically examined in bipolar subjects across different tasks. The aim of this study was to quantify the magnitude of patient-control differences for distinct social cognition assessment instruments: the Hinting Task, the Eyes Test, Faux Pas, the Mayer–Salovey–Caruso Emotional Intelligence Test, and emotional labeling using visual stimuli. Method Effect sizes were extracted from studies chosen according to more stringent criteria than previously used in systematic reviews on the topic and pooled by means of meta-analytical procedures. Results No significant patient-control differences were found for the recognition of three basic emotions (happiness, sadness, and anger). Small but significant effect sizes favoring healthy controls (Hedges׳ g <0.5) were noted for emotional intelligence, the Hinting Task, the Eyes Test, and the recognition of fear, disgust, and surprise. A medium effect size (Hedges׳ g =0.58) was noted for the Faux Pas Test. Limitations The possible effects of other neurocognitive impairments on social cognitive performance could not be explored. Conclusion On average, small-to-moderate differences may exist between euthymic bipolar disorder subjects and healthy controls regarding social cognitive performance, with mental state decoding being more preserved than mental state reasoning. The influence of clinical and neurocognitive variables, which may play an important role in the social cognitive outcomes of these patients, deserves further clarification.
Objectives
In the coming generation, older adults with bipolar disorder (BD) will increase in absolute numbers as well as proportion of the general population. This is the first report of the ...International Society for Bipolar Disorder (ISBD) Task Force on Older‐Age Bipolar Disorder (OABD).
Methods
This task force report addresses the unique aspects of OABD including epidemiology and clinical features, neuropathology and biomarkers, physical health, cognition, and care approaches.
Results
The report describes an expert consensus summary on OABD that is intended to advance the care of patients, and shed light on issues of relevance to BD research across the lifespan. Although there is still a dearth of research and health efforts focused on older adults with BD, emerging data have brought some answers, innovative questions, and novel perspectives related to the notion of late onset, medical comorbidity, and the vexing issue of cognitive impairment and decline.
Conclusions
Improving our understanding of the biological, clinical, and social underpinnings relevant to OABD is an indispensable step in building a complete map of BD across the lifespan.
The aim of this study was to estimate the relationship between clinical course and trajectory of neurocognitive functioning during a follow-up period in a sample of euthymic bipolar patients.
...Fifty-one patients with BD performed two-neurocognitive assessment separated by a period of at least 48 months. The clinical course during the follow-up period was documented by: three measures 1) number of affective episodes, 2) time spent ill, and 3) mood instability.
Patients were followed-up for a mean period of 73.21 months. Neurocognitive performance tended to be stable throughout the follow-up. Performance in verbal memory and executive functions at the end of study were related with the number of hypo/manic episodes and time spent with hypo/manic symptoms during the follow-up. None of the clinical measures considered were related to changes in neurocognitive performance over the follow-up period.
The relatively small sample size limits the value of subgroup analysis. The study design does not rule out some risk of selection bias.
Although there may be a positive relationship between number of episodes and neurocognitive deficits in patients with bipolar disorder, successive episodes do not seem to modify the trajectory of neurocognitive functioning over time. Theoretical implications of these findings are discussed.
•Patients with more affective episodes have greater cognitive déficits.•Successive episodes are not related to the trajectory of cognitive déficits.•Accurate interpretation of these findings would require further study.
Objectives
A sizeable body of work has consistently documented that a number of euthymic mixed‐age bipolar disorder subjects exhibit prominent impairments in a variety of cognitive domains. By ...contrast, knowledge about neuropsychological functioning in elderly patients is scant, despite being necessary for the adequate treatment of this population and the understanding of illness evolution. The aim of this study was to combine findings from the available literature in order to examine the pattern and extent of cognitive deficits in euthymic late‐life bipolar disorder subjects.
Methods
A literature search was conducted through the online databases PubMed, ScienceDirect, EBSCO, and Wiley‐Blackwell, covering the period between January 1990 and April 2012. Effect sizes reflecting patient–control differences for 10 cognitive variables were extracted from selected investigations and combined by means of meta‐analytical procedures.
Results
No significant patient–control differences were found for global cognitive status as assessed with the Mini‐Mental State Examination and the Clock Drawing Test. Significant overall effect sizes (Hedges' g) of between 0.61 and 0.88 were noted for sustained attention, digit span (forwards and backwards), delayed recall, serial learning, cognitive flexibility, and verbal fluency (phonemic and categorical).
Conclusions
The extent of cognitive dysfunction in euthymic late‐life bipolar disorder subjects may be, on average, similar to that reported for remitted young adult patients. Larger effect sizes of impairment may be associated with late illness onset. Implications and future directions for research are proposed.
Abstract Objective The hypothesis of a progressive nature of neuropsychological deficits in bipolar disorders is often accepted as an axiom by many clinicians and researchers in the field. However, ...contradictory pieces of data and a number of methodological concerns put it under debate. Method We reviewed findings from three different approaches to the study of the trajectory of cognitive features in bipolar disorders: longitudinal evaluation of cognition in affected subjects, cross-sectional neuropsychological assessment of patients belonging to different age groups, and exploration of the risk of dementia in bipolar subjects. Results An increased risk of developing dementia was found in bipolar subjects. However, evidence from cross-sectional studies did not show more severe cognitive deficits in patients with longer illness duration. Furthermore, longitudinal studies revealed that bipolar subjects׳ cognitive performance did not change between different points in time. Conclusions After a thorough discussion of these findings and the limitations of the different approaches, we argue that, at present, there is no consistent evidence supporting that bipolar disorders, as a group, have a progressively deteriorating course of cognitive functions. Furthermore, we highlight the possible influence of psychotropic agents and metabolic factors on neuropsychological outcomes. Finally, we discuss the clinical implications of these findings and propose targets for forthcoming research.
Abstract It is well known that patients with bipolar disorder (BD) have cognitive impairments even during periods of euthymia. However, to date it remains unclear the moment when these deficits ...onset. Therefore, the aim of this study was to review the evidence focusing on the cognitive status of patients with BD in their premorbid stage and in their first episode. An extensive search was conducted through the online databases Pubmed/PsychInfo, covering the period between 1980 and 2014. A total of 23 studies were selected for the review (nine studies explored premorbid stage of people who lately develop BD and 14 examined first-episodes in bipolar patients). There is evidence that general intelligence is not impaired in the premorbid stage. Impairments in verbal memory, attention, and executive functions tend to be present during and after the first episode. Preliminary evidence suggests that these deficits in specific cognitive domains might precede the onset of illness.
The aim of this study was to estimate the prevalence of clinically significant cognitive deficits in a sample of euthymic older age bipolar disorder (OABD) patients, and its relationship with ...functional outcome. Sixty-six outpatients and 30 controls completed a neuropsychological battery and a measure of psychosocial functioning. There were 33.3% (CI95% 22–44%) of patients without clinically significant cognitive deficits, 36.4% (CI95% 24–48%) with selective deficits, and 30.3% (CI95% 19–41%) with global deficits. Patients without cognitive deficits were indistinguishable of healthy controls in terms of psychosocial functioning, while patients with cognitive impairments had lower functional outcome. Neurocognitive and psychosocial functioning might be heterogeneous among patients with OABD.
•Neurocognitive functioning is heterogeneous in older-age bipolar disorder.•About a third of this population could have preserved neurocognitive functioning.•Neurocognitive indemnity is associated with preserved psychosocial functioning.
PDF
