Cognitive Impairment in Manic Bipolar Patients: Important, Understated, Significant Aspects
BACKGROUND:
Bipolar
disorder is a chronic mood disorder with episodic progress and high relapse
rate. Growing evidence suggests that individuals with bipolar disorder display
cognitive impairment which persists even throughout periods of symptom's
remission.
METHOD:
137
bipolar patients met the inclusion criteria (depressive episode: DSM-IV-TR
criteria for major depressive episode, HAMD score ≥17; manic/hypomanic episode:
DSM-IV-TR criteria for manic/hypomanic episode, YMRS score ≥12, euthymic:
6 months of remission, HAMD score ≤8, YMRS score ≤6; and mixed: DSM-IV-TR
criteria for mixed episode, HAMD score >8 and YMRS score >6) and were
therefore enrolled in the study. Patients were free of psychotic symptoms
(hallucinations/delusions) at the moment of testing. Control group consisted of
62 healthy subjects without history of neurological and/or psychiatric
disorder. Cognitive battery has been applied in order to assess verbal memory,
working memory, psychomotor speed, verbal fluency, attention and speed of
information processing, and executive function. Following data were collected:
demographics, psychiatric history, age of illness onset; current and previous
treatment (including hospitalizations). Cognitive deficits were assessed in
bipolar patients experiencing manic, depressive, mixed episodes or who were
euthymic in mood. Results were compared between the subgroups and with healthy
individuals. The association of impaired cognition with illness course was
analyzed.
RESULTS:
Bipolar
patients showed cognitive deficits in all evaluated domains when compared to
controls. The lowest scores were obtained for the verbal fluency test. After
adjusting for current episode, manic subgroup showed greater cognitive
impairment in verbal and working memory, executive function/reasoning and
problem solving, compared to depressive, mixed, and euthymic subgroup.
Low-neurocognitive performance was directly associated with a predominance of
manic episodes and severe course of bipolar illness. An increased number of
past manic episodes was the strongest correlated event with the poorest
outcomes in verbal memory testing. Other factors correlated with poor verbal
memory scores in manic subgroup were age at illness onset (positive
correlation), illness length, and hospitalizations (negative correlations).
CONCLUSIONS:
Bipolar
patients showed cognitive deficits regardless of the phase of illness. Subjects
experiencing a manic episode displayed higher deficits in verbal and working
memory, executive function/reasoning, and problem solving. Severe course of
illness also showed significant contribution in terms of cognitive impairment.
- 1University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania ; 7th Ward, Clinical Hospital of Psychiatry "Al. Obregia" Bucharest, Bucharest, Romania.
- 27th Ward, Clinical Hospital of Psychiatry "Al. Obregia" Bucharest, Bucharest, Romania ; University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania.
- 3University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania ; 9th Ward, Clinical Hospital of Psychiatry "Al. Obregia" Bucharest, Bucharest, Romania.
- 4University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, Romania ; Department of Cardiology, Clinical Emergency Hospital Bucharest, Bucharest, Romania.
- 5Faculty of Medicine and Pharmacy, "Danubius" University, Galati, Romania ; Clinical Hospital of Psychiatry "Elisabeta Doamna" Galati, Galati, Romania.
- 6University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj-Napoca, Romania ; Second Psychiatric Clinic, Emergency County Hospital Cluj-Napoca, Cluj-Napoca, Romania.
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