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Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

Published online by Cambridge University Press:  31 August 2012

E. Mora ,
M. J. Portella ,
I. Forcada ,
E. Vieta  and
M. Mur
E. Mora
Affiliation:
Psychiatric Service, Hospital Santa Maria, University of Lleida, IRBLleida (Biomedicine Research Institute), Lleida, Spain
M. J. Portella
Affiliation:
Psychiatric Service, Research Institute, Hospital de Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
I. Forcada
Affiliation:
Psychiatric Service, Hospital Santa Maria, University of Lleida, IRBLleida (Biomedicine Research Institute), Lleida, Spain
E. Vieta
Affiliation:
Bipolar Disorders Program, Hospital Clínic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
M. Mur*
Affiliation:
Psychiatric Service, Hospital Santa Maria, University of Lleida, IRBLleida (Biomedicine Research Institute), Lleida, Spain
*
*Address for correspondence: M. Mur, M.D., Ph.D., Servei de Psiquiatria, Hospital Santa Maria, C/Rovira Roure, 44, 25198 Lleida, Catalunya, Spain. (Email: [email protected])
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Abstract

Background

Previous cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome.

Method

A total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test.

Results

Repeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05).

Conclusions

Executive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

Keywords

Bipolar disordercognitionfollow-up studylithium treatmentpsychosocial functioning
Type
Original Articles
Information
Psychological Medicine , Volume 43 , Issue 6 , June 2013 , pp. 1187 - 1196
Copyright
Copyright © Cambridge University Press 2012 

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References

Arts, B, Jabben, N, Krabbendam, L, van Os, J (2008). Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives. Psychological Medicine 38, 771–785.CrossRefGoogle ScholarPubMed
Balanzá-Martínez, V, Tabarés-Seisdedos, R, Selva-Vera, G, Martínez-Arán, A, Torrent, C, Salazar-Fraile, J, Leal-Cercós, C, Vieta, E, Gómez-Beneyto, M (2005). Persistent cognitive dysfunctions in bipolar I disorder and schizophrenic patients: a 3-year follow-up study. Psychotherapy and Psychosomatics 74, 113–119.CrossRefGoogle ScholarPubMed
Berk, M, Kapczinski, F, Andreazza, AC, Dean, OM, Giorlando, F, Maes, M, Yucel, M, Gama, CS, Dodd, S, Dean, B, Magalhaes, PV, Amminger, P, McGorry, P, Malhi, GS (2011). Pathways underlying neuroprogression in bipolar disorder: focus on inflammation, oxidative stress and neurotrophic factors. Neuroscience and Biobehavioral Reviews 35, 804–817.CrossRefGoogle ScholarPubMed
Bonnín, CM, Martínez-Arán, A, Torrent, C, Pacchiarotti, I, Rosa, AR, Franco, C, Murru, A, Sanchez-Moreno, J, Vieta, E (2010). Clinical and neurocognitive predictors of functional outcome in bipolar euthymic patients: a long-term, follow-up study. Journal of Affective Disorders 121, 156–160.CrossRefGoogle ScholarPubMed
Bora, E, Vahip, S, Akdeniz, F, Gonul, AS, Eryavuz, A, Ogut, M, Alkan, M (2007). The effect of previous psychotic mood episodes on cognitive impairment in euthymic bipolar patients. Bipolar Disorders 9, 468–477.CrossRefGoogle ScholarPubMed
Bora, E, Yucel, M, Pantelis, C (2009). Cognitive endophenotypes of bipolar disorder: a meta-analysis of neuropsychological deficits in euthymic patients and their first-degree relatives. Journal of Affective Disorders 113, 1–20.CrossRefGoogle ScholarPubMed
Burdick, KE, Goldberg, JF, Harrow, M (2010). Neurocognitive dysfunction and psychosocial outcome in patients with bipolar I disorder at 15-year follow-up. Acta Psychiatrica Scandinavica 122, 499–506.CrossRefGoogle ScholarPubMed
Burdick, KE, Goldberg, JF, Harrow, M, Faull, RN, Malhotra, AK (2006). Neurocognition as a stable endophenotype in bipolar disorder and schizophrenia. Journal of Nervous and Mental Diseases 194, 255–260.CrossRefGoogle ScholarPubMed
Clark, L, Iversen, SD, Goodwin, GM (2002). Sustained attention deficit in bipolar disorder. British Journal of Psychiatry 180, 313–319.CrossRefGoogle ScholarPubMed
Conners, C (2000). Conners' Continuous Performance Test II Manual. Multi-Health Systems Inc.: Toronto.Google Scholar
Dean, BB, Gerner, D, Gerner, RH (2004). A systematic review evaluating health-related quality of life, work impairment, and healthcare costs and utilization in bipolar disorder. Current Medical Research Opinion 20, 139–154.CrossRefGoogle ScholarPubMed
Delis, DC, Kramer, JH, Kaplan, E, Ober, BA (1987). The California Verbal Learning Test Manual. Psychological Corp.: New York, NY.Google Scholar
Dias, VV, Brissos, S, Frey, BN, Andreazza, AC, Cardoso, C, Kapczinski, F (2009). Cognitive function and serum levels of brain-derived neurotrophic factor in patients with bipolar disorder. Bipolar Disorders 11, 663–671.CrossRefGoogle ScholarPubMed
Donaldson, S, Goldstein, LH, Landau, S, Raymont, V, Frangou, S (2003). The Maudsley Bipolar Disorder Project: the effect of medication, family history, and duration of illness on IQ and memory in bipolar I disorder. Journal of Clinical Psychiatry 64, 86–93.CrossRefGoogle Scholar
Engelsmann, F, Katz, J, Ghadirian, AM, Schachter, D (1988). Lithium and memory: a long-term follow-up study. Journal of Clinical Psychopharmacology 8, 207–212.CrossRefGoogle ScholarPubMed
Gildengers, AG, Mulsant, BH, Begley, A, Mazumdar, S, Hyams, AV, Reynolds, CF III, Kupfer, DJ, Butters, MA (2009). The longitudinal course of cognition in older adults with bipolar disorder. Bipolar Disorders 11, 744–752.CrossRefGoogle ScholarPubMed
Goodwin, G, Vieta, E (2005). Effective maintenance treatment – breaking the cycle of bipolar disorder. European Psychiatry 20, 365–371.CrossRefGoogle ScholarPubMed
Goswami, U, Sharma, A, Khastigir, U, Ferrier, IN, Young, AH, Gallagher, P, Thompson, JM, Moore, PB (2006). Neuropsychological dysfunction, soft neurological signs and social disability in euthymic patients with bipolar disorder. British Journal of Psychiatry 188, 366–373.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery, and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Heaton, R (1981). The Wisconsin Card Sorting Test Manual. Psychological Assessment Resources: Odessa, TX.Google Scholar
Kapczinski, F, Dal-Pizzol, F, Teixeira, AL, Magalhaes, PV, Kauer-Sant'Anna, M, Klamt, F, Moreira, JC, de Bittencourt Pasquali, MA, Fries, GR, Quevedo, J, Gama, CS, Post, R (2011). Peripheral biomarkers and illness activity in bipolar disorder. Journal of Psychiatry Research 45, 156–161.CrossRefGoogle ScholarPubMed
Kauer-Sant'Anna, M, Kapczinski, F, Andreazza, AC, Bond, DJ, Lam, RW, Young, LT, Yatham, LN (2009). Brain-derived neurotrophic factor and inflammatory markers in patients with early- vs. late-stage bipolar disorder. International Journal of Neuropsychopharmacology 12, 447–458.CrossRefGoogle ScholarPubMed
Kurtz, MM, Gerraty, RT (2009). A meta-analytic investigation of neurocognitive deficits in bipolar illness: profile and effects of clinical state. Neuropsychology 23, 551–562.CrossRefGoogle ScholarPubMed
López-Jaramillo, C, Lopera-Vásquez, J, Ospina-Duque, J, García, J, Gallo, A, Cortez, V, Palacio, C, Torrent, C, Martínez-Arán, A, Vieta, E (2010). Lithium treatment effects on the neuropsychological functioning of patients with bipolar I disorder. Journal of Clinical Psychiatry 71, 1055–1060.CrossRefGoogle ScholarPubMed
Maj, M, Pirozzi, R, Magliano, L, Bartoli, L (1998). Long-term outcome of lithium prophylaxis in bipolar disorder: a 5-year prospective study of 402 patients at a lithium clinic. American Journal of Psychiatry 155, 30–35.CrossRefGoogle Scholar
Mann-Wrobel, MC, Carreno, JT, Dickinson, D (2011). Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disorders 13, 334–342.CrossRefGoogle ScholarPubMed
Martínez-Arán, A, Torrent, C, Solé, B, Bonnín, CM, Rosa, AR, Sánchez-Moreno, J, Vieta, E (2011). Functional remediation for bipolar disorder. Clinical Practice and Epidemiology in Mental Health 7, 112–116.CrossRefGoogle ScholarPubMed
Martínez-Arán, A, Vieta, E, Colom, F, Torrent, C, Reinares, M, Goikolea, JM, Benabarre, A, Comes, M, Sánchez-Moreno, J (2005). Do cognitive complaints in euthymic bipolar patients reflect objective cognitive impairment? Psychotherapy and Psychosomatics 74, 295–302.CrossRefGoogle ScholarPubMed
Martínez-Arán, A, Vieta, E, Colom, F, Torrent, C, Sánchez-Moreno, J, Reinares, M, Benabarre, A, Goikolea, JM, Brugué, E, Daban, C, Salamero, M (2004 a). Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disorders 6, 224–232.CrossRefGoogle ScholarPubMed
Martínez-Arán, A, Vieta, E, Reinares, M, Colom, F, Torrent, C, Sánchez-Moreno, J, Benabarre, A, Goikolea, JM, Comes, M, Salamero, M (2004 b). Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. American Journal of Psychiatry 161, 262–270.CrossRefGoogle ScholarPubMed
Martino, DJ, Marengo, E, Igoa, A, Scapola, M, Ais, ED, Perinot, L, Strejilevich, SA (2009). Neurocognitive and symptomatic predictors of functional outcome in bipolar disorders: a prospective 1 year follow-up study. Journal of Affective Disorders 116, 37–42.CrossRefGoogle ScholarPubMed
Meyers, JE, Meyers, KR (1995). Rey Complex Figure Test and Recognition Trial. Psychological Assessment Resources: Odessa, FL.Google Scholar
Moorhead, TW, McKirdy, J, Sussmann, JE, Hall, J, Lawrie, SM, Johnstone, EC, McIntosh, AM (2007). Progressive gray matter loss in patients with bipolar disorder. Biological Psychiatry 62, 894–900.CrossRefGoogle ScholarPubMed
Mur, M, Portella, MJ, Martínez-Arán, A, Pifarré, J, Vieta, E (2007). Persistent neuropsychological deficit in euthymic bipolar patients: executive function as a core deficit. Journal of Clinical Psychiatry 68, 1078–1086.CrossRefGoogle ScholarPubMed
Mur, M, Portella, MJ, Martínez-Arán, A, Pifarré, J, Vieta, E (2008). Long-term stability of cognitive impairment in bipolar disorder: a 2-year follow-up study of lithium-treated euthymic bipolar patients. Journal of Clinical Psychiatry 69, 712–719.CrossRefGoogle ScholarPubMed
Mur, M, Portella, MJ, Martinez-Aran, A, Pifarre, J, Vieta, E (2009). Influence of clinical and neuropsychological variables on the psychosocial and occupational outcome of remitted bipolar patients. Psychopathology 42, 148–156.CrossRefGoogle ScholarPubMed
O'Shea, R, Poz, R, Michael, A, Berrios, GE, Evans, JJ, Rubinsztein, JS (2010). Ecologically valid cognitive tests and everyday functioning in euthymic bipolar disorder patients. Journal of Affective Disorders 125, 336–340.CrossRefGoogle ScholarPubMed
Reitan, R (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills 8, 271–276.CrossRefGoogle Scholar
Robinson, LJ, Ferrier, IN (2006). Evolution of cognitive impairment in bipolar disorder: a systematic review of cross-sectional evidence. Bipolar Disorders 8, 103–116.CrossRefGoogle ScholarPubMed
Robinson, LJ, Thompson, JM, Gallagher, P, Goswami, U, Young, AH, Ferrier, IN, Moore, PB (2006). A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. Journal of Affective Disorders 93, 105–115.CrossRefGoogle ScholarPubMed
Rosa, AR, Bonnín, CM, Vázquez, GH, Reinares, M, Solé, B, Tabarés-Seisdedos, R, Balanzá-Martínez, V, González-Pinto, A, Sánchez-Moreno, J, Vieta, E (2010). Functional impairment in bipolar II disorder: is it as disabling as bipolar I? Journal of Affective Disorders 127, 71–76.CrossRefGoogle ScholarPubMed
Rosa, AR, Sánchez-Moreno, J, Martínez-Aran, A, Salamero, M, Torrent, C, Reinares, M, Comes, M, Colom, F, Van Riel, W, Ayuso-Mateos, JL, Kapczinski, F, Vieta, E (2007). Validity and reliability of the Functioning Assessment Short Test (FAST) in bipolar disorder. Clinical Practice and Epidemiology in Mental Health 3, 5.CrossRefGoogle ScholarPubMed
Savitz, J, Solms, M, Ramesar, R (2005). Neuropsychological dysfunction in bipolar affective disorder: a critical opinion. Bipolar Disorders 7, 216–235.CrossRefGoogle ScholarPubMed
Solé, B, Bonnin, CM, Torrent, C, Balanzá-Martinez, V, Tabarés-Seisdedos, R, Popovic, D, Martínez-Arán, A, Vieta, E (2012). Neurocognitive impairment and psychosocial functioning in bipolar II disorder. Acta Psychiatrica Scandinavica 125, 309–317.CrossRefGoogle ScholarPubMed
Solé, B, Martínez-Aran, A, Torrent, C, Bonnin, CM, Reinares, M, Popovic, D, Sánchez-Moreno, J, Vieta, E (2011). Are bipolar II patients cognitively impaired? A systematic review. Psychological Medicine 41, 1791–1803.CrossRefGoogle ScholarPubMed
Spreen, O, Strauss, E (1998). A Compendium of Neuropsychological Tests. Oxford University Press: New York.Google Scholar
Tabarés-Seisdedos, R, Balanzá-Martínez, V, Sanchez-Moreno, J, Martinez-Aran, A, Salazar-Fraile, J, Selva-Vera, G, Rubio, C, Mata, I, Gómez-Beneyto, M, Vieta, E (2008). Neurocognitive and clinical predictors of functional outcome in patients with schizophrenia and bipolar I disorder at one-year follow-up. Journal of Affective Disorders 109, 286–299.CrossRefGoogle ScholarPubMed
Torres, IJ, Boudreau, VG, Yatham, LN (2007). Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Acta Psychiatrica Scandinavica Supplementum, issue 434, 17–26.CrossRefGoogle Scholar
Wechsler, D (2001). Wechsler Adult Intelligence Scale-III: Technical Manual (Spanish Version). TEA: Madrid.Google Scholar
Wingo, AP, Harvey, PD, Baldessarini, RJ (2009). Neurocognitive impairment in bipolar disorder patients: functional implications. Bipolar Disorders 11, 113–125.CrossRefGoogle ScholarPubMed
Young, RC, Biggs, JT, Ziegler, VE, Meyer, DA (1978). A rating scale for mania: reliability, validity and sensitivity. British Journal of Psychiatry 133, 429–435.CrossRefGoogle ScholarPubMed